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A 45-year-old female patient was admitted to the emergency department with syncope. Her medical history revealed a diagnosis of Familial Partial Lipodystrophy 2 (FPLD2). The patient's electrocardiogram showed a complete atrioventricular (A-V) block, and she had a history of insulin-dependent diabetes mellitus and coronary artery bypass surgery. A severe stenosis was observed in the aortic right coronary artery saphenous vein graft during coronary angiography, which was successfully revascularized. Subsequently, due to persistant syncope attacks, a permanent pacemaker was implanted after an electrophysiological study. This case highlights that serious cardiac conduction defects in patients with FPLD2 may not only be related to coronary artery disease but can also present as direct conduction defects.
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Aterosclerose , Bloqueio Atrioventricular , Doença da Artéria Coronariana , Lipodistrofia Parcial Familiar , Feminino , Humanos , Pessoa de Meia-Idade , Lipodistrofia Parcial Familiar/complicações , Lipodistrofia Parcial Familiar/diagnóstico , Lipodistrofia Parcial Familiar/genética , SíncopeRESUMO
BACKGROUND: Pulmonary hypertension (PH) and right ventricular dysfunction are poor prognostic predictors in patients underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). AIMS: The prognostic impact of the main pulmonary artery/ascending aorta diameter ratio (MPA/AOr), measured simply by computed-tomographic angiography (CTA), was investigated in this patient group. METHODS: A total of 374 retrospectively evaluated patients (mean age 78.1 ± 8.4 years, 192 [51.3%] females) who underwent TAVI for severe AS were included. MPA/AOr was measured on preprocedural CTA in all patients and the effect of this measurement on the presence of PH, in-hospital and 2-year-overall long-term mortality was investigated. RESULTS: The presence of PH was defined as a systolic pulmonary artery pressure (sPAP) >42 mmHg measured by echocardiography. According to multivariate-logistic-regression analysis, MPA/AOr (adjusted [Adj] odds ratio [OR]: 1.188, confidence interval [CI] 95% [1.002-1.410], p = 0.048), tricuspid annular plane systolic excursion (TAPSE) (adj OR:0.736, CI 95% [0.663-0.816], p < 0.001) and left atrial diameter (adj OR:1.051, CI 95% [1.007-1.098], p = 0.024) were identified as independent predictors of PH. In addition, a statistically significant correlation was found between MPA/AOr and TAPSE (r: -0.283, p < 0.001). Furthermore, MPA/AOr was found to be an independent predictor of both in-hospital (adj OR:1.434, CI 95% [1.093-1.881], p = 0.009) and 2-year long-term (adj OR:1.518, CI 95% [1.243-1.853], p < 0.001) mortality in multivariate analysis including TAPSE, STS score and sPAP. In the 2-year Kaplan-Meier survival probability analysis, an MPA/AOr >0.86 was found to have a hazard ratio of 3.697 (95% CI: 2.341-5.840), with a log-rank p < 0.001. CONCLUSION: MPA/AOr, which can be measured simply by CTA, may be useful as an indicator of the presence of PH and poor prognosis in patients planned for TAVI for severe AS.
