Abstract 13007: Myocardial Ischemia in Anomalous Aortic Origin of a Right Coronary Artery: Medium-term Follow-up in a Large Prospective Cohort

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tam T Doan ◽  
Carlos Bonilla-Ramirez ◽  
Shagun Sachdeva ◽  
J. Kevin Wilkes ◽  
Dana L Reaves-O’neal ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Myocardial Ischemia ◽  
Right Coronary Artery ◽  
Low Risk ◽  
Medium Term ◽  
Coronary Cta ◽  
Group 2 ◽  
Group 1

Introduction: Anomalous aortic origin of a right coronary artery (AAORCA) may lead to myocardial ischemia (ISCH) and sudden death in the young. Current guidelines deem asymptomatic patients (pts) low-risk if normal exercise stress test (EST). Hypothesis: The frequency of ISCH in AAORCA pts is seen more commonly on stress perfusion imaging (sPI) compared to EST. Method: Pts <21 yrs with AAORCA were prospectively enrolled and managed following a standardized approach (12/2012-04/2020). Coronary CTA was used to define details of AAORCA. EST and sPI were performed in pts >7 yrs and in younger pts if concern for ISCH. sPI included nuclear imaging initially and dobutamine stress cardiac MRI since 06/2014. High-risk features included intramural length (IML), abnormal ostium, symptoms or evidence of myocardial ISCH. Shared decision-making directed medical/surgical management. Results: Of 220 pts (male 135, 61%) enrolled at median age of 12 [IQR 6-15] yrs, 168 (76%) had no/non-exertional symptoms (Group-1) and 52 (24%) had exertional chest pain/syncope (Group-2). Coronary CTA was available in 180 and EST in 164 pts. EST was positive in 2/164 (1%), both had positive sPI. Of 162 negative EST, inducible ISCH was seen in 10/96 (10%) in Group-1 and 8/42 (19%) in Group-2. No difference in IML was noted between pts with/without ISCH (5.7±2.4 vs 6.0±2.1 mm, p=0.6). Surgery was indicated in 67 (30%) pts with high-risk features, not indicated in 143 (65%), and 10 (5%) are undergoing evaluation. In 51 operated pts (38 unroofing; 13 translocation), 3 await post-operative assessment, 48 on normal physical activities; median follow-up of 4.6 [IQR 2.3-6.3] yrs. All patients were alive at last follow-up; median of 2.9 [IQR 1.2-5.1] yrs. Conclusions: AAORCA pts can present with reversible ISCH on sPI regardless of symptoms or IML. EST may be a poor predictor of ISCH and caution should be given to determine low-risk. Most high-risk patients return to exercise and remain well at medium-term follow-up.

scholarly journals Optimal treatment strategies for coronary artery disease in patients with advanced kidney disease: a meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232110243
Author(s):  
Jingwen Yong ◽  
Jinfan Tian ◽  
Xin Zhao ◽  
Xueyao Yang ◽  
Haoran Xing ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Kidney Disease ◽  
Low Risk ◽  
Medium Term ◽  
Short Term ◽  
Artery Disease

Background: Coronary artery disease (CAD) is the leading cause of death in advanced kidney disease. However, its best treatment has not been determined. Methods: We searched PubMed and Cochrane databases and scanned references to related articles. Studies comparing the different treatments for patients with CAD and advanced CKD (estimated glomerular filtration rate <30 ml/min/1.73 m2 or dialysis) were selected. The primary result was all-cause death, classified according to the follow-up time: short-term (<1 month), medium-term (1 month-1 year), and long-term (>1 year). Results: A total of 32 studies were selected to enroll 84,498 patients with advanced kidney disease. Compared with medical therapy (MT) alone, percutaneous coronary intervention (PCI) was associated with low risk of short-, medium-term and long-term all-cause death (more than 3 years). For AMI patients, compared with MT, PCI was not associated with low risk of short- and medium-term all-cause death. For non-AMI patients, compared with MT, PCI was associated with low risk of long-term mortality (more than 3 years). Compared with MT, coronary artery bypass surgery (CABG) had no significant advantages in each follow-up period of all-cause death. Compared with PCI, CABG was associated with a high risk of short-term death, but low risk of long-term death: 1–3 years; more than 3 years. CABG could also reduce the risk of long-term risk of cardiac death, major adverse cardiovascular events (MACEs), myocardial infarction (MI), and repeat revascularization. Conclusions: In patients with advanced kidney disease and CAD, PCI reduced the risk of short-, medium- and long- term (more than 3 years) all-cause death compared with MT. Compared with PCI, CABG was associated with a high risk of short-term death and a low risk of long-term death and adverse events.

