Important and interesting articles are published annually in the most important publications in cardiovascular medicine. An overview.
In the area of original research achievement, Prof. Dr. med. Dr. h.c. Ch. Bode, Freiburg, et al. A paper by Lee JM et al. ago [1]. This dealt with prospective fractional flow reserve (FFR) measurement in all three major coronary vessels in 1136 patients with coronary artery disease. The patient clientele was then divided into a group with low or high 3-V FFR. It is shown that in terms of MACE (death, stroke, ischemia-related repeat revascularization) after two years, the patients with a low 3-V FFR also had a worse prognosis. “Since this is a physiological measurement and not a biomarker, I think this study is very interesting,” Bode said. Thus, the 3-V FFR could be used as a prognostic functional parameter in the decision making of the therapeutic strategy in patients with CHD.
Paying attention to potassium levels in heart failure
Prof. Dr. med. S. Frantz, Würzburg, Germany, dealt with the association between hypo- and hyperkalemia and mortality. In a cohort of approximately 15 000 patients with acute heart failure, it is shown that particularly high or low potassium levels have a negative prognostic impact [2]. With regard to the medical therapy of heart failure with reduced pump function, it has been shown that renal function has an influence on mortality. The worse the kidney function, the lower the survival. “In contrast, the administration of diuretics and also the use of mineralocorticoid receptor antagonists and ACE inhibitors had no effect on the outcome,” Frantz said. “Apparently, beta-blockers could be prognostically favorable. However, this is an epidemiologic phenomenon because it was not a clinical intervention study.”
Risk of thrombosis in atrial fibrillation
Prof. Chr. Veltmann, Hannover, MD, addressed the prevalence of left atrial thrombi before planned catheter ablation for atrial fibrillation [3]. According to the current standard, patients undergo TOE. “However, there is already preliminary data that it is possible to dispense with the procedure, which is very stressful for patients,” Veltmann explained. 447 patients with a Vit. K antagonists and 496 patients taking NOAKs were subjected to the study. At 0.3%, the prevalence of LAA thrombus was very low. “What was interesting was that the patients with LAA thrombus all had persistent AF, were in AF at the time of the study, and were treated with Wafarin,” the expert said. Accordingly, one might consider whether patients at low risk for thrombus who are efficiently anticoagulated and in sinus rhythm really need to undergo TOE.
Load limits in aortic valve stenosis
16 TAVI patients were treated with dobutamine infusions before and after implantation, Prof. V. Rudolph, MD, Bad Oeyenhausen, Germany, elaborated [4]. An FFR wire was placed in the aorta and left ventricle for continuous measurement of the transvalvular pressure gradient. A pulmonary artery catheter assessed cardiac output by thermodilution. “The basis was the finding from image morphology studies that the geometry of aortic valve stenosis is not constant,” Rudolph explained. However, neither linear resistance nor quadratic aperture models predict the loading gradient. “It is impossible to predict how the pressure rise will behave under load,” the expert opined. In clinical terms, this means that a patient may not have relevant aortic valve stenosis at rest, but it then becomes relevant during exercise.
Source: 85th Annual Meeting of the DGK
Literature:
- Lee JM, et al: Clinical implications of three-vessel fractional flow reserve measurement in patients with coronary artery disease. Eur Heart J 2018; 39: 945-951.
- Legrand M, et al: Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications. Clin Res Cardiol 2018; 107: 214-221.
- Alqarawi W, et al: Prevalence of left atrial appendage thrombus detected by transesophageal echocardiography before catheter ablation of atrial fibrillation in patients anticoagulated with non-vitamin K antagonist oral anticoagulants. Europace 2019; 21: 48-53.
- Johnson NP, et al: Pressure gradient vs. flow relationship to characterize the physiology of a severely stenotic aortic valve before and after transcatheter valve implantation. Eur Heart J 2018; 39: 2646-2655.
CARDIOVASC 2019; 18(3): 39 (published 7/6/19, ahead of print).