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Estenose da Valva Aórtica , Hipertensão Pulmonar , Substituição da Valva Aórtica Transcateter , Feminino , Humanos , Idoso , Idoso de 80 Anos ou mais , Masculino , Substituição da Valva Aórtica Transcateter/efeitos adversos , Prognóstico , Artéria Pulmonar/diagnóstico por imagem , Resultado do Tratamento , Estudos Retrospectivos , Aorta Torácica , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgiaRESUMO
The present study evaluated the prognostic significance of right ventricular-pulmonary arterial (RV-PA) coupling, assessed by the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio, in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). This retrospective, single-center study involved 403 patients (mean age: 78.2 ± 8.4; 50.9% female). RV-PA coupling was categorized based on the pre-procedural TAPSE/sPAP ratio: severe uncoupling (≤0.32), moderate uncoupling (0.32-0.55), and normal coupling (>0.55). The study primary endpoints were in-hospital mortality and 2-year all-cause mortality. Multivariate logistic regression revealed that the TAPSE/sPAP ratio is an independent predictor of both in-hospital (adjusted OR: 0.61, 95% CI [0.44-0.84], P = .002) and 2-year mortality (adjusted OR: 0.69, 95% CI [0.56-0.85], P = .001). Severe uncoupling was strongly associated with increased 2-year mortality (adjusted OR: 3.92, 95% CI [1.67-9.20], P = .002). Our study establishes a significant association between reduced preoperative TAPSE/sPAP ratios and increased risks of both in-hospital and 2-year all-cause mortality in patients undergoing TAVI for severe AS. These results highlight the prognostic utility of evaluating RV-PA coupling. Incorporating this metric into preoperative risk stratification could potentially refine prognostic accuracy and inform clinical decision-making.
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Transcatheter edge-to-edge repair treatment is mainly used for patients with chronic heart failure concomitant severe mitral regurgitation. However, utilization of this system in the acute seting of myocardial infarction is still limited. In this case report authors aimed to show the eï¬ectiveness of the percutaneous treatment for severe acute mitral regurgitation early after myocardial infarction.
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Insuficiência Cardíaca , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Infarto do Miocárdio , Humanos , Insuficiência da Valva Mitral/etiologia , Valva Mitral/cirurgia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Insuficiência Cardíaca/complicações , Resultado do Tratamento , Implante de Prótese de Valva Cardíaca/efeitos adversos , Cateterismo Cardíaco/efeitos adversosRESUMO
INTRODUCTION: Up to one-third of patients indicated for transcatheter aortic valve implantation (TAVI) may be unsuitable for transfemoral TAVI (TF-TAVI) according to manufacturers' recommendations and numerous professional societies. OBJECTIVE: This study aimed to investigate the predictive value of manufacturers' guidelines for major vascular access site complications using the Perclose ProGlide device. METHODS: Among 208 patients undergoing TF-TAVI, 144 patients (69.2%) were deemed eligible for TF-TAVI according to the manufacturer's instructions. A minimal lumen diameter (MLD) of the femoral artery below the manufacturer's specified limits and/or the presence of circumferential calcification were the reasons for ineligibility. Calcium score (CS), sheath-to-femoral artery ratio (SFAR) and MLD were estimated from computed tomography imaging. Vascular complications (VCs) (defined according to VARC-2 criteria) were retrospectively compared. RESULTS: Patients in the ineligible group had higher SFAR (1.13±0.15 vs. 0.88±0.107, p<0.001) and CS (1.66±0.99 vs. 1.24±0.73; p=0.003), and significantly lower MLD (7.72±1.03 vs. 6.31±0.96 mm; p<0.001) compared to the eligible group. Major (6.3% vs. 12.3%, p=0.13) and minor VCs (10.4% vs. 15.6%, p=0.29) were similar in the eligible and ineligible groups. The ineligible group had higher rates of rupture (0.7% vs. 6.3%; p=0.03). SFAR was the only independent predictor of major VCs (OR 469.1, 95% CI 4.95-44466.57, p=0.008). CONCLUSION: The TAVI team should not decide whether the patient is suitable for a femoral approach based solely on the manufacturer's criteria, and should incorporate additional factors that could be predictive of major VCs.
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Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Doenças Vasculares , Humanos , Substituição da Valva Aórtica Transcateter/métodos , Estudos Retrospectivos , Estenose da Valva Aórtica/cirurgia , Resultado do Tratamento , Doenças Vasculares/etiologia , Artéria Femoral/cirurgia , Valva Aórtica/cirurgiaRESUMO
BACKGROUND: The failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice. METHODS: This research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared. RESULTS: No significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P = .36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P = .14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P = .25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P = .34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P = .044). CONCLUSION: Finding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal "bailout" procedure.
