Evaluating the Efficacy of a Pre-Established Lipid-Lowering Algorithm in Managing Hypercholesterolemia in Patients at Very High Cardiovascular Risk.

BACKGROUND: Recent data from European studies (EUROASPIRE V, DA VINCI, SANTORINI) indicate that achieving the LDL cholesterol (LDL-C) target in patients at very high cardiovascular risk is uncommon. Additionally, using a combination therapy involving statins and ezetimibe remains infrequent. METHODS: A single-center assessment of a pre-defined lipid lowering treatment algorithm's effectiveness at achieving the LDL-C target in patients at very high cardiovascular risk one month and one year after hospitalization. RESULTS: 81 patients were included, all in secondary prevention. The average age of the patient was 66.9 years, and the main cardiovascular risk factors included hypertension, diabetes mellitus, and smoking history. Following the predefined lipid-lowering algorithm specific to our study, which involves initiating high-intensity statin therapy or a combination of statin and ezetimibe depending on initial LDL-C levels and patient history; 30 (37%) patients initiated high-intensity statin therapy (Atorvastatin (40 mg, 80 mg) or Rosuvastatin (20 mg, 40 mg)), while 51 (63%) started combination therapy with high-intensity statin and ezetimibe 10 mg. After one year, 57 (70.4%) remained adherent to their initial treatment, achieving a mean LDL-C of 49.5 ± 16.9 mg/dL, with 36 (63.2%) of them reaching the LDL-C target of <55 mg/dL. A total of 13 patients discontinued treatment, and 9 were lost to follow-up, withdrew from the study, or died. CONCLUSION: Initiating dual statin and ezetimibe therapy or high-intensity statin therapy early, based on the expected treatment efficacy, holds the potential to more rapidly and effectively achieve LDL-C targets in a larger proportion of very high-risk cardiovascular patients.

Method, safety, and outcomes of persistent AF ablation without a circular mapping catheter: 3 years experience of a Belgian Tertiary Centre.

BACKGROUND: We aimed to share our methods and experience of persistent AF ablation without a circular mapping catheter (CMC), thereby avoiding femoral venous and transseptal punctures, decreasing the cost of the procedure, and possibly reducing the duration of the procedure and fluoroscopy time. METHODS: We report our experience with 261 persistent AF ablations performed without a CMC over the past 3 years. RESULTS: The procedures were performed with no apparent loss of efficacy or safety. Freedom from recurrence was defined as a 1-year absence of AF/atrial flutter (AFL) episodes >30 s, beyond the 3-month blanking period. At 1 year, 72% of the patients were free from arrythmias. CONCLUSIONS: Persistent AF ablation is feasible without a CMC, reducing the need for venous and transseptal punctures and the cost of the procedure. We suggest that prospective studies should aim to characterise the reduction in procedure and fluoroscopy times as a result of this technique.

Impact of Pre-Transplant Left Ventricular Diastolic Pressure on Primary Graft Dysfunction after Lung Transplantation: A Narrative Review.

Lung transplantation (LT) constitutes the last therapeutic option for selected patients with end-stage respiratory disease. Primary graft dysfunction (PGD) is a form of severe lung injury, occurring in the first 72 h following LT and constitutes the most common cause of early death after LT. The presence of pulmonary hypertension (PH) has been reported to favor PGD development, with a negative impact on patients' outcomes while complicating medical management. Although several studies have suggested a potential association between pre-LT left ventricular diastolic dysfunction (LVDD) and PGD occurrence, the underlying mechanisms of such an association remain elusive. Importantly, the heterogeneity of the study protocols and the various inclusion criteria used to define the diastolic dysfunction in those patients prevents solid conclusions from being drawn. In this review, we aim at summarizing PGD mechanisms, risk factors, and diagnostic criteria, with a further focus on the interplay between LVDD and PGD development. Finally, we explore the predictive value of several diastolic dysfunction diagnostic parameters to predict PGD occurrence and severity.

