Gottsegen National Cardiovascular Center

Quantitative coronary plaque measures differ in prognostic value between women and men. It remains unclear whether cardiovascular risk increases proportionally with plaque extent in both sexes. We aimed to compare cardiovascular risk trajectories across quantitative coronary plaque measures in women and men with stable chest pain. We analyzed data from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) coronary computed tomography angiography arm, quantifying total coronary plaque volume and burden (plaque burden [PB]; % vessel volume), including calcified, noncalcified, and low-attenuation components. Associations with major adverse cardiovascular events (death, myocardial infarction, or unstable angina hospitalization) were assessed using sex-stratified spline Cox models over a median 26 months (interquartile range, 18-34). Among 4267 patients (mean age, 60.4±8.2; 2199 women), plaque was less frequent in women (55% versus 75%; P<0.001), with lower total plaque volume but similar total PB and incident major adverse cardiovascular events (2.3% versus 3.4%). Major adverse cardiovascular event risk became elevated at lower PB in women than in men: for total PB, hazard ratio crossed 1.0 at 20% in women versus 28% in men, reaching hazard ratio 1.5 at 32% in women versus 42% in men, respectively. Noncalcified PB showed a similar pattern, crossing hazard ratio 1.0 at 7% in women versus 9% in men; hazard ratio 1.5 at 13% in women versus 20% in men. Findings were similar after adjustment for atherosclerotic cardiovascular disease risk score. In women, major adverse cardiovascular events appeared to emerge at a lower PB, and to rise more sharply. Findings support sex-specific interpretation of coronary computed tomography angiography-derived plaque metrics for timely intervention in women. URL: https://www.clinicaltrials.gov; Unique identifier: NCT01174550.

Despite the increasing use of coronary computed tomographic angiography (CCTA) in patients with known or suspected coronary artery disease (CAD), comparatively little is known about its predictive value for adverse events or clinical applicability of volumetric plaque analysis. To assess the incremental prognostic value of quantitative CAD measures in symptomatic outpatients without known CAD. This post hoc analysis involved a prospective randomized clinical trial conducted across 193 clinical sites in North America. Participants were symptomatic outpatients without known CAD who were randomized to receive CCTA. The trial was conducted from July 27, 2010, to October 31, 2014, and the data analyzed for this report from January 2021 to July 2024. Core laboratory-based quantitative plaque measures, including total plaque volume (TPV), calcified (CPV) and noncalcified (NCPV) plaque volume, low-attenuation plaque volume (LAPV), total plaque burden (TPB), and noncalcified plaque burden (NCPB), normalized with vessel volume. The primary outcome was major adverse cardiovascular events MACE (composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina). Optimal predictive cut points for plaque measures were identified using Euclidean distance methods and tested in multivariable Cox regression models. Among 4267 patients, the mean (SD) age was 60.4 (8.2) years; 2199 patients (51.5%) were female and 2068 (48.5%) were male. The median (IQR) TPV was 39.8 mm3 (0-167) mm3. Patients with TPV at the median or higher were older (mean [SD] age, 62.1 [8.4] vs 58.7 [7.5] years for those with lower than median TPV), more likely to be male (1286/2133 [60.3%] vs 782/2134 [36.6%], respectively), and had higher median (IQR) atherosclerotic cardiovascular disease risk scores (14.4 [8.8-24.0] vs 7.9 [4.5-13.4], respectively). TPB showed similar demographic associations. Both TPB and NCPB independently predicted MACE after adjusting for clinical risk factors, statin use, and qualitative CCTA findings (TPB: adjusted HR [aHR], 1.18; 95% CI, 1.05-1.34; P = .006; NCPB: aHR, 1.20; 95% CI, 1.05-1.37; P = .007). Optimal cutoffs of TPV 87 mm3 or greater, TPB 35% or greater, and NCPB 20% or greater were each associated with nearly a 2-fold increase in MACE risk (TPV: aHR, 2.07; 95% CI, 1.24-3.49; TPB: aHR, 1.96; 95% CI, 1.21-3.17; and NCPB: aHR, 1.77; 95% CI, 1.12-2.82). In symptomatic patients without known CAD, coronary plaque volumes and burdens are low but are related to CAD risk factors and independently predictive of MACE. The clinical utility of quantitative CCTA-based cardiovascular risk estimation in early CAD requires prospective evaluation. ClinicalTrials.gov Identifier: NCT01174550.

