Introduction
According to the WHO's World Health Report 2003, 1cardiovascular disease was responsible for 16.7 million deaths annually. As a result, it is now the leading cause of death in developed count... Introduction
According to the WHO's World Health Report 2003, 1cardiovascular disease was responsible for 16.7 million deaths annually. As a result, it is now the leading cause of death in developed countries and in many developing countries. Detecting and preventing the progression of coronary artery disease is the target of many pharmaceutical, technological and other scientific programs today. Presently, the main diagnostic tool for evaluating coronary arteries is thc conventional coronary angiogram (CCA).……展开更多
OBJECTIVES Whether left atrial appendage closure(LAAC)in octogenarians yield similar net clinical benefit compared to younger patients,was the purpose of the present study.METHODS Two real-world LAAC registries,enroll...OBJECTIVES Whether left atrial appendage closure(LAAC)in octogenarians yield similar net clinical benefit compared to younger patients,was the purpose of the present study.METHODS Two real-world LAAC registries,enrolling 744 consecutive Amplatzer and Watchman patients from 2009 to 2018,were retrospectively analyzed.RESULTS All events are reported per 100 patient-years.Two hundred and sixty one octogenarians and 483 non-octogenarians with a mean follow-up of 1.7±1.3 and 2.3±1.6 years,and a total of 1,502 patient-years were included.Octogenarians had a higher risk for stroke(CHA2DS2-VASc score:5.2±1.2 vs.4.3±1.7,P<0.0001)and bleeding(HAS-BLED score:3.3±0.8 vs.3.1±1.1,P=0.001).The combined safety endpoint of major periprocedural complications and major bleeding events at follow-up was comparable(30/446,6.7%vs.47/1056,4.4%;hazard ratio[HR]=1.2;95%confidence interval[CI]:0.73−1.98;P=0.48)between the groups.The efficacy endpoint of all-cause stroke,systemic embolism,and cardiovascular/unexplained death occurred more often in octogenarians(61/446,13.7%vs.80/1056,7.6%;HR=7.0;95%CI:4.53−10.93;P<0.0001).Overall,octogenarians had a lower net clinical benefit,i.e.,the composite of all above mentioned hazards,from LAAC compared to younger patients(82/446,18.4%vs.116/1056,11.0%;HR=4.6;95%CI:3.11−7.0;P<0.0001).Compared to the anticipated stroke rate,the observed rate de-creased by 41%in octogenarians and 53%in non-octogenarians.The observed bleeding rate was reduced by 10%octogenarians and 41%non-octogenarians.CONCLUSIONS LAAC can be performed with similar safety in octogenarians as compared to younger patients.On the long-term,it both reduces stroke and bleeding events,although to a lesser extent than in non-octogenarians.展开更多
Objectives: There is an increasing use of three-dimensional rotational angiography (3D-RA) during catheterization of congenital heart disease. Dose-area-product (DAP) measured by the angiography system and computed-to...Objectives: There is an increasing use of three-dimensional rotational angiography (3D-RA) during catheterization of congenital heart disease. Dose-area-product (DAP) measured by the angiography system and computed-tomography dose index (CTDI) do not appear practical for dose assessment. Hence, we performed real dose measurements in anthropomorphic phantoms. Methods: Three different anthropomorphic phantoms (10 kg, 19 kg and 73 kg bodyweight) equipped with thermoluminescent dosimeters (TLD) were used. We used a typical standard diagnostic program and a low-dose program. The effective dose (ED) was calculated according to the International Commission on Radiological Protection (ICRP) 103. The 3D distribution of radiation in the body was assessed. Results: ED for the male 10 kg phantom was 0.192 mSv in the diagnostic program and 0.050 mSv (male) in the low-dose program. The 19 kg phantom received an ED of 0.205 mSv (male) in the diagnostic program. In the low-dose program the ED reached 0.058 mSv (male). The male adult 73 kg phantom was exposed with an ED of 0.730 mSv in the diagnostic program and 0.282 mSv in the low-dose program. ED for the female phantoms was slightly higher for both acquisition-programs. Dose distribution was inhomogeneous with a dose maximum in the esophageal region behind the heart, whereas in the brain, intestine and gonads we found nearly no radiation. Conclusions: 3D-RA imaging in the interventional catheter laboratory is possible with an effective dose lower than 1 mSv. With its potential to reduce fluoroscopic time and the number of control angiographies in catheterization and intervention in complex anatomy, it can decrease the radiation dose.展开更多
