共查询到20条相似文献，搜索用时 15 毫秒
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Frederick L. Grover Sreekanth Vemulapalli John D. Carroll Fred H. Edwards Michael J. Mack Vinod H. Thourani Ralph G. Brindis David M. Shahian Carlos E. Ruiz Jeffrey P. Jacobs George Hanzel Joseph E. Bavaria E. Murat Tuzcu Eric D. Peterson Susan Fitzgerald Matina Kourtis Joan Michaels Barbara Christensen David R. Holmes 《Journal of the American College of Cardiology》2017,69(10):1215-1230
Background
The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry captures all procedures with Food and Drug Administration–approved transcatheter valve devices performed in the United States, and is mandated as a condition of reimbursement by the Centers for Medicaid & Medicare Services.Objectives
This annual report focuses on patient characteristics, trends, and outcomes of transcatheter aortic and mitral valve catheter-based valve procedures in the United States.Methods
We reviewed data for all patients receiving commercially approved devices from 2012 through December 31, 2015, that are entered in the TVT Registry.Results
The 54,782 patients with transcatheter aortic valve replacement demonstrated decreases in expected risk of 30-day operative mortality (STS Predicted Risk of Mortality [PROM]) of 7% to 6% and transcatheter aortic valve replacement PROM (TVT PROM) of 4% to 3% (both p < 0.0001) from 2012 to 2015. Observed in-hospital mortality decreased from 5.7% to 2.9%, and 1-year mortality decreased from 25.8% to 21.6%. However, 30-day post-procedure pacemaker insertion increased from 8.8% in 2013 to 12.0% in 2015. The 2,556 patients who underwent transcatheter mitral leaflet clip in 2015 were similar to patients from 2013 to 2014, with hospital mortality of 2% and with mitral regurgitation reduced to grade ≤2 in 87% of patients (p < 0.0001). The 349 patients who underwent mitral valve-in-valve and mitral valve-in-ring procedures were high risk, with an STS PROM for mitral valve replacement of 11%. The observed hospital mortality was 7.2%, and 30-day post-procedure mortality was 8.5%.Conclusions
The TVT Registry is an innovative registry that that monitors quality, patient safety and trends for these rapidly evolving new technologies. 相似文献4.
Pamela E. Scott Ellis F. Unger Marjorie R. Jenkins Mary Ross Southworth Tzu-Yun McDowell Ruth J. Geller Merina Elahi Robert J. Temple Janet Woodcock 《Journal of the American College of Cardiology》2018,71(18):1960-1969
Background
Concerns exist that women are underrepresented in trials of cardiovascular medications.Objectives
The authors sought to examine women’s participation and the reported safety and efficacy by gender for pivotal cardiovascular disease (CVD) trials submitted to the U.S. Food and Drug Administration (FDA) supporting marketing applications.Methods
On the basis of publicly available FDA reviews, the authors assessed enrollment of women in trials supporting 36 drug approvals from 2005 to 2015. Prevalence-corrected estimates for the participation of women were calculated as the percentage of women among trial participants divided by the percentage of women in the disease population (participation to prevalence ratio [PPR]), with a range between 0.8 and 1.2 reflecting similar representation of women in the trial and disease population. Sex differences in efficacy and safety were assessed.Results
The proportion of women enrolled ranged from 22% to 81% (mean 46%). The calculated PPR by disease area was within or above the desirable range for atrial fibrillation (0.8 to 1.1), hypertension (0.9), and pulmonary arterial hypertension (1.4); PPR was <0.8 for heart failure (0.5 to 0.6), coronary artery disease (0.6), and acute coronary syndrome/myocardial infarction (0.6). The authors found little indication of clinically meaningful gender differences in efficacy or safety. Gender differences in efficacy or safety were described in labeling for 4 drugs.Conclusions
Women were well represented in trials of drugs for hypertension and atrial fibrillation, and overrepresented for pulmonary arterial hypertension. Representation of women fell below a PPR of 0.8 for trials in heart failure, coronary artery disease, and acute coronary syndrome. Minimal gender differences in drug efficacy and safety profiles were observed. 相似文献5.
