Prediction and risk factor analysis of new-onset conduction disturbance after transcatheter aortic valve replacement / 中国介入心脏病学杂志

Objective To explore the relevant factors of new-onset conduction disturbance(NOCD)after transcatheter aortic valve replacement(TAVR),such as anatomical structure,device type,surgical strategies,etc.,discover relevant predictive factors,and establish a predictive model to assess the risk of conduction blockages.Methods From January 2016 to March 2022,clinical data of symptomatic patients with severe aortic valve stenosis or severe regurgitation who underwent TAVR at Xiangya Second Hospital of Central South University were collected through the hospital information system and imaging database.ECG,echocardiography,CTA,surgical materials,etc.,were extracted and analyzed by specialists.SPSS software was used for statistical analysis,and a multi-factor regression prediction model for NOCDwas built.Results A total of 184 patients were included,the occurrence rate of NOCD after TAVR was 31.0%,pure regurgitation patients'NOCD occurrence rate was 63.6%(7/11).The NOCD group had a larger aortic angles[(57.7±10.3)°vs.(52.0±9.0)°,P＜0.001],larger Oversizing[(129±28)%vs.(120±21)%,P=0.018],deeper implantation depth[(7.2±5.1)mm vs.(4.8±4.2)mm,P=0.001],and higher pure regurgitation patients'proportion[12.3%vs.3.1%,P=0.037]than the non-NOCD group.Multifactorial Logistic regression analysis indicated that an aorta angle＞54.5°(OR 3.78,95%CI 1.86-7.63,P＜0.001)or implantation depth＞5.7 mm(OR 3.39,95%CI 1.68-6.85,P＜0.001)are independent risk factors for new onset conduction disturbances after TAVR,and a predictive model was established with aortic angle,implantation depth,and Oversizing ratio as variables.The receiver operating characteristics curve showed area under ROC curve 0.709,95%CI 0.623-0.795,predicting NOCD after TAVR.Conclusions A retrospective analysis carried out at a single center discovered that the aortic angle in the NOCD group was larger than that in the non-NOCD group,the Oversizing ratio was higher,the implantation location was deeper,and there was a higher proportion of patients with pure regurgitation lesions.An aortic angle greater than 54.5°or an implantation depth more than 5.7 mm were identified as independent risk factors for NOCD after TAVR.

Preliminary evaluation on the efficacy of emergency transcatheter aortic valve replacement: a multicenter study / 中华心血管病杂志

Objectives: To explore the efficacy and safety of emergency transcatheter aortic valve replacement (TAVR). Methods: Data of patients who underwent emergency TAVR in eight centers, namely Fuwai Hospital, Wuhan Asia Heart Hospital, Xijing Hospital, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Guangdong Provincial People's Hospital, Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of Zhengzhou University, the Second Xiangya Hospital of Central South University, between May 2017 and December 2020 were retrospectively analyzed. The use of mechanical circulatory support system (MCS) and the results of laboratory tests (N-terminal B-type natriuretic peptide (NT-proBNP)) and echocardiography (mean aortic valve cross valve pressure difference and left ventricular ejection fraction) before and after operation were collected. The primary endpoint was all-cause death, and the secondary endpoints were stroke, major bleeding, major vascular complications, myocardial infarction, permanent pacemaker implantation, and acute renal injury. Device success was caculated, which refered to absence of procedural mortality and correct positioning of a single prosthetic heart valve into the proper anatomical location and intended performance of the prosthetic heart valve (mean aortic valve gradient<20 mmHg(1 mmHg=0.133 kPa) or peak velocity<3 m/s, with no moderate or severe prosthetic valve regurgitation). Kaplan-Meier survival curve was used to estimate the survival rate of patients during follow-up. Results: This study included 48 patients. The age was (72.5±8.1) years, and 34 patients were males (70.8%). Device success rate was 91.7% (44/48). The mean aortic valve transvalvular pressure was significantly decreased after operation ((12.3±6.4)mmHg vs. (60.2±23.8)mmHg, P<0.000 1). Left ventricular ejection fraction was significantly increased ((41.5±11.7)% vs. (31.0±11.3)%, P<0.000 1). NT-proBNP significantly decreased (3 492.0 (1 638.8, 7 165.5) ng/L vs. 12 418.5 (6 693.8, 35 000.0) ng/L, P<0.000 1). In-hospital all-cause mortality was 8.3% (4/48). During hospitalization, the rate of stroke was 2.1% (1/48), major bleeding was 6.3% (3/48), major vascular complications was 10.4% (5/48), myocardial infarction was 4.2% (2/48), permanent pacemaker implantation was 6.3% (3/48), and the rate of acute renal injury was 12.5% (6/48). MCS was used in 20 patients (41.7%). The median follow-up time was 196 days. During the follow-up, one patient died (due to systemic metastasis of pancreatic cancer), two cases suffered new myocardial infarction and one case received permanent pacemaker implantation. The survival rate of 30 days, 1 year and 2 years after the operation were 91.7% (44/48), 89.6% (43/48), 89.6% (43/48), respectively. Conclusion: Emergency TAVR may be a safe and effective treatment for patients with severe decompensated aortic valve stenosis.