Introduction Myocardial injury related to acute ischaemic stroke is common even without primary cardiac disease.We intended to determine associations between values of left ventricular ejection fraction(LVEF)and ischa...Introduction Myocardial injury related to acute ischaemic stroke is common even without primary cardiac disease.We intended to determine associations between values of left ventricular ejection fraction(LVEF)and ischaemic stroke lesion sites.Methods Of a local database,patients with acute first-ever ischaemic stroke confirmed by brain imaging but without pre-existing heart disease were included.The cardiac morphology and LVEF were obtained from transthoracic or transesophageal echocardiography,and impaired LVEF was categorised as mild(35%-50%),moderate(34%-25%)and severe(<25%).Patient age,stroke severity,ischaemic lesion volume,prevalence of troponin I increase(>0.1 ng/mL),atrial fibrillation and cardiac wall motion abnormalities were assessed and compared between patients with and without impaired LVEF after stroke(significance:p<0.05).A multivariate voxelwise lesion analysis correlated LVEF after stroke with sites of ischaemic lesions.Results Of 1209 patients who had a stroke,231(mean age 66.3±14.0 years)met the inclusion criteria;40 patients(17.3%)had an impaired LVEF after stroke.Patients with impaired LVEF had higher infarct volumes(53.8 mL vs 30.0 mL,p=0.042),a higher prevalence of troponin increase(17.5%vs 4.2%,p=0.006),cardiac wall motion abnormalities(42.5%vs 5.2%,p<0.001)and atrial fibrillation(60.0%vs 26.2%,p<0.001)than patients with LVEF of>50%.The multivariate voxelwise lesion analysis yielded associations between decreased LVEF and damaged voxels in the insula,amygdala and operculum of the right hemisphere.Conclusion Our imaging analysis unveils a prominent role of the right hemispheric central autonomic network,especially of the insular cortex,in the brain-heart axis.Our results support preliminary evidence that acute ischaemic stroke in distinct brain regions of the central autonomic network may directly impair cardiac function and thus further supports the concept of a distinct stroke-heart syndrome.展开更多
文摘 Introduction
According to the WHO's World Health Report 2003, 1cardiovascular disease was responsible for 16.7 million deaths annually. As a result, it is now the leading cause of death in developed countries and in many developing countries. Detecting and preventing the progression of coronary artery disease is the target of many pharmaceutical, technological and other scientific programs today. Presently, the main diagnostic tool for evaluating coronary arteries is thc conventional coronary angiogram (CCA).……
文摘OBJECTIVES Whether left atrial appendage closure(LAAC)in octogenarians yield similar net clinical benefit compared to younger patients,was the purpose of the present study.METHODS Two real-world LAAC registries,enrolling 744 consecutive Amplatzer and Watchman patients from 2009 to 2018,were retrospectively analyzed.RESULTS All events are reported per 100 patient-years.Two hundred and sixty one octogenarians and 483 non-octogenarians with a mean follow-up of 1.7±1.3 and 2.3±1.6 years,and a total of 1,502 patient-years were included.Octogenarians had a higher risk for stroke(CHA2DS2-VASc score:5.2±1.2 vs.4.3±1.7,P<0.0001)and bleeding(HAS-BLED score:3.3±0.8 vs.3.1±1.1,P=0.001).The combined safety endpoint of major periprocedural complications and major bleeding events at follow-up was comparable(30/446,6.7%vs.47/1056,4.4%;hazard ratio[HR]=1.2;95%confidence interval[CI]:0.73−1.98;P=0.48)between the groups.The efficacy endpoint of all-cause stroke,systemic embolism,and cardiovascular/unexplained death occurred more often in octogenarians(61/446,13.7%vs.80/1056,7.6%;HR=7.0;95%CI:4.53−10.93;P<0.0001).Overall,octogenarians had a lower net clinical benefit,i.e.,the composite of all above mentioned hazards,from LAAC compared to younger patients(82/446,18.4%vs.116/1056,11.0%;HR=4.6;95%CI:3.11−7.0;P<0.0001).Compared to the anticipated stroke rate,the observed rate de-creased by 41%in octogenarians and 53%in non-octogenarians.The observed bleeding rate was reduced by 10%octogenarians and 41%non-octogenarians.CONCLUSIONS LAAC can be performed with similar safety in octogenarians as compared to younger patients.On the long-term,it both reduces stroke and bleeding events,although to a lesser extent than in non-octogenarians.
