Wentworthholbrook1843
onography and baPWV measurement could predict the risk for CVD ability more accurately than a single measurement alone.
Percutaneous coronary intervention (PCI) of Chronic total occlusions (CTOs) has been traditionally considered a challenging procedure, with a lower success rate and a higher incidence of complications compared to non-CTO-PCI. An accurate and comprehensive evaluation of potential candidates for CTO-PCI is of great importance. Indeed, assessment of myocardial viability, left ventricular function, individual risk profile and coronary lesion complexity as well as detection of inducible ischemia are key information that should be integrated for a shared treatment decision and interventional strategy planning. In this regard, multimodality imaging can provide combined data that can be very useful for the decision-making algorithm and for planning percutaneous CTO recanalization.
The purpose of this article is to appraise the value and limitations of several non-invasive imaging tools to provide relevant information about the anatomical characteristics and functional impact of CTOs that may be useful for the predistal coronary bed, vessel tortuosity and calcifications that can predict PCI success, whereas stress CMR, nuclear imaging and stress-CT can provide functional evaluation in terms of myocardial ischemia and viability and perfusion defect extension.
An integrated and holistic approach is increasingly advocated in patients with atrial fibrillation (AF), based on the "Atrial fibrillation Better Care (ABC) pathway A, Avoid stroke with anticoagulation; B, better symptom management; C, cardiovascular and comorbidity risk management." The aim of this study was to examine the prevalence of adherence to each component of the ABC pathway and to analyze its impact on long-term prognosis in the "real-world" cohort of AF patients from the FANTASIIA registry.
This prospective study included consecutive AF outpatients anticoagulated with direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) from June 2013 to October 2014. From the ABC pathway, adherence to the "A criterion" was defined by a time in the therapeutic range (TTR) ≥ 70% or correct dose with DOAC; "B criterion" adherence was defined by a European Heart Rhythm Association (EHRA) Symptom Scale I-II; and "C criterion" adherence was defined as optimized risk factors and comorbidity management. Bamanaged according to the ABC pathway was associated with a significant reduction in adverse outcomes during long follow-up, suggesting the benefit of a holistic and integrated approach to AF management.
Stroke is predominately attributed to left atrial thrombus (LAT) in patients with non-valvular atrial fibrillation (NVAF), however, its detection rate in real clinical practice has been few reported in China.
This study aimed to investigate the prevalence and associated factors of LAT in patients with NVAF in China.
All adult NVAF patients undergoing transesophageal echocardiography (TEE) in the China Atrial Fibrillation Center database from January 2017 to January 2022 were enrolled in this study. The prevalence of LAT was calculated, and associated factors were identified.
A total of 36,007 NVAF inpatients from 602 hospitals in 30 provinces/autonomous regions/municipalities were included in the final analysis, with a median age of 66 years and 39.4% were female. LAT was present in 1,467 (4.1%) patients overall, 2.7, 5.7, and 6.8% in patients with paroxysmal, persistent, and long-standing persistent AF, respectively. In subgroup analysis, including age ≥ 65 years, CHA
DS
-VAS
score ≥ 2, left atri4.1% of Chinese adult NVAF inpatients underwent TEE in real-world experience. The prevalence of LAT mainly associated with non-paroxysmal AF, cardiovascular diseases, diabetes mellitus, enlarged left atrium, lower LVEF, and lack of anticoagulation therapy.
Acute myocardial infarction (AMI) with pulmonary edema shows a worse prognosis. Lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. It has been proved to predict prognosis in heart failure; however, whether it can be used as a short-term prognostic marker in AMI and provide incremental value to Killip classification is unknown.
We performed echocardiography and LUS by the 8-zone method in patients enrolled in Guangdong Provincial People's Hospital undergoing percutaneous coronary intervention for AMI from March to July 2021. The lung water detected by LUS was defined as B-lines, and the sum of the B-line number from 8 chest zones was calculated. Besides, the classification into LUS according to the pulmonary edema severity was as follows normal (B-line numbers <5), mild (B-line numbers ≥5 and <15), moderate (B-line numbers ≥15 and <30), and severe (B-line numbers ≥30). The NT-proBNP analysis was performed on the same day. All patients were followed up for 30 days 8 for LUS (
= 0.010), and 0.778 for their combination (
= 0.002).
B-lines by lung ultrasound can be an independent predictor of worsening heart failure in AMI during hospitalization and short-term follow-up and provides significant incremental prognostic value to Killip classification.
B-lines by lung ultrasound can be an independent predictor of worsening heart failure in AMI during hospitalization and short-term follow-up and provides significant incremental prognostic value to Killip classification.
Albuminuria is a well-known risk factor for end-stage kidney disease, all-cause mortality, and cardiovascular mortality, even when the albumin-to-creatinine ratio is <30 mg/g. However, the association between transiently observed trace albuminuria and these major adverse outcomes has not yet been reported. This study aimed to examine the effect of transient albuminuria on these major adverse outcomes using the National Health Insurance Service data in Korea.
