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1.
Europace ; 23(9): 1400-1408, 2021 09 08.
Artículo en Inglés | MEDLINE | ID: mdl-33693595

RESUMEN

AIMS: To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping. METHODS AND RESULTS: Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80-0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97-0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF <40% carried a sensitivity of 83% and specificity of 76% (area under the curve 0.8; 95% CI 0.71-0.89) to predict presence of LVA. For patients scanned in AF only minimal LA-Vi on CMR (OR: 1.06; 95% CI: 1.02-1.10; P = 0.002) predicted presence of LVA. CONCLUSION: For patients scanned in SR LA-EF and LA booster pump SR are closely linked to the presence and extent of LA LVA.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Fibrilación Atrial/cirugía , Función del Atrio Izquierdo , Fibrosis , Atrios Cardíacos/cirugía , Humanos , Espectroscopía de Resonancia Magnética
2.
Radiology ; 296(2): 290-298, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32484413

RESUMEN

Background In heart failure with preserved ejection fraction (HFpEF), echocardiographic studies suggest that global longitudinal strain (GLS) has an impact on survival. Feature-tracking cardiovascular MRI also allows for strain analysis; however, to the knowledge of the authors, little is known about its prognostic value and whether it reflects severity of diffuse fibrosis, as assessed by cardiovascular MRI T1 mapping. Purpose To investigate the association between myocardial strain at cardiovascular MRI with extracellular volume by T1 mapping and outcome in participants with HFpEF. Materials and Methods In this secondary analysis of a prospective study (NCT03405987), consecutive participants with HFpEF underwent cardiovascular MRI between July 2012 and March 2018, including T1 mapping and three-dimensional strain analysis. Extracellular volume and strain results were assessed to determine if there was a correlation between these two factors. Cox regression was performed to determine the prognostic relevance of MRI-derived myocardial strain for a combined end point (events) of heart failure hospitalizations and cardiovascular death. Results In total, 206 consecutive participants with HFpEF (mean age, 71 years ± 8 [standard deviation]; 69% women) were included. Median myocardial global longitudinal strain (GLS) at MRI was -8.5% and showed low correlation with extracellular volume (r = 0.28; P = .003). A total of 109 events (53%) were recorded during a follow-up of 38 months ± 29. Participants with a GLS above the median had higher event rates (log-rank test, P < .001). By multivariable Cox regression analysis, GLS remained independently associated with outcome (hazard ratio, 1.06 per 1% strain increase; 95% confidence interval: 1.01, 1.11; P = .03) when corrected for risk factors including age, diabetes, renal function, N-terminal pro-b-type natriuretic peptide serum concentration, and right ventricular size and function. Conclusion In participants with heart failure with preserved ejection fraction, global longitudinal strain at cardiovascular MRI was correlated with extracellular volume by T1 mapping and was associated with cardiovascular events. © RSNA, 2020 Online supplemental material is available for this article.


Asunto(s)
Técnicas de Imagen Cardíaca/métodos , Insuficiencia Cardíaca Diastólica , Imagen por Resonancia Magnética/métodos , Anciano , Anciano de 80 o más Años , Femenino , Corazón/diagnóstico por imagen , Corazón/fisiopatología , Insuficiencia Cardíaca Diastólica/diagnóstico por imagen , Insuficiencia Cardíaca Diastólica/mortalidad , Insuficiencia Cardíaca Diastólica/fisiopatología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
3.
Eur J Clin Invest ; 50(2): e13184, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31732964

RESUMEN

BACKGROUND: Atrial fibrillation (AF) is a frequent finding in HFpEF. However, its association with invasive haemodynamics, imaging parameters and outcome in HFpEF is not well established. Furthermore, the relevance of AF subtype with regard to outcome is unclear. This study sought to investigate the prognostic impact of paroxysmal and persistent AF in a well-defined heart failure with preserved ejection fraction (HFpEF) population. MATERIALS AND METHODS: Between 2010 and 2016, 254 HFpEF patients were prospectively enrolled. All patients underwent echocardiography as well as left and right heart catheterization. Patients without contraindications underwent CMR including T1 mapping. Follow-up and outcome data were collected. Patients with significant coronary artery disease were excluded. RESULTS: A total of 153 patients (60%) suffered from AF, 119 (47%) had persistent and 34 (13%) had paroxysmal AF. By multiple logistic regression analysis, persistent AF was independently associated with NT-proBNP (P = .003), NYHA functional class (P = .040), left and right atrial size (P = .022 and <.001, respectively), cardiac output (P = .002) and COPD (P = .034). After a median follow-up of 23 months (interquartile range 5-48), 92 patients (36%) reached the primary end point defined as hospitalization for heart failure or cardiovascular death. By multivariate Cox regression analysis, only persistent AF (P = .005) and six-minute walk distance (P = .011) were independently associated with the primary end point. CONCLUSIONS: Sixty percent of our HFpEF patients suffered from AF. Persistent but not paroxysmal AF was strongly associated with event-free survival and was independently related to NYHA functional class, serum NT-proBNP, atrial size, cardiac ouput and presence of COPD.