Characteristics and outcomes following transcatheter aortic valve replacement in China: a report from China aortic valve transcatheter replacement registry (CARRY) / 中华医学杂志(英文版)

BACKGROUND@#The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.@*METHODS@#CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan-Meier curve was used to estimate the risk of adverse events during follow-up.@*RESULTS@#The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7-8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%).@*CONCLUSIONS@#TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients.@*TRIAL REGISTRATION@#https://www.chictr.org.cn/ (No. ChiCTR2000038526).

Comparison of heart failure and COVID-19 in chest CT features and clinical characteristics / 中华心血管病杂志

Objective: To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and COVID-19. Methods: This study was a retrospective study. A total of 7 patients with heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed. Results: There was no significant difference in age and sex between the two groups(both P>0.05), but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 0, P<0.001; 12/12 vs. 4/7, P=0.013). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001；0 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of pulmonary veins was also higher (3/7 vs. 0，P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there were more cases with rounded morphology in COVID-19 group（9/12 vs. 2/7, P=0.048）. Conclusions: More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.

Application of the "buddy-in-jail" technique during percutaneous coronary intervention:choice of wire and artery / 中国介入心脏病学杂志

Objective To evaluate the efficacy of the ' buddy-in-jail ' technique applied to complex coronary artery lesions during percutaneous coronary intervention.Methods A total of 12640 PCI cases from 4 different hospitals admitted between June 2014 to June 2017 were reviewed. Among them, the balloons or stents were unable to be delivered into the lesions in 25 cases. The "buddy-in-jail"technique was applied in 21 of these 25 cases. According to the guidewires used, the 21 cases were divided into the hydrophilic coated guidewire group(n=9) and non-hydrophilic coated guidewire group(n=21). The rates of procedural success and complications were compared between the 2 groups.Results 18 cases(18/21)were successfully treated with the "buddy-in-jail " technique. The success rates were similar between patients using the same artery(9/11) as the "buddy" vessel patients using other arteries(9/10) (P=0.593). Procedural success rates were also similar between patients using hydrophilic-coated guidewires (7/9) and non- hydrophilic coated guidewires(11/12)(P=0.386). All the wires were successfully taken out without complication.Conclusions "Buddy-in-jail" technique offers a potential alternative approach for patients with difflculty in delivering the balloon or stent to the target lesion.

