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OBJECTIVE: This study aims to assess the efficacy and safety of tricuspid valve (TV) transcatheter edge-to-edge repair (TEER) procedures using the MitraClip or TriClip device in high-risk patients with severe secondary tricuspid regurgitation (TR) and provide Turkish-specific data on procedural outcomes and clinical follow-up. METHODS: This study enrolled 42 high-risk patients with severe secondary TR who underwent transcatheter edge-to-edge repair using either the MitraClip or TriClip device. Patient selection criteria included severe TR, high surgical risk (EuroScore ≥ 8 and Tricuspid Regurgitation Impact Severity Score (TRI-SCORE) ≥ 6), symptomatic despite medical therapy, and anatomical suitability for TriClip. Patients underwent rigorous evaluation by a specialized cardiac team before the procedure, including 2D/3D transesophageal echocardiography to assess eligibility. RESULTS: The study achieved a 100% procedural success rate, defined as successful implantation and at least one-degree reduction in TR severity. Post-procedure assessments revealed that 88.1% of patients had mild to moderate TR, indicating significant improvement, while only 11.9% retained severe TR. During the median follow-up of 11.5 months, rehospitalization occurred in 23.8% of patients, and mortality was observed in 7.1% of patients, demonstrating a favorable safety profile. Comparative analysis between TriClip and MitraClip devices showed similar efficacy and safety outcomes, with no significant differences in procedural durations or complication rates. CONCLUSION: The study demonstrates the effectiveness and safety of TV TEER using TriClip or MitraClip devices in managing severe secondary TR in high-risk patients. Procedure success, improved TR severity, and favorable clinical outcomes were observed, supporting the role of transcatheter techniques in TR management.
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Cateterismo Cardíaco , Insuficiencia de la Válvula Tricúspide , Humanos , Insuficiencia de la Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Masculino , Femenino , Anciano , Resultado del Tratamiento , Cateterismo Cardíaco/métodos , Turquía , Válvula Tricúspide/cirugía , Válvula Tricúspide/diagnóstico por imagen , Ecocardiografía Transesofágica , Persona de Mediana Edad , Anciano de 80 o más Años , Índice de Severidad de la Enfermedad , Implantación de Prótesis de Válvulas Cardíacas/métodosRESUMEN
Background: Haloperidol and dexmedetomidine are used to treat delirium in the intensive care unit (ICU). The effects of these drugs on the corrected QT (QTc) interval have not been compared before. It was aimed to compare the effects of haloperidol and dexmedetomidine treatment on QTc intervals in patients who developed delirium during ICU follow-up. Method: The study is single-center, randomized, and prospective. Half of the patients diagnosed with delirium in the ICU were treated with haloperidol and the other half with dexmedetomidine. The QTc interval was measured in the treatment groups before and after drug treatment. The study's primary endpoints were maximal QT and QTc interval changes after drug administration. Results: 90 patients were included in the study, the mean age was 75.2±12.9 years, and half were women. The mean time to delirium was 142+173.8 hours, and 53.3% of the patients died during their ICU follow-up. The most common reason for hospitalization in the ICU was sepsis (%37.8.). There was no significant change in QT and QTc interval after dexmedetomidine treatment (QT: 360.5±81.7, 352.0±67.0, p= 0.491; QTc: 409.4±63.1, 409.8±49.7, p=0.974). There was a significant increase in both QT and QTc interval after haloperidol treatment (QT: 363.2±51.1, 384.6±59.2, p=0.028; QTc: 409.4±50.9, 427.3±45.9, p=0.020). Conclusions: Based on the results obtained from the study, it can be concluded that the administration of haloperidol was associated with a significant increase in QT and QTc interval. In contrast, the administration of dexmedetomidine did not cause a significant change in QT and QTc interval.