Asunto(s)
Fibrilación Atrial/fisiopatología , Gasto Cardíaco , Enfermedades Cardiovasculares/mortalidad , Insuficiencia Cardíaca/fisiopatología , Hospitalización/estadística & datos numéricos , Volumen Sistólico , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/sangre , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Cateterismo Cardíaco , Ecocardiografía , Ecocardiografía Doppler , Tolerancia al Ejercicio , Femenino , Corazón/diagnóstico por imagen , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico por imagen , Hemodinámica , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Análisis Multivariante , Miocardio/patología , Péptido Natriurético Encefálico/sangre , Tamaño de los Órganos , Fragmentos de Péptidos/sangre , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Índice de Severidad de la Enfermedad , Prueba de Paso , gamma-Glutamiltransferasa/sangre
4.
Circulation ; 129(7): 728-36, 2014 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-24211823

RESUMEN

BACKGROUND: Data on the outcomes of ventricular tachycardia (VT) ablation in nonischemic dilated cardiomyopathy (NIDCM) are insufficient. The Heart Center of Leipzig VT (HELP-VT) study was conducted prospectively to compare outcomes after radiofrequency catheter ablation of VT in patients with NIDCM compared with ischemic cardiomyopathy (ICM). METHODS AND RESULTS: Two hundred twenty-seven patients, 63 with NIDCM and 164 with ICM, presenting with sustained VT were ablated with radiofrequency catheter ablation. Noninducibility of any clinical and nonclinical VT was achieved in 66.7% of NIDCM and in 77.4% of ICM patients. Ablation of the clinical VT only was achieved in 18.3% of ICM and in 22.2% of NIDCM patients. There was no statistically significant difference in short-term outcomes between the 2 groups. At the 1-year follow-up, VT-free survival in NIDCM was 40.5% compared with 57% in ICM. In univariate analysis, the hazard ratio for VT recurrence was significantly higher for NIDCM (1.62; 95% confidence interval, 1.12- 2.34; P=0.01). In both the ICM and NIDCM subgroups, procedure failure and incomplete procedural success were independent predictors of VT recurrence. CONCLUSIONS: Although the short-term success rates after VT ablation in NIDCM and ICM patients were similar, the long-term outcomes in NIDCM patients were significantly worse. Complete VT noninducibility at the end of the ablation is associated with beneficial long-term outcome in NIDCM. Pursuing compete elimination of all inducible VTs is desirable and may improve the long-term success in NIDCM.


Asunto(s)
Cardiomiopatía Dilatada/cirugía , Ablación por Catéter , Isquemia Miocárdica/cirugía , Taquicardia Ventricular/cirugía , Anciano , Cardiomiopatía Dilatada/mortalidad , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Isquemia Miocárdica/mortalidad , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Taquicardia Ventricular/mortalidad , Resultado del Tratamiento
5.
J Clin Med ; 13(19)2024 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-39407745

RESUMEN

Background: The incidence of atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) is high. Impaired left atrial (LA) function is a major determinant in HFpEF. However, the extent of electrical LA tissue degeneration in HFpEF is unknown. Therefore, we sought to investigate the amount of arrhythmogenic and fibrotic LA tissue degeneration in HFpEF patients presenting for AF ablation. Methods: We prospectively screened consecutive patients presenting for first time AF ablation. The HFA-PEFF score was used to identify HFpEF patients. Bipolar high-density voltage mapping was created in sinus rhythm prior to ablation to evaluate the general LA bipolar voltage and quantify areas of low voltage. LVAs were defined as areas with bipolar voltage < 0.5 mV. Results: In total, 187 patients were prospectively enrolled (age 65 ± 11 years, 45% female, 46% persistent AF, 25% HFpEF) in this study. HFpEF patients were older and had a higher CHA2DS2-VASc score (70 ± 9 vs. 63 ± 11 years and 3.2 ± 1.5 vs. 2.3 ± 1.5, each p < 0.001, respectively). Overall, low-voltage areas (LVAs) were present in 97 patients (52%), whereas 76% of the HFpEF population had LVA, as compared to 44% of patients without HFpEF (p < 0.001). HFpEF was associated with generally decreased LA bipolar voltage (1.09 ± 0.64 vs. 1.83 ± 0.91 mV; p < 0.001) and predictive of the presence of low-voltage areas (76% vs. 44% p < 0.001). The HFA-PEFF score inversely correlated with LA bipolar voltage (=-0.454; p < 0.001). Conclusions: HFpEF closely relates to generally decreased LA bipolar voltage and to the existence of fibrotic and arrhythmogenic LA tissue degeneration.