Association of Plasma Pentraxin-3 Levels on Admission with In-hospital Mortality in Patients with Acute Type A Aortic Dissection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute aortic dissection is a life-threatening cardiovascular emergency. Pentraxin-3 (PTX3) is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. This study sought to investigate the association of circulating PTX3 levels with in-hospital mortality in patients with acute Type A aortic dissection (TAAD).</p><p><b>METHODS</b>A total of 98 patients with TAAD between January 2012 and December 2015 were enrolled in this study. Plasma concentrations of PTX3 were measured upon admission using a high-sensitivity enzyme-linked immunosorbent assay system. Patients were divided into two groups as patients died during hospitalization (Group 1) and those who survived (Group 2). The clinical, laboratory variables, and imaging findings were analyzed between the two groups, and predictors for in-hospital mortality were evaluated using multivariate analysis.</p><p><b>RESULTS</b>During the hospital stay, 32 (33%) patients died and 66 (67%) survived. The patients who died during hospitalization had significantly higher PTX3 levels on admission compared to those who survived. Pearson's correlation analysis demonstrated that PTX3 correlated positively with high-sensitivity C-reactive protein (hsCRP), maximum white blood cell count, and aortic diameter. Multivariate logistic regression analysis demonstrated that PTX3 levels, coronary involvement, cardiac tamponade, and a conservative treatment strategy are significant independent predictors of in-hospital mortality in patients with TAAD. The receiver operating characteristic curve analysis further illustrated that PTX3 levels on admission were strong predictors of mortality with an area under the curve of 0.89. A PTX3 level ≥5.46 ng/ml showed a sensitivity of 88% and a specificity of 79%, and an hsCRP concentration ≥9.5 mg/L had a sensitivity of 80% and a specificity of 69% for predicting in-hospital mortality.</p><p><b>CONCLUSION</b>High PTX3 levels on admission are independently associated with the in-hospital mortality in patients with TAAD.</p>

Prevalence and risk factors of peri-procedure electrical storm in acute myocardial infarction patients underwent emergency percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine the prevalence and to identify risk factors of peri-procedure electrical storm (ES) in patients with acute myocardial infarction (AMI) underwent emergency percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>The clinical data of 228 AMI patients underwent emergency PCI were retrospectively analyzed and patients were divided into ES group (n = 39) and non-ES (n = 189) group. ES was referred to spontaneous ventricular tachycardia or ventricular fibrillation occurring twice or more within 24 h and requiring emergency treatment including anti-arrhythmic medicine and/or cardioversion or defibrillation.</p><p><b>RESULTS</b>ES was diagnosed in 39 out of 228 patients (17.1%) during peri-procedure stage. The incidence of ES in patients with various infarct related arteries (IRA) was as follows: 55.6% with left main artery (LM), 23.7% with right coronary artery (RCA), 12.4% with anterior descending branch (LAD) and 0 with left circumflex artery (LCX). Older age, lager diameter of IRA, higher concentration of CK-MB and cTnT, higher incidence of reperfusion arrhythmia (RA), lower grade of TIMI after PCI and higher mortality were associated with increased risks of ES (The P value was 0.043, 0.012, 0.036, 0.018, 0.001, 0.049, respectively). Gender, systolic pressure, diastolic pressure, random blood glucose level, white blood count and concentration of hs-CRP were similar between ES and non-ES patients. Logistic analysis showed that the diameter of IRA (OR 2.381, 95%CI 1.127-5.028, P = 0.023), TIMI grade of IRA after PCI (OR 4.744, 95% CI 1.773-12.691, P = 0.002) and RA (OR 12.680, 95% CI 4.360-36.879, P = 0.000) were the independent risk factors of per-procedure ES in AMI patients underwent emergency PCI.</p><p><b>CONCLUSIONS</b>The AMI patients with LM as IRA had the highest incidence of ES during emergency PCI and the diameter of IRA, TIMI grade of IRA after PCI and RA were independent risk factors for the development of ES during peri-PCI stage.</p>

Immediate or elective PCI after coronary angiography / 中南大学学报(医学版)

OBJECTIVE@#To compare the success rate and the complication rate of immediate percutaneous coronary intervention (PCI) and elective PCI after coronary angiography(CAG), and to estimate the clinical value of immediate PCI.@*METHODS@#One-hundred fifteen patients who underwent immediate PCI after CAG were enrolled into the immediate group, and 172 patients on whom PCI and CAG were performed on 2 days were enrolled into the elective group in Second Xiangya Hospital of Central South University during 2005. The clinical manifestations, lesion vessel characteristics, and length and diameter of stents in the 2 groups were similar. Lesion vessels were defined as Type A, B, and C according to the standard of ACC/AHA in 1988.@*RESULTS@#The success rate and the complication rate of Type A and B lesion were not significantly different in the 2 groups (P>0.05). The success rate of Type C lesion in the immediate group was lower than that in the elective group (P<0.01). The complication rate of Type C lesion in the immediate group was higher than that in the elective group (P<0.05).@*CONCLUSION@#Type A and B lesions may undergo immediate PCI, while Type C lesion is not suitable to be performed immediately PCI after CAG. Immediate PCI after CAG has some clinical value.