scholarly journals Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francisco Albuquerque ◽  
Pedro de Araújo Gonçalves ◽  
Hugo Marques ◽  
António Ferreira ◽  
Pedro Freitas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Right Coronary Artery ◽  
Cardiac Death ◽  
Anomalous Origin ◽  
Cardiac Symptoms ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
The Right

AbstractAnomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

Survival of Patients with High-Risk Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

2021 ◽  
Vol 104 (6) ◽  
pp. 895-901
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Congenital Heart ◽  
First Year ◽  
Pulmonary Arterial ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) with uncorrected left-to-right shunts. Currently, no consensus guideline exists on the management of PAH-CHD in children, especially those who do not meet operability criteria. Objective: To compare survival between three groups of high-risk PAH-CHD, group 1: total correction including both surgical and percutaneous intervention, group 2: palliative treatment, and group 3: conservative with medical treatment group. Materials and Methods: All pediatric patients with PAH-CHD that underwent cardiac catheterization between January 1, 2008 and December 31, 2017 were retrospectively reviewed. Inclusion criteria were high risk PAH-CHD patients who had pulmonary vascular resistance (PVR) greater than 6 Wood unit·m² and PVR-to-SVR ratio greater than 0.3 evaluated in room air. Exclusion criteria were younger than three months of age, severe left side heart disease with pulmonary capillary wedge pressure greater than 15 mmHg, obstructive total pulmonary venous return, and single ventricle physiology. The Kaplan-Meier analysis was performed from the date of PAH diagnosis to the date of all-cause mortality or to censored date at last follow-up. Results: Seventy-six patients with a median age at diagnosis of 27.5 months (IQR 14.5 to 69.0 months) were included in this study. The patients were divided into three subgroups and included 38 patients (50.0%) in group 1, six patients (7.9%) in group 2, and 32 patients (42.1%) in group 3. The median follow-up time was 554 days (IQR 103 to 2,133 days). The overall mortality was 21.7%. One-year survival in patients with simple lesion in group 1 and 3 were 79.5% and 87.5% and patients with complex lesions in group 1, 2, and 3 were 93.8%, 83.3%, and 73.1%, respectively. The results showed that most mortalities occurred in the first year. There were no statistically significant differences in survival among difference types of treatment (log rank test, p=0.522). Conclusion: The mortality of high-risk PAH-CHD patients were not different among those who underwent corrective surgery, palliative, or conservative treatment. The mortality was high in the first year after PAH diagnosis and remain stable afterward. Management decision for an individual with high-risk PAH-CHD patients requires comprehensive clinical assessment to balance the risks and benefits before making individualized clinical judgment. Keywords: Pulmonary hypertension; Congenital heart disease; High-risk patients

scholarly journals Clinical and functional features of the post-infarction course of coronary heart disease on the background of cardiac rehabilitation (with cycling training in the II phase) at 3-year follow-up

2020 ◽  
Vol 27 (3) ◽  
pp. 36-48
Author(s):  
V. O. Shumakov ◽  
I. E. Malynovska ◽  
N. M. Tereshchenko ◽  
L. M. Babii ◽  
O. V. Voloshina
Keyword(s):  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Bicycle Ergometer ◽  
Load Test ◽  
Physical Load ◽  
Therapeutic Exercises ◽  
Functional Features ◽  
Group 2 ◽  
Group 1