Emerging Trends in Left Ventricular Thrombus: A Comprehensive Review of Non-Ischemic and Ischemic Cardiopathies, Including Eosinophilic Myocarditis, Chagas Cardiomyopathy, Amyloidosis, and Innovative Anticoagulant Approaches.

This comprehensive review explores the intricate aspects of left ventricular thrombus (LVT), a potential complication in both ischemic and non-ischemic cardiomyopathies. It provides a thorough understanding of left ventricular thrombus, revealing its uncommon incidence in the general population (7 cases per 10,000 patients), predominantly linked to ischemic heart diseases (ICMs) at an 80% prevalence rate. Diagnostic tools, notably transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), demonstrate varying sensitivity but remain indispensable in specific clinical contexts related to LVT as non-invasive diagnostic modalities. A detailed comparison between ICM patients and those with non-ischemic cardiomyopathy (NICM) who have left ventricular thrombus reveals subtle distinctions with significant clinical implications. This analysis underscores the importance of these imaging techniques in distinguishing between the two conditions. Additionally, we explored the occurrence of LVT in specific non-ischemic cardiomyopathies, including Takotsubo syndrome, hypertrophic cardiomyopathy, eosinophilic myocarditis, Chagas disease, cardiac amyloidosis, and several other conditions. The article further delves into anticoagulation strategies, thoroughly examining their impact on LVT regression and patient outcomes. Pharmacological interventions, with a focus on direct oral anticoagulants, emerge as promising alternatives; however, there is insufficient information on their efficiency and safety, especially in NICM population. In conclusion, this review highlights the complex nature of LVT, incorporating a range of etiopathogenic factors, diagnostic complexities, and evolving therapeutic approaches. It emphasizes the pressing need for ongoing research in this field.

Unmasking Pandemic Echoes: An In-Depth Review of Long COVID's Unabated Cardiovascular Consequences beyond 2020.

At the beginning of 2020, coronavirus disease 2019 (COVID-19) emerged as a new pandemic, leading to a worldwide health crisis and overwhelming healthcare systems due to high numbers of hospital admissions, insufficient resources, and a lack of standardized therapeutic protocols. Multiple genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected since its first public declaration in 2020, some of them being considered variants of concern (VOCs) corresponding to several pandemic waves. Nevertheless, a growing number of COVID-19 patients are continuously discharged from hospitals, remaining symptomatic even months after their first episode of COVID-19 infection. Long COVID-19 or 'post-acute COVID-19 syndrome' emerged as the new pandemic, being characterized by a high variability of clinical manifestations ranging from cardiorespiratory and neurological symptoms such as chest pain, exertional dyspnoea or cognitive disturbance to psychological disturbances, e.g., depression, anxiety or sleep disturbance with a crucial impact on patients' quality of life. Moreover, Long COVID is viewed as a new cardiovascular risk factor capable of modifying the trajectory of current and future cardiovascular diseases, altering the patients' prognosis. Therefore, in this review we address the current definitions of Long COVID and its pathophysiology, with a focus on cardiovascular manifestations. Furthermore, we aim to review the mechanisms of acute and chronic cardiac injury and the variety of cardiovascular sequelae observed in recovered COVID-19 patients, in addition to the potential role of Long COVID clinics in the medical management of this new condition. We will further address the role of future research for a better understanding of the actual impact of Long COVID and future therapeutic directions.

A circular mapping catheter is not mandatory for isolating pulmonary veins during paroxysmal atrial fibrillation ablation with radiofrequency.

