ABSTRACT
We examined the effect of minimal lumen segmentation uncertainty on Fractional Flow Reserve obtained from Coronary Computed Tomography Angiography FFR CT . A total of 14 patient-specific coronary models with different stenosis locations and degrees of severity were enrolled in this study. The optimal segmented coronary lumens were disturbed using intra ± 6 % and inter-operator ± 15 % variations on the segmentation threshold. FFR CT was evaluated in each case by 3D-OD CFD simulations. The findings suggest that the sensitivity of FFR CT to this type of uncertainty increases distally and with the stenosis severity. Cases with moderate or severe distal coronary lesions should undergo either exact and thorough segmentation operations or invasive FFR measurements, particularly if the FFR CT is close to the cutoff (0.80). Therefore, we conclude that it is crucial to consider the lesion's location and degree of severity when evaluating FFR CT results.
Subject(s)
Coronary Vessels , Fractional Flow Reserve, Myocardial , Humans , Fractional Flow Reserve, Myocardial/physiology , Coronary Vessels/diagnostic imaging , Coronary Vessels/physiopathology , Models, Cardiovascular , Computed Tomography Angiography , Coronary Angiography , Male , Uncertainty , Female , Middle Aged , Computer Simulation , Coronary Stenosis/physiopathology , Coronary Stenosis/diagnostic imaging , Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. METHODS: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. RESULTS: In the matched population of n = 5410 patients, the mean age was 81 ± 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0-12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02-1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86-1.37, p = 0.48). CONCLUSION: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves.
ABSTRACT
An 85-year-old patient with permanent atrial fibrillation with a DDD pacemaker, and with indication for left atrial appendage occlusion (LAAO). Sent for LAAO due to recurrent gastrointestinal bleedings even on apixaban and with a CHA 2 DS 2 VASc and HAS-BLED scores of 4 and 3 respectively.
Subject(s)
Atrial Appendage , Atrial Fibrillation , Cardiologists , Septal Occluder Device , Stroke , Aged, 80 and over , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgery , Atrial Fibrillation/diagnosis , Atrial Fibrillation/diagnostic imaging , Humans , Predictive Value of Tests , Treatment OutcomeABSTRACT
INTRODUCTION AND OBJECTIVE: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in different series. This study aimed to clarify the bleeding predictive factors that could influence these differences. METHODS: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. RESULTS: Cox regression analysis revealed that age ≥75 years (HR: 2.5; 95% CI: 1.3 to 4.8; p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1; 95% CI: 1.1 to 3.9; p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged <75 or ≥75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p < 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9%; HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years; HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 ± 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 ± 1.2; p = 0.029). CONCLUSIONS: In this high-risk population, GIB history and age ≥75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patients.
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No disponible
Subject(s)
Humans , Transcatheter Aortic Valve Replacement/adverse effects , Staphylococcal Infections , Staphylococcus aureus , Endocarditis/therapy , Endocarditis/etiology , IncidenceABSTRACT
No disponible
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Humans , Atrial Fibrillation/drug therapy , Atrial Appendage/drug effects , Anticoagulants/administration & dosage , Severity of Illness Index , Atrial Fibrillation/physiopathology , Atrial Appendage/physiopathologySubject(s)
Atrial Appendage , Atrial Fibrillation , Cardiac Surgical Procedures , Anticoagulants , HumansABSTRACT
