BACKGROUND: Advancing the retrograde microcatheter (MC) into the antegrade guide catheter during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be challenging or impossible, preventing guidewire externalization. OBJECTIVES: To detail and evaluate all the techniques focused on wiring to achieve intubation of the distal tip of a microcatheter, balloon, or stent with an antegrade or retrograde guidewire, aiming to reduce complications by minimizing tension on fragile collaterals during externalization and enabling rapid antegrade conversion in various clinical scenarios. METHODS: We describe the two main techniques, tip-in and rendezvous, and their derivatives such a facilitated tip-in, manual MC-tip modification, tip-in the balloon, tip-in the stent, deep dive rendezvous, catch-it and antegrade microcatheter probing. We provide case studies that demonstrate the effectiveness of these techniques in complex scenarios involving extreme vessel angulation, severe calcification, fragile collaterals, and challenging retrograde MC crossing without externalization. CONCLUSION: The development of advanced variants along with traditional techniques to establish retrograde guidewire connection and antegrade conversion has led to the establishment of a cohesive group of methods known as portal techniques. These approaches serve as strategic advantages in retrograde CTO-PCI, providing a valuable and feasible alternative to conventional retrograde connection techniques, particularly when those techniques fail. Their ability to avoid the externalization process reduces potential damage to collateral channels and the ostium of the donor artery, potentially leading to a reduction in complication rates.
- MeSH
- Angioplasty, Balloon, Coronary instrumentation adverse effects MeSH
- Chronic Disease MeSH
- Equipment Design MeSH
- Percutaneous Coronary Intervention instrumentation adverse effects MeSH
- Coronary Occlusion * diagnostic imaging therapy physiopathology MeSH
- Humans MeSH
- Miniaturization MeSH
- Cardiac Catheters * MeSH
- Stents * MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
BACKGROUND: Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease. METHODS: This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed. FINDINGS: Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference -18·5 [90% CI -27·8 to -9·7]), which was below the 15% prespecified non-inferiority margin (pnon-inferiority<0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06-0·51]; psuperiority<0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010). INTERPRETATION: The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment. FUNDING: Isala Heart Centre and Medtronic.
- MeSH
- Aortic Valve Stenosis * surgery complications MeSH
- Heart Valve Prosthesis Implantation methods MeSH
- Fractional Flow Reserve, Myocardial * MeSH
- Percutaneous Coronary Intervention * methods MeSH
- Coronary Artery Bypass * methods MeSH
- Humans MeSH
- Coronary Artery Disease * surgery complications therapy MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Transcatheter Aortic Valve Replacement * methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Equivalence Trial MeSH
- Multicenter Study MeSH
- Comparative Study MeSH
BACKGROUND: Inflammation is associated with adverse cardiovascular events. Data from recent trials suggest that colchicine reduces the risk of cardiovascular events. METHODS: In this multicenter trial with a 2-by-2 factorial design, we randomly assigned patients who had myocardial infarction to receive either colchicine or placebo and either spironolactone or placebo. The results of the colchicine trial are reported here. The primary efficacy outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization, evaluated in a time-to-event analysis. C-reactive protein was measured at 3 months in a subgroup of patients, and safety was also assessed. RESULTS: A total of 7062 patients at 104 centers in 14 countries underwent randomization; at the time of analysis, the vital status was unknown for 45 patients (0.6%), and this information was most likely missing at random. A primary-outcome event occurred in 322 of 3528 patients (9.1%) in the colchicine group and 327 of 3534 patients (9.3%) in the placebo group over a median follow-up period of 3 years (hazard ratio, 0.99; 95% confidence interval [CI], 0.85 to 1.16; P = 0.93). The incidence of individual components of the primary outcome appeared to be similar in the two groups. The least-squares mean difference in C-reactive protein levels between the colchicine group and the placebo group at 3 months, adjusted according to the baseline values, was -1.28 mg per liter (95% CI, -1.81 to -0.75). Diarrhea occurred in a higher percentage of patients with colchicine than with placebo (10.2% vs. 6.6%; P<0.001), but the incidence of serious infections did not differ between groups. CONCLUSIONS: Among patients who had myocardial infarction, treatment with colchicine, when started soon after myocardial infarction and continued for a median of 3 years, did not reduce the incidence of the composite primary outcome (death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization). (Funded by the Canadian Institutes of Health Research and others; CLEAR ClinicalTrials.gov number, NCT03048825.).
