Relacja z kongresu ACC 2018

Kolejna edycja kongresu American College of Cardiology 2018, który miał miejsce w tym roku w dniach 10–12 marca w Orlando, obfitowała w wiele ważnych wyników badań klinicznych dotyczących prewencji oraz leczenia chorób układu sercowo-naczyniowego. Poniżej przedstawiamy subiektywny przegląd najciekawszych spośród nich.Kolejna edycja kongresu American College of Cardiology 2018, który miał miejsce w tym roku w dniach 10-12. marca w Orlando, obfitowała w wiele ważnych wyników badań klinicznych dotyczących prewencji oraz leczenia chorób układu sercowo-naczyniowego. Poniżej przedstawiamy subiektywny przegląd najciekawszych spośród nich

Independent predictors of early mortality after coronary artery bypass grafting in a single centre experience — does gender matter?

Wstęp: Powszechnie uważa się, że kobiety poddawane izolowanemu pomostowaniu aortalno-wieńcowemu (CABG) są obarczone większym ryzykiem okołooperacyjnych powikłań i zgonu. Cel: Celem badania była ocena wpływu płci jako czynnika ryzyka wczesnych powikłań i śmiertelności po izolowanym CABG w krążeniu pozaustrojowym oraz ocena profilu ryzyka warunkowanego przez płeć pacjenta. Metody: Analizie poddano dane pochodzące z wszystkich 2194 zabiegów wykonanych w Klinice Kardiochirurgii Uniwersytetu Medycznego w Łodzi w okresie między styczniem 2009 a marcem 2011 roku. Dla celów badania skonstruowano bazę danych opartą na retrospektywnej analizie zmiennych zawartych w formularzach Krajowego Rejestru Operacji Kardiochirurgicznych. Wyniki: Izolowane CABG w krążeniu pozaustrojowym wykonano u 1303 pacjentów (59,4% wszystkich zabiegów). Kobiety stanowiły mniejszość (24,2%) i były starsze od mężczyzn (średni wiek 67,3 vs. 62,8 roku; p < 0,001). Istotnie częściej chorowały na cukrzycę (43,1% vs. 33,41%, p = 0,003), charakteryzowały się gorszą funkcją nerek (mediana eGFR 88,5 vs. 95,0 ml/min/1,73 m2; p < 0,001) oraz rzadziej paliły tytoń (54,1% vs. 83,0%; p < 0,001). Tętnicę piersiową wewnętrzną rzadziej wykorzystywano jako pomost w grupie kobiet (84,8% vs. 95,0%; p < 0,001). Kobiety były obarczone wyższym ryzykiem wystąpienia ostrego zawału pooperacyjnego (5,5% vs. 2,9%; p = 0,03) oraz rzadziej wymagały reoperacji (4,5% vs. 8,1%; p = 0,04). Wśród kobiet zaobserwowano wyższą śmiertelność 30-dniową (7,6% vs. 2,8%; p < 0,001), a płeć żeńska w analizie wieloczynnikowej regresji logistycznej okazała się niezależnym predyktorem zgonu (OR = 1,8; 95% CI 1,2–2,7). Wnioski: Kobiety poddawane izolowanemu CABG charakteryzują się wyższą śmiertelnością 30-dniową. Płeć żeńska jest niezależnym czynnikiem ryzyka zgonu po izolowanym CABG. Należy przeprowadzić kolejne badania w celu identyfikacji przyczyn odmienności w rokowaniu wśród kobiet.Background: It is commonly believed that women undergoing isolated coronary artery bypass graft surgery (CABG) are subject to a higher risk of perioperative complications and death. Aim: To evaluate the effect of sex as a risk factor on early complications and mortality after isolated CABG performed with cardiopulmonary bypass, and to evaluate the profile of the risk determined by the patient’s sex. Methods: Data derived from 2,194 surgical procedures performed in the Department of Cardiac Surgery at the Medical University of Lodz between January 2009 and March 2011 was analysed. The database was constructed on the basis of retrospective analysis of variables contained in a form of the National Registry of Cardiac Surgery. Results: Isolated CABG with cardiopulmonary bypass was carried out in 1,303 patients (59.4% of all procedures). Women constituted the minority of patients (24.2%), and were significantly older (mean age 67.3 vs. 62.8 years, p < 0.001). They more often suffered from concomitant diabetes (43.1% vs. 33.41%, p = 0.003), had impaired renal function (median eGFR 88.5 vs. 95.0 mL/min1/1.73 m2, p < 0.001), and had a history of smoking in fewer cases (54.1% vs. 83.0%, p < 0.001). Internal mammary artery was more rarely used as arterial graft in the group of women (84.8% vs. 95.0%, p < 0.001). Women were subject to a higher risk of recent postoperative myocardial infarction (5.5% vs. 2.9%, p = 0.03) and required reoperation more rarely than men (4.5% vs. 8.1%, p = 0.04). Higher 30-day mortality was observed among women (7.6% vs. 2.8%, p < 0.001) and female sex appeared to be an independent predictor of death in the multiple logistic regression analysis (OR = 1.8; 95% CI 1.2–2.7). Conclusions: Women undergoing isolated CABG are subject to higher 30-day mortality. Female sex is an independent risk factor for death after isolated CABG. Further studies are necessary to identify causes of differences in prognoses among women

The differences in the relationship between diastolic dysfunction, selected biomarkers and collagen turn-over in heart failure patients with preserved and reduced ejection fraction

