BACKGROUND: The optimal energy protocol for direct current cardioversion of atrial fibrillation remains uncertain. The PROTOCOLENERGY randomised trial compared a stepwise escalating energy algorithm (RaA, 150J, 360J and 360J) with a maximum fixed energy algorithm (MfA, 3x360J). METHODS: In a 1:1 randomised trial, 300 patients with atrial fibrillation received biphasic discharges via hand-held paddles in the anterolateral position. Primary endpoints were sinus rhythm at 1 minute and neurological complications at 2 hours; secondary endpoints included sinus rhythm at 2 hours, skin changes and chest discomfort at 24 hours. RESULTS: Sinus rhythm at 1 minute was achieved in 92.7% of RaA and 94.0% of MfA patients (p=0.643) and maintained at 2 hours in 91.3% of both groups. There were no neurological complications. The protocols differed significantly after the first shock (72.7% in RaA vs. 83.3% in MfA; p=0.026) but equalised after subsequent maximum energy shocks. Fewer RaA patients experienced skin redness compared to MfA (19.3% vs. 36.0%, p=0.001), which was attributed to the lower initial 150J shock and total energy delivered (r=0.243, p<0.0001). Chest discomfort at 24 hours was not different between groups (p=0.378). In multivariate analysis, lower body mass index (p<0.001, cut-off 29-34 kg/m2) was associated with cardioversion success after the initial 150J shock. CONCLUSIONS: Both protocols showed similar high cumulative efficacy, but RaA with the initial 150J shock proved to be beneficial in patients with body mass index less than 29-34 kg/m2 due to fewer skin complications.
- Klíčová slova
- Atrial fibrillation, BMI, Cardioversion, Patient-specific treatment, Shock energy algorithms,
- Publikační typ
- časopisecké články MeSH
In the 30 years since Dr Sigwart's first pioneering procedures, alcohol septal ablation (ASA) has become the standard catheterisation procedure to reduce or eliminate obstruction in the left ventricular outflow tract. This procedure reduces the pressure gradient by 70%-80%, and only 10%-20% of patients have a residual gradient > 30 mm Hg after ASA. The mortality rate of the procedure is < 1%, and ∼ 10% of patients require permanent pacemaker implantation for higher degrees of atrioventricular block. Given the potential risks, ASA should be performed only in centres with extensive experience in the treatment of hypertrophic cardiomyopathy and with comprehensive therapeutic options, including myectomy. In the future, ASA is likely to be increasingly complemented by catheter-based mitral valve repair, which will increase its efficacy.
- MeSH
- ablace * metody trendy MeSH
- dějiny 20. století MeSH
- dějiny 21. století MeSH
- ethanol * terapeutické užití MeSH
- hypertrofická kardiomyopatie * chirurgie MeSH
- katetrizační ablace metody MeSH
- lidé MeSH
- obstrukce výtoku ze srdeční komory * chirurgie MeSH
- předpověď MeSH
- srdeční septum chirurgie MeSH
- Check Tag
- dějiny 20. století MeSH
- dějiny 21. století MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- historické články MeSH
- přehledy MeSH
BACKGROUND: There are dated and conflicting data about the optimal timing of initiation of P2Y12 inhibitors in elective percutaneous coronary intervention (PCI). Peri-PCI myocardial necrosis is associated with poor outcomes. We aimed to assess the impact of the P2Y12 inhibitor loading time on periprocedural myocardial necrosis in the population of the randomized Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting (ALPHEUS) trial, which compared ticagrelor with clopidogrel in high-risk patients who received elective PCI. METHODS: The ALPHEUS trial divided 1809 patients into quartiles of loading time. The ALPHEUS primary outcome was used (type 4 [a or b] myocardial infarction or major myocardial injury) as well as the main secondary outcome (type 4 [a or b] myocardial infarction or any type of myocardial injury). RESULTS: Patients in the first quartile group (Q1) presented higher rates of the primary outcome (P = 0.01). When compared with Q1, incidences of the primary outcome decreased in patients with longer loading times (adjusted odds ratio [adjOR], 0.70 [0.52.-0.95]; P = 0.02 for Q2; adjOR 0.65 [0.48-0.88]; P < 0.01 for Q3; adjOR 0.66 [0.49-0.89]; P < 0.01 for Q4). Concordant results were found for the main secondary outcome. There was no interaction with the study drug allocated by randomization (clopidogrel or ticagrelor). Bleeding complications (any bleeding ranging between 4.9% and 7.3% and only 1 major bleeding at 48 hours) and clinical ischemic events were rare and did not differ among groups. CONCLUSIONS: In elective PCI, administration of the oral P2Y12 inhibitor at the time of PCI could be associated with more frequent periprocedural myocardial necrosis than an earlier administration. The long-term clinical consequences remain unknown.