6.
Europace ; 15(4): 570-7, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23054216

RESUMEN

AIMS: This study aimed to characterize P-wave morphology (PWM) in leads V3-V6 during focal atrial tachycardia (AT) originating from the lower right atrium (RA), and to investigate the role of interatrial conduction (IAC) pathways in the formation of PWM. METHODS AND RESULTS: Twenty-eight consecutive patients with tachycardia foci in the lower RA underwent detailed atrial endocardial activation mapping and radiofrequency catheter ablation. P-wave configuration was analysed using standard 12-lead electrocardiogram. Atrial tachycardia originated from lower non-septal tricuspid annulus (LTA) (n = 11), coronary sinus ostium (CSo) (n = 11), lower crista terminalis (LCT) (n = 4), or lower free wall (n = 2). In leads V3-V6, PWM showed a negative pattern in at least two consecutive leads during AT originating from CSo (11/11) and LTA (9/11), with an associated sensitivity of 91%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 75%. A positive PWM was observed in three of four ATs originating from LCT, with an associated sensitivity of 75%, specificity of 100%, PPV of 60%, and NPV of 96%. A negative PWM in V3-V6 was consistent with a preferential IAC through musculature in the vicinity of the CS and an activation of both atria in an antero-posterior direction. In contrast, a positive PWM was associated with the engagement of a posterior (non-CS-related) interatrial connection. CONCLUSION: Characteristic PWMs in V3-V6 may accurately differentiate the anatomic sites of AT from the low RA with high PPVs and NPVs. P-wave morphology in V3-V6 is likely to be influenced by the engagement of the preferential IAC.


Asunto(s)
Función del Atrio Derecho , Electrocardiografía , Sistema de Conducción Cardíaco/fisiopatología , Taquicardia Supraventricular/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Ablación por Catéter , Técnicas Electrofisiológicas Cardíacas , Femenino , Atrios Cardíacos/fisiopatología , Sistema de Conducción Cardíaco/cirugía , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Taquicardia Supraventricular/fisiopatología , Taquicardia Supraventricular/cirugía , Adulto Joven
7.
Panminerva Med ; 65(3): 303-311, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34761886

RESUMEN

BACKGROUND: In addition to diagnosing acute myocardial infarction (MI), the electrocardiogram (ECG) may also predict the culprit coronary artery. We aimed to assess the diagnostic accuracy of ECG algorithms predicting the occluded vessel in inferior ST-segment elevation myocardial infarction (STEMI). METHODS: This retrospective cohort study included 300 consecutive patients with inferior STEMI undergoing acute coronary angiography. A new method based on the summation of ST-segment deviations in multiple leads from the first 12-lead-ECG was used to develop algorithms to discriminate between right coronary artery (RCA) and circumflex artery (CX) occlusion. Additionally, older algorithms were reassessed. RESULTS: The RCA was occluded in 235 patients (78%) and the CX in 65 (22%). ST-segment deviations differed significantly between RCA and CX occlusions in leads I, III, aVR, aVL, aVF and V1. ST-segment deviations in lead I showed the highest discriminatory ability of a single lead (area under the receiver operating curve [AUC]=0.77). The summation of multiple leads further increased the discriminatory ability ("III-II+aVF+aVR+V1:" AUC=0.86; "III-II-I+aVF+V1:" AUC=0.85). The best binary algorithm "III-II-I+aVF+V1>0.1 mV" classified 86% of cases correctly and was better than the best old algorithm (83.3%). The simpler algorithm "III+aVR+V1≥0.1 mV" still predicted 85.0% correctly. All algorithms had higher sensitivities for RCA than for CX detection and performed better in right-dominant anatomy. CONCLUSIONS: A new approach summating multiple ST-segment deviations generated ECG algorithms with higher diagnostic accuracy to predict the occluded vessel in inferior STEMI compared to previous studies. These algorithms may facilitate earlier risk stratification for patients at risk of postinfarct complications.


Asunto(s)
Infarto del Miocardio , Infarto del Miocardio con Elevación del ST , Humanos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/complicaciones , Estudios Retrospectivos , Infarto del Miocardio/diagnóstico , Electrocardiografía/efectos adversos , Electrocardiografía/métodos , Angiografía Coronaria/efectos adversos , Algoritmos
8.
Panminerva Med ; 65(3): 292-302, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34309331

