The latest medical research on Cardiology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about cardiology gathered by our medical AI research bot.
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Request AccessDevice-Related Adverse Events and Flow Capacity of Percutaneous Ventricular Assist Devices.
European Heart Journal: Acute Cardio CareComplication management is crucial in patients receiving mechanical circulatory devices. However, there are limited data on the association between the risks of complications and device type in patients with percutaneous ventricular assist devices (PVAD).
The Japanese registry for PVAD (J-PVAD) is a nationwide ongoing registry that enrolls consecutive patients with cardiogenic shock treated with PVAD. We analyzed 5717 patients in the J-PVAD from February 1, 2020, to December 31, 2022, to compare the incident risks of device-related problems and all-cause mortality within 30 days after PVAD introduction based on flow capacities of first-line PVAD (low: Impella 2.5/CP, n=5375; high: Impella 5.0/5.5, n=342).
The overall incidence of major device-related problems, including hemolysis, major bleeding, kidney injury, sepsis, and pump stop were 13%, 21%, 7%, 3%, and 1%, respectively. The all-cause mortality rate was 34%. The incident risks of hemolysis (hazard ratio [HR] 0.38, 95% confidence interval [CI] 0.24-0.58), kidney injury (HR 0.32, 95%CI 0.18-0.57), and pump stop (HR 0.38, 95%CI 0.16-0.91) were lower in patients with high-flow PVAD compared with those with low-flow PVAD. The risks of major bleeding or sepsis did not differ significantly between groups. The risk of all-cause mortality was lower in patients with high-flow PVAD compared with those with low-flow PVAD (HR 0.79, 95%CI 0.65-0.96).
Compared with those with low-flow PVAD, patients with high-flow PVAD had lower incident risks of device-related problems, including hemolysis, kidney injury, and pump stop, as well as lower risk of all-cause mortality.
A Novel 2D Echo View to Determine Right Ventricular Lead Position on the Tricuspid Valve Level.
EchocardiographyRecently, a subcostal en-face view of the tricuspid valve (TV) was described which can determine right ventricular (RV) lead position on the TV level. We sought to (1) prospectively evaluate the feasibility of this novel view in patients with cardiac implantable electronic devices (CIED) to visualize the position of the device lead relative to the TV leaflets and (2) study the association between lead position and degree of tricuspid regurgitation (TR).
Consecutive patients with a history of CIED implantation with at least one RV lead who underwent echocardiography for any cause at our tertiary center were included in this prospective observational study. A subcostal 2D en-face view of the TV was obtained and the position of the RV lead in the TV plane was determined whenever feasible.
A total of 176 patients were included, 70% were male, the median age was 74 years. The exact RV lead position in respect to the TV plane could be determined in 112/176 patients (64%) via the proposed view. In 37 patients (21%) moderate TR could be found, while 10 patients (6%) presented with severe TR. The lead position was not associated with the degree of TR.
A novel 2D en-face view of the TV can accurately identify the RV lead position in the TV plane. At least moderate TR was present in 27% of patients with CIED. There was no association of lead position with the occurrence of moderate or more TR.
Diagnostic Value of Regional Wall Motion Abnormalities on Resting Transthoracic Echocardiography for Coronary Artery Disease.
EchocardiographyRegional wall motion abnormality (RWMA) on transthoracic echocardiography (TTE) is used as a clinical decision-making tool to assess systolic function, but there is limited data regarding the validity of this tool to predict obstructive coronary artery disease (CAD). This study evaluates the utility of RWMA on TTE for detecting obstructive CAD in patients with no prior CAD history.
We retrospectively reviewed charts of adults who underwent resting TTE and coronary angiography within 30 days, analyzing RWMA in relation to angiographic luminal stenosis.
Among 754 patients (mean age 62, 60% male), TTE sensitivity varied with timing relative to angiography: 68.7% after angiography versus 49.5% before. In ST-elevation myocardial infarction (STEMI) patients (n = 126 after vs. n = 4 before), sensitivity was 89.8%. RWMA correlated with CAD severity, particularly in STEMI cases.
TTE specificity remains high, but sensitivity varies significantly by timing, with the highest sensitivity in STEMI patients. These findings could refine decision-making in uncertain STEMI cases, supporting TTE as a valuable adjunctive diagnostic tool.
Optimizing ring selection for secondary tricuspid regurgitation: the role of body size.
Cardiothoracic SurgeryTo investigate whether a larger prosthetic ring relative to a patient's body surface area (BSA) is associated with an increased risk of tricuspid regurgitation (TR) recurrence after tricuspid annuloplasty and adverse effects on long-term outcomes.