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Hemorragia , Técnicas Hemostáticas , Substituição da Valva Aórtica Transcateter , Dispositivos de Oclusão Vascular , Humanos , Artéria Femoral/cirurgia , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento , Dispositivos de Oclusão Vascular/efeitos adversos , Hemorragia/etiologia , Hemorragia/terapiaRESUMO
OBJECTIVE: Vascular complications (VCs) contribute to increased morbidity and mortality in patients who have undergone transcatheter aortic valve implantation (TAVI); however, studies on their incidence and predictors show conflicting results. In this study, we sought to assess the incidence, impact, and predictors of VCs in transfemoral (TF) TAVI and also investigated the predictive role of manufacturer's size charts and a new predictor modified sheath-to-femoral artery ratio. METHODS: A total of 223 patients undergoing TF-TAVI were categorized into 2 groups. The patients were divided as eligible and ineligible according to the manufacturer's guidelines (MG), and the same patient cohort was dichotomized into eligible and ineligible on the basis of sheath-to-femoral artery ratio (SFAR) value of less than or greater than or equal to modified SFAR (md-SFAR). VCs (defined according to the Valve Academic Research Consortium II criteria) were retrospectively compared. RESULTS: According to the manufacturer's size charts, 65 patients were unsuitable; however, 35 patients were ineligible for TF-TAVI per the md-SFAR criteria. Although VCs occurred in 42 (18.8%) patients, 17 (27.7%) of those patients were classified as ineligible according to MG, whereas 14 (41.2%) were classified as ineligible in the md-SFAR group. In a multiple logistic regression analysis that included md-SFAR, MG, SFAR ≥1.05, peripheral artery disease, and minimum iliofemoral artery diameter, only md-SFAR was the independent predictor of VCs (odds ratio=3.71, 95% confidence interval=1.13-12.53, p=0.031). CONCLUSION: According to our results, md-SFAR might provide better patient selection to prevent VCs and improve outcomes in TF-TAVI procedures.
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Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Artéria Femoral/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVE: The data on using novolimus-eluting DESolve bioresorbable scaffolds (BVS) for long-segment coronary artery lesions remains insufficient. In this study, our main objective was to assess the long-term effects of the overlapping applications of both DESolve-DESolve and the drug-eluting stent (DES)-DESolve. METHODS: A single-centered study of 103 patients scheduled for DESolve placement for long-segment lesions (>28 mm) was conducted (October 2013 to November 2016). A DESolve-DESolve overlap was used on 43 patients and a DES-DESolve overlap on 60 patients. Acute procedural success and major adverse cardiac events (MACE) (stent thrombosis, targeted vessel revascularization, targeted lesion revascularization, and cardiac death) were evaluated. The patients were followed up for 48 months. RESULTS: Revascularization was performed on 4 (6.7%) patients in the DES-DESolve group and 5 (11.6%) patients in the DESolve-DESolve group for target lesion revascularization. Among the study population, 10 (9.7%) patients had MACE, including 5 (8.3%) patients in the DES-DESolve group and 5 (11.6%) patients in the DESolve-DESolve group. CONCLUSION: The positive results of our study concerning the use of DESolve for the treatment of long coronary lesions demonstrate that BVS will emerge with new platforms and become non-inferior to the DES.