- MeSH
- C-Reactive Protein * analysis MeSH
- Stroke prevention & control MeSH
- Double-Blind Method MeSH
- Myocardial Infarction * prevention & control mortality MeSH
- Kaplan-Meier Estimate MeSH
- Colchicine * therapeutic use adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Recurrence MeSH
- Secondary Prevention MeSH
- Aged MeSH
- Spironolactone therapeutic use adverse effects MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
BACKGROUND: Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain. METHODS: In this multicenter trial with a 2-by-2 factorial design, we randomly assigned patients with myocardial infarction who had undergone percutaneous coronary intervention to receive either spironolactone or placebo and either colchicine or placebo. The results of the spironolactone trial are reported here. The two primary outcomes were a composite of death from cardiovascular causes or new or worsening heart failure, evaluated as the total number of events; and a composite of the first occurrence of myocardial infarction, stroke, new or worsening heart failure, or death from cardiovascular causes. Safety was also assessed. RESULTS: We enrolled 7062 patients at 104 centers in 14 countries; 3537 patients were assigned to receive spironolactone and 3525 to receive placebo. At the time of our analyses, the vital status was unknown for 45 patients (0.6%). For the first primary outcome, there were 183 events (1.7 per 100 patient-years) in the spironolactone group as compared with 220 events (2.1 per 100 patient-years) in the placebo group over a median follow-up period of 3 years (hazard ratio adjusted for competing risk of death from noncardiovascular causes, 0.91; 95% confidence interval [CI], 0.69 to 1.21; P = 0.51). With respect to the second primary outcome, an event occurred in 280 of 3537 patients (7.9%) in the spironolactone group and 294 of 3525 patients (8.3%) in the placebo group (hazard ratio adjusted for competing risk, 0.96; 95% CI, 0.81 to 1.13; P = 0.60). Serious adverse events were reported in 255 patients (7.2%) in the spironolactone group and 241 (6.8%) in the placebo group. CONCLUSIONS: Among patients with myocardial infarction, spironolactone did not reduce the incidence of death from cardiovascular causes or new or worsening heart failure or the incidence of a composite of death from cardiovascular causes, myocardial infarction, stroke, or new or worsening heart failure. (Funded by the Canadian Institutes of Health Research and others; CLEAR ClinicalTrials.gov number, NCT03048825.).
- MeSH
- Mineralocorticoid Receptor Antagonists * therapeutic use adverse effects MeSH
- Stroke mortality MeSH
- Double-Blind Method MeSH
- Myocardial Infarction * mortality drug therapy MeSH
- Kaplan-Meier Estimate MeSH
- Cardiovascular Diseases mortality prevention & control MeSH
- Percutaneous Coronary Intervention MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Spironolactone * therapeutic use adverse effects MeSH
- Heart Failure * drug therapy mortality MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
BACKGROUND AND AIM: Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic. METHODS AND RESULTS: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020. Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints were postprocedural TIMI 0-2 flow and 30-day mortality. Our population is represented by 16083 STEMI patients. A total of 3812 (23,7 %) patients suffered from diabetes. They were older, more often males as compared to non-diabetes. Diabetic patients were less often active smokers and had less often a positive family history of CAD, but they were more often affected by hypertension and hypercholesterolemia, with higher prevalence of previous STEMI and previous CABG. Diabetic patients had longer ischemia time, had more often anterior MI, cardiogenic shock, rescue PCI and multivessel disease. They had less often out-of-hospital cardiac arrest and in-stent thrombosis, received more often a mechanical support, received less often a coronary stent and DES. Diabetes was associated with a significantly impaired postprocedural TIMI flow (TIMI 0-2: 9.8 % vs 7.2 %, adjusted OR [95 % CI] = 1.17 [1.02-1.38], p = 0.024) and higher mortality (in-hospital: 9.1 % vs 4.8 %, Adjusted OR [95 % CI] = 1.70 [1.43-2.02], p < 0.001; 30-day mortality: 10.8 % vs 6 %, Adjusted HR [95 % CI] = 1.46 [1.26-1.68], p < 0.001) as compared to non-diabetes, particularly during the pandemic. CONCLUSIONS: Our study showed that in a contemporary STEMI population undergoing PPCI, diabetes is significantly associated with impaired epicardial reperfusion that translates into higher in-hospital and 30-day mortality, particularly during the pandemic.
