Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from c...Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days （range： 192-738 days）, five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.展开更多
Objective: Using receiver operating characteristics (ROC) curve to evaluate the value of pulse wave velocity (PWV) in the diagnosis of coronary heart disease (CHD). Methods: By using coronary angiography as golden dia...Objective: Using receiver operating characteristics (ROC) curve to evaluate the value of pulse wave velocity (PWV) in the diagnosis of coronary heart disease (CHD). Methods: By using coronary angiography as golden diagnostic standard of CHD, 218 patients were divided into both CHD group (n=121) and non-CHD group (n = 97). All these patients received PWV test. The efficacy of PWV of each artery segments in the diagnosis of CHD was evaluated by ROC curve. The sensitivity and specificity were calculated with the golden diagnostic standard of CHD. Results:The PWV of right carotid to femoral artery (Rc-f), left carotid to femoral artery (Lc-f), right radial to carotid artery (Rc-r), left radial to carotid artery (Lc-r) in CHD group were significantly higher than that of non-CHD group (9. 31±1. 75 vs 7.60±1.59, P<0. 01; 9. 02±1.71 vs 7. 52±1.50, P<0. 01; 8. 69±1. 37 vs 8. 00±1. 27, P<0. 01; 8.52±1. 03 vs 8. 03±1. 2, P<0. 01 respectively). However, the PWV of both right and left femoral to ankle artery (Rf-a and Lf-a) had no significant differences between the two groups. We then compared the area under curve (AUC) of each ROC(AUCROC) of PWV of Rc-f, Lc-f Rc-r and Lc-r to evaluate their diagnostic efficacy for CHD. We found that AUCROC of Rc-f PWV was the biggest (AUCROC = 0. 818), at the peak point of its ROC curve, the PWV was 8. 32 m/s. PWV>8. 32 m/s of Rc-f could predict the presence of CHD with a sensitivity of 79% and specificity of 77%. Conclusion: The PWV of Rc-f, Lc-f, Rc-r, Lc-r are significantly higher in CHD group than that in non-CHD group, and PWV of Rc-f is the most accurate in the detection of CHD. The PWV>8. 32 m/s of RC-F is a valuable predictor of CHD.展开更多
Background Transvenous lead placement is the standard approach for left ventricular （LV） pacing in cardiac resynchronization ther- apy （CRT）, while the open chest access epicardial lead placement is currently the ...Background Transvenous lead placement is the standard approach for left ventricular （LV） pacing in cardiac resynchronization ther- apy （CRT）, while the open chest access epicardial lead placement is currently the most frequently used second choice. Our study aimed to compare the ventricular electromechanical synchronicity in patients with heart failure after CRT with these two different LV pacing tech- niques. Methods We enrolled 33 consecutive patients with refractory heart failure secondly to dilated cardiomyopathy who were eligible for CRT in this study. Nineteen patients received transvenous （TV group） while 14 received open chest （OP group） LV lead pacing. Intraand inter-ventricular electromechanical synchronicity was assessed by tissue Doppler imaging （TDI） before and one year after CRT procedure. Results Before CRT procedure, the mean QRS-duration, maximum time difference to systolic peak velocity among 12 left ventricle segments （LV Ts-12）, standard deviation of time difference to systolic peak velocity of 12 left ventricle segments （LV Ts-SD）, and inter-ventficular mechanical delay （IVMD） in OP and TV group were 166 ± 17 ms and 170 ± 21 ms, 391 ±42 ms and 397 ± 36 ms, 144 ± 30 ms and 148 ± 22 ms, 58 ± 25 ms and 60 ± 36 ms, respectively （all P 〉 0.05）. At one year after the CRT, the mean QRS-duration, LV Ts-12, LV Ts-SD, and IVMD in TV and OP group were 128 ± 14 ms and 141 ± 22 ms （P = 0.031）, 136 ± 37 ms and 294 ± 119 ms （P = 0.023）, 50± 22 ms and 96 ± 34 ms （P = 0.015）, 27 ± 11 ms and 27 ± 26 ms （P = 0.86）, respectively. The LV lead implantation procedure time was 53.4±16.3 rain for OP group and 136 ± 35.1 min for TV group （P = 0.016）. The mean LV pacing threshold increased significantly from 1.7 ± 0.6 V/0.5 ms to 2.3 ± 1.6 V/0.5 ms （P 〈 0.05） in TV group while it remained stable in the OP group. Conclusions Compared to conventional endovascular approach, open chest access of LV pacing for CRT leads to better improvement of the intraventricular synchronization.展开更多
BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Imp...BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in CS patients from routine clinical practice.METHODS This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of CS and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to CS severity,age and cause of CS.Main outcome measured was in-hospital mortality.RESULTS A total of 50 patients were included(median age:59.3±10 years).The most common cause of CS was acute coronary syndrome(ACS)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound CS.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound CS(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACS(n=34),35.3%of patients had profound CS;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound CS.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUSIONS In this cohort of real-life CS patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.展开更多
Introduction
Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general popu...Introduction
Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general population,1 and patients with concurrent CKD and coronary artery disease (CAD) have greater mortality than patients without CKD.2-4 The rate of cardiovascular mortality is approximately 50%,five to 10 times higher than the general population.展开更多
Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has...Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replace- ment is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper stemotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.展开更多
Cardiovascular risk factors(CVRF)are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline,which limits the quality of life in this p...Cardiovascular risk factors(CVRF)are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline,which limits the quality of life in this population.The objective of this work is to offer a review of the current evidence in the management of CVRF in the elderly population.The search strategy was executed in PubMed,Clinicalstrials.org and Embase,to search for clinical trials,observational cohort or cross-sectional studies,reviews,and clinical practice guidelines focused or including elderly population.The results provided were refined after reading the title and abstract,as well as elimination of duplicates,and were finally identified and assessed following the GRADE methodology.A total of 136 studies were obtained for all predefined risk factors,such as sedentary lifestyle,smoking,obesity and metabolic syndrome,hypertension,diabetes mellitus,dyslipidemia and alcohol.We described the results of the studies identified and assessed according to their methodological quality in different recommendation sections:diagnostic and prevention,intervention,or treatment in the elderly population.As the main limitation to the results of this review,there is the lack of quality studies whose target population is elderly patients.This issue limits the recommendations that can be made in this population.Due to this reason,comprehensive geriatric assessment seems the best tool currently available to implement the most appropriate treatment plans based on the baseline situation and comorbidity of each elderly patient.展开更多
文摘Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days （range： 192-738 days）, five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.
文摘Objective: Using receiver operating characteristics (ROC) curve to evaluate the value of pulse wave velocity (PWV) in the diagnosis of coronary heart disease (CHD). Methods: By using coronary angiography as golden diagnostic standard of CHD, 218 patients were divided into both CHD group (n=121) and non-CHD group (n = 97). All these patients received PWV test. The efficacy of PWV of each artery segments in the diagnosis of CHD was evaluated by ROC curve. The sensitivity and specificity were calculated with the golden diagnostic standard of CHD. Results:The PWV of right carotid to femoral artery (Rc-f), left carotid to femoral artery (Lc-f), right radial to carotid artery (Rc-r), left radial to carotid artery (Lc-r) in CHD group were significantly higher than that of non-CHD group (9. 31±1. 75 vs 7.60±1.59, P<0. 01; 9. 02±1.71 vs 7. 52±1.50, P<0. 01; 8. 69±1. 37 vs 8. 00±1. 27, P<0. 01; 8.52±1. 03 vs 8. 03±1. 2, P<0. 01 respectively). However, the PWV of both right and left femoral to ankle artery (Rf-a and Lf-a) had no significant differences between the two groups. We then compared the area under curve (AUC) of each ROC(AUCROC) of PWV of Rc-f, Lc-f Rc-r and Lc-r to evaluate their diagnostic efficacy for CHD. We found that AUCROC of Rc-f PWV was the biggest (AUCROC = 0. 818), at the peak point of its ROC curve, the PWV was 8. 32 m/s. PWV>8. 32 m/s of Rc-f could predict the presence of CHD with a sensitivity of 79% and specificity of 77%. Conclusion: The PWV of Rc-f, Lc-f, Rc-r, Lc-r are significantly higher in CHD group than that in non-CHD group, and PWV of Rc-f is the most accurate in the detection of CHD. The PWV>8. 32 m/s of RC-F is a valuable predictor of CHD.
