Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease

An impaired heart rate recovery (HRR) has been associated with increased risk of cardiovascular events, cardiovascular, and all‐cause mortality. However, the diagnostic ability of HRR for the presence and severity of coronary artery disease (CAD) has not been clearly elucidated. Our aim was to investigate the relationship between HRR and the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score in patients with stable CAD (SCAD). A total of 406 patients with an abnormal treadmill exercise test and ≥50% coronary stenosis on coronary angiography were included. The HRR was calculated by subtracting the HR in the first minute of the recovery period from the maximum HR during exercise. The SYNTAX score ≥23 was accepted as high. Correlation of HRR with SYNTAX score and independent predictors of high SYNTAX score were determined. A high SYNTAX score was present in 172 (42%) patients. Mean HRR was lower in patients with a high SYNTAX score (9.8 ± 4.5 vs. 21.3 ± 9, p < 0.001). The SYNTAX score was negatively correlated with HRR (r: -0.580, p < 0.001). In multivariate logistic regression analysis, peripheral arterial disease (OR: 13.3; 95% CI: 3.120–34.520; p < 0.001), decreased HRR (OR: 0.780; 95% CI: 0.674–0.902; p = 0.001), peak systolic blood pressure (OR: 1.054; 95% CI: 1.023–1.087; p = 0.001), and peak HR (OR: 0.950; 95% CI: 0.923–0.977; p < 0.001) were found to be independent predictors of a high SYNTAX score. Our results showed that HRR is significantly correlated with the SYNTAX score, and a decreased HRR is an independent predictor of a high SYNTAX score in patients with SCAD

Evaluation of Endothelialization After Percutaneous Closure of Paravalvular Leaks

Background and aim of the study. There is limited data regarding the duration of endothelialization following paravalvular leak closure. We aimed to observe the endothelialization process in 2 patients who underwent surgery 6 and 16 months after failed percutaneous mitral paravalvular leak closure, respectively. Methods. Two-dimensional transesophageal echocardiography (2D-TEE) and real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) were utilized to demonstrate mitral paravalvular leaks. The status of endothelialization was explored in the surgery. Results. Two patients underwent percutaneous closure of mitral paravalvular leaks both with 2 occluder devices. The first patient was admitted with dyspnea 6 months later. RT-3D TEE demonstrated a defect around the proximal part of one of the occluder devices. The residual mitral regurgitation was considered moderate to severe by 2D TEE and RT-3D TEE. The patient was referred to surgery in which failed endothelialization of both devices was observed. In the second patient, 2 occluder devices were implanted. He underwent surgery at 16 months due to progressive increase in the severity of mitral regurgitation, which disclosed partially endothelialized closure device. Conclusion. These cases suggest that endothelialization of closure devices may be significantly delayed or even absent for a long time following implantation