- MeSH
- infarkt myokardu * etiologie MeSH
- inhibitory agregace trombocytů terapeutické užití MeSH
- klopidogrel terapeutické užití MeSH
- koronární angioplastika * metody MeSH
- lidé MeSH
- purinergní receptory P2Y - antagonisté terapeutické užití MeSH
- ticagrelor terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- inhibitory agregace trombocytů MeSH
- klopidogrel MeSH
- purinergní receptory P2Y - antagonisté MeSH
- ticagrelor MeSH
BACKGROUND: The current ACC/AHA guidelines on hypertrophic cardiomyopathy (HCM) caution that alcohol septal ablation (ASA) might be less effective in patients with left ventricular outflow tract obstruction (LVOTO) ≥ 100 mm Hg. METHODS: We used a multinational registry to evaluate the outcome of ASA patients according to baseline LVOTO. RESULTS: A total of 1346 ASA patients were enrolled and followed for 5.8 ± 4.7 years (7764 patient-years). The patients with baseline LVOTO ≥ 100 mm Hg were significantly older (61 ± 14 years vs 57 ± 13 years; P < 0.01), more often women (60% vs 45%; P < 0.01), and had a more pronounced HCM phenotype than those with baseline LVOTO < 100 mm Hg. There were no significant differences in the occurrences of 30-day major cardiovascular adverse events in the 2 groups. After propensity score matching (2 groups, 257 pairs of patients), the long-term survival was similar in both groups (P = 0.10), the relative reduction of LVOTO was higher in the group with baseline LVOTO ≥ 100 mm Hg (82 ± 21% vs 73 ± 26%; P < 0.01), but the residual resting LVOTO remained higher in this group (23 ± 29 mm Hg vs 13 ± 13 mm Hg; P < 0.01). Dyspnoea (NYHA functional class) at the most recent clinical check-up was similar in the 2 groups (1.7 ± 0.7 vs 1.7 ± 0.7; P = 0.85), and patients with baseline LVOTO ≥ 100 mm Hg underwent more reinterventions (P = 0.02). CONCLUSIONS: After propensity matching, ASA patients with baseline LVOTO ≥ 100 mm Hg had similar survival and dyspnoea as patients with baseline LVOTO < 100 mm Hg, but their residual LVOTO and risk of repeated procedures were higher.
- MeSH
- dyspnoe etiologie MeSH
- hypertrofická kardiomyopatie * komplikace diagnóza chirurgie MeSH
- kardiochirurgické výkony * MeSH
- lidé MeSH
- obstrukce výtokového traktu levé komory srdeční * MeSH
- obstrukce výtoku ze srdeční komory * chirurgie MeSH
- retrospektivní studie MeSH
- tendenční skóre MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers in women, and women's greatest barriers according to enrollment status. METHODS: In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale was administered to CR-indicated patients globally via Qualtrics from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated participant recruitment. Mitigation strategies were provided and rated. RESULTS: Participants were 2163 patients from 16 countries across all 6 World Health Organization regions; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in 2 regions (Americas, Western Pacific) and men in 1 (Eastern Mediterranean; all P < 0.001). Women's barriers were greatest in the Western Pacific (2.6 ± 0.4/5) and South East Asian (2.5 ± 0.9) regions (P < 0.001), with lack of CR awareness as the greatest barrier in both. Women who were unemployed reported significantly greater barriers than those not (P < 0.001). Among nonenrolled referred women, the greatest barriers were not knowing about CR, not being contacted by the program, cost, and finding exercise tiring or painful. Among enrolled women, the greatest barriers to session adherence were distance, transportation, and family responsibilities. Mitigation strategies were rated as very helpful (4.2 ± 0.7/5). CONCLUSIONS: CR barriers-men's and women's-vary significantly according to region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women's barriers in particular.
BACKGROUND: A biomechanical model of the heart can be used to incorporate multiple data sources (electrocardiography, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of patients with tetralogy of Fallot after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. METHODS: Twenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance imaging were included in this retrospective study. Biomechanical models specific to individual patient and physiology (before and after PVR) were created and used to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values. RESULTS: RV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) after PVR than those with predominant pulmonary regurgitation (median decrease 11%). The model simulated post-PVR decreased EDV for the majority and suggested an increase of Qeff-both in line with published data. CONCLUSIONS: This study used a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.