RESUMEN

BACKGROUND: Within the presented prospective study, we aimed to illuminate the effect of long-term physical exercise on serum levels of adipsin (complement factor D) and angiopoietin-like 4 (ANGPTL4). Although past studies already outlined the effects of acute exercise, our trial design aimed to depict the development under long-term physical activity conditions. METHODS: Ninety-eight participants were included in the study and were asked to perform eight months of moderate physical activity for at least 150 minutes/week and/or vigorous-intensity exercise for at least 75 minutes/week. According to initial performance and performance gain throughout the study period, four groups were formed and subsequently compared. Blood sampling for the determination of routine laboratory parameters was done at baseline, after 2, 6, and 8 months. Additionally, adipsin and ANGPTL4 serum levels were concurrently quantified using commercially available ELISA kits. RESULTS: The study cohort consisted of 61.2% male participants with an average age of 49.3±6.7 years. Adipsin and ANGPTL4 were found to be strongly increased by long-term physical exercise. Participants displaying a performance gain of >2.9% throughout the study showed significantly increased serum levels of both biomarkers. CONCLUSIONS: Serum levels of adipsin and ANGPTL4 were closely tied to the individual performance gain of the participating probands. An association of adipsin levels, initial performance, and serum triglycerides was found at baseline. Interestingly, this interrelationship was not detectable after eight months of physical training. This finding might indicate adipsin's involvement in linking triglyceride-balance to individual performance and energy demands in a homeostatic state.


Asunto(s)
Factor D del Complemento , Ejercicio Físico , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteína 4 Similar a la Angiopoyetina , Biomarcadores , Estudios Prospectivos , Triglicéridos
9.
J Clin Med ; 12(16)2023 Aug 09.
Artículo en Inglés | MEDLINE | ID: mdl-37629221

RESUMEN

BACKGROUND: This study sought to investigate the prognostic impact of right atrial (RA) size and function in patients with heart failure with preserved ejection fraction (HFpEF) in sinus rhythm (SR) and atrial fibrillation (AF). METHODS: Consecutive HFpEF patients were enrolled and indexed RA volumes and emptying fractions (RA-EF) were assessed by cardiac magnetic resonance imaging (CMR). For patients in SR, feature tracking of the RA wall was performed during CMR. In addition, all patients underwent right and left heart catheterization and 6 min walk distance (6MWD) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) evaluations. We prospectively followed patients and used Cox regression models to determine the association of RA size and function with a composite endpoint of heart failure hospitalization and cardiovascular death. RESULTS: A total of 188 patients (71% female patients, 70 ± 8 years old) were included. Ninety-two patients (49%) were in persistent AF. Eighty-five patients reached the combined endpoint during a follow-up of 69 (42-97) months. After a multivariate cox regression analysis, the impaired RA reservoir strain (HR 0.949; 95% CI [0.909-0.990], p = 0.016), the RA reservoir strain rate (HR 0.991; 95% CI [0.983-0.999], p = 0.028), the RA conduit strain (HR 0.932; 95% CI [0.879-0.988], p = 0.019), and the RA conduit strain rate (HR 0.989; 95% CI [0.881-0.997], p = 0.011) were significantly associated with a worse outcome for patients in SR. In persistent AF, no RA imaging parameter was related to outcome after a multivariate regression analysis. CONCLUSIONS: In HFpEF patients in SR, CMR parameters of impaired RA conduit and reservoir function are associated with dismal cardiovascular outcomes. In persistent AF, RA parameters lose their prognostic ability.

10.
Minerva Med ; 114(3): 307-315, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36255709

RESUMEN

BACKGROUND: We aimed to investigate predictors for long-term survival of in-hospital patients with medical emergency team (MET) consultation with or without in-hospital cardiac arrest (IHCA) in Austria's largest medical center. METHODS: Data of patients, who needed an intervention of a MET between 01/2014 and 03/2020 were reviewed for this retrospective analysis. RESULTS: In total, 708 MET calls were analyzed. The minimum follow-up was 7 months, the maximum 6.2 years. The main MET indications were circulatory failure (63%) followed by respiratory failure (27.1%), and bleeding events (3.5%). IHCA with subsequent cardiopulmonary resuscitation (CPR) was experienced by 425 (60%) patients. Of those, 274 (64%) reached return of spontaneous circulation (ROSC), and 221 (52%) survived the first 24-hours (median survival: 146 days) and 22.1% the first year. After adjustment for potential confounders, age (P<0.001), time to ROSC (P<0.001), a non-shockable rhythm (P=0.041), chronic kidney disease (CKD, P=0.041), peak lactate levels (P<0.001), and C-reactive protein (P=0.001) were associated with long-term all-cause mortality in IHCA patients in Cox regression analysis. The 283 MET calls (40%) which were due to other reasons than IHCA were associated with a much better 24-hours (93%) and 1-year survival (61.8%). Beside age (P<0.001), the main risk factors associated with mortality in MET patients without IHCA were comorbidities such as chronic obstructive pulmonary disease (COPD, P=0.008), CKD (P=0.001), pulmonary hypertension/chronic thromboembolic pulmonary hypertension (PH/CTEPH, P=0.024), and cancer (P=0.040). CONCLUSIONS: Patients triggering MET calls have an increased mortality, especially those with IHCA. Predictors of mortality comprise age, comorbidities, and cardiac arrest-related parameters. A better characterization of MET call populations and their outcome might help to improve clinical decision making.