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Doença da Artéria Coronariana , Stents Farmacológicos , Intervenção Coronária Percutânea , Implantes Absorvíveis , Angiografia Coronária , Doença da Artéria Coronariana/cirurgia , Humanos , Macrolídeos , Desenho de Prótese , Resultado do TratamentoRESUMO
OBJECTIVE: Bioresorbable vascular scaffolds (BVSs) have been a disappointment in the evolution of drug-eluting stents used in percutaneous coronary intervention because an excessive number of thrombotic complications have been reported. The aim of this study was to evaluate long-term clinical outcomes of the Absorb BVS in patients treated using a predilation, proper sizing, and post-dilation implantation technique. METHODS: The records of 110 patients who had a total of 150 Absorb BVSs implanted were retrospectively analyzed. The rate of major adverse cardiovascular events (MACEs), defined as the composite of cardiac death, target vessel myocardial infarction (MI), and target-lesion revascularization were studied using quantitative coronary angiography. RESULTS: Of the study population, 80% were male and the mean age was 60±11.3 years. The most common diagnosis was stable angina (84%). The median length of follow-up was 53 months (range: 46-59 months). The rate of predilation and postdilation was 100%, and 95%, respectively. The 4-year rate of MACEs was 20%: cardiac death in 3 patients (2.7%), target vessel MI in 9 (8.2%), and target lesion revascularization in 20 (18.2%). Definite device thrombosis occurred in 6 of 110 patients (5.5%). One case of very late scaffold thrombosis was observed at 47 months. A small BVS diameter (2.5 mm) was found to be the most powerful independent predictor of a MACE (p=0.05). CONCLUSION: The Absorb BVS was associated with an increased risk of adverse events, including late and very late device thrombosis, despite the use of a good implementation protocol.
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Implantes Absorvíveis/efeitos adversos , Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea/efeitos adversos , Alicerces Teciduais/efeitos adversos , Angiografia Coronária/métodos , Dilatação/estatística & dados numéricos , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Trombose/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: Worsening of renal function in a patient with acute decompensated heart failure is called cardiorenal syndrome (CRS) type 1. Recent studies have shown an association of persistent systemic venous congestion with renal dysfunction. This trial was set up to investigate the changes of renal Doppler parameters with diuretic therapy in patients with CRS type 1. METHODS: Cases of CRS type 1 were identified among patients hospitalized for decompensated heart failure. Serial measurements of the renal venous impedance index (VII) and arterial resistive index (ARI) were calculated by pulsed wave Doppler sonography. RESULTS: A total of 30 patients who had creatinine improvement with diuresis (group 1) and 34 patients without any improvement (group 2) were analyzed. Patients in group 1 had higher median VII and ARI (VII, 0.86 versus 0.66; P < .001; ARI, 0.78 versus 0.65; P < .001) on admission. A high ARI on admission (odds ratio, 6.25; 95% confidence interval, 1.84-14.3; P = .003) predicted the improvement of serum creatinine levels with diuretic therapy independent of confounding factors in patients with CRS type 1. CONCLUSIONS: Renal vascular Doppler parameters might offer guidance on the diagnostic and therapeutic strategies in prescribing decongestive therapy for decompensated heart failure.
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Síndrome Cardiorrenal , Insuficiência Cardíaca , Síndrome Cardiorrenal/diagnóstico por imagem , Creatinina , Diuréticos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Rim/diagnóstico por imagem , Ultrassonografia DopplerRESUMO
BACKGROUND: Most of the current data regarding the use of bioresorbable scaffolds (BRS) come from everolimus-eluting stent platforms. Adverse events with the everolimus-eluting BRSs which are the most comprehensively characterized BRS, hampered the clinical use of other BRS. There is paucity of published data regarding long term use of novolimus-eluting BRS. METHODS: This study sought to evaluate the performance of novolimus-eluting BRS device at midterm follow-up in real world clinical practice. One hundred and forty-four patients (mean age 57.5±9.7 years, 78.5% male) treated with 206 scaffolds between October 2015 and December 2017 were enrolled. A device-oriented composite endpoint (DOCE) comprising cardiac death, target vessel myocardial infarction (TV-MI), clinically driven target lesion revascularization (TLR) and rate of scaffold thrombosis were investigated. RESULTS: During a mean follow-up of 33±9 months, DOCE occurred in 9 patients (6.3%) of which cardiac death occurred in 2 patients (1.4%), and clinically driven TLR in 7 patients (4.9%), TV-MI in one patient. Target vessel revascularization (TVR) was observed in nine patients. None of the patients experienced scaffold thrombosis. CONCLUSIONS: The use of novolimus-eluting BRS in this real-world population achieved good clinical outcomes.
