Introduction
Despite of the wide evidence of use fractional flow reserve (FFR), isolated angiography evaluation is still the main tool to indicate percutaneous coronary intervention. Quantitative ...flow ratio (QFR) is a new functional index to assess functional significance. Recently, few studies have showed the capacity of QFR to predict significance stenosis. The aim of this research has been to describe the evidence of QFR in this clinical setting, to analyze the global diagnosis accuracy of QFR versus FFR and to compare the difference in feasibility between retrospective and prospective analysis.
Methods and results
Systematic review of literature was performed. Eligible studies for the meta‐analysis were considered those directly evaluating de QFR versus FFR. Pooled values of diagnosis test and summary receiver operator curve were calculated. Main causes of not‐perform QFR analysis according to study design were also evaluated.
Sixteen studies were included. Good correlation and agreement were showed. Global sensibility, specificity, PPV, and NPV were 0.84, 0.89, 0.80, and 0.92, respectively. Then, 18% of evaluated vessels could not be analyzed. Significant differences were found in the percentage of discarded vessels and the cause of nonperformed analysis between retrospective or prospective analysis.
Conclusions
Excellent correlation and agreement between QFR and FFR was demonstrated. QFR assessment could be improved by its prospective analysis with a dedicated protocol.
Ramipril in High-Risk Patients With COVID-19 Amat-Santos, Ignacio J.; Santos-Martinez, Sandra; López-Otero, Diego ...
Journal of the American College of Cardiology,
07/2020, Letnik:
76, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory-syndrome coronavirus-2 that interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting ...enzyme 2. This interaction has been proposed as a potential risk factor in patients treated with RAAS inhibitors.
This study analyzed whether RAAS inhibitors modify the risk for COVID-19.
The RASTAVI (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation) trial is an ongoing randomized clinical trial randomly allocating subjects to ramipril or control groups after successful transcatheter aortic valve replacement at 14 centers in Spain. A non-pre-specified interim analysis was performed to evaluate ramipril’s impact on COVID-19 risk in this vulnerable population.
As of April 1, 2020, 102 patients (50 in the ramipril group and 52 in the control group) were included in the trial. Mean age was 82.3 ± 6.1 years, 56.9% of the participants were male. Median time of ramipril treatment was 6 months (interquartile range: 2.9 to 11.4 months). Eleven patients (10.8%) have been diagnosed with COVID-19 (6 in control group and 5 receiving ramipril; hazard ratio: 1.150; 95% confidence interval: 0.351 to 3.768). The risk of COVID-19 was increased in older patients (p = 0.019) and those with atrial fibrillation (p = 0.066), lower hematocrit (p = 0.084), and more comorbidities according to Society of Thoracic Surgeons score (p = 0.065). Admission and oxygen supply was required in 4.9% of patients (2 in the ramipril group and 3 in the control group), and 4 of them died (2 in each randomized group). A higher body mass index was the only factor increasing the mortality rate (p = 0.039).
In a high-risk population of older patients with cardiovascular disease, randomization to ramipril had no impact on the incidence or severity of COVID-19. This analysis supports the maintenance of RAAS inhibitor treatment during the COVID-19 crisis. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation RASTAVI; NCT03201185)
Display omitted
Objectives
To assess the clinical characteristics, management, and outcomes of patients diagnosed with infective endocarditis (IE) after edge‐to‐edge mitral valve repair with the MitraClip device.
...Background
Transcatheter edge‐to‐edge mitral valve repair has emerged as an alternative to surgery in high‐risk patients. However, few data exist on IE following transcatheter mitral procedures.
Methods
Four electronic databases (PubMed, Google Scholar, Embase, and Cochrane Library) were searched for original published studies on IE after edge‐to‐edge transcatheter mitral valve repair from 2003 to 2017.
Results
A total of 10 publications describing 12 patients with definitive IE (median age 76 years, 55% men) were found. The mean logistic EuroSCORE/EuroSCORE II were 41% and 45%, respectively. The IE episode occurred early (within 12 months post‐procedure) in nine patients (75%; within the first month in five patients). Staphylococcus aureus was the most frequent (60%) causal microorganism, and severe mitral regurgitation was present in all cases but one. Surgical mitral valve replacement (SMVR) was performed in most (67%) patients, and the mortality associated with the IE episode was high (42%).
Conclusions
IE following transcatheter edge‐to‐edge mitral valve repair is a rare but life‐threatening complication, usually necessitating SMVR despite the high‐risk profile of the patients. These results highlight the importance of adequate preventive measures and a prompt diagnosis and treatment of this serious complication.