The National Health Insurance Service-National Sample Cohort from Korea, followed from 2002 to 2015, consisted of 1,025,340 individuals, accounting for 2.2% of the total Korean population. We analyzed the effect of transient albuminuria on all-cause death, cardiovascular death, and incident chronic kidney disease (CKD) and compared it with the group without albuminuria. Among 1,025,340 individuals, 121,876 and 2,815 had transient albuminuria and no albuminuria, respectively. Adjusted hazard ratios of the transient albuminuria group for cardiovasculesting that transient albuminuria could be a risk marker for adverse outcomes in the future, and that its own subclinical phenotype could play an important role during the course of CKD.
Predictive value of myocardial injury as defined by elevated cardiac tropnins (cTns) in patients with COVID-19 has not been fully investigated. We performed a meta-analysis to evaluate the dose-response relationship between myocardial injury and short-term all-cause mortality.
Pubmed, Embase, and the Cochrane Library database were searched for all the studies which evaluated the relationship between cTns and the risk of short-term all-cause mortality in patients with COVID-19.
Compared with patients without myocardial injury, the group with elevated cTns was associated with increased short-term mortality (11 studies, 29,128 subjects, OR 3.17, 95% CI 2.19-4.59,
= 0.000,
= 92.4%,
for heterogeneity 0.00). For the dose-response analysis, the elevation of cTns 1 × 99th percentile upper reference limit (URL) was associated with increased short-term mortality (OR 1.99, 95% CI 1.53-2.58,
= 0.000). The pooled OR of short-term mortality for each 1 × URL increment of cTns was 1.25 (95% CI 1.22-1.28,
= 0.000).
We found a positive dose-response relationship between myocardial injury and the risk of short-term all-cause mortality, and propose elevation of cTns > 1 × 99th percentile URL was associated with the increased short-term risk of mortality.
1 × 99th percentile URL was associated with the increased short-term risk of mortality.Myocardial infarction with non-obstructive coronary arteries (MINOCA), despite a lower burden of coronary atherosclerosis, has a non-negligible prognostic impact. The label of MINOCA includes an array of different aetiologies and pathologic conditions, thus the identification of the underlying disease is crucial to patient management. Myocardial infarction with obstructive coronary artery disease and MINOCA share only some risk factors and comorbid conditions. While traditional cardiovascular risk factors have a lower prevalence in MINOCA patients, atypical ones-e.g., anxiety, depression, and autoimmune diseases-are much more frequent in this population. Other conditions-e.g., pregnancy, cancer, and anti-cancer therapy-can predispose to or even induce MINOCA through various mechanisms. The evidence of such risk factors for MINOCA is still scarce and contradicting, as no randomised controlled trials exist in this field. In our work, we performed a review of registries, clinical studies, and case reports of MINOCA, in order to summarise the available data and analyse its possibile pathogenic mechanisms.
Stereotactic arrhythmia radioablation (STAR) has been suggested as a promising therapeutic alternative in cases of failed catheter ablation for recurrent ventricular tachycardias in patients with structural heart disease. Cyberknife
robotic radiosurgery system utilizing target tracking technology is one of the available STAR treatment platforms. Thioflavine S inhibitor Tracking using implantable cardioverter-defibrillator lead tip as target surrogate marker is affected by the deformation of marker-target geometry. A simple method to account for the deformation in the target definition process is proposed.
Radiotherapy planning CT series include scans at expiration and inspiration breath hold, and three free-breathing scans. All secondary series are triple registered to the primary CT 6D/spine + 3D translation/marker + 3D translation/target surrogate-a heterogeneous structure around the left main coronary artery. The 3D translation difference between the last two registrations reflects the deformation between the marker and the similarity coefficient range 0.80-0.87) to their equivalents based on the DIR of the primary target volume delineated by dedicated software.
The proposed GDM method is a simple way to account for marker-target deformation-related uncertainty for tracking with Cyberknife
and better control of the risk of target underdose. The principle applies to general radiotherapy as well.
The proposed GDM method is a simple way to account for marker-target deformation-related uncertainty for tracking with Cyberknife® and better control of the risk of target underdose. The principle applies to general radiotherapy as well.
This study aimed to construct a model to predict the risk of in-hospital death in patients with acute renal injury (AKI) receiving continuous renal replacement therapy (CRRT) after acute type A aortic dissection (ATAAD) surgery.
We reviewed the data of patients with AKI undergoing CRRT after ATAAD surgery. The patients were divided into survival and nonsurvival groups based on their vital status at hospital discharge. The data were analyzed using univariate and multivariate logistic regression analyses. Establish a risk prediction model using a nomogram and its discriminative ability was validated using C statistic and the receiver operating characteristic (ROC) curve. Its calibration ability was tested using a calibration curve, 10-fold cross-validation and Hosmer-Lemeshow test.
Among 175 patients, in-hospital death occurred in 61 (34.9%) patients. The following variables were incorporated in predicting in-hospital death age > 65 years, lactic acid 12 h after CRRT, liver dysfunction, and permanent neurological dysfunction.