Treatment of postcatheterization femoral arteriovenous fistulas with simple prolonged bandaging / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome. Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.</p><p><b>METHODS</b>To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization.</p><p><b>RESULTS</b>All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4 - 46 days (mean (15 +/- 10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6 - 24 months (mean (11.8 +/- 3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed.</p><p><b>CONCLUSION</b>The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.</p>

Peripheral vascular complications after the cardiac catheterization / 中南大学学报(医学版)

OBJECTIVE@#To explore the cause, the clinical manifestation and the management of peripheral vascular complications after cardiac catheterization.@*METHODS@#Clinical data of patients with peripheral vascular complications were analyzed retrospectively.@*RESULTS@#Of the 4,531 patients, 122 (2.7%) had peripheral vascular complications, including local hematoma (86 cases, 1.90%), pseudoaneurysm (15 cases, 0.33%), arteriovenous fistula (8 cases, 0.18%), femoral venous thrombosis (5 cases, 0.11%), excessive hemorrhage (5 cases, 0.11%), femoral arterial thrombosis (2 cases, 0.04%), and femoral nerve malfunction (1 case, 0.02%). All complications were relieved after conservative therapy except that one case needed surgery.@*CONCLUSION@#Peripheral vascular complications are associated with anticoagulation, diabetes, and hypertension. Prognosis of overwhelming complications is good, as long as patients are treated timely and appropriately.

Changes of plasma CD40L and PAPP-A in patients with acute coronary syndrome after the PCI operation / 中南大学学报(医学版)

OBJECTIVE@#To observe the changes and significance of plasma CD40L and pregnancy-associated plasma protein-A (PAPP-A) in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI) operation.@*METHODS@#According to the occurrence of primary heart events or restenosis 6 months after the PCI, 68 patients were divided into the ACS group and the stable angina pectoris (SAP) group. Plasma CD40L and PAPP-A after the PCI operation were measured and compared. Thirty-six patients underwent repeated angiography after the PCI. Their baseline and follow up angiograms were compared by quantitative coronary angiography to assess the incidence of restenosis.@*RESULTS@#CD40L and PAPP-A after the PCI operation were higher in the ACS group than that in the SAP group.The group having primary heart events within 6 months had higher level of PAPP-A after the PCI. The group having restenosis 6 months had higher level of PAPP-A after the PCI. The change of later loss index of coronary artery lumen diameter was correlated with PAPP-A level after the PCI.@*CONCLUSION@#CD40L and PAPP-A were higher in the ACS group, indicating the possible mechanism by which CD40L facilitates the plaque rupture via up-regulating the PAPP-A expression.Plasma PAPP-A level after the PCI possibly for cases the occurrence of primary heart events or restenosis within 6 months.

Transcatheter closure for patent ductus arteriosus in children / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the results of transcatheter closure for patent ductus arteriosus (PDA) by different devices in children.@*METHODS@#Seventy-eight cases of PDA in children (7 months to 14 years old), diagnosed by physical examination and transthoracic 2-dimensional echocardiography (TTE), were included in the study. The examination included the cardiac catheterization, photograph of the thoracic aorta and conventional technique of PDA closure. Among these patients, 16 were treated with coils, 9 with Amplatzer duct occluder (ADO), and 53 with native produced PDA occluders.@*RESULTS@#TTE examination on the next day of the operation showed that PDAs were completely occluded in 76 cases, while the other 2 cases treated by coil had minimal residual shunt. Sixty-four patients, who were detected enlargement of the left ventricle before the operation, showed obvious diminishment of the cardiac size. By the end of 3 months, TTE examination showed that the closure of PDA was complete, and the left ventricle size was normal in 77 cases, while one case treated with coil had minimal residual shunt, which persisted for more than 4 years. The 3 - 80 months follow-up showed that the closure of PDA was complete in 77 cases, the configurations of the left ventricle, the thoracic aorta,and the left pulmonary artery were all normal. The occluders were well remained in situ.@*CONCLUSION@#The usual procedures of transcatheter closure for PDA are effective and safe with ADO, native produced occluders and coil in children. Interventional method, which shows minute insult, few complications, and few adverse effects, can substitute the thoracic surgery.