Postepy W Kardiologii Interwencyjnej最新文献

Introduction: The Fibrosis-4 (FIB-4) index is used to assess the risk of liver fibrosis but is also a cardiovascular risk factor.

Aim: To analyze the impact of FIB-4 on the incidence of contrast-induced nephropathy (CIN) and clinical outcomes in acute coronary syndrome (ACS).

Material and methods: A retrospective study included 1465 patients with ACS who underwent coronary angiography or percutaneous coronary intervention (PCI) and were stratified according to FIB-4 levels: < 1.45, 1.45-3.25, and ≥ 3.25.

Results: The subgroup with FIB-4 index ≥ 3.25 showed the highest incidence of CIN (4.8% vs. 5.9% vs. 10.0%; p = 0.018), as well as the highest mortality rates at 30 days (1.9% vs. 1.8% vs. 8.0%; p < 0.001) and at 365 days (5.2% vs. 6.7% vs. 18.1%; p < 0.001). This subgroup also had the highest combined rates of death or hospitalization at both 30 days (3.1% vs. 3.5% vs. 9.6%; p < 0.001) and 365 days (12.7% vs. 20.3% vs. 30.5%; p < 0.001). In multivariable models, factors associated with 30-day mortality included a history of stroke (HR > 6), occurrence of CIN (HR > 6), and high FIB-4 index group (HR > 3.5). Additionally, high-sensitive troponin T (hs-TnT) levels were associated with a 3% mortality increase with each 100 ng/l increase. For 1-year mortality, multivariable analysis identified male gender (HR = 1.97), high FIB-4 (≥ 3.25, HR = 2.21), and CIN (HR = 2.76) as independent predictors.

Conclusions: The subgroup of patients with a high FIB-4 index is characterized by a higher percentage of CIN, hospitalizations, and deaths from ACS. A high FIB-4 index value is an independent predictor of short- and long-term mortality. The FIB-4 index is an additional risk factor for poor prognosis in patients with ACS.

Introduction: De novo heart failure (DNHF) and acute decompensated chronic heart failure (ADCHF) represent two distinct subtypes of acute heart failure (AHF).

Aim: To investigate whether the predictive value of the triglyceride-glucose index (TyG) for 5-year all-cause mortality differs between patients with DNHF and those with ADCHF.

Material and methods: 1160 patients out of 1740 hospitalized AHF patients were recruited and were classified into DNHF (n = 536) and ADCHF (n = 624) groups. All participants were followed up for a 5-year period, with the primary endpoint being all-cause mortality.

Results: DNHF patients had lower TyG levels than ADCHF patients (p < 0.001). Higher TyG levels were associated with increased 5-year mortality in ADCHF patients (log-rank p < 0.001), but not in DNHF patients (log-rank p = 0.97). TyG acted as an independent predictor of mortality in ADCHF patients (adjusted HR = 2.72 [95% CI: 1.93-3.85], p < 0.001), but not in DNHF patients (unadjusted HR = 1.15 [95% CI: 0.68-1.94], p = 0.61). In ADCHF patients, TyG had a good predictive power for 5-year mortality (AUC = 0.852; 95% CI: 0.821-0.884) and was superior to EFFECT risk of death score and NT-proBNP. TyG was not significantly associated with 5-year all-cause mortality in DNHF patients (non-linear p = 0.19). However, in ADCHF patients, when the TyG value exceeded 10.36, the risk of all-cause mortality in non-diabetic AHF patients was significantly increased (HR increased 2.96, 95% CI: 2.48-3.52, non-linear p = 0.024).

Conclusions: Among non-diabetic patients, TyG index was significantly associated with 5-year all-cause mortality in ADCHF patients but not in DNHF patients. Differentiating the predictive value of TyG between DNHF and ADCHF patients could enhance our understanding and refine treatment strategies for individuals with AHF.

Introduction: Hypertension is a significant public health concern and a contributor to cardiovascular conditions. Although physicians are essential in preventing and managing hypertension, limited research has been conducted on their own awareness of the condition.

Aim: We aimed to examine the prevalence and awareness of hypertension among doctors in Turkey and identify relevant demographic and behavioral risk factors.