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INTRODUCTION: This study aims to compare the addition of SGLT2 inhibitors or doubling the diuretic dose in patients receiving treatment with beta-blockers, angiotensin-converting enzyme inhibitors (ACEi), or angiotensin receptor blockers (ARB), as well as mineralocorticoid receptor antagonists (MRA), for heart failure with reduced ejection fraction (HFrEF) who present to the emergency department with decompensated heart failure. METHODS: This study is a single-center and prospective analysis. A total of 980 decompensated heart failure (HFrEF) patients receiving optimal medical therapy (OMT) according to the 2021 European heart failure guidelines were randomized in a 2:1 ratio into the furosemide and empagliflozin treatment arms. The analysis includes patient clinical characteristics, laboratory results, and echocardiographic data. Factors influencing rehospitalization were identified through multivariate Cox regression analysis. Log-rank analysis was employed to assess factors affecting rehospitalization. RESULTS: The mean age of the patients was 67.9 years, with 52.1% being men. There was no significant impact of demographic, clinical, or echocardiographic factors on rehospitalization at 1 month; only the effect of treatment subgroups on rehospitalization was observed (p = 0.039). Significant echocardiographic and clinical improvements were seen in both treatment arms. The empagliflozin group exhibited significant improvements in 6-min walk distance, heart rate, body weight, NT-pro BNP levels, and eGFR level compared to the furosemide group. The rate of rehospitalization in the first month was significantly lower in those receiving empagliflozin (28.7%) compared to those receiving a double dose of furosemide (40.2%) (log-rank p = 0.013). DISCUSSION AND CONCLUSION: This study provides valuable insights into the management of decompensated HFrEF and demonstrates that SGLT2 inhibitors offer benefits beyond glycemic control in this patient group. The significant reduction in rehospitalization rates and improvements in echocardiographic parameters underscore the potential of SGLT2 inhibitors in reducing acute heart failure episodes.
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BACKGROUND: Identifying and understanding the microstructural changes within the wall of the pulmonary artery (PA) is crucial for elucidating disease mechanisms and guiding treatment strategies. We assessed the utility of optical coherence tomography (OCT) in identifying such changes within segmental/subsegmental PAs and compared the morphological variations in WHO group 4 pulmonary hypertension associated with Behcet Disease (BD), Takayasu arteritis (TA) and chronic thromboembolic pulmonary hypertension (CTEPH). Idiopathic pulmonary arterial hypertension (IPAH) patients served as controls.MethodsâandâResults: A total of 197 cross-sectional images were analyzed from 20 consecutive patients. BD patients exhibited lower %wall area and mean wall thickness (MWT) compared with CTEPH, TA and, IPAH patients. TA patients showed a notably higher %wall area, which was significant in IPAH and BD patients. Variations in %wall area measurements were observed across distinct cross-sectional segments of the PA within individual patients (22% in CTEPH, 19% in BD, 16% in TA, 23% in IPAH patients). Intravascular webs, bands, and thrombi were observed in BD and CTEPH patients. OCT provided clear delineation of vascular wall calcifications and adventitial vasa vasorum. No procedure-related complications were observed. CONCLUSIONS: PA involvement differs among the various etiologies of PH, with the PA being heterogeneously affected. OCT offers promise in elucidating microstructural vascular wall changes and providing insights into disease mechanisms and treatment effects.
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OBJECTIVE: This retrospective study aimed to investigate the potential impact of ticagrelor and clopidogrel treatment on cardiovascular outcomes in patients with anemia and acute coronary syndrome (ACS) and to provide insights into the optimal therapeutic approach for this vulnerable patient population. METHODS: A retrospective research design was employed, involving patients diagnosed with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) between 2014 and 2021. Inclusion criteria required a hemoglobin level below 12 mg/dL and a minimum 12-month P2Y12 inhibitor treatment. Comprehensive clinical, biochemical, and echocardiographic data were collected from the hospital's electronic repository. The primary efficacy endpoint was major adverse cardiovascular events (MACE), encompassing total mortality, cardiovascular mortality, reinfarction, ischemic stroke, and hemorrhagic stroke. Major hemorrhage was the primary safety endpoint. Secondary outcomes included total mortality, cardiovascular mortality, reinfarction, ischemic stroke, and hemorrhagic stroke, individually. RESULTS: Patients treated with ticagrelor (n = 118) and clopidogrel (n = 538) were compared. No significant difference was observed in major adverse cardiovascular events (MACE) and major bleeding between ticagrelor and clopidogrel treatment groups (MACE: clopidogrel 10.0% vs. ticagrelor 11.0%, p = 0.75; major bleeding: clopidogrel 2.8%, ticagrelor 2.5%, p = 0.88). Patients with hemoglobin levels ≤ 8 mg/dL demonstrated significantly higher MACE and major bleeding rates in the ticagrelor group (p = 0.008 and p = 0.002, respectively). Among patients aged ≥ 75 years, ticagrelor treatment was associated with a higher risk of major bleeding (p = 0.04). CONCLUSIONS: Ticagrelor and clopidogrel exhibited comparable efficacy and safety outcomes in anemic ACS patients over a one-year period. Although ticagrelor demonstrated superiority in reducing ischemic events, it is crucial to recognize the limitations of retrospective studies in informing clinical practice. This study offers valuable insights into tailoring antiplatelet therapy for anemic ACS patients and provides guidance for personalized treatment strategies, acknowledging the hypothesis-generating nature of retrospective analyses.
