RESUMEN

We examined the effect of minimal lumen segmentation uncertainty on Fractional Flow Reserve obtained from Coronary Computed Tomography Angiography FFR CT . A total of 14 patient-specific coronary models with different stenosis locations and degrees of severity were enrolled in this study. The optimal segmented coronary lumens were disturbed using intra ± 6 % and inter-operator ± 15 % variations on the segmentation threshold. FFR CT was evaluated in each case by 3D-OD CFD simulations. The findings suggest that the sensitivity of FFR CT to this type of uncertainty increases distally and with the stenosis severity. Cases with moderate or severe distal coronary lesions should undergo either exact and thorough segmentation operations or invasive FFR measurements, particularly if the FFR CT is close to the cutoff (0.80). Therefore, we conclude that it is crucial to consider the lesion's location and degree of severity when evaluating FFR CT results.

Asunto(s)

Vasos Coronarios , Reserva del Flujo Fraccional Miocárdico , Humanos , Reserva del Flujo Fraccional Miocárdico/fisiología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Modelos Cardiovasculares , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Masculino , Incertidumbre , Femenino , Persona de Mediana Edad , Simulación por Computador , Estenosis Coronaria/fisiopatología , Estenosis Coronaria/diagnóstico por imagen , Anciano , Tomografía Computarizada por Rayos X

RESUMEN

BACKGROUND: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. METHODS: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. RESULTS: In the matched population of n = 5410 patients, the mean age was 81 ± 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0-12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02-1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86-1.37, p = 0.48). CONCLUSION: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves.

RESUMEN

An 85-year-old patient with permanent atrial fibrillation with a DDD pacemaker, and with indication for left atrial appendage occlusion (LAAO). Sent for LAAO due to recurrent gastrointestinal bleedings even on apixaban and with a CHA 2 DS 2 VASc and HAS-BLED scores of 4 and 3 respectively.

Asunto(s)

Apéndice Atrial , Fibrilación Atrial , Cardiólogos , Dispositivo Oclusor Septal , Accidente Cerebrovascular , Anciano de 80 o más Años , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/diagnóstico por imagen , Humanos , Valor Predictivo de las Pruebas , Resultado del Tratamiento

RESUMEN

INTRODUCTION AND OBJECTIVE: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in different series. This study aimed to clarify the bleeding predictive factors that could influence these differences. METHODS: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. RESULTS: Cox regression analysis revealed that age ≥75 years (HR: 2.5; 95% CI: 1.3 to 4.8; p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1; 95% CI: 1.1 to 3.9; p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged <75 or ≥75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p < 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9%; HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years; HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 ± 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 ± 1.2; p = 0.029). CONCLUSIONS: In this high-risk population, GIB history and age ≥75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patients.

RESUMEN

No disponible

Asunto(s)

Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Infecciones Estafilocócicas , Staphylococcus aureus , Endocarditis/terapia , Endocarditis/etiología , Incidencia

Asunto(s)

Endocarditis Bacteriana , Endocarditis , Reemplazo de la Válvula Aórtica Transcatéter , Endocarditis/etiología , Endocarditis/cirugía , Endocarditis Bacteriana/etiología , Humanos , Incidencia , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos

RESUMEN

No disponible

Asunto(s)

Humanos , Fibrilación Atrial/tratamiento farmacológico , Apéndice Atrial/efectos de los fármacos , Anticoagulantes/administración & dosificación , Índice de Severidad de la Enfermedad , Fibrilación Atrial/fisiopatología , Apéndice Atrial/fisiopatología

Asunto(s)

Apéndice Atrial , Fibrilación Atrial , Procedimientos Quirúrgicos Cardíacos , Anticoagulantes , Humanos