Material and methods: A cross-sectional study was carried out with 178 physicians aged 25 to 64, randomly chosen from 35 healthcare institutions in 24 cities across Turkey. Data collection involved a structured questionnaire that examined hypertension awareness, sociodemographic details, and cardiovascular risk factors, complemented by standardized blood pressure assessments and body measurements. Hypertension was identified based on a systolic blood pressure of ≥ 140 mm Hg and/or a diastolic pressure of ≥ 90 mm Hg, self-reported diagnosis, or the use of antihypertensive drugs.

Results: The overall prevalence of hypertension was 15.7%, with a significantly higher rate among males (20.2%) than females (7.8%) (p = 0.03). Age was a strong predictor, as individuals over 40 years had a markedly higher hypertension prevalence (27.9%) compared to those under 40 (4.3%) (p < 0.001). Body mass index (BMI), smoking, and physical inactivity were also significantly associated with hypertension. Among hypertensive doctors, awareness was 78.5%, though it did not show significant differences based on gender, BMI, or comorbidities.

Conclusions: Despite relatively high awareness levels, hypertension remains prevalent among medical professionals, particularly in older and male doctors. Targeted strategies, such as routine screenings and lifestyle intervention programs, are essential to improve hypertension prevention and management in this population.

Introduction: Subclavian vein occlusion (SVO) is a common complication following pacemaker implantation.

Aim: The study aimed to determine the long-term incidence of SVO following cardiac resynchronization therapy (CRT) implantation using venous Doppler ultrasonography (USG).

Material and methods: This cross-sectional study included 181 patients who underwent CRT implantation and were due for elective battery replacement. Patients in whom venous Doppler USG examination did not reveal subclavian vein flow were pre-diagnosed with SVO. A definitive diagnosis of SVO was made in patients who were pre-diagnosed with SVO using venography on the day of CRT battery replacement. Patients were divided into two groups as patients with and without SVO.

Results: A definitive SVO diagnosis was made in 59 (33%) patients. Patients with SVO were significantly older, were more likely to have hypertension and diabetes mellitus (DM), and had longer duration of CRT implantation than patients without SVO. Venous Doppler USG examination revealed that the respirophasic flow disappeared in all patients with SVO, a continuous flow pattern was present, and the axillary vein flow velocity was significantly lower compared to patients without SVO. Variables found to be significantly associated with SVO in univariate analysis were further evaluated using multivariate logistic regression analysis. Consequently, DM and advanced age were found to be independent variables significantly predicting SVO (p < 0.05 for each case).

Conclusions: Approximately one-third of our sample was diagnosed with definitive SVO in the long term after CRT implantation. Venous Doppler USG is a useful, simple and non-invasive method that can be used for the preliminary diagnosis of SVO.

Introduction: High-power, short-duration radiofrequency ablation (RFA) is considered an effective treatment for atrial fibrillation (AF) patients.

Aim: This study aimed to evaluate long-term outcomes over a follow-up period up to 3 years.

Material and methods: This was a single-center, retrospective real-world study. 132 patients were consecutively enrolled. The effectiveness endpoints included freedom from any atrial arrhythmia during 1-year and 3-year follow-up. The efficiency endpoints included first-pass pulmonary vein isolation (PVI) rate, RFA time, procedure time, and fluoroscopy time. The main safety endpoint was the incidence of acute pericardial tamponade and steam pop.

Results: All patients (n = 132, mean age: 60.1 ±9.7 years, male: 65.9%, left ventricular ejection fraction: 64.3 ±7.8%, persistent AF: 50.8%) achieved acute PVI, and the first-pass PVI rate was 87.9%. During 1-year follow-up, the overall success rate was 82.6%, and the overall success rate was 77.06% in a 3-year follow-up. The mean procedure time, total RFA time, baseline impedance value, and fluoroscopy time were 55.3 ±11.3 min, 36.0 ±8.5 min, 118.5 ±9.4 Ω, and 7.1 ±3.6 min, respectively. Seventy-two (54.6%) patients experienced impedance spike cut-offs during RFA, mostly during PVI at the anterior carina of the right pulmonary vein (RPV) (25.8%), the ridge between the left atrial (LA) appendage and left pulmonary vein (LPV) (22.0%), and the inferior region of the RPV (16.7%). The overall major adverse event rate was 0.8%. The results of Cox regression analysis showed that sex (female), baseline impedance value, and contact force were independent prognostic factors for recurrence during 1-year follow-up.

Conclusions: Ablation index-guided high-power (AI HP) RFA combined with impedance spike cut-off appears to be a safe and effective ablation technique for AF.