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Síndrome Coronario Agudo , Anemia , Accidente Cerebrovascular Hemorrágico , Accidente Cerebrovascular Isquémico , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Clopidogrel/efectos adversos , Ticagrelor/efectos adversos , Inhibidores de Agregación Plaquetaria/efectos adversos , Estudios Retrospectivos , Síndrome Coronario Agudo/tratamiento farmacológico , Accidente Cerebrovascular Hemorrágico/inducido químicamente , Accidente Cerebrovascular Hemorrágico/tratamiento farmacológico , Intervención Coronaria Percutánea/efectos adversos , Recurrencia Local de Neoplasia/inducido químicamente , Recurrencia Local de Neoplasia/tratamiento farmacológico , Hemorragia/inducido químicamente , Anemia/etiología , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Hemoglobinas , Resultado del Tratamiento , Clorhidrato de Prasugrel/uso terapéuticoRESUMEN
BACKGROUND: This single-center observational study aimed to compare the echocardiographic and clinical features in patients diagnosed with migraine and embolic stroke of undetermined source (ESUS) who presented with a known patent foramen ovale (PFO). METHODS: Two-dimensional and color Doppler images were obtained using various transthoracic echocardiography views for both migraine and ESUS patients. Suspected PFO cases underwent further assessment through contrast echocardiography and transesophageal echocardiography (TEE). High-risk PFO characteristics were evaluated using TEE, and the Risk of Paradoxical Embolism (RoPe) score was calculated. RESULTS: The study included 310 participants (age range: 18-60, 73.2% female), with 43.5% diagnosed with migraine and 56.5% with ESUS. Common comorbidities included diabetes (26.1%). High-velocity shunting through the interatrial septum was observed in 35.5% of patients. ESUS patients were older, with higher rates of diabetes and hypertension, while active smoking was more prevalent among migraine patients. Basic echocardiographic parameters were mostly similar, except for elevated pulmonary artery systolic pressure in ESUS. ESUS patients exhibited a greater occurrence of large microbubble passage through the interatrial septum and longer PFO lengths compared to migraine patients. However, the RoPe and High-risk PFO scores were similar between the groups. CONCLUSIONS: ESUS patients, characterized by older age and higher rates of diabetes and hypertension, demonstrated increased pulmonary artery pressure, more significant microbubble crossings, and longer PFO lengths. Conversely, migraine patients had a higher prevalence of active smoking. Despite differing clinical profiles, the risk scores for PFO-related embolic events were comparable between the groups. These findings underscore potential distinctions between ESUS and migraine patients with PFO and their implications for management strategies.
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Diabetes Mellitus , Accidente Cerebrovascular Embólico , Foramen Oval Permeable , Hipertensión , Trastornos Migrañosos , Accidente Cerebrovascular , Humanos , Femenino , Adolescente , Masculino , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Ecocardiografía/métodos , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/diagnóstico por imagen , Ecocardiografía Transesofágica , Accidente Cerebrovascular/diagnóstico por imagenRESUMEN
OBJECTIVE: This study aims to assess the predictive value of the Systemic Immune Inflammation Index (SII) in determining in-stent restenosis (ISR) likelihood in patients with acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI). METHODS: The study enrolled 903 ACS patients undergoing PCI, categorized into ISR (+) and ISR (-) groups based on control coronary angiography results. Demographic, clinical, laboratory, and angiographic-procedural characteristics were systematically compared. RESULTS: The ISR (+) group encompassed 264 individuals (29.2%), while the ISR (-) group comprised 639 individuals (70.8%). Patients had a mean age of 55.8â ±â 10.2 years, with 69% being male. The ISR (+) group had higher diabetes and smoking prevalence and notably larger stent dimensions. Lab parameters showed significantly elevated creatinine, total cholesterol, red cell distribution width, white blood cell and neutrophil counts, SII index and C-reactive protein (CRP) in the ISR (+) group, while lymphocyte levels were lower. Binary logistic regression identified stent diameter (odds ratio [OR]: 0.598, 95% confidence interval [CI]: 0.383-0.935; P â =â 0.024), stent length (OR: 1.166, 95% CI: 1.132-1.200; P â <â 0.001), creatinine (OR: 0.366, 95% CI: 0.166-0.771; P â =â 0.003), CRP (OR: 1.075, 95% CI: 1.042-1.110; P â =â 0.031), and SII index (OR: 1.014, 95% CI: 1.001-1.023; P â <â 0.001) as independent ISR predictors. CONCLUSION: The SII index exhibits potential as a predictive marker for ISR in ACS patients post-PCI, indicating systemic inflammation and heightened restenosis risk. Integrating the SII index into risk models could identify high-risk patients for targeted interventions.