We retrospectively enrolled 239 patients who underwent tricuspid ring annuloplasty and mitral valve surgery between 2011 and 2016. The tricuspid annuloplasty ring index (TARI) was calculated by dividing the size of the annuloplasty ring (mm) by the BSA (m2). Risk factors for recurrent TR were determined using multivariate analysis. Long-term clinical outcomes were compared between propensity score-matched large and small TARI groups.
The annuloplasty ring size unadjusted for BSA did not affect TR recurrence (P = 0.388). TARI (subdistribution hazard ratio 1.34; 95% CI 1.07-1.67, P = 0.009) and right ventricular dimension (P = 0.020) were independent risk factors for recurrent TR in multivariate analyses. The cutoff value for discriminating the small from the large TARI group was 19.0 mm/m2. In the matched cohort, the cumulative TR recurrence at 3 years postoperatively was 0% in the small TARI group and 7.1% (95% CI 0-14.8%) in the large TARI group(P = 0.025). The cumulative incidence of adverse events at 3 years postoperatively was 8.3% (95% CI 5.1-16.2%) in the small TARI group and 13.2% (95% CI 3.3-23.0) in the large TARI group (P = 0.085).
The patient's body size might better be considered when determining the tricuspid ring size.
Early Detection of Left Ventricular Dysfunction With Machine Learning-Based Strain Imaging in Aortic Stenosis Patients.
EchocardiographyAortic stenosis (AS) is a common cardiovascular condition where early detection of left ventricular (LV) dysfunction is essential for timely intervention and optimal management. Current echocardiographic measurements, such as ejection fraction (EF), are insensitive to minor changes in LV function, and strain imaging is typically limited to the global longitudinal strain (GLS) parameter due to robustness issues. This study introduces a novel, fully automatic algorithm to enhance the detection of LV dysfunction in AS patients using multiple strain imaging parameters.
We applied supervised machine-learning techniques to classify data from 82 severe AS patients, 96 chest pain subjects, and 319 healthy volunteers.
Our model significantly outperformed EF and GLS in distinguishing AS patients from healthy volunteers (area under the curve [AUC] = 0.97 vs. 0.88 and 0.82, respectively). It also surpassed EF and GLS in differentiating AS patients from chest pain subjects (AUC = 0.95 vs. 0.90 and 0.55, respectively).
This novel, clinically interpretable model leverages the potential of strain imaging to enhance diagnostic accuracy and guide clinical decision-making in LV dysfunction, thereby improving clinical practice.
Intensive care unit admissions following enhanced recovery video-assisted thoracoscopic surgery lobectomy.
Cardiothoracic SurgeryVideo-assisted thoracoscopic surgery (VATS) lobectomy combined with enhanced recovery after surgery (ERAS) protocols has improved postoperative outcomes, yet concerns persist regarding complications and readmissions. Limited research has explored intensive care unit (ICU) admissions and outcomes within this context. This study aimed to analyze ICU admissions following VATS lobectomy within an established ERAS protocol.
Consecutive patients who underwent VATS lobectomy between 2018-2023 were included. Patient data were obtained from our prospective institutional database, while ICU data were extracted from electronic patients' records.
Of 2099 patients included, 48 (2.3%) required ICU admission. Median-age was 70 (IQR : 64-76), with ICU patients being older and predominantly male (73%). Overall 30-day-mortality was 1.0% with an ICU mortality of 31%. Multiple logistic regression revealed significant associations between ICU admission and male gender (p = <0.001), diabetes mellitus (p = 0.026), heart failure (p = 0.040), DLCO%(0.013). Median time to ICU admission was 4 days (IQR : 2-10). Respiratory failure was the primary reason for ICU admission (60%). Severe surgical complications accounted for 8.3% of all ICU-admissions.
In an ERAS setting, the incidence of ICU admission following VATS lobectomy was 2.3%, with a mortality rate of 31%. Respiratory failure was the leading cause of ICU admission.
Multi-Modality Imaging to Detect Ischemic and Valvular Heart Disease in Adult Cancer Patients.
EchocardiographyThanks to impressive advances in the field of oncology over the last 30 years, there has been a significant rise in cancer survivors. Nowadays, car...
Revisiting the Normal Ranges of Aortic Valve Area in 2D Echocardiography and Its Association With Age, Sex, and Anthropometric Characteristics.
EchocardiographyDefining normative aortic echocardiographic values in each geographical district is crucial as aortic valve area (AVA) may vary across races, genders, and ages. Notably, variations in normal values can have implications for clinical decision-making, and available data on the Middle East population is also scarce. We sought to establish normal ranges for aortic valve echocardiographic parameters in the Iranian population and assess the effect of age, gender, weight, height, BMI, BSA, and blood pressure on them.