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Implantes Absorvíveis , Stents Farmacológicos , Idoso , Everolimo , Feminino , Humanos , Macrolídeos , Masculino , Pessoa de Meia-IdadeAssuntos
Estenose da Valva Aórtica/cirurgia , Oclusão Coronária/diagnóstico , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Angiografia por Tomografia Computadorizada , Oclusão Coronária/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Fatores de Risco , Gravação em VídeoRESUMO
INTRODUCTION: Elevated risk of adverse events in comparison to metallic stents resulted in withdrawal of everolimus-eluting bioresorbable scaffolds (eBVS), known as the most intensively studied BVS. There is a paucity of data comparing the two different BVS. AIM: To evaluate the long-term clinical outcomes of the novolimus-eluting bioresorbable vascular scaffold (nBVS) compared with eBVS. MATERIAL AND METHODS: Consecutive patients treated with nBVS or eBVS in our center were screened. The primary outcome was the 3-year rate of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI), and target-lesion revascularization (TLR). RESULTS: After matching, 98 patients treated with 135 eBVS were compared with 98 patients treated with 136 nBVS. Baseline characteristics, clinical presentation, and lesion characteristics were comparable in both groups. The 3-year MACE rate was higher in the eBVS group (17.3% vs. 6.1%; p log-rank = 0.02). The occurrence of TLR (16.3% vs. 5.1%; p log-rank = 0.02) and TV-MI (8.2% vs. 0 %; p log-rank = 0.004) was also higher in the eBVS group except for cardiac deaths (1% vs. 2%; p log-rank = 0.98, eBVS vs. nBVS, respectively). Of note, definite device thrombosis rate was markedly increased in the eBVS group (5.1% vs. 0%; p log-rank = 0.03). CONCLUSIONS: The present study revealed that the 3-year event risk was lower for nBVS compared to eBVS. More evidence is needed to evaluate long-term performance of novolimus-eluting biovascular platforms.
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OBJECTIVE: In this study, we aimed to assess the relationship between radial artery spasm (RAS) and arterial stiffness (AS) measured by the oscillometric method. MATERIALS AND METHODS: A total of 123 consecutive patients scheduled for elective coronary angiography in a single default radial center were enrolled for the study. AS [namely, augmentation pressure; augmentation index (AIx); and pulse wave velocity] was assessed using a validated oscillometric device (Mobil-O-Graph NG 24 h PWA). Central arterial pressures were also recorded. In the cath lab, the number of puncture attempts, total procedural time (TPT), and largest catheter size were noted. If greater than two catheters were required to complete imaging, it was additionally specified. RAS was considered to exist if two or more of predefined clinical features were present. RESULTS: RAS was observed in 20 (16.3%) patients. Patients were divided into two distinct groups in terms of the occurence of RAS. In the RAS(+) group, the proportion of hypertensive individuals was significantly higher, whereas there were fewer smokers. With respect to operational data, TPT (24.3±9.8 vs. 29.3±9.1 mins; P=0.038) and procedures carried out with more than one puncture attempts were significantly higher in the RAS(+) group. Among all oscillometric parameters, augmentation pressure, AIx, and PR were found to be higher in the RAS(+) group. According to multivariate analysis, TPT (P=0.029) and AIx (odds ratio: 1.044, 95% confidence interval=0.977-1.117; P=0.009) were found to be independent predictors of RAS. CONCLUSION: Along with conventional risk factors, AS assessment, as a practical, noninvasive method, may help to predict RAS in angiographic procedures.