Asunto(s)
Paro Cardíaco , Equipo Hospitalario de Respuesta Rápida , Hipertensión Pulmonar , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Estudios Retrospectivos , Austria , Hospitales , Medición de Riesgo
11.
J Cardiovasc Electrophysiol ; 23(5): 499-505, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22313170

RESUMEN

BACKGROUND: Remote magnetic navigation (RMN) aims to reduce some inherent limitations of manual radiofrequency (RF) ablation. However, data comparing the effectiveness of both methods are scarce. This study evaluated the acute and long-term success of RMN guided versus manual RF ablation in patients with ischemic sustained ventricular tachycardia (sVT). METHODS: One hundred two consecutive patients (age 68 ± 10 years, LVEF 32 ± 12%, 88 men) with ischemic sVT were ablated with RMN (Stereotaxis; 49%) or manually (51%) using substrate and/or activation mapping (Carto) and open-irrigated-tip catheters. All received implantable defibrillators or loop recorders. Acute success was defined as noninducibility of any sVT at the end of the ablation procedure and long-term success as freedom from VT upon follow-up. RESULTS: There was no difference in the baseline characteristics between the groups. Three patients died in hospital. Acute success rate was similar for RMN and manual ablation (82% vs 71%, P = 0.246). RMN was associated with significantly shorter fluoroscopy time (13 ± 12 minutes vs 32 ± 17 minutes, P = 0.0001) and RF time (2337.59 ± 1248.22 seconds vs 1589.95 ± 1047.42 seconds, P = 0.049), although total procedure time was similar (157 ± 40 minutes vs 148 ± 50 minutes, P = 0.42). There was a nonsignificant trend toward better long-term success in RMN group: after a median of 13 (range 1-34) months, 63% in the RMN and 53% in the manual ablation group were free from VT recurrence (P = 0.206). CONCLUSION: RMN guided RF ablation of ischemic sustained VT is equally efficient compared with manual ablation in terms of acute and long-term success rate. These results are achieved with a significantly reduced fluoroscopy time and shorter RF time.


Asunto(s)
Ablación por Catéter/métodos , Magnetismo , Isquemia Miocárdica/complicaciones , Robótica , Cirugía Asistida por Computador , Taquicardia Ventricular/cirugía , Anciano , Ablación por Catéter/efectos adversos , Ablación por Catéter/mortalidad , Distribución de Chi-Cuadrado , Supervivencia sin Enfermedad , Técnicas Electrofisiológicas Cardíacas , Femenino , Fluoroscopía , Alemania , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/fisiopatología , Modelos de Riesgos Proporcionales , Radiografía Intervencional , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Volumen Sistólico , Cirugía Asistida por Computador/efectos adversos , Cirugía Asistida por Computador/mortalidad , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Función Ventricular Izquierda
12.
ESC Heart Fail ; 9(1): 465-475, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34866363

RESUMEN

AIMS: We sought to determine the prognostic impact of left atrial (LA) size and function in patients with heart failure with preserved ejection fraction (HFpEF) in sinus rhythm (SR) vs. atrial fibrillation (AF). METHODS AND RESULTS: We enrolled consecutive HFpEF patients and assessed indexed LA volumes and emptying fractions (LA-EF) on cardiac magnetic resonance imaging. In addition, all patients underwent right and left heart catheterization, 6 min walk test, and N-terminal prohormone of brain natriuretic peptide evaluation. We prospectively followed patients and used Cox regression models to determine the association of LA size and function with a composite endpoint of heart failure hospitalization and cardiovascular death. A total of 188 patients (71% female patients, 70 ± 8 years old) were included of whom 92 (49%) were in persistent AF. Sixty-five patients reached the combined endpoint during a follow-up of 31 (9-57) months. Multivariate Cox regression adjusted for established risk factors revealed that LA-EF was significantly associated with outcome in patients in SR [adjusted hazard ratio 2.14; 95% confidence interval (1.32-3.47) per 1-SD decline, P = 0.002]. In persistent AF, no LA imaging parameter was related to outcome. By receiver operating characteristic and restricted cubic spline analyses, we identified an LA-EF ≥ 40% as best indicator for favourable outcomes in patients with HFpEF and SR. Persistent AF carried a similar risk for adverse outcome compared with impaired LA-EF (<40%) in SR (log-rank, P = 0.340). CONCLUSIONS: In HFpEF patients in SR, impaired LA-EF is independently associated with worse cardiovascular outcome, which is similar to persistent AF. In persistent AF, LA parameters lose their prognostic ability.


Asunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Anciano , Fibrilación Atrial/complicaciones , Función del Atrio Izquierdo , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Volumen Sistólico
13.
Artículo en Inglés | MEDLINE | ID: mdl-35886510

RESUMEN

Regular physical exercise was found to be associated with an improved immune response in previous studies. RANTES and CD40L play a pivotal role in host defense, and individuals lacking adequate expression are prone to virus and opportunistic infections. A total of 98 participants were enrolled in this study. The probands were asked to perform moderate physical activity, and bicycle stress tests were performed at the baseline and after 8 months of training to evaluate individual performance. RANTES and CD40L were found to be increased by long-term physical exercise. In particular, probands with a performance gain of ≥3% displayed a pronounced elevation of both markers, paired with a decrease in circulating IL6 levels and an improved lipid profile. In summary, we were able to highlight rising levels of serum RANTES and CD40L under the conditions of physical exercise. Taking their role in host defense into account, a conjunction of physical activity and the adaptive immune system could therefore be assumed. Furthermore, low inflammatory profiles in probands with a significant performance gain suggest a modulation through exercise rather than a generalized pro-inflammatory status.


Asunto(s)
Ligando de CD40 , Quimiocina CCL5 , Inmunidad Adaptativa , Biomarcadores , Ligando de CD40/metabolismo , Ejercicio Físico/fisiología , Humanos
14.
ESC Heart Fail ; 9(4): 2367-2377, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35593128

RESUMEN

AIMS: We aim to explore the relationship of heart failure (HF) and diabetes with cardiovascular (CV) death or hospitalization for HF (HHF) and to study the clinical utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in an unselected patient population with atrial fibrillation (AF). METHODS AND RESULTS: Patients with AF admitted to a tertiary academic center between January 2005 and July 2019 were identified through a search of electronic health records. We used Cox regression models adjusted for age, sex, estimated glomerular filtration rate, diabetes, HF, body mass index, prior myocardial infarction, coronary artery disease, hypertension, smoking, C-reactive protein, and low-density lipoprotein cholesterol. To select the most informative variables, we performed a least absolute shrinkage and selection operator Cox regression with 10-fold cross-validation. In total, 7412 patients (median age 70 years, 39.7% female) were included in this analysis and followed over a median of 4.5 years. Both diabetes [adjusted (Adj.) HR 1.87, 95% CI 1.55-2.25] and HF (Adj. HR 2.57, 95% CI 2.22-2.98) were significantly associated with CV death/HHF after multivariable adjustment. Compared with patients with diabetes, HF patients had a higher risk of HHF but a similar risk of CV and all-cause death. NT-proBNP showed good discriminatory performance (area under the curve 0.78, 95% CI 0.77-0.80) and the addition of NT-proBNP to the covariates used for adjustment resulted in a significant area under the curve improvement (Δ = 0.04, P < 0.001). With least absolute shrinkage and selection operator, the strongest associations for CV death/HHF were obtained for NT-proBNP [HR 1.91 per 1-SD in log-transformed biomarker], HF (HR 1.72), and diabetes (HR 1.56). CONCLUSIONS: Diabetes and HF were independently associated with an increased risk of CV death/HHF in an unselected AF patient population, and NT-proBNP improved risk assessment. These findings suggest that AF patients with diabetes and/or HF should be managed not only for their risk of stroke and systemic embolic events but also for CV death/HHF.


Asunto(s)
Fibrilación Atrial , Diabetes Mellitus , Insuficiencia Cardíaca , Anciano , Fibrilación Atrial/complicaciones , Diabetes Mellitus/epidemiología , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Péptido Natriurético Encefálico , Fragmentos de Péptidos , Pronóstico
15.
NEJM Evid ; 1(11): EVIDoa2200141, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-38319851

RESUMEN

BACKGROUND: Clinically effective ablation approaches for patients with persistent atrial fibrillation (AF) are still being debated. So far, ablation targets and strategies beyond pulmonary vein isolation (PVI) have failed to show systematic outcome improvement in randomized controlled clinical trials. METHODS: We conducted a multicenter, randomized trial to determine whether PVI plus individualized substrate ablation of atrial low-voltage myocardium improves outcome in patients with persistent AF. We randomly assigned 324 patients in a 1:1 ratio to receive PVI alone (163 patients; PVI only) or PVI plus substrate modification (161 patients; PVI+SM). The primary study end point was the first recurrence of an atrial arrhythmia longer than 30 seconds after single ablation, with 3 months blanking, using serial 7-day electrocardiogram recordings over 12 months of observation. Patients were also encouraged to receive implantable cardiac monitors. RESULTS: The primary study end point occurred in 75 PVI-only patients (50%) and in 54 PVI+SM patients (35%) (Kaplan­Meier event rate estimates: hazard ratio=0.62, 95% confidence interval [CI]=0.43 to 0.88, log rank P=0.006). Adverse events occurred in three PVI-only patients (1.8%) and in six PVI+SM patients (3.7%) (difference: −1.9 percentage points, 95% CI=−5.5 to 1.7 percentage points). Implant monitoring was used in 242 patients. Among them, 65 PVI-only patients (55%) versus 47 PVI+SM patients (39%) experienced recurrences (difference: 15 percentage points, 95% CI=3 to 28 percentage points). CONCLUSIONS: In this randomized trial, PVI plus individualized ablation of atrial low-voltage myocardium significantly improved outcomes in patients with persistent AF. (ClinicalTrials.gov number, NCT02732626.)