- MeSH
- Time-to-Treatment MeSH
- Time Factors MeSH
- COVID-19 * mortality epidemiology MeSH
- Diabetes Mellitus * mortality diagnosis epidemiology MeSH
- Risk Assessment MeSH
- ST Elevation Myocardial Infarction * mortality therapy diagnosis MeSH
- Percutaneous Coronary Intervention * mortality adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Hospital Mortality MeSH
- Registries MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
BACKGROUND: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic. METHODS: The ISACS-STEMI COVID-19 was a retrospective registry that included STEMI patients treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 in 109 high-volume primary PCI centers from 4 continents. We collected data on baseline, clinical and procedural characteristics, in-hospital outcome and 30-day mortality. For this analysis patients were grouped according to history of hypertension at admission. RESULTS: A total of 16083 patients were assessed, including 8813 (54.8%) with history of hypertension. These patients were more often elderly, with a worse cardiovascular risk profile, but were less frequently active smoker. Some procedural differences were observed between the two groups, including lower rate of thrombectomy and use of glycoprotein IIb/IIIa inhibitors or cangrelor but more extensive coronary disease in patients with hypertension. Between patients with and without hypertension, there was no significant difference in SARS-CoV-2 positivity. Hypertensive patients had a significantly higher in-hospital and 30-day mortality, similarly observed in both pre-COVID-19 and COVID-19 era, and confirmed after adjustment for main baseline differences and propensity score (in-hospital mortality: adjusted odds ratio (OR) [95% confidence interval (CI)] =1.673 [1.389-2.014], P < 0.001; 30-day mortality: adjusted hazard ratio (HR) [95% CI] = 1.418 [1.230-1.636], P < 0.001). CONCLUSION: This is one of the largest and contemporary study assessing the impact of hypertension in STEMI patients undergoing primary angioplasty, including also the COVID-19 pandemic period. Hypertension was independently associated with significantly higher rates of in-hospital and 30-day mortality.
- MeSH
- COVID-19 * complications mortality MeSH
- Hypertension * complications mortality MeSH
- ST Elevation Myocardial Infarction * mortality complications therapy MeSH
- Percutaneous Coronary Intervention * MeSH
- Middle Aged MeSH
- Humans MeSH
- Hospital Mortality MeSH
- Registries * MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- SARS-CoV-2 MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
Extra-intrakraniální bypass představuje kontroverzní, ale významnou součást neurochirurgické léčby cerebrovaskulárních onemocnění. Indikacemi jsou nemoc moyamoya, stenookluzivní aterosklerotická choroba vnitřní karotidy, akutní ischemická cévní mozková příhoda (CMP) a vzácně i komplexní aneuryzmata a tumory baze lební. Přestože historické studie přinesly smíšené výsledky a omezily jeho využití, moderní diagnostické a chirurgické techniky opět otevírají cestu k selektivnímu uplatnění bypassu u vysoce rizikových pacientů. Jednoznačnou indikací je vzácná nemoc moyamoya, kde je bypass prokázanou metodou vedoucí k prevenci ischemických nebo hemoragických CMP. U pacientů se symptomatickým chronickým uzávěrem vnitřní karotidy a vyčerpanou cerebrovaskulární rezervou bypass představuje možnou léčebnou modalitu, pokud je pečlivě indikován na základě komplexního specializovaného vyšetření. Emergentní bypass by měl být zvažován pro úzkou skupinu pacientů u akutní ischemické CMP při selhání nebo nemožnosti standardní léčby. Přes pokračující diskuzi je extra-intrakraniální bypass i nadále důležitou součástí cerebrovaskulární chirurgie. Klíčovým faktorem úspěchu je správná selekce pacientů a precizní mikrochirurgické provedení. Moderní přístupy a technologie umožňují snížit riziko komplikací a zvýšit efektivitu této intervence, čímž poskytují naději pacientům s jinak omezenými možnostmi léčby.
Extra-intracranial bypass represents a controversial yet significant component of neurosurgical treatment for cerebrovascular diseases. The indications are moyamoya disease, steno-occlusive atherosclerotic disease of the internal carotid artery, acute ischemic stroke, and, more rarely, complex intracranial aneurysms and skull base tumors. Although historical studies have yielded mixed results and limited its use, modern diagnostic and surgical techniques are reopening the path for selective application of bypass in high-risk patients. A clear indication is the rare moyamoya disease, where bypass is a proven method for preventing ischemic or hemorrhagic strokes. In patients with symptomatic chronic internal carotid artery occlusion and exhausted cerebrovascular reserve, bypass may serve as a potential treatment modality, provided it is carefully indicated through comprehensive specialized evaluation. Emergent bypass should be considered for a narrow group of patients with acute ischemic stroke when standard treatment fails or is not feasible. Despite ongoing debate, extra-intracranial bypass remains an essential part of cerebrovascular surgery. The key to success lies in the proper selection of patients and precise microsurgical execution. Modern approaches and technologies help reduce the risk of complications and enhance the effectiveness of this intervention, offering hope to patients with otherwise limited treatment options.