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Artéria Radial , Rigidez Vascular , Idoso , Angiografia Coronária , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Oscilometria/métodos , Análise de Onda de Pulso , Artéria Radial/fisiopatologia , Fatores de Risco , EspasmoRESUMO
Amelioration of the valvular geometry is a possible mechanism for mitral regurgitation (MR) improvement in patients receiving cardiac resynchronization therapy (CRT). We aimed to establish the precise definition, incidence, and predictors of reversed mitral remodeling (RMR), as well as the association with MR improvement and short-term CRT outcome. Ninety-five CRT recipients were retrospectively evaluated for the end-point of "MR response" defined as the absolute reduction in regurgitant volume (RegV) at 6 months. To identify RMR, changes in mitral deformation indices were tested for correlation with MR response and further analyzed for functional and echocardiographic CRT outcomes. Overall, MR response was observed in 50 patients (53%). Among the echocardiographic indices, the change in tenting area (TA) had the highest correlation with the change in RegV (r = 0.653, p < 0.001). The mean TA significantly decreased in MR responders (4.15 ± 1.05 to 3.67 ± 1.01 cm2 at 6 months, p < 0.001) and increased in non-responders (3.68 ± 1.04 to 3.98 ± 0.97 cm2, p = 0.014). The absolute TA reduction was used to identify patients with RMR (47%) which was found to be associated with higher rates of functional improvement (p = 0.03) and volumetric CRT response (p = 0.036) compared to those without RMR. Non-ischemic etiology and the presence of LBBB independently predicted RMR at multivariate analysis. In conclusion, reduction in TA is a reliable index of RMR, which relates to MR response, and functional and echocardiographic improvement with CRT. LBBB and non-ischemic etiology are independent predictors of RMR.
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Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/terapia , Valva Mitral/fisiopatologia , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Estudos Retrospectivos , Remodelação VentricularRESUMO
Background/aim: Myocarditis in the acute phase usually presents with sinus tachycardia but many other arrhythmias might be seen as well. In this study we aimed to investigate repolarization abnormalities in baseline ECG of patients with myocarditis for the first time.Materials and methods: Thirty patients diagnosed with myocarditis and 25 healthy age-matched controls were included. Two different cardiologists measured corrected QT (QTc), QT dispersion (QTd), QT peak (QTp), T wave peak to T wave end (TpTe), TpTe/QT ratio, and TpTe/QTc ratio in 12-lead ECG.Results: When compared with the control group, QTp (P: 0.021), QT (P: 0.003), TpTe (P < 0.001), TpTe/QTc ratio (P < 0.001), and TpTe/QT ratio (P: 0.005) were significantly higher in patients with myocarditis. A comparison of receiver operating characteristic (ROC) curves was conducted using the Hanley and McNeil method. The area under the curve (AUC) of the electrocardiographic characteristics QT (AUC: 0.736; 95% CI [0.600-0.846]), QTP (AUC: 0.680; 95% CI [0.540-0.799]), and TpTe (AUC: 0.771; 95% CI [0.638-873]) and TpTe/QTc (AUC: 0.774; 95% CI [0.641-0.876]) and TpTe/QT (AUC: 0.726; 95% CI [0.589-0.838]) in myocarditis were not significantly different from each other but all of them were different from 0.5.Conclusion: Baseline ECGs of patients with myocarditis were associated with repolarization abnormalities. These novel findings may be one of the reasons underlying arrhythmic events in patients with myocarditis.
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OBJECTIVES: We aimed to evaluate the peri-procedural success of DESolve bio-resorbable scaffolds (BRSs) and analyzed real-life data about major cardiac events during 1-year follow-up. BACKGROUND: There is little information about real-life data of DESolve BRS which is a novel stent technology offering various advantages over drug eluting stents and commonly used in daily cardiology practice. METHODS: We conducted this single-center and non-randomized cross-sectional study from June 2015 through August 2016 in Medipol University Department of Cardiology and included 117 patients undergoing single or multivessel percutaneous coronary interventions (PCI) with novolimus-eluting BRS devices (152 scaffolds) (Elixir Medical Corporation). Study end points were acute device and procedural success, scaffold thrombosis and major adverse cardiac event (MACE) rates of DESolve BRS. RESULTS: Device success was 96.7% and procedural success was 99.3%. We detected MACE rate as 0.9% while clinical-driven target lesion revascularization was performed in one patient. None of the patients experienced scaffold thrombosis or death. Peri-procedural complications were reported in three patients. CONCLUSIONS: High rates of successful scaffold implantations, low rates of peri-procedural complications, and major cardiac events in long-term suggest that DESolve scaffolds can safely and effectively be used in daily intervention practice by particularly experienced operators.