INTRODUCCIÓN: La endocarditis infecciosa (EI) sobre transcatheter aortic valve implantation (TAVI) es una complicación emergente. Existen datos incompletos y dispares sobre su incidencia. Se aporta la experiencia en nuestro centro sobre incidencia, mortalidad y factores asociados de la EI post-TAVI y se compara con datos de la literatura. MÉTODOS: Estudio retrospectivo observacional de los casos de EI diagnosticados en pacientes que habían recibido TAVI, entre el 1 de junio de 2009 y el 1 de noviembre de 2017, en un centro universitario tras una mediana de seguimiento de 15,3 meses (rango intercuartil [RIC] 9,1-36,2). Se analizaron la incidencia, los datos clínicos, microbiológicos y pronósticos, y los factores asociados a EI post-TAVI. RESULTADOS: Se detectaron 11 pacientes con EI de 200 TAVI. Incidencia global: 5,5% (2,77 casos por 100 años-paciente). La mediana de tiempo hasta la EI post-TAVI fue de 112 días (RIC 36-578), la tasa de mortalidad intrahospitalaria fue del 36,4% y la mortalidad al año, del 54,5%. Todos los microorganismos identificados fueron grampositivos (4 Enterococcus faecalis, 3 Staphylococcus coagulasa negativo). Los pacientes con EI post-TAVI eran significativamente más jóvenes (mediana 78, RIC 73-80, frente a 82, RIC 79-84, p = 0,002), tenían un EuroSCORE mayor (5,1 ± 2,4 frente a 3,2 ± 1,2, p < 0,001) y más frecuentemente antecedentes de neoplasia (18,2% frente al 4,2%, p < 0,03). CONCLUSIONES: En nuestro medio, la incidencia de EI post-TAVI es mayor que la descrita en series multicéntricas, lo que concuerda con la tendencia publicada en la literatura. Conlleva una elevada mortalidad y se asocia con una peor situación clínica basal
INTRODUCTION: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an emerging complication. There are incomplete and disparate data on its incidence. We present the experience of a single-centre of incidence, mortality and associated factors of IE after TAVI. METHODS: A retrospective observational study of IE cases in people who received a TAVI, between 06/01/2009 and 11/01/2017, in a university hospital, during a median follow-up period of 15.3months (interquartile range [IQR] 9.1-36.2). Incidence, clinical, microbiological and prognostic data, and factors associated with IE after TAVI were analysed. RESULTS: Eleven patients with IE of 200 TAVI were detected. Global incidence: 5.5% (2.77 cases per 100 patient-year). The median of days from TAVI to IE was 112 (IQR 36-578), the in-hospital mortality rate was 36.4%, and the one-year mortality rate was 54.5%. All the organisms identified were gram-positive (4 Enterococcus faecalis, 3 coagulase-negative Staphylococcus). The patients with IE after TAVI were significantly younger (median 78 years, IQR 73-80, versus 82 years, IQR 79-84, P=.002), they had a higher EuroSCORE (5.1±2.4 versus 3.2 ± 1.2, P < .001), and they more frequently had a history of neoplasia (18.2% versus 4.2%, P < .03). CONCLUSIONS: In our area, IE after TAVI has an incidence greater than that described in multicentre series, this is in line with the trend published in the literature. It leads to high mortality and is associated with a worse baseline clinical situation
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Endocarditis, Bacterial/microbiology , Transcatheter Aortic Valve Replacement/adverse effects , Endocarditis, Bacterial/epidemiology , Risk Factors , Retrospective Studies , Hospital Mortality , Antibiotic Prophylaxis/methods , Microbial Sensitivity Tests , Endocarditis, Bacterial/etiologyABSTRACT
INTRODUCTION: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an emerging complication. There are incomplete and disparate data on its incidence. We present the experience of a single-centre of incidence, mortality and associated factors of IE after TAVI. METHODS: A retrospective observational study of IE cases in people who received a TAVI, between 06/01/2009 and 11/01/2017, in a university hospital, during a median follow-up period of 15.3months (interquartile range [IQR] 9.1-36.2). Incidence, clinical, microbiological and prognostic data, and factors associated with IE after TAVI were analysed. RESULTS: Eleven patients with IE of 200 TAVI were detected. Global incidence: 5.5% (2.77 cases per 100 patient-year). The median of days from TAVI to IE was 112 (IQR 36-578), the in-hospital mortality rate was 36.4%, and the one-year mortality rate was 54.5%. All the organisms identified were gram-positive (4 Enterococcus faecalis, 3 coagulase-negative Staphylococcus). The patients with IE after TAVI were significantly younger (median 78years, IQR 73-80, versus 82 years, IQR 79-84, P=.002), they had a higher EuroSCORE (5.1±2.4 versus 3.2±1.2, P<.001), and they more frequently had a history of neoplasia (18.2% versus 4.2%, P<.03) CONCLUSIONS: In our area, IE after TAVI has an incidence greater than that described in multicentre series, this is in line with the trend published in the literature. It leads to high mortality and is associated with a worse baseline clinical situation.