文摘Background Transvenous lead placement is the standard approach for left ventricular （LV） pacing in cardiac resynchronization ther- apy （CRT）, while the open chest access epicardial lead placement is currently the most frequently used second choice. Our study aimed to compare the ventricular electromechanical synchronicity in patients with heart failure after CRT with these two different LV pacing tech- niques. Methods We enrolled 33 consecutive patients with refractory heart failure secondly to dilated cardiomyopathy who were eligible for CRT in this study. Nineteen patients received transvenous （TV group） while 14 received open chest （OP group） LV lead pacing. Intraand inter-ventricular electromechanical synchronicity was assessed by tissue Doppler imaging （TDI） before and one year after CRT procedure. Results Before CRT procedure, the mean QRS-duration, maximum time difference to systolic peak velocity among 12 left ventricle segments （LV Ts-12）, standard deviation of time difference to systolic peak velocity of 12 left ventricle segments （LV Ts-SD）, and inter-ventficular mechanical delay （IVMD） in OP and TV group were 166 ± 17 ms and 170 ± 21 ms, 391 ±42 ms and 397 ± 36 ms, 144 ± 30 ms and 148 ± 22 ms, 58 ± 25 ms and 60 ± 36 ms, respectively （all P 〉 0.05）. At one year after the CRT, the mean QRS-duration, LV Ts-12, LV Ts-SD, and IVMD in TV and OP group were 128 ± 14 ms and 141 ± 22 ms （P = 0.031）, 136 ± 37 ms and 294 ± 119 ms （P = 0.023）, 50± 22 ms and 96 ± 34 ms （P = 0.015）, 27 ± 11 ms and 27 ± 26 ms （P = 0.86）, respectively. The LV lead implantation procedure time was 53.4±16.3 rain for OP group and 136 ± 35.1 min for TV group （P = 0.016）. The mean LV pacing threshold increased significantly from 1.7 ± 0.6 V/0.5 ms to 2.3 ± 1.6 V/0.5 ms （P 〈 0.05） in TV group while it remained stable in the OP group. Conclusions Compared to conventional endovascular approach, open chest access of LV pacing for CRT leads to better improvement of the intraventricular synchronization.
文摘BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in CS patients from routine clinical practice.METHODS This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of CS and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to CS severity,age and cause of CS.Main outcome measured was in-hospital mortality.RESULTS A total of 50 patients were included(median age:59.3±10 years).The most common cause of CS was acute coronary syndrome(ACS)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound CS.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound CS(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACS(n=34),35.3%of patients had profound CS;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound CS.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUSIONS In this cohort of real-life CS patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.
文摘Introduction
Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general population,1 and patients with concurrent CKD and coronary artery disease (CAD) have greater mortality than patients without CKD.2-4 The rate of cardiovascular mortality is approximately 50%,five to 10 times higher than the general population.
文摘Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replace- ment is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper stemotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.
文摘Cardiovascular risk factors(CVRF)are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline,which limits the quality of life in this population.The objective of this work is to offer a review of the current evidence in the management of CVRF in the elderly population.The search strategy was executed in PubMed,Clinicalstrials.org and Embase,to search for clinical trials,observational cohort or cross-sectional studies,reviews,and clinical practice guidelines focused or including elderly population.The results provided were refined after reading the title and abstract,as well as elimination of duplicates,and were finally identified and assessed following the GRADE methodology.A total of 136 studies were obtained for all predefined risk factors,such as sedentary lifestyle,smoking,obesity and metabolic syndrome,hypertension,diabetes mellitus,dyslipidemia and alcohol.We described the results of the studies identified and assessed according to their methodological quality in different recommendation sections:diagnostic and prevention,intervention,or treatment in the elderly population.As the main limitation to the results of this review,there is the lack of quality studies whose target population is elderly patients.This issue limits the recommendations that can be made in this population.Due to this reason,comprehensive geriatric assessment seems the best tool currently available to implement the most appropriate treatment plans based on the baseline situation and comorbidity of each elderly patient.