Han S. Lim Mélèze Hocini Remi Dubois Arnaud Denis Nicolas Derval Stephan Zellerhoff Seigo Yamashita Benjamin Berte Saagar Mahida Yuki Komatsu Matthew Daly Laurence Jesel Carole Pomier Valentin Meillet Sana Amraoui Ashok J. Shah Hubert Cochet Frédéric Sacher Michel Haïssaguerre 《Journal of the American College of Cardiology》2017,69(10):1257-1269
Background
The underlying mechanisms sustaining human persistent atrial fibrillation (PsAF) is poorly understood.Objectives
This study sought to investigate the complexity and distribution of AF drivers in PsAF of varying durations.Methods
Of 135 consecutive patients with PsAF, 105 patients referred for de novo ablation of PsAF were prospectively recruited. Patients were divided into 3 groups according to AF duration: PsAF presenting in sinus rhythm (AF induced), PsAF <12 months, and PsAF >12 months. Patients wore a 252-electrode vest for body surface mapping. Localized drivers (re-entrant or focal) were identified using phase-mapping algorithms.Results
In this patient cohort, the most prominent re-entrant driver regions included the pulmonary vein (PV) regions and inferoposterior left atrial wall. Focal drivers were observed in 1 or both PV regions in 75% of patients. Comparing between the 3 groups, with longer AF duration AF complexity increased, reflected by increased number of re-entrant rotations (p < 0.05), number of re-entrant rotations and focal events (p < 0.05), and number of regions harboring re-entrant (p < 0.01) and focal (p < 0.05) drivers. With increased AF duration, a higher proportion of patients had multiple extra-PV driver regions, specifically in the inferoposterior left atrium (p < 0.01), superior right atrium (p < 0.05), and inferior right atrium (p < 0.05). Procedural AF termination was achieved in 70% of patients, but decreased with longer AF duration.Conclusions
The complexity of AF drivers increases with prolonged AF duration. Re-entrant and focal drivers are predominantly located in the PV antral and adjacent regions. However, with longer AF duration, multiple drivers are distributed at extra-PV sites. AF termination rate declines as patients progress to longstanding PsAF, underscoring the importance of early intervention. 相似文献6.
Akram Kawsara Iván J. Núñez Gil Fahad Alqahtani Jason Moreland Charanjit S. Rihal Mohamad Alkhouli 《JACC: Cardiovascular Interventions》2018,11(13):1211-1223
Aneurysmal dilation of coronary arteries is observed in up to 5% of patients undergoing coronary angiography. Due to their poorly elucidated underlying mechanisms, their variable presentations, and the lack of largescale outcome data on their various treatment modalities, coronary artery aneurysms and coronary ectasia pose a challenge to the managing clinician. This paper aims to provide a succinct review of aneurysmal coronary disease, with a special emphasis on the challenges associated with its interventional treatment. 相似文献
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Johnny Chahine Amer N. Kadri Rama D. Gajulapalli Amar Krishnaswamy Stephanie Mick Oscar Perez Hassan Lak Raunak M. Nair Bryce Montane James Tak E. Murat Tuzcu Brian Griffin Lars G. Svensson Serge C. Harb Samir R. Kapadia 《JACC: Cardiovascular Interventions》2019,12(22):2299-2306
ObjectivesThe aim of this study was to compare outcomes after transcatheter aortic valve replacement (TAVR) in patients with pure aortic stenosis (AS) (i.e., no or trivial associated aortic regurgitation [AR]) with those in patients with AS and mild or more severe AR (i.e., mixed aortic valve disease [MAVD]).BackgroundTAVR is indicated in treating patients with severe AS. Limited data exist regarding the outcomes of TAVR in patients with MAVD.MethodsA total of 1,133 patients who underwent TAVR between January 2014 and December 2017 were included. The primary outcome was all-cause mortality. The comparison was adjusted to account for post-TAVR AR development in both groups. The secondary outcomes included composite endpoints of early safety and clinical efficacy as specified in the Valve Academic Research Consortium-2 criteria. Variables were compared using Mann-Whitney, chi-square, and Fisher exact tests, while Kaplan-Meier analyses were used to compare survival.ResultsA total of 688 patients (61%) had MAVD (median age 83 years , 43% women). Among these, 17% developed mild, 2% moderate, and <1% severe post-TAVR AR. Overall, patients with MAVD had better survival compared with patients with pure AS (p = 0.03). Among patients who developed post-TAVR AR, those in the MAVD group had better survival (p = 0.04). In contrast, in patients who did not develop post-TAVR AR, pre-TAVR AR did not improve survival (p = 0.11).ConclusionsPatients with MAVD who underwent TAVR had better survival compared with patients with pure AS. This is explained by the better survival of patients with MAVD who developed post-TAVR AR, likely due to left ventricular adaptation to AR. 相似文献