The aim – to study the clinical and functional characteristics of patients after myocardial infarction (MI) who referred stage II of cardiac rehabilitation (CR) with physical training (PT) during 3 years follow-up. Materials and methods. The study included 91 patients with primary Q-MI in the absence of contraindications to the CR. Criteria for inclusion were an early postinfarct angina, large aneurysm of the left ventricle, intracavitary formation of thrombus, the reduction of the EF to 35 % and below, complex cardiac arrhythmias and disturbances of conduction, the atrial fibrillation at the time of inclusion in the study, multivessel lession of coronary arteries, left bundle branch block, disorders of the musculoskeletal system, which prevented holding bicycle ergometry test, acute violation of cerebral circulation in the anamnesis, cancer and decompensation of comorbidities. Treatment was carried out according to modern recommendations; at admission coronary angiography with stenting of the infarct-occluded coronary artery was performed. Depending on the volume of rehabilitation measures, the patients were divided into two groups: group 1 consisted 47 patients who in the early post-hospital phase accomplished the program of PT on the bicycle ergometer; group 2 consisted of 44 patients in whom CR was carried out only in the form of distance walking and complexes of therapeutic exercises. Dosed physical load test on a bicycle ergometer, echocardiography, lipid metabolism indexes were evaluated in all patients at discharge from hospital. All exams were performed in dynamics in 4 months (the period corresponding to the end of the program 30 PT), after 1, 2 and 3 years. Results and discussion. At baseline the patients of both groups did not differ in any of the clinical-functional and anamnestic data. The clinical course was evaluated by the following indices: recurrent MI, coronary artery bypass grafting and stenting. Events increased after 2 (7 patients in 1 and 9 patients in 2 group) and 3 (6 and 15 patients, respectively) years. During the first year, all patients took 100 % of P2Y12 receptor blockers, rosuvastatin and beta-blockers; aspirin was used in 95 % of patients in each group; the number of patients who have received ACE inhibitors increased to 81 % in group 1 and 91 % in group 2. A decrease in the doses of statins at the outpatient stage as they move away from acute MI has led to an increase in LDL cholesterol over the years. This index in 4 months after MI in 1st group was 1.82 (1.39–2.20) and 2nd group was 1.83 (1.49–2.21) mmol/l, after 1 year – 1.79 (1.48–2.04) and 2.80 (2.33–3.21) mmol/l, after 2 years – 2.48 (2.12–2.98) and 2.34 (1,93–3.01) mmol/l, after 3 years – 2.29 (2.15–2.49) and 2.40 (2.26–2.61) mmol/l, respectively. The tolerance to physical load with the best hemodynamic efficiency of the work has increased significantly to (140.0; 125.0–150.0) W after 1 year compared with the 2nd group (p<0,01). For 3 years, it remained high in the 1st group, and it decreased to baseline levels in the 2nd group. Postinfarction remodeling processes were manifested by a decrease in EDV and an increase in EF, especially in the 1st group (p<0,01) after six months without significant dynamics for 3 years.Conclusions. CR with PT (30 sessions) contributed to an increase in exercise tolerance maximally after the end of training and lasted for 3 years. The aspects of psychological rehabilitation and health education for patients and their relatives were important (38 % of patients of the 1st group continued PT on their own at home). The training start time (on average, on the 15th or 40th day of MI) did not affect the results of the load test. It is important that a large percentage of patients continued to take the drugs recommended at discharge, but during 3 years follow up, the doses of the drugs were significantly reduced with insufficient control of hemodynamic and biochemical parameters, which led to the growth of one of the main factors in the progression of atherosclerosis – the level of low density lipoproteins.

scholarly journals 775 Impact of frailty on medium-term follow-up in patients undergoing transcatheter aortic valve implantation in a high flow referral centre with high volumes

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Carlo Fumagalli ◽  
Giulia Nardi ◽  
Pierluigi Demola ◽  
Francesco Meucci ◽  
Renato Valenti ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Composite Endpoint ◽  
High Flow ◽  
Low Risk ◽  
Medium Term ◽  
Transcatheter Aortic Valve ◽  
Frailty Assessment ◽  
Valve Implantation