CONTEXTE :: Une modélisation biomécanique du cœur peut être utilisée pour intégrer des sources de données multiples (électrocardiographie, imagerie, hémodynamique invasive). Le but de cette étude était d’utiliser cette approche pour une cohorte de patients atteints de tétralogie de Fallot aprèsr réparation complète (TdFr) pour évaluer, au niveau du ventricule, les influences comparatives de la sténose résiduelle de la voie d’éjection du ventricule droit (SVEVD) et de la régurgitation pulmonaire. MÉTHODES :: Vingt patients atteints de TdFr ayant subi un remplacement percutane de la valve pulmonaire (RVP) et une imagerie par résonance magnétique cardiovasculaire ont été inclus dans cette étude rétrospective. Des modèles biomécaniques adaptés à chaque patient et à sa physiologie (avant et après le RVP) ont été créés et utilisés pour estimer la contractilité myocardique du ventricule droit (VD). La capacité des modèles à capturer les changements post-RVP du volume télédiastolique (VTD) du VD et du débit effectif dans l’artère pulmonaire (Qeff) a également été comparée aux valeurs attendues. RÉSULTATS :: La contractilité du VD avant le RVP (moyenne 66 ± 16 kPa, moyenne ± déviation standard)) était plus élevée chez les patients atteints de TdFr par rapport au VD normal (38–48 kPa) (P < 0,05). La contractilité a diminué de manière significative chez tous les patients après le RVP (P < 0,05). Les patients présentant une SVEVD prédominante ont montré une plus grande réduction de la contractilité (diminution médiane de 35 %) après le RVP que ceux présentant une régurgitation pulmonaire prédominante (diminution médiane de 11 %). Le modèle a simulé une diminution du VTD-VD après le RVP pour la majorité des patients et a suggéré une augmentation du Qeff, ce qui est conforme aux données publiées. CONCLUSIONS :: Cette étude a utilisé un modèle biomécanique pour synthétiser de multiples données cliniques et donner un aperçu de l’état de santé du VD. La modélisation individualisée nous permet de prédire la réponse du VD au RVP. Les premières données suggèrent que la SVEVD résiduelle impose un travail ventriculaire plus important que la régurgitation pulmonaire isolée.
- MeSH
- biologické modely * MeSH
- chirurgická náhrada chlopně metody MeSH
- dospělí MeSH
- Fallotova tetralogie chirurgie MeSH
- hemodynamika fyziologie MeSH
- insuficience plicnice vrozené diagnóza chirurgie MeSH
- kardiochirurgické výkony metody MeSH
- lidé MeSH
- magnetická rezonance kinematografická MeSH
- mnohočetné abnormality * MeSH
- následné studie MeSH
- plicní chlopeň abnormality diagnostické zobrazování chirurgie MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- srdeční komory diagnostické zobrazování patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: Implantation of left-ventricular assist systems (LVASs) has become the standard of care for advanced heart failure (HF). The absence of pulsatility in previous devices contributes to vascular and endothelial dysfunction related to atherosclerotic or vascular complications. We hypothesized that the artificial pulsatility provided by the HeartMate 3 (HM3) (Abbott, Chicago, IL) LVAS would exert a favourable effect on the vasculature. METHODS: In 32 patients implanted with HM3 (5 female patients, mean age 55 ± 13.6 years), the reactive hyperemia index (RHI) and peripheral augmentation index (AI), markers of endothelial function and arterial stiffness, were measured with an EndoPAT2000 before and in the third and sixth month after implantation. RHI and AI data from 30 HeartMate II (HM II) (Abbott) recipients in the third and sixth month after implantation, from 15 patients with advanced HF without LVASs and from 13 healthy volunteers were also analyzed. RESULTS: In HM3 recipients, the mean RHI significantly decreased at 3 and 6 months after implantation. The RHI was substantially lower at baseline than that of healthy or the HF reference group. Increasing AI values, indicating worsening arterial stiffness, were also observed. Similar trends were observed in HM II recipients between the third and sixth months but with higher absolute values of RHI and AI. CONCLUSIONS: We detected impaired vascular function in HM3 patients and provided additional evidence on the negative effect of low pulsatility on vascular function after LVAS implantation. The results suggest that the artificial pulsatility of the HM3 does not avert the progression of endothelial dysfunction.
- MeSH
- arterie patofyziologie MeSH
- časové faktory MeSH
- cévní endotel patofyziologie MeSH
- cévní rezistence fyziologie MeSH
- funkce levé komory srdeční fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- podpůrné srdeční systémy * MeSH
- prospektivní studie MeSH
- srdeční komory patofyziologie MeSH
- srdeční selhání patofyziologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