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Síndrome Coronario Agudo , Reestenosis Coronaria , Intervención Coronaria Percutánea , Humanos , Masculino , Persona de Mediana Edad , Anciano , Femenino , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/epidemiología , Reestenosis Coronaria/etiología , Factores de Riesgo , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/terapia , Síndrome Coronario Agudo/etiología , Creatinina , Angiografía Coronaria/efectos adversos , Stents/efectos adversos , Proteína C-Reactiva/análisis , Inflamación , Constricción Patológica , Estudios RetrospectivosRESUMEN
OBJECTIVE: Earthquakes can significantly impact both the occurrence and the management of acute coronary syndromes (ACS). This study aimed to investigate the effects of an earthquake on patients with ACS by comparing their clinical and angiographic features before and after the event. METHODS: We utilized a retrospective observational cohort design, involving 260 ACS patients who underwent coronary angiography. Data on patient characteristics, clinical variables, and procedural details were extracted from medical records. Statistical analyses were conducted to compare the ACS groups pre- and post-earthquake and to assess outcomes, which included in-hospital mortality and complications. RESULTS: After the earthquake, the ACS patients were older and predominantly male. The distribution of ACS subtypes remained similar between the groups. The use of anticoagulation before the procedure decreased after the earthquake, while the usage of other medications remained stable. The incidence of non-critical coronary arteries decreased post-earthquake, and there was a higher frequency of non-intervention in this group. Intervention in the left anterior descending coronary artery was more common after the earthquake. In-hospital mortality was associated with post-earthquake ACS, certain ACS subtypes, shock at admission, bifurcation stenting, and the no-reflow phenomenon. Complete revascularization was found to reduce mortality. The duration of intensive care unit stays was longer before the earthquake, while in-hospital mortality was higher after the earthquake. Gender differences were observed in coronary ectasia, with females being more affected post-earthquake. CONCLUSION: Earthquakes significantly influence the clinical and angiographic features of ACS cases, thereby affecting mortality rates and revascularization outcomes.
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Síndrome Coronario Agudo , Terremotos , Intervención Coronaria Percutánea , Femenino , Humanos , Masculino , Síndrome Coronario Agudo/epidemiología , Angiografía Coronaria , Vasos Coronarios , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Introduction: Atrial fibrillation (AF) may co-exist in patients with non-ST-elevation myocardial infarction (NSTEMI). In patients with NSTEMI, AF should therefore be regarded as an important risk factor irrespective of its presentation. To predict outcomes in AF patients presenting with NSTEMI, early risk stratification can help to identify the patients with a possible poor long-term prognosis. The development of the PRECISE-DAPT score aimed to predict the risk of bleeding in patients who underwent stent implantation and received dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), providing a valuable tool for assessing bleeding risk in this specific patient population. Aim: To assess the performance of the PRECISE-DAPT score in predicting long-term prognosis in AF patients with NSTEMI. Material and methods: Five hundred and twenty-six consecutive AF patients presenting with NSTEMI were included in the present study. The PRECISE-DAPT score was calculated in each case and evaluated for the association of increased mortality in the study population, who survived in-hospital but died in the long term. Results: All-cause mortality deaths occurred in 278 (52.6%) patients. Higher PRECISE-DAPT score, shorter duration of P2Y12 inhibitor therapy, decreased left ventricular ejection fraction (LVEF), and a history of diabetes mellitus (DM) were all associated with an increased risk of all-cause mortality in the multivariable logistic regression model. Conclusions: High PRECISE-DAPT score was associated with higher long-term all-cause mortality in AF patients presenting with NSTEMI.