Abstract Aims Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients. To assess the impact of frailty status on a composite endpoint comprising all-cause death and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care centre. Methods and results Consecutive patients &gt;80 years referred to TAVI from January to December 2019 at our institution were screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the multidimensional prognostic index (MPI). Physical function was evaluated by the short physical performance battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB &lt;6 is an established strong predictor of mortality and disability. The MPI is a three-level score used to stratify risk of mortality (low, intermediate, or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy, and co-habitation). Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up. Overall, 134 patients were referred for TAVI (mean age: 84 ± 4 years; &gt;90 years: 12%, women 67%). The STS risk score was 4.6 ± 3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3 ± 3.7 (SPPB &lt;6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R = 0.31, P = 0.01, MPI R = 0.29, P = 0.03, Figure 1A and B). At 1 year, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N = 6(4.5%); stroke: N = 4 (3.0%); re-do: N = 1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs. low risk: HR: 2.9, 95% CI: 1.1–6.8, P = 0.031, Figure 1C), while no association with STS (P = 0.332) was found. Conclusions In a prospective cohort of TAVI candidates, frailty stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure. 120 Figure

P1962Impact of Dual Antiplatelet Therapy duration on clinical outcome after stent implantation for coronary bifurcation lesions: results from the Euro Bifurcation Club - P2BiTO - registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Di Serafino ◽  
H Gamra ◽  
P Cirillo ◽  
M Zimarino ◽  
I J Amat-Santos ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Clinical Outcome ◽  
Dual Antiplatelet Therapy ◽  
Coronary Bifurcation ◽  
Kaplan Meier ◽  
Bifurcation Lesions ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Duration of Dual Antiplatelet Therapy (DAPT) following Acute Coronary Syndromes (ACS) or Stable Coronary Artery Disease (SCAD) treated with coronary stenting is still debated. Although current guidelines consider several “clinical” criteria to decide for short DAPT (<6 months), standard DAPT (12 months) and prolonged DAPT (>12 months), the relationship between DAPT duration, treatment of bifurcations and its impact on clinical outcome has been poorly investigated in real world registries. Purpose We evaluated the impact of DAPT duration on clinical outcomes in consecutive all-comers patients treated with stenting of coronary artery bifurcation lesions included in the Euro Bifurcation Club -P2BiTO - registry. Methods Data on 5036 consecutive patients who underwent PCI on coronary bifurcation at 17 major coronary intervention centres between January 2012 and December 2014 were collected. The primary endpoint of the study was the cumulative occurrence of Major Adverse Cardiac Events (MACCE), defined as a composite of overall-death death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and stroke during the follow-up; the secondary endpoints were the single occurrence of any of the above mentioned events. Results Data on DAPT duration was available for 3992 patients (79%). Patients were divided into 3 groups: Group 1) DAPT <6-months (n=720); Group 2) DAPT >6-months but <12-month (n=1602); Group 3) DAPT >12-months (n=1670). Follow up was completed in 3935 (98%) patients with a median of 20 months (C.I.=12–28). At 24 months after the index procedure, MACCE occurred more frequently in the DAPT <6-month group (Group 1) as compared with both Group 2 and 3 (respectively, 102 (14%) versus 154 (10%) and 164 (10%), HR: 0.72 (0.64–0.82), p<0.001). This difference remains after adjustment for clinical and angiographic characteristics (HR: 0.66 (0.58–0.77), p<0.001). On the contrary, no significant difference was found between Group 2 and Group 3 patients. At the Kaplan-Meier analysis (Figure 1), freedom from MACCE survival was significantly lower in patients receiving DAPT for less than 6 months (Log-Rank: 29.5, p<0.001). Figure 1. Kaplan-Meier curves Conclusions In the P2BiTO registry, short DAPT duration of less than 6 months was associated with a significantly higher risk of MACCE compared to longer DAPT in a real-world registry of patients treated for coronary artery bifurcation stenosis.