RESUMEN

INTRODUCCIÓN: La endocarditis infecciosa (EI) sobre transcatheter aortic valve implantation (TAVI) es una complicación emergente. Existen datos incompletos y dispares sobre su incidencia. Se aporta la experiencia en nuestro centro sobre incidencia, mortalidad y factores asociados de la EI post-TAVI y se compara con datos de la literatura. MÉTODOS: Estudio retrospectivo observacional de los casos de EI diagnosticados en pacientes que habían recibido TAVI, entre el 1 de junio de 2009 y el 1 de noviembre de 2017, en un centro universitario tras una mediana de seguimiento de 15,3 meses (rango intercuartil [RIC] 9,1-36,2). Se analizaron la incidencia, los datos clínicos, microbiológicos y pronósticos, y los factores asociados a EI post-TAVI. RESULTADOS: Se detectaron 11 pacientes con EI de 200 TAVI. Incidencia global: 5,5% (2,77 casos por 100 años-paciente). La mediana de tiempo hasta la EI post-TAVI fue de 112 días (RIC 36-578), la tasa de mortalidad intrahospitalaria fue del 36,4% y la mortalidad al año, del 54,5%. Todos los microorganismos identificados fueron grampositivos (4 Enterococcus faecalis, 3 Staphylococcus coagulasa negativo). Los pacientes con EI post-TAVI eran significativamente más jóvenes (mediana 78, RIC 73-80, frente a 82, RIC 79-84, p = 0,002), tenían un EuroSCORE mayor (5,1 ± 2,4 frente a 3,2 ± 1,2, p < 0,001) y más frecuentemente antecedentes de neoplasia (18,2% frente al 4,2%, p < 0,03). CONCLUSIONES: En nuestro medio, la incidencia de EI post-TAVI es mayor que la descrita en series multicéntricas, lo que concuerda con la tendencia publicada en la literatura. Conlleva una elevada mortalidad y se asocia con una peor situación clínica basal

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INTRODUCTION: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an emerging complication. There are incomplete and disparate data on its incidence. We present the experience of a single-centre of incidence, mortality and associated factors of IE after TAVI. METHODS: A retrospective observational study of IE cases in people who received a TAVI, between 06/01/2009 and 11/01/2017, in a university hospital, during a median follow-up period of 15.3months (interquartile range [IQR] 9.1-36.2). Incidence, clinical, microbiological and prognostic data, and factors associated with IE after TAVI were analysed. RESULTS: Eleven patients with IE of 200 TAVI were detected. Global incidence: 5.5% (2.77 cases per 100 patient-year). The median of days from TAVI to IE was 112 (IQR 36-578), the in-hospital mortality rate was 36.4%, and the one-year mortality rate was 54.5%. All the organisms identified were gram-positive (4 Enterococcus faecalis, 3 coagulase-negative Staphylococcus). The patients with IE after TAVI were significantly younger (median 78 years, IQR 73-80, versus 82 years, IQR 79-84, P=.002), they had a higher EuroSCORE (5.1±2.4 versus 3.2 ± 1.2, P < .001), and they more frequently had a history of neoplasia (18.2% versus 4.2%, P < .03). CONCLUSIONS: In our area, IE after TAVI has an incidence greater than that described in multicentre series, this is in line with the trend published in the literature. It leads to high mortality and is associated with a worse baseline clinical situation

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Endocarditis Bacteriana/microbiología , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Endocarditis Bacteriana/epidemiología , Factores de Riesgo , Estudios Retrospectivos , Mortalidad Hospitalaria , Profilaxis Antibiótica/métodos , Pruebas de Sensibilidad Microbiana , Endocarditis Bacteriana/etiología

RESUMEN

INTRODUCTION: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an emerging complication. There are incomplete and disparate data on its incidence. We present the experience of a single-centre of incidence, mortality and associated factors of IE after TAVI. METHODS: A retrospective observational study of IE cases in people who received a TAVI, between 06/01/2009 and 11/01/2017, in a university hospital, during a median follow-up period of 15.3months (interquartile range [IQR] 9.1-36.2). Incidence, clinical, microbiological and prognostic data, and factors associated with IE after TAVI were analysed. RESULTS: Eleven patients with IE of 200 TAVI were detected. Global incidence: 5.5% (2.77 cases per 100 patient-year). The median of days from TAVI to IE was 112 (IQR 36-578), the in-hospital mortality rate was 36.4%, and the one-year mortality rate was 54.5%. All the organisms identified were gram-positive (4 Enterococcus faecalis, 3 coagulase-negative Staphylococcus). The patients with IE after TAVI were significantly younger (median 78years, IQR 73-80, versus 82 years, IQR 79-84, P=.002), they had a higher EuroSCORE (5.1±2.4 versus 3.2±1.2, P<.001), and they more frequently had a history of neoplasia (18.2% versus 4.2%, P<.03) CONCLUSIONS: In our area, IE after TAVI has an incidence greater than that described in multicentre series, this is in line with the trend published in the literature. It leads to high mortality and is associated with a worse baseline clinical situation.