文摘Objectives: There is an increasing use of three-dimensional rotational angiography (3D-RA) during catheterization of congenital heart disease. Dose-area-product (DAP) measured by the angiography system and computed-tomography dose index (CTDI) do not appear practical for dose assessment. Hence, we performed real dose measurements in anthropomorphic phantoms. Methods: Three different anthropomorphic phantoms (10 kg, 19 kg and 73 kg bodyweight) equipped with thermoluminescent dosimeters (TLD) were used. We used a typical standard diagnostic program and a low-dose program. The effective dose (ED) was calculated according to the International Commission on Radiological Protection (ICRP) 103. The 3D distribution of radiation in the body was assessed. Results: ED for the male 10 kg phantom was 0.192 mSv in the diagnostic program and 0.050 mSv (male) in the low-dose program. The 19 kg phantom received an ED of 0.205 mSv (male) in the diagnostic program. In the low-dose program the ED reached 0.058 mSv (male). The male adult 73 kg phantom was exposed with an ED of 0.730 mSv in the diagnostic program and 0.282 mSv in the low-dose program. ED for the female phantoms was slightly higher for both acquisition-programs. Dose distribution was inhomogeneous with a dose maximum in the esophageal region behind the heart, whereas in the brain, intestine and gonads we found nearly no radiation. Conclusions: 3D-RA imaging in the interventional catheter laboratory is possible with an effective dose lower than 1 mSv. With its potential to reduce fluoroscopic time and the number of control angiographies in catheterization and intervention in complex anatomy, it can decrease the radiation dose.
文摘Introduction Myocardial injury related to acute ischaemic stroke is common even without primary cardiac disease.We intended to determine associations between values of left ventricular ejection fraction(LVEF)and ischaemic stroke lesion sites.Methods Of a local database,patients with acute first-ever ischaemic stroke confirmed by brain imaging but without pre-existing heart disease were included.The cardiac morphology and LVEF were obtained from transthoracic or transesophageal echocardiography,and impaired LVEF was categorised as mild(35%-50%),moderate(34%-25%)and severe(<25%).Patient age,stroke severity,ischaemic lesion volume,prevalence of troponin I increase(>0.1 ng/mL),atrial fibrillation and cardiac wall motion abnormalities were assessed and compared between patients with and without impaired LVEF after stroke(significance:p<0.05).A multivariate voxelwise lesion analysis correlated LVEF after stroke with sites of ischaemic lesions.Results Of 1209 patients who had a stroke,231(mean age 66.3±14.0 years)met the inclusion criteria;40 patients(17.3%)had an impaired LVEF after stroke.Patients with impaired LVEF had higher infarct volumes(53.8 mL vs 30.0 mL,p=0.042),a higher prevalence of troponin increase(17.5%vs 4.2%,p=0.006),cardiac wall motion abnormalities(42.5%vs 5.2%,p<0.001)and atrial fibrillation(60.0%vs 26.2%,p<0.001)than patients with LVEF of>50%.The multivariate voxelwise lesion analysis yielded associations between decreased LVEF and damaged voxels in the insula,amygdala and operculum of the right hemisphere.Conclusion Our imaging analysis unveils a prominent role of the right hemispheric central autonomic network,especially of the insular cortex,in the brain-heart axis.Our results support preliminary evidence that acute ischaemic stroke in distinct brain regions of the central autonomic network may directly impair cardiac function and thus further supports the concept of a distinct stroke-heart syndrome.
基金The BigData@Heart project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 116074This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and European Federation of Pharmaceutical Industries and Associations.