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Esther Toes-Zoutendijk Monique E. van Leerdam Evelien Dekker Frank van Hees Corine Penning Iris Nagtegaal Miriam P. van der Meulen Anneke J. van Vuuren Ernst J. Kuipers Johannes M.G. Bonfrer Katharina Biermann Maarten G.J. Thomeer Harriët van Veldhuizen Sonja Kroep Marjolein van Ballegooijen Gerrit A. Meijer Harry J. de Koning Manon C.W. Spaander M.A. Blankenstein 《Gastroenterology》2017,152(4):767-775.e2
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Antonios Douros Laurent Azoulay Hui Yin Samy Suissa Christel Renoux 《Journal of the American College of Cardiology》2018,71(10):1105-1113
Background
Non–vitamin K antagonist oral anticoagulants (NOACs) are relatively new drugs used for stroke prevention in nonvalvular atrial fibrillation (NVAF). However, there are concerns that their use may be associated with hepatotoxic effects.Objectives
The purpose of this study was to determine whether the use of NOACs is associated with an increased risk of serious liver injury compared with the use of vitamin K antagonists (VKAs) in NVAF patients with and without prior liver disease.Methods
Using the administrative databases of the Canadian province of Quebec’s health insurances, the authors conducted a cohort study among patients newly diagnosed with NVAF between January 2011 and December 2014. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of serious liver injury (defined as either a hospitalization or related death) were estimated using time-dependent Cox proportional hazards models, comparing current use of NOACs to current use of VKAs separately among patients with or without prior liver disease.Results
The cohort comprised 51,887 patients, including 3,778 with prior liver disease. During 68,739 person-years of follow-up, 585 patients experienced a serious liver injury. Compared with current use of VKAs, current use of NOACs was not associated with an increased risk of serious liver injury in patients without or with prior liver disease (adjusted HR: 0.99; 95% CI: 0.68 to 1.45; and adjusted HR: 0.68; 95% CI: 0.33 to 1.37, respectively).Conclusions
Compared with VKAs, NOACs were not associated with an increased risk of serious liver injury irrespective of baseline liver status. Overall, these results provide reassurance regarding the hepatic safety of NOACs. 相似文献12.
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Sofia Chatzidou Christos Kontogiannis Diamantis I. Tsilimigras Georgios Georgiopoulos Marinos Kosmopoulos Elektra Papadopoulou Georgios Vasilopoulos Stylianos Rokas 《Journal of the American College of Cardiology》2018,71(17):1897-1906
Background
Electrical storm (ES), characterized by unrelenting recurrences of ventricular arrhythmias, is observed in approximately 30% of patients with implantable cardioverter-defibrillators (ICDs) and is associated with high mortality rates.Objectives
Sympathetic blockade with β-blockers, usually in combination with intravenous (IV) amiodarone, have proved highly effective in the suppression of ES. In this study, we compared the efficacy of a nonselective β-blocker (propranolol) versus a β1-selective blocker (metoprolol) in the management of ES.Methods
Between 2011 and 2016, 60 ICD patients (45 men, mean age 65.0 ± 8.5 years) with ES developed within 24 h from admission were randomly assigned to therapy with either propranolol (160 mg/24 h, Group A) or metoprolol (200 mg/24 h, Group B), combined with IV amiodarone for 48 h.Results
Patients under propranolol therapy in comparison with metoprolol-treated individuals presented a 2.67 times decreased incidence rate (incidence rate ratio: 0.375; 95% confidence interval: 0.207 to 0.678; p = 0.001) of ventricular arrhythmic events (tachycardia or fibrillation) and a 2.34 times decreased rate of ICD discharges (incidence rate ratio: 0.428; 95% CI: 0.227 to 0.892; p = 0.004) during the intensive care unit (ICU) stay, after adjusting for age, sex, ejection fraction, New York Heart Association functional class, heart failure type, arrhythmia type, and arrhythmic events before ICU admission. At the end of the first 24-h treatment period, 27 of 30 (90.0%) patients in group A, while only 16 of 30 (53.3%) patients in group B were free of arrhythmic events (p = 0.03). The termination of arrhythmic events was 77.5% less likely in Group B compared with Group A (hazard ratio: 0.225; 95% CI: 0.112 to 0.453; p < 0.001). Time to arrhythmia termination and length of hospital stay were significantly shorter in the propranolol group (p < 0.05 for both).Conclusions
The combination of IV amiodarone and oral propranolol is safe, effective, and superior to the combination of IV amiodarone and oral metoprolol in the management of ES in ICD patients. 相似文献15.