Combined treatment image guided-intensity modulated radiotherapy (IG-IMRT) plus high-dose rate brachytherapy (HDR) and hormonotherapy (HT) as treatment for high-risk prostate cancer: Five-year result of a phase II study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15571-15571
Author(s):  
B. Guix ◽  
J. Bartrina ◽  
I. Henriquez ◽  
R. Serrate ◽  
P. Palombo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Dose Rate ◽  
Late Effects ◽  
High Dose Rate ◽  
High Dose ◽  
Group 2 ◽  
Grade 3 ◽  
Group 1

15571 Background: To report early and late toxicity and preliminary biochemical outcome in 345 patients with high-risk (Gleason >=7; PSA>20 or T2c-T3) clinically localized prostate cancer treated with combined high-dose-rate brachytherapy and IMRT (IMRT-HDR) to the prostate and seminal vesicles with 24–36 months of hormononal treatment (goserelin+bicalutamide) (HT). Methods: Between 12/1999 and 10/2003, 345 patients with PSA>20, Gleason score>6 and/or T2c-T3 N0 M0 prostate cancer were treated with IG-IMRT followed by HDR implant to the prostate and HT. Patients were randomly assigned to receive HT for 24 (group 1, 172 patients) or 36 months (group 2, 173 patients). Acute and late toxicities were scored by the EORTC/RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. PSA failure was defined as nadir +2.0 ng/ml. Results: All patients completed treatment. One patient included in the group 1 and none of the group 2 experienced grade 3 rectal toxicity (rectal ulcer). Seven patients in each group (4.0%) developed acute Grade 2 urinary symptoms, and none experienced urinary retention. No patient (0%) developed Grade 4 rectal complications or grade 3 or 4 urinary complications. With a median follow-up of 44 months, the 5-year actuarial PSA relapse-free survival rates for the whole group of patients was 95.7 %. No statistical differences between group 1 and 2 patients were found. Conclusions: High-dose IG-IMRT+HDR and HT was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute and late rectal and urinary complications were significantly low, compared with what has been observed with high-dose conventional, 3D-conformal or IMRT-only. Short-term PSA control rates seem to be at least comparable to those achieved with 3D-EBRT or IMRT. Both treatment regimes were very effective. Longer follow-up is needed to know if better PSA control rate are achieved with longer HT. No significant financial relationships to disclose.

scholarly journals Impact of frailty status on medium-term follow up in patients undergoing percutaneous transcatheter aortic valve implantation in a high-flow referral center with high procedural volumes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Fumagalli ◽  
A Blandina ◽  
G Nardi ◽  
S Campicelli ◽  
G Bandini ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Tertiary Care ◽  
Composite Endpoint ◽  
Low Risk ◽  
Medium Term ◽  
Frailty Status ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

Abstract Background Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Current guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients. Purpose To assess the impact of frailty status on a composite endpoint comprising mortality and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care center. Methods Consecutive patients &gt;80 years referred to TAVI from January to December 2019 at our tertiary care institution were prospectively screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the Multidimensional Prognostic Index (MPI). Physical function was evaluated by the Short Physical Performance Battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB &lt;6 is an established strong predictor of mortality and disability. The MPI is a three-level score used to stratify risk of mortality (low, intermediate or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy and co-habitation). Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up. Results Overall, 134 patients were referred for TAVI (mean age: 84±4 years; &gt;90 years: 12%, women 67%). The average STS risk score was 4.6±3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3±3.7 (SPPB &lt;6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R=0.31, p=0.01, MPI R=0.29, p=0.03, Figure Panel A and B). At 12 months, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N=6 (4.5%); stroke: N=4 (3.0%); re-do: N=1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs low risk: HR 2.9, 95% CI 1.1–6.8, p=0.031, Figure 1 Panel C), while no association with STS (p=0.332) was found. Conclusions In a prospectively enrolled cohort of TAVI candidates, frailty indices stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Surgery for Anomalous Aortic Origin of Coronary Arteries: Technical Safeguards and Pitfalls