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INTRODUCTION: Drug-eluting stents (DES) have revolutionized percutaneous coronary intervention (PCI) by improving event-free survival compared to older stent designs. However, early-generation DES with polymer matrixes have raised concerns regarding late stent thrombosis due to delayed vascular healing. To address these issues, biologically bioabsorbable polymer drug-eluting stents (BP-DES) and polymer-free drug-eluting stents (PF-DES) have been developed. AIM: The aim of the present study is to evaluate and compare the long-term effects of different stent platforms in patients with acute coronary syndrome (ACS) undergoing PCI. MATERIAL AND METHODS: We conducted a retrospective, observational study involving 1192 ACS patients who underwent urgent PCI. Patients were treated with thin- strut DP-DES, ultra-thin strut BP-DES, or thin-strut PF-DES. The primary endpoint was a composite of cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (CITLR) at 12 months and 4 years. RESULTS: The baseline demographics and clinical characteristics of patients in the three stent subgroups were similar. No significant differences were observed in target lesion failure (TLF), cardiac mortality, TVMI, and stent thrombosis (ST) rates among the three subgroups at both 12 months and 4 years. However, beyond the first year, the rate of CITLR was significantly lower in the ultra-thin strut BP-DES subgroup compared to thin-strut DP-DES, suggesting potential long-term advantages of ultra-thin strut BP-DES. Additionally, both ultra-thin strut BP-DES and thin-strut PF-DES demonstrated lower ST rates after the first year compared to thin-strut DP-DES. CONCLUSION: Our study highlights the potential advantages of ultra-thin strut BP-DES in reducing CITLR rates in the long term, and both ultra-thin strut BP-DES and thin-strut PF-DES demonstrate lower rates of ST beyond the first year compared to thin-strut DP-DES. However, no significant differences were observed in overall TLF, cardiac mortality and TVMI rates among the three stent subgroups at both 12 months and 4 years.
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Síndrome Coronario Agudo , Stents Liberadores de Fármacos , Infarto del Miocardio , Intervención Coronaria Percutánea , Trombosis , Humanos , Sirolimus/efectos adversos , Polímeros/química , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/terapia , Síndrome Coronario Agudo/etiología , Intervención Coronaria Percutánea/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Infarto del Miocardio/etiología , Stents , Implantes Absorbibles , Trombosis/etiología , Diseño de PrótesisRESUMEN
Introduction: Data on the change in mitral valve annulus diameter (MAD), and left atrial appendage (LAA) structure and function after transcatheter edge-to-edge repair (TEER) of the mitral valve in patients with secondary mitral regurgitation (MR) are lacking. Aim: To evaluate the change in these parameters just after the clip insertion and its relationship with prognosis in the long term. Material and methods: A total of 50 patients (age: 71.5 ±11.3 years, 70% male) with moderate-to-severe or severe MR were included in the study. Transthoracic (TTE) and transoesophageal echocardiography (TEE) were performed before and after the procedure. Prognostic data were recorded with post-procedure telephone calls and follow-up visits. Results: TEE performed during the procedure showed that LAA contraction and filling velocity significantly increased (p < 0.001 for all). Systolic pulmonary artery pressure (SPAP), MAD, and LAA landing zone dimension significantly decreased (p < 0.001 for all). There was only a significant correlation between the MAD before clip placement and the MAD change after clip placement (r = 0.6, p < 0.001). During a mean follow-up period of 10.5 ±8.9 months, no significant correlation was found between MAD change, LAA contraction and filling velocity change, and LAA landing zone dimension change and rehospitalization, stroke, mortality, and composite outcome. Conclusions: The contraction and filling velocity of LAA, SPAP, MAD, and LAA landing zone dimension changed significantly immediately after the MitraClip procedure. Although these parameters are not related to composite outcome in our study, MAD, LAA diameter, and velocity need to be compared between successful and unsuccessful procedures to predict their clinical relevance.