Asunto(s)

Infección Hospitalaria/etiología , Endocarditis Bacteriana/etiología , Infecciones por Bacterias Grampositivas/etiología , Infección de la Herida Quirúrgica/etiología , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Anciano , Anciano de 80 o más Años , Profilaxis Antibiótica , Estenosis de la Válvula Aórtica/cirugía , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Enterococcus , Enterococcus faecalis/aislamiento & purificación , Femenino , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Hospitales Universitarios , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Staphylococcus aureus/aislamiento & purificación , Staphylococcus epidermidis , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/microbiología

RESUMEN

No disponible

Asunto(s)

Humanos , Masculino , Persona de Mediana Edad , Anciano , Dispositivos de Cierre Vascular/efectos adversos , Trombosis/prevención & control , Fibrilación Atrial/cirugía , Apéndice Atrial/cirugía , Resultado del Tratamiento

RESUMEN

No disponible

Asunto(s)

Humanos , Masculino , Adulto , Imagen Multimodal/métodos , Miocarditis/diagnóstico por imagen , Infarto del Miocardio/diagnóstico por imagen , Angiografía Coronaria , Diagnóstico Diferencial

Asunto(s)

Apéndice Atrial/lesiones , Fibrilación Atrial/terapia , Cateterismo Cardíaco/efectos adversos , Lesiones Cardíacas/etiología , Derrame Pericárdico/prevención & control , Venas Pulmonares/lesiones , Anciano de 80 o más Años , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/diagnóstico por imagen , Cateterismo Cardíaco/instrumentación , Lesiones Cardíacas/diagnóstico por imagen , Humanos , Masculino , Derrame Pericárdico/etiología , Venas Pulmonares/diagnóstico por imagen , Resultado del Tratamiento

Asunto(s)

Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Errores Diagnósticos , Cardiopatías/etiología , Complicaciones Posoperatorias , Dispositivo Oclusor Septal/efectos adversos , Trombosis/etiología , Anciano , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/complicaciones , Ecocardiografía , Estudios de Seguimiento , Cardiopatías/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Raras , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Trombosis/diagnóstico

RESUMEN

We present a case of a 52 year old female who suffered from a sudden syncope. A coronariography was performed and spontaneous coronary dissection was diagnosed in the posterior descending artery after an optical coherence tomography (OCT) was performed. A conservative management was decided. During hospitalization the patient presented with an episode of chest pain with an anterior ST elevation on ECG. Coronariography showed total occlusion of the left descending artery and again a dissection was diagnosed by OCT. This time, 2 stents were implanted in the affected artery. The hypothesis that the coronary adventitial volume of vasa vasorum is higher in patients with spontaneous coronary artery dissection has been demonstrated in a recent small study and it was observed in this patient. Conservative management is preferred in most cases, proceeding to revascularization for patients with ongoing chest pain, hemodynamic instability and ST elevation, mostly if it affects major arteries.

Asunto(s)

Anomalías de los Vasos Coronarios/complicaciones , Vasos Coronarios/cirugía , Intervención Coronaria Percutánea/métodos , Infarto del Miocardio con Elevación del ST/etiología , Enfermedades Vasculares/congénito , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/cirugía , Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Recurrencia , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/cirugía , Tomografía de Coherencia Óptica , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/cirugía

RESUMEN

Transcatheter aortic valve replacement (TAVR) is an increasingly common procedure for the treatment of aortic stenosis in elderly patients with comorbidities that prevent the use of standard surgery. It has been shown that implantation without aortic regurgitation is related to lower mortality. Mild paravalvular regurgitation is inevitable in some cases due to calcification of the aortic annulus and its usually somewhat elliptical shape. Central regurgitation is less common, but has been associated with valve overdilatation in cases in which reduction of paravalvular regurgitation was attempted after the initial inflation. However, there are no reported cases of central prosthetic aortic regurgitation due to acute LV dysfunction. We report a case in which central aortic regurgitation occurred due to transient ventricular dysfunction secondary to occlusion of the right coronary artery by an embolus. The regurgitation disappeared after thrombus aspiration and normal ventricular function was immediately recovered.

Asunto(s)

Insuficiencia de la Válvula Aórtica/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Válvula Aórtica , Estenosis de la Válvula Aórtica , Embolia , Humanos

RESUMEN

No disponible

Asunto(s)

Humanos , Hiperlipidemias/tratamiento farmacológico , Síndrome Coronario Agudo/complicaciones , Alta del Paciente/estadística & datos numéricos

Asunto(s)

Síndrome Coronario Agudo/complicaciones , Manejo de la Enfermedad , Hiperlipidemias , Hipolipemiantes/uso terapéutico , Alta del Paciente , Síndrome Coronario Agudo/sangre , Anciano , Femenino , Humanos , Hiperlipidemias/sangre , Hiperlipidemias/complicaciones , Hiperlipidemias/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto

RESUMEN

No disponible

Asunto(s)

Humanos , Enfermedad Arterial Periférica/diagnóstico , Índice Tobillo Braquial , Diagnóstico Precoz , Arteriosclerosis/diagnóstico , Oscilometría , Tamizaje Masivo/métodos