The diagnosis of cardiac device infections, particularly device-related endocarditis, is challenging. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is based on in vivo FDG targeting of the pre-existing inflammatory cells at an infectious site. Hence, it is able to identify cardiac device infection early, before the development of morphological damages from the infectious process. Transesophageal echocardiography (TEE) and electrocardiographically gated computed tomographic angiography (CTA) are currently the first-line imaging studies for device-related endocarditis, but their application to evaluate the extracardiac components or sources of primary infection and/or emboli is limited. Functional FDG PET/CT may have unique advantages over the anatomically based TEE and CT or CTA in the following settings: 1) diagnosing infection earlier than TEE and CTA, before morphological damage ensues; 2) identifying prosthetic endocarditis when findings on TEE and CTA are inconclusive; 3) evaluating infection in the extracardiac components of devices; 4) detecting unexpected source of the primary infection; and 5) discovering embolic consequences of endocarditis in the body. All of these findings may ultimately affect patient management. Although the nonspecific nature of FDG is a concern in differentiating infection from inflammation, accurate diagnosis of infection can be reasonably achieved on the basis of FDG distribution pattern and clinical history or by adding radiolabeled white blood cell scan to improve specificity. Recent publications support the judicious use of FDG PET/CT, particularly in patients with inconclusive or negative results on initial echocardiography and CT. 相似文献
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Sean M. Davidson Péter Ferdinandy Ioanna Andreadou Hans Erik Bøtker Gerd Heusch Borja Ibáñez Michel Ovize Rainer Schulz Derek M. Yellon Derek J. Hausenloy David Garcia-Dorado 《Journal of the American College of Cardiology》2019,73(1):89-99
Many treatments have been identified that confer robust cardioprotection in experimental animal models of acute ischemia and reperfusion injury. However, translation of these cardioprotective therapies into the clinical setting of acute myocardial infarction (AMI) for patient benefit has been disappointing. One important reason might be that AMI is multifactorial, causing cardiomyocyte death via multiple mechanisms, as well as affecting other cell types, including platelets, fibroblasts, endothelial and smooth muscle cells, and immune cells. Many cardioprotective strategies act through common end-effectors and may be suboptimal in patients with comorbidities. In this regard, emerging data suggest that optimal cardioprotection may require the combination of additive or synergistic multitarget therapies. This review will present an overview of the state of cardioprotection today and provide a roadmap for how we might progress towards successful clinical use of cardioprotective therapies following AMI, focusing on the rational combination of judiciously selected, multitarget therapies. This paper emerged as part of the discussions of the European Union (EU)-CARDIOPROTECTION Cooperation in Science and Technology (COST) Action, CA16225. 相似文献
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Seoyoung C. Kim Tuhina Neogi Eun Ha Kang Jun Liu Rishi J. Desai MaryAnn Zhang Daniel H. Solomon 《Journal of the American College of Cardiology》2018,71(9):994-1004
Background
Patients with gout are at an increased risk of cardiovascular (CV) disease including myocardial infarction (MI), stroke, and heart failure (HF).Objectives
The authors conducted a cohort study to examine comparative CV safety of the 2 gout treatments—probenecid and allopurinol—in patients with gout.Methods
Among gout patients ≥65 years of age and enrolled in Medicare (2008 to 2013), those who initiated probenecid or allopurinol were identified. The primary outcome was a composite CV endpoint of hospitalization for MI or stroke. MI, stroke, coronary revascularization, HF, and mortality were assessed separately as secondary outcomes. The authors estimated the incidence rate and hazard ratio of the primary and secondary outcomes in the 1:3 propensity score–matched cohort of probenecid and allopurinol initiators.Results
A total of 9,722 probenecid initiators propensity score–matched to 29,166 allopurinol initiators with mean age of 76 ± 7 years, and 54% males were included. The incidence rate of the primary composite endpoint of MI or stroke per 100 person-years was 2.36 in probenecid and 2.83 in allopurinol initiators with a hazard ratio of 0.80 (95% confidence interval: 0.69 to 0.93). In the secondary analyses, probenecid was associated with a decreased risk of MI, stroke, HF exacerbation, and mortality versus allopurinol. These results were consistent in the subgroup analyses of patients without baseline CV disease or those without baseline chronic kidney disease.Conclusions
In this large cohort of 38,888 elderly gout patients, treatment with probenecid appears to be associated with a modestly decreased risk of CV events including MI, stroke, and HF exacerbation compared with allopurinol. 相似文献18.
Christopher Ma Isra M. Hussein Yousef J. Al-Abbar Remo Panaccione Richard N. Fedorak Claire E. Parker Tran M. Nguyen Reena Khanna Corey A. Siegel Laurent Peyrin-Biroulet Rish K. Pai Niels Vande Casteele Geert R. D’Haens William J. Sandborn Brian G. Feagan Vipul Jairath 《Clinical gastroenterology and hepatology》2018,16(9):1407-1419.e22
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Stephen G. Ellis Tommaso Gori Patrick W. Serruys Holger Nef Giuseppe Steffenino Salvatore Brugaletta Thomas Munzel Cordula Feliz Götz Schmidt Manel Sabaté Yoshinobu Onuma R.J. van Geuns Run-Lin Gao Maurizio Menichelli Dean J. Kereiakes Gregg W. Stone Luca Testa Takeshi Kimura Alexandre Abizaid 《JACC: Cardiovascular Interventions》2018,11(7):638-644