Our data were provided from the web-based echocardiographic data registry of Imam Khomeini Hospital Complex (IKHC). A total of 3251 healthy subjects older than 18 years old without any valvular stenosis were included in our study.
AVA's normal range was estimated at 1.92-4.52 and 1.67-3.80 cm2 in men and women, respectively. The annulus, AVA, AV VTI, and LVOT VTI were significantly larger in males, and this association remained significant after indexing AVA for weight, height, BMI, and BSA. Also, smaller AVA was associated with lower height, weight, BMI, and BSA in both men and women. Obese and hypertensive subjects had significantly larger AVA and annulus diameters.
Our study provided region-specific normal reference values for AV echocardiographic parameters and compared them across genders, ages, BMI, and blood pressure groups in the Iranian population.
Anatomical Significance of the Patent Foramen Ovale by Real-Time 3D TEE in Cryptogenic Stroke and Migraine.
EchocardiographyThe transesophageal echocardiogram (TEE) is the standard imaging modality for confirming the presence or absence of patent foramen ovale. PFO is a flap valve depending on the pressure change between the left and right atrium, which can help determine whether to open. 3D-TEE was shown to optimize the visualization of PFO. There is a causal association between PFO and unexplained stroke. It seems that 3D-TEE can present a high-risk PFO morphological feature, which seems to show more than just being easier to open.
In total, 134 consecutive patients with cryptogenic stroke or migraine who had suspected PFO and underwent c-TCD, TTE, and c-TEE were included in this study. TEE confirmed the PFO. The right-to-left shunt (RLS) grade of PFO at rest and abdominal compression Valsalva maneuver was detected by c-TEE.
The long diameter of FO (1.74 ± 0.3 vs. 1.60 ± 0.4, p = 0.039), the short diameter of FO (1.12 ± 0.3 vs. 1.00 ± 0.3, p = 0.036), perimeter of FO (4.62 ± 0.7 vs. 4.22 ± 1.0, p = 0.026), and area (1.80 ± 0.8 vs. 1.35 ± 0.8, p = 0.05) of the FO were significantly larger in the larger RLS group. In group of CS, a larger proportion of Eustachian valve or a Chiari's network (14.3% vs. 3.5%, p = 0.036), a larger proportion of in the left funnelform (55.1% vs. 16.3%, p < 0.001), a longer length of the PFO tunnel (13.4 ± 4.4 vs. 7.8 ± 2.5, p < 0.001), a lower IVC-PFO angle (16.4 ± 3.4 vs. 20.3 ± 7.7, p = 0.001), a higher proportion of LA multiple exits of the tunnel (46.9% vs. 14.3%, p < 0.001). Multivariate regression analysis showed that male gender (HR: 4.026, 95% CI: 0.883-18.361, p = 0.072), age (HR: 1.076, 95% CI: 1.002-1.155, p = 0.045), the left funnelform (HR: 7.299, 95% CI: 1.585-33.618, p = 0.011), a longer length of the PFO tunnel (HR: 1.843, 95% CI: 1.404-2.418, p < 0.001) and multiple exits of the tunnel of LA (HR: 8.544, 95% CI: 1.595-45.754, p = 0.012) increased the risk of cerebral infarction. The cut-off value calculated by ROC for the diagnosis of high-risk PFO was that the length of the PFO tunnel was 12 mm and the left funnelform combined with multiple exits of the left atrial (sensitivity was 92%, specificity was 90%). The area under the curve of the combined index versus PoPE score (0.932 vs. 0.736) relative to the RoPE score was statistically significant.
TEE has shown outstanding advantages in displaying the specific morphological characteristics of PFO. The left funnelform, a longer length of the PFO tunnel, and multiple exits of the tunnel of LA are associated with an increasing risk of CS in anatomical PFO respect.
Multicentre frozen elephant trunk technique experience as redo surgery to treat residual type A aortic dissections following ascending aortic replacement.
Cardiothoracic SurgeryTo assess the efficacy of reoperative frozen elephant trunk (FET) surgery for treating residual type A aortic dissections.
Between 04/2015 and 10/2023, 237 patients underwent elective redo surgical aortic arch replacement via the FET technique to treat residual type A aortic dissection in eleven European aortic centres. Data were pooled and analysed retrospectively.