2021 ◽  
Vol 8 ◽  
Author(s):  
Massimo A. Padalino ◽  
Anusha Jegatheeswaran ◽  
David Blitzer ◽  
Gabriella Ricciardi ◽  
Alvise Guariento
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Surgical Repair ◽  
Surgical Techniques ◽  
Technical Knowledge ◽  
Medium Term ◽  
Repair Techniques

Anomalous aortic origin of a coronary artery (AAOCA) is reported as the second leading cause of sudden cardiac death in otherwise healthy young individuals. Several surgical studies have reported a shallow operative risk, describing repair as safe and effective with short or medium-term follow-up. However, surgical repair can also be associated with a high risk of complications. Numerous repair techniques have been described in the literature, but each technique's indications and limitations are often not well-understood or understated. Since explicit technical knowledge of the most appropriate surgical technique is highly desirable, we sought to thoroughly and clearly outline the safeguards and pitfalls of the most common surgical techniques used to repair AAOCA.

scholarly journals Association between the severity of coronary artery disease and ST2 expression in patients with heart failure

2020 ◽  
Vol 4 (7) ◽  
pp. 399-405
Author(s):  
E.V. Grakova ◽  
◽  
K.V. Kopieva ◽  
A.T. Teplyakov ◽  
M.V. Soldatenko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Revascularization ◽  
Patients With Heart Failure ◽  
Lv Remodeling ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Aim: to study the association between ST2 (sST2) and severity of coronary artery lesion in patients with chronic heart failure (CHF), and to analyze changes in sST2 levels and left ventricle (LV) remodeling indicators depending on complete or incomplete myocardial revascularization (MR) after the 12-month follow-up period.Patients and Methods: a total of 118 patients (16.1% women, mean age of 62.5 [57; 68] years) with stable coronary heart disease (CHD) with LV ejection fraction 60% [46; 64] and CHF of NYHA functional class I–III were enrolled in the study. All patients underwent MR. Depending on the completeness of the performed MR, all patients were retrospectively divided into 2 groups: group 1 (n=75) consisted of patients with complete MR, group 2 (n=43) — with incomplete MR. Serum levels of sST2 were measured using an enzyme immunoassay before MR and after the 12-month follow-up period.Results: the sST2 level in patients with single vessel coronary artery disease was 29.92 [22.43; 32.68] ng/ml and was 21% lower (p=0.002) than in patients with two or more coronary arteries (CA) — 37.87 [37.87; 51.82] ng/ml. During 12-month follow-up, the incidence of adverse cardiovascular events (CVE) in group 1 was 18.7%, in group 2–46.5% (p=0.001). After 12-month follow-up, the level of sST2 in group 1 decreased by 33.6% (p=0.0001) (from 30.51 [26.38; 37.06] to 20.27 [16.56; 27.11] ng/ml), while in group 2 there was only a tendency to decrease in the level of this biomarker, which was 6.9%. In group 2, after 12-month follow-up, there was a tendency to increase in the LV EF, which increased by only 2.4%, as well as a tendency to increase in the end-systolic dimension (ESD), which increased by 5.4%. In the group of patients with complete MR, the increase in the LV EF was significant (p=0.001) — by 13.6% (from 54.0 [42.0; 63.0] to 62.5 [49.0; 64.0]%), and the ESD decreased by 3%, the final ESV — by 4.6%.Conclusion: the sST2 level can be used as a diagnostic marker for assessing the severity of atherosclerotic CA lesion in patients with CHF. Performing complete MR in patients with stable CHD with CHF has a predominance over incomplete MR, leading to reversed LV remodeling, a decrease in sST2 levels and, as a result, the incidence of adverse CVE during the 12-month follow-up. KEYWORDS: coronary atherosclerosis, soluble ST2, myocardial revascularization, heart failure, prognosis, left ventricular remodeling.FOR CITATION: Grakova E.V., Kopieva K.V., Teplyakov A.T., Soldatenko M.V. Association between the severity of coronary artery disease and ST expression in patients with heart failure. Russian Medical Inquiry. 2020;4(7):399–405. DOI: 10.32364/2587-6821-2020-4-7-399-405.

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