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OBJECTIVE: This study aimed to compare the sympathetic nervous system activity of atrial ���brillation patients without structural heart disease and the normal population in terms of urinary metanephrine levels. METHODS: Our study was conducted with 40 paroxysmal or persistent patients without structural heart disease and CHA2DS2VASc score of 0 or 1 and 40 healthy controls. Laboratory parameters, demographic characteristics, and 24-hour urine metanephrine levels were compared between the 2 groups included in the study. RESULTS: Metanephrine value in urine was found to be signi���cantly higher in the atrial ���brillation group (atrial ���brillation group 97.50 �� 17.19 ��g/day vs. control group 74.27 �� 15.55 ��g/day; P < 0.001). The body mass index of the atrial ���brillation group was found to be signi���cantly higher than the control group (atrial ���brillation group 27.26 �� 2.97 kg/m2 vs. control group 24.05 �� 2.24 kg/m2; P < 0.001). In multivariate linear regression analysis, body mass index (beta: 0.266, P =.02) and urinary metanephrine level (beta: 0.522, P = 0.002) were found to be independent risk factors. According to receiver operating characteristic analysis, it was determined that urinary metanephrine value (area under the curve = 0.834, P < 0.001) and body mass index (area under the curve = 0.803, P < 0.001) predicted the development of atrial ���brillation. CONCLUSION: Our study found that urinary metanephrine levels were higher in patients with atrial ���brillation without structural heart disease than those without atrial ���brillation, and metanephrine values predicted the development of atrial ���brillation.
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Fibrilación Atrial , Cardiopatías , Humanos , Metanefrina/orina , Fibrilación Atrial/epidemiología , Curva ROC , Factores de RiesgoRESUMEN
Background Studies have shown that increased body weight and obesity may be associated with an increased risk of arrhythmic events. The aim of this study was to evaluate the effect of obesity on the risk of arrhythmic events, hospitalization, and death in patients who received implantable cardioverter defibrillator (ICD) therapy for primary or secondary prevention.Material and Methods A single-center, prospective, observational study was conducted. Patients with body mass index (BMI) <30 kgâ/âm2 were classified as non-obese, and patients with BMI ≥30 kgâ/âm2 were classified as obese. The primary endpoints were arrhythmic events and device interventions. The secondary endpoints were all-cause mortality, cardiac mortality, cardiac rehospitalization, and a composite endpoint of mortality and hospitalization.Results Among a total of 340 patients, 78.2â% were male, and 22.1â% were obese. The mean age was 60.9âyrs. Ventricular tachycardia (VT) was more frequent in non-obese patients (HR 0.57, [CI] 0.38-0.87, p=0.009). All-cause mortality and cardiac mortality in all patients tended to be more frequent in non-obese (HR 2.71, [CI] 0.93-7.93, p= 0.069 for all-cause mortality; HR 3.29, [CI] 0.97-11.17, p=0.056 for cardiac mortality). In the subgroup analysis, VT, all-cause mortality, and cardiac mortality were more common for non-obese patients in primary prevention and ischemic heart failure (HF) groups.Conclusion While VT was more frequent in non-obese patients, VF, ICD appropriate shock, inappropriate shock, and antitachycardia pacing were similar in obese and non-obese patients. All-cause mortality and cardiac mortality were more frequent in non-obese patients.
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Desfibriladores Implantables , Taquicardia Ventricular , Humanos , Masculino , Persona de Mediana Edad , Femenino , Desfibriladores Implantables/efectos adversos , Estudios Prospectivos , Taquicardia Ventricular/etiología , Taquicardia Ventricular/prevención & control , Arritmias Cardíacas/etiología , Arritmias Cardíacas/prevención & control , Obesidad/complicacionesRESUMEN
Patients with non-valvular atrial fibrillation who are under chronic oral anticoagulant therapy (OAC) treatment frequently require interruption of OAC treatment. By examining the presence of left atrial/left atrial appendage (LA/LAA) thrombus or dense spontaneous echo contrast (SEC) with transesophageal echocardiography (TEE) we aimed to develop an individualized strategy. To test the validity of CHA2DS2VASc score based recommendations was our secondary purpose. In this prospective study patients with non-valvular atrial fibrillation on OAC therapy were included. Patients' baseline characteristics, CHA2DS2VASc and HASBLED scores, medications, type of invasive procedures and clinical events were recorded. Each patient underwent to TEE examination prior to the invasive procedure. Bridging anticoagulation was recommended only to patients with LA/LAA thrombus. We included 155 patients and mean CHA2DS2VASc score of the study population was 3.4 ± 1.4. Seventy-one of them had LA/LAA thrombi or SEC on TEE examination and bridging anticoagulation was applied. OAC treatment was not bridged in 8 of 11 patients with prior cerebrovascular accident and 17 of 31 patients with CHA2DS2VASc score of > 4. 57 of 124 patients with CHA2DS2VASc score of ≤ 4 required bridging anticoagulation. There were 14 major bleedings decided according to ISTH bleeding classification. Major bleeding was observed only in patients underwent to high-risk bleeding procedure. In conclusion CHA2DS2VASc score by itself is not enough for decision-making regarding ischemic risk. Furthermore, since major bleedings occurred only in patients underwent to high-risk bleeding surgery, TEE-based individualisation may be a feasible approach particularly for those with high thromboembolic risk undergoing high-bleeding risk procedure.