Velký rozvoj a zlepšení výsledků konzervativní léčby u pacientů s asymptomatickými stenózami krkavice v posledních letech nastartoval diskuzi o optimální invazivní léčbě, v některých případech se dokonce diskutovalo a nadále diskutuje i o její potřebnosti. Několik studií, jejichž cílem bylo najít nejvýhodnější přístup pro bezpříznakové pacienty se stenózami krkavic již proběhlo, u jiných ještě randomizace probíhá a na výsledky se čeká. Zásadní nezodpovězenou otázkou je, zda má revaskularizace větší přínos než intenzivní konzervativní léčba, zejména vzhledem k nižšímu počtu cévních mozkových příhod, kterých se dosahuje bez klasické nebo endovaskulární intervence v posledních letech. Dlouhodobým cílem by měla být identifikace takové podskupiny pacientů, která by profitovala z konzervativního postupu. V tomto textu shrnujeme problematiku v kontextu dosavadních výsledků dvou čerstvě ukončených zásadních studií.
In recent years, the significant progress in the outcomes of conservative treatment for patients with asymptomatic carotid stenosis has sparked discussions about the most effective invasive treatment. The necessity of such treatment is still being debated in certain cases. Several studies have already been conducted to find the most appropriate approach for asymptomatic patients with carotid stenosis, while others are still randomizing and awaiting results. A major unanswered question is whether revascularization is more beneficial than intensive conservative treatment, particularly in view of the lower stroke rates achieved in recent years without conventional or endovascular intervention. The long-term goal should be to identify a subset of patients who would benefit from conservative treatment. In this text, we summarize the issue in the context of the results of two recently completed pivotal studies.
- Keywords
- studie SPACE-2, studie ACST-2,
- MeSH
- Asymptomatic Diseases * MeSH
- Stroke etiology prevention & control MeSH
- Endarterectomy, Carotid MeSH
- Conservative Treatment MeSH
- Humans MeSH
- Multicenter Studies as Topic MeSH
- Randomized Controlled Trials as Topic MeSH
- Carotid Stenosis * surgery complications therapy MeSH
- Stents MeSH
- Check Tag
- Humans MeSH
Úvod a cíl: Autotransplantace zubů u dospělých pacientů představuje výzvu kvůli nízké pravděpodobnosti revaskularizace zubní dřeně vyžadující ošetření kořenových kanálků. Toto ošetření nejen komplikuje celkové ošetření, ale v některých případech jej činí neproveditelným. Cílem této práce je prozkoumat alternativní postupy pro autotransplantaci zubů u dospělých pacientů, které by eliminovaly potřebu následného ošetření kořenových kanálků donorového zubu. Metodika: Pro zodpovězení této otázky provedl autor rešerši v online databázích Scopus, Web of Science a MEDLINE. Výsledky: Současné protokoly pro autotransplantované zuby s ukončeným vývojem doporučují ošetření kořenových kanálků před operací anebo 14 dní po operaci. Studie řídící se těmito protokoly prezentují vysokou úspěšnost a prediktabilitu. Alternativním přístupem je zahájit ošetření kořenových kanálků pouze v případě výskytu postoperačních komplikací. Tento přístup však přináší výzvy v postoperačním hodnocení klinického stavu zubní dřeně. Pro zvýšení potenciálu zubní dřeně pro revaskularizaci lze provést extraorální resekci kořenového hrotu (EORR). Závěr: Pro klinickou praxi je důležitý správný výběr případů i s ohledem na anatomii endodontu. Riziko komplikací alternativních postupů ve srovnání se současnými protokoly zastiňuje potenciální benefity. EORR v kombinaci s metodami umožňujícími objektivní měření revaskularizace zubní dřeně může představovat možnosti pro další výzkum.
