Angina pectoris bez obstrukce koronárních tepen je častý nález u pacientů s bolestmi na hrudi, v jehož patofyziologii se uplatňují zejména dva mechanismy – strukturální nebo funkční poškození mikrocirkulace či funkční poškození epikardiálních tepen, případně jejich kombinace. Souhrnný článek se zabývá dia- gnostikou koronární mikrovaskulární dysfunkce se zaměřením na kontinuální termodiluci jako bezpečnou, jednoduchou, rychlou a na operatérovi nezávislou metodu. Popisuje teoretický základ i praktické aspekty s grafickými ukázkami měření.
Angina with non-obstructive coronary artery disease is a frequent finding in patients with chest pain. Its pathophysiology involves two main mechanisms: structural and functional dysfunction of microcircula- tion, functional dysfunction of epicardial arteries, and their combination. The review article focuses on the diagnostics of microvascular dysfunction, particularly continuous thermodilution, as a safe, easy, fast, and operator-independent method. It describes both theoretical background and practical aspects with graphical examples of measurements.
INTRODUCTION: Use of the mechanically expandable transcatheter aortic valve (MEV) has been recently linked to increased risks of valve dysfunction and cardiovascular mortality. The risk of developing conduction disturbance with the MEV valve is well known, and the negative prognostic impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation is another consideration. AIM: This study aimed to compare the mid-term survival of patients with MEV and self-expandable valves (SEV), and to examine survival of both groups according to the presence or absence of PPI. METHODS: This single-centre, retrospective, observational study examined data from MEV and SEV groups comprising 92 and 373 patients, respectively. The mean clinical follow-up was 2.5±1.7 years. Mortality information was obtained from the National Institutes of Health Information and Statistics. RESULTS: Baseline characteristics were comparable between the groups. The log-rank test showed higher cardiovascular mortality in the MEV group (p=0.042; the relative risk (RR) 1.594 (95% CI 1.013 to 2.508)). The Cox proportional hazards model identified MEV implantation as an independent predictor of cardiovascular mortality. The rate of PPI was twice as high in the MEV vs SEV group (33.7% vs 16.1%; p<0.001). We compared the survival of both groups according to the presence or absence of PPI and found higher mortality in the MEV group without PPI versus the SEV group without PPI (p=0.007; RR 2.156 (95% CI 1.213 to 3.831)). Survival did not differ in the groups with PPI. CONCLUSIONS: A higher mid-term cardiovascular mortality rate was observed with MEV versus SEV implants. Comparing both groups according to the presence or absence of PPI, we observed a higher mortality risk in patients with MEV without PPI than in SEV without PPI. In contrast, mortality did not differ between the groups when PPI was implanted.
- MeSH
- aortální chlopeň diagnostické zobrazování chirurgie MeSH
- aortální stenóza * diagnostické zobrazování chirurgie MeSH
- kardiostimulátor * MeSH
- lidé MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Introduction: Long-term data on the Lotus® (Boston Scientific, USA) valve are lacking. Aim: To evaluate mid-term outcomes of aortic stenosis patients treated with either Lotus or Evolut R® valves (Medtronic, USA). Material and methods: Our study sample comprised 190 patients (71 Lotus and 119 Evolut valves). The mean clinical follow-up was 2.0 ±0.9 years. Information on mortality was obtained from the National Institutes of Health Information and Statistics. Results: No significant differences existed in baseline characteristics between the groups. The rate of procedural complications was low and without significant differences between groups. The log rank test showed higher mortality in the Lotus group for cardiovascular mortality (p = 0.02; RR = 2.4, 95% CI: 1.123-5.075). Multivariable analysis revealed that the Lotus valve was independently associated with cardiovascular mortality (p = 0.03). At the end of echocardiography follow-up (4.1 ±0.9 years), we found a significantly higher mean aortic valve gradient (AVGm) in the Lotus group than in the Evolut group (17.9 ±9.5 vs. 10.2 ±3.5 mm Hg; p = 0.0006), and 3 (10%) patients from the Lotus group suffered from symptomatic re-stenosis requiering re-intervention. Conclusions: The results of our study suggest that higher cardiovascular mortality rates during mid-term follow-up were associated with Lotus compared with Evolut valves. Higher AVGm in the Lotus valves suggests the possibility of accelerated prosthesis degeneration.