Subject(s)
Cross Infection/etiology , Endocarditis, Bacterial/etiology , Gram-Positive Bacterial Infections/etiology , Surgical Wound Infection/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aged, 80 and over , Antibiotic Prophylaxis , Aortic Valve Stenosis/surgery , Cross Infection/epidemiology , Cross Infection/microbiology , Endocarditis, Bacterial/epidemiology , Endocarditis, Bacterial/microbiology , Enterococcus , Enterococcus faecalis/isolation & purification , Female , Follow-Up Studies , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Hospitals, University , Humans , Incidence , Kaplan-Meier Estimate , Male , Middle Aged , Retrospective Studies , Risk Factors , Staphylococcus aureus/isolation & purification , Staphylococcus epidermidis , Surgical Wound Infection/epidemiology , Surgical Wound Infection/microbiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Aged , Vascular Closure Devices/adverse effects , Thrombosis/prevention & control , Atrial Fibrillation/surgery , Atrial Appendage/surgery , Treatment OutcomeABSTRACT
No disponible
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Humans , Male , Adult , Multimodal Imaging/methods , Myocarditis/diagnostic imaging , Myocardial Infarction/diagnostic imaging , Coronary Angiography , Diagnosis, DifferentialSubject(s)
Atrial Appendage/injuries , Atrial Fibrillation/therapy , Cardiac Catheterization/adverse effects , Heart Injuries/etiology , Pericardial Effusion/prevention & control , Pulmonary Veins/injuries , Aged, 80 and over , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/diagnostic imaging , Cardiac Catheterization/instrumentation , Heart Injuries/diagnostic imaging , Humans , Male , Pericardial Effusion/etiology , Pulmonary Veins/diagnostic imaging , Treatment OutcomeSubject(s)
Atrial Appendage/surgery , Atrial Fibrillation/surgery , Diagnostic Errors , Heart Diseases/etiology , Postoperative Complications , Septal Occluder Device/adverse effects , Thrombosis/etiology , Aged , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/complications , Echocardiography , Follow-Up Studies , Heart Diseases/diagnosis , Humans , Male , Middle Aged , Rare Diseases , Stroke/etiology , Stroke/prevention & control , Thrombosis/diagnosisABSTRACT
We present a case of a 52 year old female who suffered from a sudden syncope. A coronariography was performed and spontaneous coronary dissection was diagnosed in the posterior descending artery after an optical coherence tomography (OCT) was performed. A conservative management was decided. During hospitalization the patient presented with an episode of chest pain with an anterior ST elevation on ECG. Coronariography showed total occlusion of the left descending artery and again a dissection was diagnosed by OCT. This time, 2 stents were implanted in the affected artery. The hypothesis that the coronary adventitial volume of vasa vasorum is higher in patients with spontaneous coronary artery dissection has been demonstrated in a recent small study and it was observed in this patient. Conservative management is preferred in most cases, proceeding to revascularization for patients with ongoing chest pain, hemodynamic instability and ST elevation, mostly if it affects major arteries.
Subject(s)
Coronary Vessel Anomalies/complications , Coronary Vessels/surgery , Percutaneous Coronary Intervention/methods , ST Elevation Myocardial Infarction/etiology , Vascular Diseases/congenital , Coronary Angiography , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Coronary Vessels/diagnostic imaging , Female , Humans , Middle Aged , Recurrence , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/surgery , Tomography, Optical Coherence , Vascular Diseases/complications , Vascular Diseases/diagnosis , Vascular Diseases/surgeryABSTRACT
Transcatheter aortic valve replacement (TAVR) is an increasingly common procedure for the treatment of aortic stenosis in elderly patients with comorbidities that prevent the use of standard surgery. It has been shown that implantation without aortic regurgitation is related to lower mortality. Mild paravalvular regurgitation is inevitable in some cases due to calcification of the aortic annulus and its usually somewhat elliptical shape. Central regurgitation is less common, but has been associated with valve overdilatation in cases in which reduction of paravalvular regurgitation was attempted after the initial inflation. However, there are no reported cases of central prosthetic aortic regurgitation due to acute LV dysfunction. We report a case in which central aortic regurgitation occurred due to transient ventricular dysfunction secondary to occlusion of the right coronary artery by an embolus. The regurgitation disappeared after thrombus aspiration and normal ventricular function was immediately recovered.
Subject(s)
Aortic Valve Insufficiency/etiology , Heart Valve Prosthesis Implantation/adverse effects , Aortic Valve , Aortic Valve Stenosis , Embolism , HumansABSTRACT
No disponible
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Humans , Hyperlipidemias/drug therapy , Acute Coronary Syndrome/complications , Patient Discharge/statistics & numerical dataSubject(s)
Acute Coronary Syndrome/complications , Disease Management , Hyperlipidemias , Hypolipidemic Agents/therapeutic use , Patient Discharge , Acute Coronary Syndrome/blood , Aged , Female , Humans , Hyperlipidemias/blood , Hyperlipidemias/complications , Hyperlipidemias/drug therapy , Male , Middle Aged , Practice Guidelines as TopicABSTRACT
No disponible