Introduction and aim: Tooth autotransplantation in adult patients presents a challenge due to the low probability of pulp revascularization, often requiring root canal treatment (RCT). RCT not only complicates the overall procedure, but in some cases makes the procedure unfeasible. The aim of this review is to explore alternative procedures for tooth autotransplantation in adult patients that could eliminate the need for elective RCT of the donor tooth. Materials: To address this question, the authors conducted a literature search in the online databases Scopus, Web of Science, and MEDLINE. Results: The current protocols involve performing RCT before or 14 days after surgery. Recent studies that follow these protocols show high predictability and success rate. An alternative approach is to initiate RCT only in the case of postoperative complications. However, this protocol poses challenges in the postoperative assessment of the clinical condition of the pulp. To enhance the potential for pulp revascularization, an extraoral root-end resection (EORR) may be performed. Conclusion: For clinical practice, proper case selection, including consideration of endodontic anatomy, is crucial. The risk of complications associated with alternative approaches outweighs their potential benefits compared to current protocols. EORR, combined with methods enabling an objective measurement of pulp revascularization, may offer opportunities for further research.
Cíl: Zjistit, zda by detekce subklinického městnání ultrazvukovým vyšetření plic (lung ultrasound, luS) pacientů se SteMi mohla pomoci předpovědět rozvoj srdečního selhání a systolické, nebo diastolické dysfunkce levé komory. Metody: Do studie bylo zařazeno 150 pacientů. u všech byla provedena úspěšná revaskularizace a při příjmu u nich nebylo z klinického hlediska přítomno srdeční selhání. Během prvních 24 hodin od příjmu u nich bylo provedeno luS s 28 plicními body a byly spočítány B-linie. Pacienti byli rozděleni do dvou skupin: 64 pacientů do skupiny luS pozitivní (se 6 nebo více B-liniemi) a 86 jedinců do skupiny luS negativní; po tříměsíčním sledování byli vyšetřeni na přítomnost srdečního selhání stupně ii nebo vyššího podle klasifikace nYhA, ejekční frakci (ef) ≤40%, a celková longitudinální deformace myokardu (global longitudinal strain, GlS) ≤–16 %. Výsledky: K rozvoji klinického srdečního selhání došlo u většího počtu pacientů ve skupině luS pozitivní (17 vs. 2 ve skupině luS negativní; p < 0,01); totéž platilo pro ef ≤ 40 % (34 vs. 3; p < 0,01) i GlS ≤ –16 % (60 vs. 58; p < 0,01). Křivky operační charakteristiky přijímače (receiver-operating characteristic, roc) prokázaly, že optimální mezní hodnota počtu B-linií pro predikci rozvoje klinického srdečního selhání i poruchy systolické funkce je 6 nebo více (senzitivita = 89,47 %, specificita = 64,62 %, resp. senzitivita = 91,89 %, specificita = 74,11 %). Analýza podskupin podle počáteční diagnózy prokázala, že predikční hodnota luS byla statisticky významná pouze v případě SteMi přední stěny. Závěry: ultrazvukové vyšetření plic u pacientů se SteMi, provedené do 24 hodin od příjmu, dokáže předpovědět rozvoj klinického srdečního selhání nebo systolické dysfunkce do tří měsíců, zvláště v případě infarktu přední stěny.
Aim: To see if the detection of subclinical congestion in STEMI patients by lung ultrasound (LUS) could be helpful in predicting the development of future heart failure, systolic dysfunction or diastolic dysfunction. Methods: 150 patients were included. All patients were successfully revascularized and were not suffering from clinical heart failure on admission. The patients had a 28-point LUS study within the first 24 hours of admission, and B-lines were counted. Patients were divided into two groups: 64 patients into the LUS positive group (with 6 or more B-lines) and 86 into the LUS negative group. They were followed-up after 3 months, looking for heart failure NYHA II or greater, ejection fraction (EF) ≤40%, and global longitudinal strain (GLS) ≤-16%. Results: More patients from the LUS positive group developed clinical heart failure (17 vs 2 in the LUS negative group, p <0.01), EF ≤40% (34 vs 3, p <0.01), GLS ≤-16% (60 vs 58, p <0.01). Optimal cutoff derived from ROC curves revealed that the best B-line number cutoff to predict clinical heart failure as well as impaired systolic function was 6 or greater (sensitivity = 89.47%, specificity = 64.62% and sensitivity = 91.89%, specificity = 74.11%, respectively). Subgroup analysis by initial diagnosis revealed that the predictive power of LUS was significant only in anterior STEMI. Conclusions: LUS in STEMI patients, performed within 24 hours of admission, is able to predict the occurrence of clinical heart failure or systolic dysfunction at 3 months, especially in anterior infarctions.