Background: The aim of the study was to assess the correlation of the selected biomarkers and collagen turn-over indices with advanced echocardiographic parameters among patients with preserved and reduced ejection fraction (EF). Methods: We included 62 patients with the symptomatic heart failure. The patients were divided in to two groups according to the evaluated ejection fraction (EF — Simpson method): heart failure with reduced ejection fraction (HFrEF) group — 30 patients with low EF — 35–50% (16 male, mean age 54.9 ± 12.6), heart failure with preserved ejection fraction (HFpEF) group — 32 patients with EF > 50% (16 male, mean age 62.3 ± 7.6). Clinical evaluation included 6-min walk test, biochemistry, procollagen type I N-terminal propeptide (PINP), procollagen type III N-terminal propetide (PIIINP), matrix metaloproteinase-2 (MMP2), ghrelin, and galectin-3 levels measurements. Echocardiographic examination was performed with analysis of diastolic function and global longitudinal strain (GLS). Results: The GLS in the HFrEF group was significantly lower than in the HFpEF group at the baseline (GLS: 9.56 vs. 16.03, p < 0.01). There was a strong negative correlation of the PIIINP and GLS in HFrEF group (r = –0.74, p = 0.005), but only a moderate negative correlation in HFpEF (r = –0.55, p = 0.02). In the HFrEF group, there was a moderate negative correlation between the baseline level of galectin-3 and GLS (r = –0.59, p = 0.03). The correlation of ghrelin and tissue inhibitor of matrix metalloproteinase-1 with EF in the HFrEF group was moderate and statistically significant (r = 0.62, p = 0.02 and r = –0.63, p = 0.02, respectively). Conclusions: Procollagen type III peptide has a strong negative correlation with left ventricular GLS. Galectin-3 relationship with strain may indicate novel pathophysiological pathways and requires further investigation.

Usefulness of assessment of fractional flow reserve and coronary flow velocity reserve in determination of the significance of borderline stenoses in the anterior descending artery in patients with multivessel disease

Introduction. Assessment of the significance of borderline stenosis in the area of the anterior descending artery in patients with multivessel coronary artery disease is a challenge. Currently, ractional flow reserve (FFR) and coronary flow reverse (CFR) methods are available. Aim. The aim of the study was to compare the usefulness of fractional flow reverse (FFR) and CFR methods in the assessment of left anterior descending artery (LAD) borderline stenosis in patients with multivessel coronary disease (MVD) and isolated LAD stenosis. Material and methods. We examined 100 patients with suspected ischemic heart disease. The examination revealed MVD disease with borderline stenosis of the LAD in 23 patients. Significant changes were confirmed with FFR and CFR. Results. Abnormal FFR (82% vs. 22%; p &lt; 0.001) and abnormal CFR (32% vs. 12%; p = 0.029) were significantly more commonly observed in patients with MVD. The mean FFR (0.76 vs. 0.84; p &lt; 0.001), the mean CFR (2.13 vs. 2.31; p = 0.075). Positive CFR and FFR values were found in 7 MVD patients and in 3 patients with single-vessel lesions (32% vs. 4%; p &lt; 0.001). Negative CFR and positive FFR values were noted in 11 patients with MVD and 14 with lesions only in LAD (50% vs. 18%; p &lt; 0.001). Positive CFR and negative FFR 0 vs 6 patients (0% vs. 8%; p &lt; 0.001). Negative CFR and negative FFR were obtained in 4 patients from the MVD group and in 55 patients from the group of borderline stenosis only in LAD (18% vs. 71%; p &lt; 0.001). MACE was observed significantly more frequently in the MVD group than in the group of patients with borderline lesions only in LAD (47% vs. 6%; p = 0.004). Conclusions. Positive FFR and CFR results correlate with more frequent MACE episodes.Introduction. Assessment of the significance of borderline stenosis in the area of the anterior descending artery in patients with multivessel coronary artery disease is a challenge. Currently, ractional flow reserve (FFR) and coronary flow reverse (CFR) methods are available. Aim. The aim of the study was to compare the usefulness of fractional flow reverse (FFR) and CFR methods in the assessment of left anterior descending artery (LAD) borderline stenosis in patients with multivessel coronary disease (MVD) and isolated LAD stenosis. Material and methods. We examined 100 patients with suspected ischemic heart disease. The examination revealed MVD disease with borderline stenosis of the LAD in 23 patients. Significant changes were confirmed with FFR and CFR. Results. Abnormal FFR (82% vs. 22%; p < 0.001) and abnormal CFR (32% vs. 12%; p = 0.029) were significantly more commonly observed in patients with MVD. The mean FFR (0.76 vs. 0.84; p < 0.001), the mean CFR (2.13 vs. 2.31; p = 0.075). Positive CFR and FFR values were found in 7 MVD patients and in 3 patients with single-vessel lesions (32% vs. 4%; p < 0.001). Negative CFR and positive FFR values were noted in 11 patients with MVD and 14 with lesions only in LAD (50% vs. 18%; p < 0.001). Positive CFR and negative FFR 0 vs 6 patients (0% vs. 8%; p < 0.001). Negative CFR and negative FFR were obtained in 4 patients from the MVD group and in 55 patients from the group of borderline stenosis only in LAD (18% vs. 71%; p < 0.001). MACE was observed significantly more frequently in the MVD group than in the group of patients with borderline lesions only in LAD (47% vs. 6%; p = 0.004). Conclusions. Positive FFR and CFR results correlate with more frequent MACE episodes