Hat der echokardiographisch ermittelte Dyssynchronietyp einen Einfluss auf das Ansprechen auf die kardiale Resynchronisationstherapie?

Problem: Zusammenhang zwischen echokardiographisch ermitteltem Dyssynchronietyp und dem klinischen Langzeitverlauf bei kardialer Resynchronisationstherapie. Methode: Bei 58 Patienten wurde der Response nach CRT untersucht. Echokardiographisch wurden 3 Dyssynchroniemuster unterschieden. Typ I mit Kontraktion der posterolat. Wand zuletzt, Typ II mit Kontraktion der ant. und sept. zuletzt und Typ III ohne Dyssynchronie. Ergebnis: Rückgang des LVEDD vor allem bei Typ I Dyssynchronie mit nichtischämischer Kardiomyopathie. Belastbarkeit vor allem bei Typ I verbessert. Kein Unterschied bei der Mortalität. Diskussion: Bei Typ I sign. Abnahme des LVEDD. Belastbarkeit mit signifikanter Verbesserung beim Dyssynchronietyp I, sodass die Bestimmung der Dyssynchronie als zusätzlicher Baustein der Patientenselektion identifiziert werden kann

Impact of sheath diameter of different sheath types on vascular complications and mortality in transfemoral TAVI approaches using the Proglide closure device.

Evaluation of the impact of the sheath diameter on vascular complications and mortality in transfemoral aortic valve implantation.Between 2012 and 2014, 183 patients underwent the procedure using a sheath diameter of 18-24 F. This collective was divided into two groups: group 1, with a sheath diameter of 18F (G1, n = 94), consisted of patients with 18F Medtronic Sentrant and 18 F Direct Flow sheaths, and group 2 with a sheath diameter of 19-24 F (G2, n = 89) consisted of patients with Edwards expandable e-sheath and Solopath sheaths. Perclose-Proglide® was used as a closure device in all patients.G1 had significantly more female patients (64.9% vs. 46.1% in G2, p = 0.01) and the average BMI was lower (26 ± 4.5% vs. 27.4 ± 4.7%, p = 0.03). There was no significant difference in the incidence of major and minor vascular complications (G1: 12.8% vs. G2: 12.4%, p = 0.9). 30-day mortality was similar in both groups (G1: 6.4 ± 2.5% [95% CI: 0.88-0.98], G2: 3.7 ± 1.9% [95% CI: 0.92-0.99]. The Kaplan Meier analysis of survival revealed no significant differences either.The difference in sheath diameter had no effect on either incidence or severity of vascular complications. There was no impact on mortality either

Impact of routine invasive physiology at time of angiography in patients with multivessel coronary artery disease on reclassification of revascularization strategy results from thedefinereal study

Objectives: This study sought to prospectively assess the impact of routine invasive physiology at the time of angiography on reclassification of therapeutic management of multivessel disease (MVD) patients, and to assess how implementation of instantaneous wave-free ratio (iFR) alters the process. Background: Routine invasive physiology in intermediate coronary lesions at the time of diagnostic angiography, primarily in patients with single-vessel disease and using fractional flow reserve (FFR), reclassifies coronary revascularization management in 26% to 44% of patients. The role of invasive physiology in patients with MVD is unclear. Methods: In 18 centers, 484 patients undergoing diagnostic angiography disclosing MVD with lesions >40% by visual assessment were included. Investigators were asked to prospectively define their initial management strategy based on angiography and clinical information. Invasive physiology (FFR or iFR driven) was then performed and final strategy defined. Initial and final vessel, patient, procedural, and overall management were described. Reclassification was defined as the difference between initial and final strategy. Results: The majority of patients were clinically stable (82.2%). Two- and 3-vessel disease was present in 73.3% and 26.7% of patients, respectively. Lesions investigated were “intermediate” with median percent stenosis, median FFR, and median iFR at 60% (interquartile range [IQR]: 50% to 70%), 0.84 (IQR: 0.78 to 0.90), and 0.92 (IQR: 0.85 to 0.96), respectively. Vessel management was reclassified by physiology in 30.0% (249 of 828) of vessels. Patient and overall management were reclassified in 26.9% (130 of 484) and 45.7% (211 of 484) of patients, respectively. Reclassification rates were high irrespective of initial management (optimal medical therapy, percutaneous coronary intervention, or coronary artery bypass grafting), and performance and results of pre-procedural noninvasive tests. Reclassification of overall management in particular increased with the number of vessels investigated (1 vessel: 37.3%; 2 vessels: 45.0%; 3 vessels: 66.7%; p = 0.002). Incorporating iFR in the decision process was associated with investigation of more vessels (p = 0.04) and higher reclassification (p = 0.0001). Conclusions: In patients with MVD and intermediate coronary lesions, invasive physiology at time of angiography reclassifies revascularization strategy in a large proportion of cases (26.9%) and investigation of more vessels is associated with higher reclassification rates

Complications compared between each group.

<p>The first part of the table presents the individual complications, and the second part the complications is grouped according to the VARC-II classification. Variables are expressed as percentage (number).</p

Baseline characteristics of the entire collective.

<p>(BMI = body mass index, LV EF = left ventricular ejection fraction, AV = aortic valve, PAD = peripheral artery disease, COPD = chronic obstructive pulmonary disease, CAD = cardiac artery disease). Variables are expressed as mean ± standard deviation (median) or percentage (number).</p

Kaplan-Meier mortality analysis in relation to sheath diameter.

<p>Kaplan-Meier mortality analysis in relation to sheath diameter.</p

Vascular complications in the entire collective.

<p>The second part of the table summarizes the complications according to the VARC-II classification. Variables are expressed as mean ± standard deviation (median) or percentage (number).</p

Baseline characteristics compared between the 18 F and 19–24 F group.

<p>Variables are expressed as mean ± standard deviation (median) or percentage (number).</p

Results of the multivariate analysis regarding the vascular complications.

<p>Results of the multivariate analysis regarding the vascular complications.</p