PURPOSE: In this study, we evaluated the feasibility, efficacy, and safety of radiofrequency ablation of paroxysmal atrial fibrillation (AF) with the use of an ablation catheter only (non-CMC group) by retrospectively comparing its procedural success and recurrence rates at 1 year to ablation performed with the help of a circular mapping catheter (CMC group). METHODS: We compared the success and recurrence rates between 226 patients and 251 patients who underwent index ablation with and without the use of CMC, respectively. RESULTS: Freedom from recurrence was defined as a 1-year absence of AF/atrial tachycardia (AT) episodes > 30 s, beyond the 3-month blanking period. There was no significant difference between the number of pulmonary vein isolations, recurrence rate of AF/AT, and the use of antiarrhythmic drugs after 1 year of ablation. The procedure and fluoroscopy times were lower in the non-CMC group compared with the CMC group (106 ± 33 vs. 125 ± 32 min, p < 0.0001; 2.2 ± 1.9 vs. 2.7 ± 2.3 min, p = 0.0002, respectively). CONCLUSIONS: Pulmonary vein isolation without the use of a CMC is feasible; moreover, the material costs, procedure time, and radiation exposure were reduced compared with the CMC group. Freedom of recurrence was similar between groups. Optimized use of 3D electro-anatomical mapping systems could reduce the radiation exposure for both the patient and physician.

3D navigation system allows remarkable reduction in fluoroscopy use during cavo-tricuspid isthmus ablation.

PURPOSE: Typical atrial flutter (AFL) is one of the most common supraventricular arrhythmias. Its treatment mainly relies on cavo-tricuspid isthmus (CTI) ablation, which can be performed either using conventional fluoroscopy, still mainly used, or 3D navigation system to track the position of the catheter. The aim of this study is to show that the use of a 3D navigation system allows a dramatic reduction of fluoroscopy use during CTI ablation, without any loss of efficacy, time, or safety. METHODS: In this single-center study, we retrospectively compared 134 cases of CTI ablation performed for typical AFL without a 3D navigation system with 95 cases of CTI ablation performed with such a 3D system. We compared the rates of procedural success (defined as obtaining a bidirectional electrical conduction block), freedom from AFL recurrence at 1-year follow-up, procedural time and safety, and fluoroscopy use. RESULTS: Compared to conventional fluoroscopy, the use of a 3D navigation system significantly decreased the duration of fluoroscopy use (2 min 13 s ± 2 min 16 s versus 14 min 41 s ± 10 min 39 s, p < 0.0001) and dose-area products (1567.9 ± 1329.5 mGy cm2 versus 8263.3 ± 8636.6 mGy cm2, p < 0.0001). Procedure success rates, duration, and safety were not different between groups. CONCLUSIONS: The use of 3D navigation during CTI ablation substantially reduces fluoroscopy use duration, without reducing the success rates and safety or prolonging the procedure duration, as compared to conventional fluoroscopy. We therefore suggest the generalization of this navigation system.

Atrial fibrillation and cardiac rehabilitation: an overview.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its frequency will only continue to increase in the future. Despite available drug and electrophysical treatments, death and functional restrictions due to AF are still common. More comprehensive standards of care are therefore needed.Purpose: After a foreword regarding the link between physical activity and AF, this article aims to give to the clinician an overview of the benefits he may expect or not when including patients suffering from AF in a cardiac rehabilitation programme.Method: We selected prospective, randomised controlled trials published during the past 10 years and referenced in the PubMed Database evaluating the safety of rehabilitation and/or its impact on AF incidence or tolerance, and tried to summarise them to propose a narrative review.Conclusion: Cardiac rehabilitation, along with moderate and regular physical activity, has been proven to reduce the time in arrhythmia of patients with paroxysmal and persistent AF. In chronic AF, cardiac rehabilitation may decrease the resting ventricular response rate in patients and therefore improve symptoms linked to arrhythmia. These studies have managed to demonstrate cardiac rehabilitation as a safe and manageable option for AF patients, without serious risk of additional side effects. Its efficiency to limit the occurrence of serious undesirable outcomes, such as mortality and hospitalisation, has not been adequately demonstrated, likely due to the small scale of most studies and lack of long-term follow-up. Large-scale and long-term studies are thus desirable.