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Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Pérdida de Sangre Quirúrgica/prevención & control , Trastornos Cerebrovasculares/prevención & control , Ecocardiografía Transesofágica , Atención Perioperativa , Hemorragia Posoperatoria/prevención & control , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/efectos de los fármacos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/etiología , Toma de Decisiones Clínicas , Técnicas de Apoyo para la Decisión , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/inducido químicamente , Valor Predictivo de las Pruebas , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
Ischemic stroke is the major complication of atrial fibrillation (AF) and only proven preventive therapy is oral anticoagulant therapy (OAC). Previous studies reported the presence of thrombus in the left atrium (LA) or left atrial appendage (LAA) despite anticoagulant therapy. We aim to investigate the predictors of LA/LAA thrombus in patients under OAC therapy and long-term clinical impact of thrombus. We prospectively enrolled consecutive patients with permanent AF under OAC therapy. Patients baseline characteristics were recorded. Transesophageal echocardiographic study performed after complete transthoracic echocardiographic study. 3-D evaluation of LAA was made using 3-D zoom mode and thrombus was defined when echo reflecting, mobile mass detected. Patients clinical outcomes were decided according to hospital records or via phone calls. Among 184 patients, 28 LAT were detected. Mean CHA2DS2-VASc score was significantly higher in patients with LAT in comparison to patients without LAT. CHA2DS2-VASc score (p: 0.001), left atrial volume (p: 0.001), left atrial flow velocity (p: 0.006) and left ventricular ejection fraction (p: 0.014) were independently associated with LAT. Among the parameters in CHA2DS2-VASc score, the previous history of stroke and age were independently related to LAT. After 12 months of follow-up, patients with LAT had more ischemic stroke than patients without LAT (7.1% vs 4.4%, p: 0.001 respectively). Although oral anticoagulation is the default treatment strategy for prevention of LAT and thromboembolism in patients with non-valvular AF, LAT still can be detected especially in patients with a high CHA2DS2-VASc score. Furthermore, the presence of LAT is significantly associated with future ischemic stroke.
Asunto(s)
Anticoagulantes/administración & dosificación , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/tratamiento farmacológico , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Accidente Cerebrovascular/prevención & control , Trombosis/prevención & control , Administración Oral , Anciano , Anciano de 80 o más Años , Apéndice Atrial/fisiopatología , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: Although previous studies reported frequent premature atrial contractions(fPACs) increased the risk of adverse cardiovascular outcomes, especially atrial fibrillation(AF), there is a substantial inconsistency between reports concerning the definition of fPAC. In this study, we aimed to investigate the relationship between fPAC and cardiovascular outcomes, especially AF. We further searched for a cutoff value of fPAC for prediction of AF. METHODS: We retrospectively analyzed the ambulatory 24-hr Holter monitoring records and 392 patients included. Frequent PAC was defined as more than 720 PAC/24 hr as used for frequent ventricular premature beats. Patients' baseline characteristics, echocardiographic variables and medical history were recorded. RESULTS: There were 189 patients with fPAC and 203 patients without fPAC. Patients with fPAC had more comorbidities in terms of hypertension, diabetes mellitus, coronary artery disease and congestive heart failure. CHA2DS2-VaSc was higher in patients with fPAC. Mean follow-up duration was 31 months, and the number of patients with new-onset AF during follow-up was significantly higher in fPAC group (22% vs. 5%, p < .001). fPAC was significantly and independently associated with new-onset AF and predicted AF with a cutoff value of 3,459 PAC/24 hr, and the risk of AF was 11-fold higher than those with <3,000 PAC/24 hr. In addition, an increased CHA2DS2-VaSc score was also associated with new-onset atrial fibrillation. CONCLUSION: In our study, we have demonstrated that fPAC is significantly associated with new-onset AF, and this association is the strongest among those patients who have more than 3,000 PAC in 24 hr.