The time between an acute type A dissection repair to FET implantation was 5 [1, 9] years. More than half of all patients (54%) presented with an entry within the aortic arch, and 174 patients (73%) presented residual dissections of supra-aortic vessels During FET repair, the axillary artery was cannulated in 181 patients (76%), while 83 patients (35%) underwent additional cardiac procedures including 39 root replacements (16%) and 15 coronary bypass procedures (6%). Zone 2 was the most common arch anastomosis site (n = 163, 69%) and bilateral antegrade cerebral perfusion was most frequent (n = 159, 67%). Fifteen patients (6%) suffered in-hospital mortality. Age in years (p < 0.001, OR: 1.069) proved to be predictive for overall mortality in our COX regression model.
Elective redo surgical aortic arch replacement using the FET technique for treating residual type A aortic dissection following ascending aortic replacement revealed a favourable outcome. The decision to undertake stage-two therapy of a residually dissected aortic arch should be made by an aortic team on a patient-by-patient basis.
Short-term outcome after isolated tricuspid valve surgery: prognostic role of right ventricular strain.
Cardiothoracic SurgeryTo assess the incremental prognostic value of right ventricular free wall longitudinal strain over conventional risk scores in predicting the peri-operative mortality in patients with severe tricuspid regurgitation (TR) undergoing isolated tricuspid valve (TV) surgery.
We retrospectively enrolled 110 consecutive patients with severe TR who underwent isolated TV surgery between November 2016 and July 2022 at San Raffaele Hospital, Milan, Italy. Exclusion criteria were previous TV surgery, urgent surgery, complex congenital heart disease, active endocarditis and inadequate acoustic window. Baseline clinical data were included, as well as laboratory tests and clinical risk score, as TRI-SCORE and MELD-XI. The clinical outcome was peri-operative mortality, defined as all-cause mortality within 30 days.
The final cohort included 79 patients. The endpoint occurred in 7 patients (9%), who died within 30-days after isolated TV surgery. ROC curves analysis showed that, among parameters of right ventricular function, right ventricular free wall longitudinal strain was the best parameter to predict peri-operative mortality (AUC: 0.854, 95% CI 0.74-0.96, p = 0.005, sensitivity 68%, specificity 100%) At univariable analysis, left ventricular ejection fraction, diabetes mellitus, creatinine, estimated glomerular filtration rate, serum sodium, MELD-XI, TRI-SCORE, right ventricular areas, right ventricular global longitudinal strain, right ventricular free wall longitudinal strain, fractional area change and the ratio between right ventricular free wall longitudinal strain/pulmonary arterial systolic pressure were significantly associated with the endpoint. The combination of TRI-SCORE and right ventricular Strain, evaluating right ventricular systolic function with speckle-tracking echocardiography, outperformed classic TRI-SCORE in outcome prediction (AUC 0.874 vs 0,787, p value=0.05).
Right ventricular free wall longitudinal strain has an incremental prognostic value over conventional parameters and significantly improves the ability of clinical scores to predict peri-operative mortality in patients undergoing isolated TV surgery.
Multicentre retrospective analysis of physician-modified fenestrated/inner-branched endovascular repair for complex aortic aneurysms.
Cardiothoracic SurgeryIn this multicentre retrospective observational study, we present the early outcomes of physician-modified fenestrated/inner-branched endovascular repair for pararenal and thoraco-abdominal aortic aneurysms in patients at high risk for open surgical repair.
We comprehensively reviewed the clinical data and outcomes of consecutive patients treated with physician-modified fenestrated/inner-branched endovascular repair for pararenal or thoraco-abdominal aortic aneurysms at six centres between December 2020 and December 2021. Primary end-points included technical success, in-hospital mortality rates, major adverse events.
Seven and 31 patients (median age, 80.5 years) had pararenal and thoraco-abdominal aortic aneurysms, respectively, involving 93 renal-mesenteric arteries incorporated through 10 fenestrations or 83 inner branches. Seven patients (18.4%) were treated non-elective conditions. The technical success rate was 89.5%. The median operative time was 334.5 min. Ten patients (26.3%) experienced major adverse events, including in-hospital mortality in six patients (15.8%), acute kidney injury in three patients (7.9%), respiratory failure in three patients (7.9%), bowel ischaemia in one patient (2.6%), stroke in one patient (2.6%), and paraplegia in one patient (2.6%). Among elective cases, in-hospital deaths occurred in three patients (9.7%), while in non-elective cases, the mortality rate was higher, with three patients (42.9%) succumbing. The median follow-up duration was 14 months.
physician-modified fenestrated/inner-branched endovascular repair is a viable treatment for pararenal or thoraco-abdominal aortic aneurysms in patients at high risk for open surgical repair. It provides customization without location constraints or production delays, but further validation is needed to ensure long-term reliability.