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Humanos , Miocardio , Recurrencia , Resultado del Tratamiento
16.
J Clin Med ; 11(5)2022 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-35268413

RESUMEN

This multicenter European survey systematically evaluated the impact of using contact force-sensing catheters (CFSCs) on fluoroscopy and procedure time in interventional electrophysiology. Data from 25 participating centers were collected and analyzed, also considering important confounders. With the use of CFSCs, fluoroscopy time was reduced for right- and left-sided atrial ablations (median −6.4 to −9.6 min, p < 0.001 for both groups), whereas no such effect could be found for ventricular ablations. Moreover, the use of CFSCs was associated with an increase in procedure time for right-sided atrial and ventricular ablations (median +26.0 and +44.0 min, respectively, p < 0.001 for both groups), but not for left-sided atrial ablations. These findings were confirmed independent of career level and operator volume, except for very highly experienced electrophysiologists, in whom the effect was blunted. In the subset of pulmonary vein isolations (PVIs), CFSCs were shown to reduce both fluoroscopy and procedure time. In conclusion, the use of CFSCs was associated with a reduced fluoroscopy time for atrial ablations and an increased procedure time for right atrial and ventricular ablations. These effects were virtually independent of the operator experience and caseload. When considering only PVIs as an important subset, CFSCs were shown to reduce both fluoroscopy and procedure time.

17.
JACC Cardiovasc Imaging ; 14(11): 2199-2208, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34147453

RESUMEN

OBJECTIVES: This study sought to evaluate preablation computed tomography angiography (CTA) for atrial and epicardial features to predict atrial fibrillation (AF) recurrence after ablation. BACKGROUND: Structural atrial remodeling is a process associated with occurrence or persistence of AF. Different anatomical imaging features have been proposed to influence atrial remodeling both negatively and positively as substrate for AF. METHODS: Patients with nonvalvular AF underwent cardiac CTA before pulmonary vein isolation at 2 high-volume centers. Left atrial (LA) and right atrial volumes, LA wall thickness (LAWT), and epicardial adipose tissue volume and attenuation were evaluated. Additional subanalyses of electroanatomical maps were made. Follow-up was performed for at least 12 months, including subanalysis of repeated cardiac CTA studies. Interrater variability was assessed. RESULTS: Of 732 patients, 270 (36.9%) had AF recurrence after a mean of 7 months. CT analysis revealed larger indexed LA volume (47.3 mL/m2 vs 43.6 mL/m2; P = 0.0001) and higher mean anterior (1.91 mm vs 1.65 mm; P < 0.0001) and posterior (1.61 mm vs 1.39 mm; P = 0.001) LAWT in patients with AF recurrence. Epicardial adipose tissue volume in patients with AF recurrence was higher (144.5 mm³ vs 128.5 mm³; P < 0.0001) and further progressed significantly in a subset of 85 patients after 2 years (+11.8 mm2 vs -3.5 mm2; P = 0.041). Attenuation levels were lower, indicating a higher lipid component associated with AF recurrence (-69.1 HU vs -67.5 HU; P = 0.001). A total of 103 atrial voltage maps were highly predictive of AF recurrence and showed good discriminatory power for patients with low voltage >50% and LAWT (1.55 ± 0.5 mm vs 1.81 ± 0.6 mm; P = 0.032). Net reclassification improvement (NRI) showed a significant incremental benefit (NRI = 0.279; P < 0.0001) when adding LAWT to established risk models. CONCLUSIONS: Atrial wall thickness, epicardial fat volume, and attenuation are associated with AF recurrence in patients undergoing ablation therapy.


Asunto(s)
Fibrilación Atrial , Remodelación Atrial , Ablación por Catéter , Atrios Cardíacos , Humanos , Valor Predictivo de las Pruebas , Recurrencia , Resultado del Tratamiento , Remodelación Ventricular
18.
J Clin Med ; 10(4)2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33671264

RESUMEN

The relationship of statin therapy with recurrence of atrial fibrillation (AF) after cardioversion (CV) has been evaluated by several investigations, which provided conflicting results and particularly long-term data is scarce. We sought to examine whether upstream statin therapy is associated with long-term recurrence of AF after CV. This was a single-center registry study including consecutive AF patients (n = 454) undergoing CV. Cox regression models were performed to estimate AF recurrence comparing patients with and without statins. In addition, we performed a propensity score matched analysis with a 1:1 ratio. Statins were prescribed to 183 (40.3%) patients. After a median follow-up period of 373 (207-805) days, recurrence of AF was present in 150 (33.0%) patients. Patients receiving statins had a significantly lower rate of AF recurrence (log-rank p < 0.001). In univariate analysis, statin therapy was associated with a significantly reduced rate of AF recurrence (HR 0.333 (95% CI 0.225-0.493), p = 0.001), which remained significant after adjustment (HR 0.238 (95% CI 0.151-0.375), p < 0.001). After propensity score matching treatment with statins resulted in an absolute risk reduction of 27.5% for recurrent AF (21 (18.1%) vs. 53 (45.7%); p < 0.001). Statin therapy was associated with a reduced risk of long-term AF recurrence after successful cardioversion.