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Implantes Absorvíveis/efeitos adversos , Doença da Artéria Coronariana , Stents Farmacológicos/efeitos adversos , Macrolídeos/uso terapêutico , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Alicerces Teciduais/efeitos adversos , Idoso , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Estudos Transversais , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVE: Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with increased morbidity and mortality. Atrial fibrosis augments recurrence rate following AF catheter ablation. Osteopontin is a multifunctional molecule involved in several pathophysiological pathways, including fibrosis. Presently described is investigation of relationship between serum osteopontin level and AF recurrence after AF cryoablation. METHODS: The study was designed to be prospective and observational; 60 patients with paroxysmal (n=47) and persistent (n=13) AF were included. Osteopontin level was measured both before and 6 months after AF ablation with cryoballoon. RESULTS: Preprocedure and postprocedure osteopontin level did not differ between the 2 groups of AF patients (p=0.286, p=0.493, respectively). Postprocedure osteopontin level was significantly higher compared with preprocedure value (32.18 ng/mL vs 15.58 ng/mL; p=<0.001). Left atrial diameter, AF type, and preprocedure osteopontin level were related to AF recurrence (p≤0.05). An age-adjusted multivariate logistic regression analysis was conducted to determine independent predictors of AF recurrence. Among these, AF type (ß=2.211; p=0.004; odds ratio [OR]: 9.124; 95% confidence interval [CI]: 2.026-41.094) was found to be the most important factor related to AF recurrence. Preprocedure osteopontin level also predicted AF recurrence independently (ß=0.059; p=0.048; OR: 1.061; 95% CI 1.001-1.125). CONCLUSION: Study results revealed persistency of AF and high preprocedure osteopontin level independently predicted AF recurrence in patients undergoing cryoballoon AF ablation. Association of a biochemical marker with AF recurrence might be beneficial to selection of appropriate patients for cryoballoon procedure and assessment of long-term procedural success.
Assuntos
Angioplastia Coronária com Balão/métodos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Criocirurgia , Osteopontina/sangue , Adulto , Idoso , Fibrilação Atrial/sangue , Biomarcadores/sangue , Cateterismo Cardíaco , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Estudos Prospectivos , RecidivaRESUMO
OBJECTIVE: The aim of the present study was to investigate the relationship between glomerular filtration rate (GFR) and acute post-scaffold recoil (PSR) in patients undergoing bioresorbable scaffold (BVS) implantation. METHODS: We included 130 patients who underwent everolimus-eluting BVS device (Absorb BVS; Abbott Vascular, Santa Clara, CA, USA) or the novolimus-eluting BVS device (Elixir Medical Corporation) implantations for single or multi-vessel disease. Clinical, angiographic variables and procedural characteristics were defined and pre-procedural GFR was calculated for each patient. Post-procedural angiographic parameters of each patient were analyzed. Primary objective of the study was to evaluate the effect of GFR on angiographic outcomes after BVS implantation while secondary objective was to compare post-procedural angiographic results between the two BVS device groups. RESULTS: Baseline clinical characteristics and angiographic parameters were similar between the two BVS groups. Post-procedural angiographic analysis revealed significantly lower PSR in the DESolve group than the Absorb group (0.10±0.04 vs. 0.13±0.05, p: 0.003). When PSR in the whole study population was evaluated, it was positively correlated with age, tortuosity , calcification and PBR as there was a negative correlation between GFR. Besides GFR were found to be independent predictors for PSR in all groups and the whole study population. CONCLUSION: In patients undergoing BVS implantation, pre-procedural low GFR is associated with increased post-procedural PSR. Calcification, age, PBR, dyslipidemia and tortuosity are other independent risk factors for PSR. DESolve has lower PSR when compared with Absorb.