Accumulating clinical experience and technological improvements have provided the basis for transcatheter aortic valve implantation (TAVI) to emerge as a well-established means for treating patients ...with severe symptomatic aortic stenosis at high or prohibitive surgical risk. During this decade, TAVI has emerged as a valid alternative to surgical aortic valve replacement in patients at intermediate surgical risk, and several studies are currently being performed to evaluate the role of TAVI in patients at low surgical risk. Furthermore, promising, but preliminary, data are emerging on the efficacy of TAVI for treating patients with bicuspid aortic valve disease, as well as patients with pure aortic regurgitation. In this Perspectives article, we summarize the evolving indications for TAVI, and give our opinion on the future perspectives for this procedure.
Abstract The recommendations for antithrombotic treatment post-left atrial appendage closure (LAAC) remain empirical, and no data exist on the changes in hemostatic markers associated with LACC. The ...objective of this study was to determine the presence, degree and timing of changes in the markers of platelet and coagulation activation following LAAC. Forty-three patients (mean age: 76±9 years, 23 men) with atrial fibrillation who underwent successful LACC with the Watchman (n=27) or Amplatzer Cardiac Plug (n=16) devices were included in the study. Patients received antiplatelet therapy post-LAAC (aspirin + clopidogrel: 27 patients; single anti-platelet therapy with aspirin or clopidogrel: 16 patients). Prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin III (TAT) were used as markers of coagulation activation, and soluble P-selectin and soluble CD40 ligand were used as markers of platelet activation. Measurements of all hemostatic markers were performed at baseline just prior to the procedure, followed by days 7, 30, and 180 post-LAAC. F1+2 and TAT levels increased from 0.27 nmol/L and 4.68 ng/mL, respectively, at baseline to peak values of 0.43 nmol/L and 9.76 ng/mL, respectively, at 7 days, partially returning to baseline levels at days 30 and 180 post-LAAC (p<0.001 for both markers). No clinical or procedural factors were associated with a greater increase in the markers of coagulation activation post-LAAC. Levels of soluble P-selectin and soluble CD40 ligand did not change at any time following LAAC. In conclusion, transcatheter LAAC is associated with significant activation of the coagulation system, yet without evidence of significant platelet activation.
...single antiplatelet therapy after LAAC in patients with a high risk of bleeding is associated with a low rate of cardioembolic and bleeding complications at a median follow-up of 19 months. ...Watchman (Boston Scientific, Natick, Massachusetts); Amplatzer Cardiac Plug/Amulet (St. Jude Medical, Minneapolis, Minnesota).CHA2DS2-VASc = congestive heart failure, hypertension, age >=75 years, diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism, vascular disease, age 65-74 years, sex category (female); CHADS2 = congestive heart failure, hypertension, age >=75 years, diabetes mellitus, prior stroke or transient ischemic attack; HAS-BLED = hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol; LAA = left atrial appendage; TEE = transesophageal echocardiography; TIA = transient ischemic attack.
Background
Significant mitral regurgitation (MR) is associated with poorer outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Factors associated with MR improvement have ...not been studied thoroughly.
Methods
Retrospective analysis of consecutive patients treated with TAVR with more than mild MR at baseline. MR evolution was assessed at 1–3 and 6–12 months after intervention. MR severity and mechanisms were assessed by echocardiography. Mitral annulus calcification (MAC) was quantified using preoperative cardiac CT.
Results
From 674 consecutive TAVR recipients, 78 with more than mild MR had a 6–12 months follow‐up. Following TAVR, MR improved in 34 patients (43%), remained stable in 38 (49%) and worsened in 6 (8%). Patients with MR improvement had greater tenting area (141 ± 56 vs. 99 ± 40 mm2, P < 0.01), tenting height (7.2 ± 1.9 vs. 5.6 ± 1.9 mm, P < 0.01) and lower ejection fraction (43 ± 16 vs. 52 ± 14%, P = 0.01). MAC was frequent (87.7% of patients) and a trend in greater MAC was observed in patients without MR improvement (3560 ± 5587 vs. 2053 ± 2800, P = 0.16). In multivariable analysis, tenting area (OR per 10 mm2 increase: 1.012, 95% CI, 1.001–1.024 P = 0.039) and annulus calcifications associated with leaflet restriction (OR = 0.108, 95% CI, 0.012–0.956, P = 0.045) were independently associated with MR outcome after TAVR.
Conclusion
Larger mitral valve tenting area was associated with more improvement of MR after TAVR whereas extensive MAC associated with leaflet restriction was associated with less improvement. This may help in the clinical decision‐making process of TAVR candidates with concomitant MR.
PDF