19.
Eur J Heart Fail ; 23(12): 2008-2016, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34506046

RESUMEN

AIMS: To investigate the epidemiological and prognostic relationship between heart failure with preserved ejection fraction (HFpEF) and left-sided valve surgery using all-cause mortality as a primary endpoint. METHODS AND RESULTS: We studied a total of 973 patients, of whom 673 had undergone left-sided valve surgery (time from surgery to enrolment 50 ± 30 months after valve surgery) and 300 patients with HFpEF without prior surgery served as control group. Among patients after surgery, 67.4% fulfilled all criteria of HFpEF according to current guideline recommendations, 20.6% had no heart failure (HF), and 12.0% had HF with mid-range or reduced ejection fraction (HFmrEF/HFrEF). During 83 ± 39 months of follow-up, a total of 335 (34.4%) patients died. Compared to surgical patients with no subsequent HF, patients with HFpEF and HFmrEF/HFrEF after surgery showed significantly higher all-cause mortality rates [hazard ratio (HR) 1.80, 95% confidence interval (CI) 1.25-2.57, P = 0.001; and HR 1.86, 95% CI 1.16-2.98, P = 0.010, respectively]. This increased mortality rate was similar to the control HFpEF group without surgery (HR 2.05, 95% CI 1.38-3.02, P < 0.001). Results remained consistent after adjustment for clinical and imaging risk factors and when using the established HFA-PEFF risk score for HFpEF diagnosis. Notably, only 12.5% of HFpEF patients after surgery were diagnosed with HF despite regular follow-up visits by board-certified cardiologists. In contrast, 92.1% of HFmrEF/HFrEF patients after surgery were diagnosed correctly. CONCLUSIONS: Heart failure with preserved ejection fraction following left-sided valve surgery is highly prevalent, associated with unfavourable outcomes, but rarely recognized.


Asunto(s)
Insuficiencia Cardíaca , Disfunción Ventricular Izquierda , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/cirugía , Humanos , Pronóstico , Volumen Sistólico , Función Ventricular Izquierda
20.
J Clin Med ; 9(6)2020 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-32560548

RESUMEN

BACKGROUND: Low levels of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) were reported in patients with coronary artery disease, heart failure, chronic kidney disease and diabetes mellitus. Soluble cluster differentiation 163 (sCD163) serum levels are related to M2 macrophages, having anti-inflammatory attributes. As sport is well-known for its anti-inflammatory and cardioprotective effects we aimed to investigate the influence of eight months of physical activity on serum sCD163 and sTWEAK levels. METHODS: In total, 109 subjects with at least one cardiovascular risk factor were asked to perform endurance training within the calculated training pulse for eight months. Overall, 98 finished the study. The performance gain was measured/quantified by bicycle stress tests at the beginning and end of the observation period. The cohort was divided into four groups, dependent on their baseline performance and performance gain. sCD163 and sTWEAK were measured at baseline and after two, six and eight months by ELISA. RESULTS: Those participants who had a performance gain of ≤2.9% (mean gain 12%) within eight months showed a significant increase in sTWEAK (group 2: from 133 to 200 pg/mL, p = 0.002 and group 4: from 166 to 212 pg/mL, p = 0.031) and sCD163 levels (group 2: from 255 to 348 ng/mL, p = 0.035 and group 4: from 247 to 288 ng/mL, p = 0.025) in contrast to subjects without performance gain (sTWEAK: group 1: from 161 to 177 pg/mL, p = 0.953 and group 3: from 153 to 176 pg/mL, p = 0.744; sCD163: group 1: from 289 to 256 ng/mL, p = 0.374 and group 4: from 291 to 271 ng/mL, p = 0.913). Baseline sCD163 correlated with erythrocyte count, hematocrit, ASAT and lipoprotein a, the presence of hypertension and a BMI > 30 kg/m2. CONCLUSION: Regular physical activity leads to a significant increase in sCD163 and sTWEAK levels of up to 37% and 50%, respectively. It is well-known that physical activity prevents or retards the onset and genesis of chronic inflammatory disease. One possible way of how training evolves its beneficial effect might be by modifying the inflammation status using the sTWEAK-sCD163 axis. Brief Summary: Regular physical activity leads to a significant increase in sTWEAK and sCD163 levels. Both factors are diminished in patients with chronic (inflammation-based) diseases, such as coronary artery disease, heart failure, pulmonary artery hypertension, chronic kidney disease and diabetes mellitus. It seems that the amounts of soluble TWEAK and CD163 are essential for a healthy balance and modulation between pro- and anti-inflammatory processes, and regular physical training could use the sCD163-sTWEAK axis to unfold its beneficial effect.

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