ABSTRACT
In the past years, transcatheter aortic valve implantation (TAVI) has emerged as a promising option for the treatment of aortic valve pathologies particularly in the the presence of surgically high-risk situations. Importantly, a variety of specific procedural complications including acute coronary osteal occlusion, though very rare, has been reported in major clinical studies. However, little is known about the late impact of TAVI on coronary system at the macro and microvascular levels. On the other hand, clinical studies as well as real life experiences have shown variable rates of acute coronary syndrome (ACS) readmissions among TAVI recipients in the short and long terms. Within this context, it may be suggested that even though late coronary ischemic events arising after TAVI, to some extent, appears to be spontaneous or attributable to certain stressors, TAVI may also have the potential to directly account for, accelerate or contribute to the evolution of these ischemic events on follow-up. Accordingly, the present review primarily focuses on potential association of TAVI with late coronary ischemic syndromes along with a particular emphasis on its mechanistic basis and clinical implications among TAVI recipients.
ABSTRACT
Abstract Background: Implantable cardioverter-defibrillator (ICD) therapy is well known to reduce mortality in selected patients with heart failure (HF). Objective: To investigate whether monitored episodes of non-sustained ventricular tachycardia (NSVT) might predict future HF hospitalizations in ICD recipients with HF. Methods: We examined 104 ICD recipients (mean age: 60 ± 10.1 years, 80.8 % male) with HF who were referred to our outpatient clinic for device follow-up. After device interrogation, patients were divided into NSVT positive and negative groups. The primary endpoint was the rate of hospitalization within the next 6 months after initial ICD evaluation. Results: Device evaluation demonstrated at least one episode of monitored NSVT in 50 out of 104 patients. As expected, no device therapy (shock or anti-tachycardia) was needed for such episodes. At 6 months, 24 patients were hospitalized due to acute decompensated HF. Hospitalization rate was significantly lower in the NSVT negative as compared with positive groups (38% versus 62%; adjusted hazard ratio [HR] 0.166 ; 95% CI 0.056 to 0.492; p = 0.01). Conclusions: Monitored NSVT bouts in ICD recordings may serve as a predictor of future HF hospitalizations in ICD recipients with HF suggesting optimization of therapeutic modalities in these patients along with a close supervision in the clinical setting.
Resumo Fundamentos: A terapia de cardioversor-desfibrilador implantável (CDI) é bem conhecida por reduzir a mortalidade em pacientes selecionados com insuficiência cardíaca (IC). Objetivo: Investigar se os episódios monitorados de taquicardia ventricular não sustentada (TVNS) poderiam prever futuras hospitalizações por IC em receptores de CDI com IC. Métodos: Examinamos 104 receptores da CDI (idade média: 60 ± 10,1 anos, 80,8% do sexo masculino) com IC que foram encaminhados para o nosso ambulatório para acompanhamento do dispositivo. Após a interrogação do dispositivo, os pacientes foram divididos em grupos positivo e negativo de TVNS. O desfecho primário foi a taxa de hospitalização nos próximos 6 meses após a avaliação inicial do CID. Resultados: A avaliação do dispositivo demonstrou pelo menos um episódio de TVNS monitorado em 50 dos 104 pacientes. Como esperado, não foi necessária terapia de dispositivo (choque ou anti-taquicardia) para tais episódios. Aos 6 meses, 24 pacientes foram hospitalizados por insuficiência cardíaca descompensada aguda. A taxa de hospitalização foi significativamente menor na TVNS negativa em relação ao grupo positivo (38% contra 62%; Razão de risco ajustada [RR] 0,166; IC 95%: 0,056 a 0,492; p = 0,01). Conclusões: Os episódios de TVNS monitorados em gravações de CDI podem servir como preditores de hospitalizações futuras por insuficiência cardíaca em receptores CDI com IC sugerindo otimização de modalidades terapêuticas nesses pacientes, além de uma estreita supervisão no cenário clínico.