- Publikační typ
- časopisecké články MeSH
Introduction: An association exists between low socio-economic status (SES) and increased cardiovascular and all-cause mortality worldwide. Aim: To evaluate the impact of educational level as a marker of socio-economic status (SES) on the clinical condition of patients before transcatheter aortic valve implantation (TAVI) and survival after TAVI. Material and methods: We conducted a retrospective observational study involving patients with severe aortic stenosis (AS) who underwent TAVI. We divided patients based on their level of education into lower (LLE) and higher educational level (HLE) groups. We evaluated periprocedural (combined endpoints of device success (DS) and early safety (ES), according to VARC2 criteria) and mid-term outcomes (all-cause and cardiovascular mortality). Results: Of the 379 study patients, 212 were in the LLE group. The mean follow-up was 2.1 ±1.8 years. Patients with a LLE were younger (77.4 ±7.2 vs. 79.4 ±6.5 years, p = 0.006) and more often female (58% vs. 40%, p < 0.001). They had higher body mass index (29.5 ±5.7 vs. 28.3 ±4.8, p = 0.037), more often type 2 diabetes mellitus (43% vs. 31%, p = 0.013) and moderate or severe aortic regurgitation (8% vs. 2%, p = 0.026), and some patients' condition required urgent TAVI (5% vs. 0%, p = 0.003). There were no differences in combined procedural endpoints. The all-cause mortality during mid-term follow-up was 25% in the LLE group and 24% in the HLE group (log-rank, p = 0.941). Cardiovascular mortality was 19% in both groups (log-rank, p = 0.925). Conclusions: Patients with an LLE required TAVI at a younger age, had more comorbidities and had a more risky profile. Level of education did not influence periprocedural and mid-term outcomes.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- časopisecké články MeSH
Introduction: There is lack of long-term data outside of controlled clinical trials in carotid artery stenting (CAS). In this study, we compared the short-term outcome, long-term survival, and rate of re-interventions for restenosis in patients after CAS, related to the extent of carotid atherosclerosis classified as single-vessel (unilateral) or double-vessel (bilateral) carotid artery disease. Material and methods: We retrospectively evaluated 599 patients with significant carotid artery stenosis, who underwent 763 CAS procedures, and used the propensity score to match 226 pairs (452 patients) in the single- or double-vessel carotid disease. Results: There was no significant difference in the occurrence of in-hospital major adverse events (3.5% vs. 3.1% of patients in the double-vessel carotid group vs. the single-vessel carotid group; p = 1) The mean follow-up was 6.1 ±4.0 years, and a total of 181 (40%) deaths occurred during 2759 patient-years, which translates into 7.8 and 5.3 deaths per 100 patient-years in the double-vessel carotid group and the single-vessel carotid group, respectively (p < 0.01). The survival in the double-vessel carotid group vs. the single-vessel carotid group at 10 years was 46% (95% CI: 38-54%) vs. 55% (95% CI: 47-63%) (p < 0.01). Twenty-four (11%) patients and 6 (3%) patients underwent re-interventions for restenosis in the double-vessel and the single-vessel carotid disease group, respectively (p < 0.01). Conclusions: Patients with CAS and significant double-vessel carotid artery disease had similar peri-procedural risk, but had a worse long-term survival, and a higher rate of re-interventions for restenosis compared to the single-vessel carotid artery disease patients.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- kazuistiky MeSH
Background: The genetic background of patients with hypertrophic cardiomyopathy (HCM) treated with alcohol septal ablation (ASA) and its relationship to the outcomes are not known. We aimed to investigate whether the outcome of genotype positive (G+) patients differs from genotype negative (G-) patients treated with ASA. Methods: We included 129 HCM patients (mean age 54±13 years) treated with ASA in a tertiary cardiovascular center and performed next generation sequencing (NGS) based genomic testing. All patients were followed-up three months after the procedure and yearly thereafter. Results: A total of 30 (23%) HCM patients were G+ patients. At the 3-months follow-up, both groups of patients had similar left ventricular outflow tract PG (16.9±15.7 mmHg in G+ vs. 16.3±18.8 mmHg in G-, P=0.73) and symptoms (follow-up NYHA class 1.40±0.62 vs. 1.37±0.53, P=0.99, follow-up CCS class 0.23±0.52 vs. 0.36±0.65, P=0.36). The independent predictors of all-cause mortality were baseline interventricular septum (IVS) thickness (HR 1.12, 95% CI: 1.00-1.26, P=0.049) and age at the time of ASA (HR 1.11, 95% CI: 1.06-1.17, P<0.01). The adjusted all-cause mortality rate did not differ significantly between G+ and G- patients (P=0.52). The adjusted combined mortality event rate did not differ between both groups (P=0.78). Conclusions: Despite more severe phenotype in G+ HCM patients, ASA is an equally effective treatment for LVOTO in G+ patients as it is for treating LVOTO in G- patients. The long-term outcome after ASA is similar in G+ and G- patients.
- Publikační typ
- časopisecké články MeSH
Transcatheter aortic valve implantation (TAVI) is a well-established management option for symptomatic patients with severe aortic stenosis. The minimally invasive transfemoral approach is considered to be superior to non-transfemoral accesses; however, its use is often limited by concomitant peripheral artery disease (PAD). Percutaneous transluminal angioplasty with stent implantation (PTA) is a gold-standard therapy for symptomatic PAD. We present 2 cases from our cohort of patients with severe aortic stenosis and PAD previously contraindicated for TAVI because of poor peripheral vascular access. However, the patients were eventually treated either by staged PTA and TAVI through an endothelialized stent or PTA and TAVI though a newly implanted peripheral stent during one procedure. We provide recommendations based on our experience of how to select the optimal patients for such a combined minimally invasive transfemoral approach (Fig. 2, Ref. 9).
- MeSH
- angiografie MeSH
- angioplastika metody MeSH
- aortální stenóza chirurgie MeSH
- balónková angioplastika metody MeSH
- lidé MeSH
- onemocnění periferních arterií * chirurgie diagnostické zobrazování MeSH
- počítačová rentgenová tomografie MeSH
- senioři MeSH
- stenty MeSH
- transkatetrální implantace aortální chlopně * metody MeSH
- vaskulární kalcifikace diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- časopisecké články MeSH