In patients with stable coronary artery disease (CAD), the long-term benefits of revascularization over medical therapy remain unclear. In the Fractional Flow Reserve versus Angiography for Multivessel Evaluation 2 trial, patients with hemodynamically significant stenoses (fractional flow reserve (FFR) ≤ 0.80) were randomized to receive FFR-guided percutaneous coronary intervention (PCI) plus medical therapy (n = 447) or medical therapy alone (n = 441). At 5 years, FFR-guided PCI reduced the risk of the primary composite outcome of time to death, myocardial infarction or urgent revascularization, largely because of fewer urgent revascularizations. We now report the long-term clinical outcomes from this trial. Sixteen hospitals, contributing 748 randomized patients (161 women, 21.5%), participated in the long-term follow-up. The primary composite outcome was analyzed hierarchically using the unstratified win ratio, which addressed differential missingness of data on nonfatal outcomes in deceased patients by prioritizing comparisons on time to death. At a median follow-up of 11.2 years, the primary endpoint occurred in 150 of 447 patients (33.6%) in the PCI group versus 182 of 441 (41.3%) in the medical therapy group. PCI was superior in 29.2% of comparisons, medical therapy in 23.3%, and the two groups were tied in 47.5%, resulting in a win ratio of 1.25 in favor of PCI (95% confidence interval (CI) 1.01-1.56, P = 0.043). The corresponding win difference was 5.9% (95% CI 0.2-11.6), and the number needed to treat was 17 (95% CI 9-500). Win ratios were 0.88 for all-cause death (95% CI 0.66-1.17), 1.50 for myocardial infarction (95% CI 0.98-2.31) and 4.57 for urgent revascularization (95% CI 2.53-8.24). During long-term follow-up, FFR-guided PCI in patients with stable CAD and hemodynamically significant stenoses reduced the composite of death, myocardial infarction or urgent revascularization, primarily because of fewer urgent revascularizations. These long-term findings reaffirm the efficacy of FFR-guided PCI over medical therapy in patients with stable CAD. ClinicalTrials.gov registration: NCT06159231 .

A tanulmány egy szülők számára alkalmazható otthoni mesefoglalkozás kipróbálásának azeredményeiről számol be, amelyben egy speciális köznevelési intézményben tanuló nyolc gyermekés szülője (mint elsődleges gondozója) vett részt. A kutatás arra kereste a választ, hogyan ösztönzia szülőt, ha a gyermekének mesél. A munka elméleti része összegzi a vizsgálatot megalapozószülői mese- és történetmondás hazai és nemzetközi kutatásainak a főbb eredményeit a következőszempontok szerint: a mesélő szülő mint gyermeke fejlesztője; a mesélő szülő mint önmagaösztönzője; az apa és az anya mese- és történetmondási különbségei. A tanulmány empirikusrésze a vizsgálatot részletezi. A kutatás kérdései: a) Megbízhatóan működik-e a mesecsomaghozszerkesztett megfigyelési protokoll? b) Milyen elemei rajzolódnak ki a szülői ösztönzésnek azotthoni meseolvasás során? c) Hogyan élték meg a szülők a gyermekükkel való közös mesélést?A kutatás eredményei megmutatták a szülőket ösztönző mesecsomag értékelésére kidolgozottmegfigyelési szempontsor megbízhatóságát, az ösztönzés jeleit a szülőknél a mesecsomagalkalmazása során, valamint a gyermekükkel folytatott közös mesélésnek a szülők általi megélését.Az eredmények szerint kirajzolódni látszanak a meseprogram szülői ösztönzői: a szülő bevonódásaa mesefoglalkozásba (önként vagy szakember felkérésére), a mesecsomag visszaküldésének ahajlandósága (egy vagy két héten belül), illetve a gyermekkel folytatott mesélés megörökítéséneka szándéka. Ez a validitásvizsgálat új szempontokat kínál a mesekutatásoknak a társas dimenzióés a szülői motiváció oldaláról.

Háttér és célkitűzés: A tudományos ismeretrendszerek klinikai jellege a diagnosztika, a terápia és a rehabilitáció kérdéseinek középpontba állításával magyarázható függetlenül azok szaktudományi besorolásától. A klinikai megközelítésnek a gyógypedagógiai pszichológiában és a gyógypedagógiában közös szakmai alapjai vannak, ami fejlődéstörténetében nyomon követhető. Ennek a fejlődési folyamatnak a kialakulásában meghatározó szerepe van Illyés Gyuláné Kozmutza Flórának (1905–1995), aki a Ranschburg-iskola képviselőjeként ezt a komplex ismeretrendszert a segítő szakember tevékenységének és képzésének részévé tette munkatársai, követői közreműködésével. Tanulmányunk célja ennek a folyamatnak a bemutatása, a pszichológiai ismeretek jelentőségének hangsúlyozása, amely a gyógypedagógiai tevékenységet a tudomány, a gyakorlat és a képzésfejlesztés eredményeként napjainkban is meghatározza. Ezáltal pedig megalapozza a gyógypedagógus szakember tevékenységének klinikai kompetenciáját, amely napjainkban megerősítést, elismerést igényel. Módszer: forráskutatás, hazai- és nemzetköziforrás-elemzések, továbbá a gyógypedagógus-képzés fejlesztésének tapasztalatai hazai és nemzetközi szakemberek munkásságának ismeretében. Eredmények és következtetések: A gyógypedagógiai pszichológia hazai hagyományai és a nemzetközi tapasztalatok egyértelműen alátámasztják tanulmányunk célkitűzéseit. A klinikai ismeretrendszerekkel kapcsolatosan új stratégia alkalmazását, a szakmai kör bővülésének igényét veti fel a klinikai gyógypedagógiával összefüggésben a klinikai nyelvészet, a klinikai pszichológia vagy a klinikai szociális munka mellett. Ez elősegítheti a neveléstudomány és az egészségtudomány között feszülő ellentétek feloldását, a kompetenciahatárok tágítását, hatékony transzdiszciplináris együttműködések kialakulását a segítő tevékenységben.

Although statins are recommended for decreasing cardiovascular risk, their efficacy across different patient phenotypes stratified by coronary artery disease (CAD) remains unclear. This study aims to evaluate whether statins decrease major adverse cardiac events (MACE) among CAD phenotypes according to severity, vulnerability and extent categorized by coronary computed tomography angiography (CTA). The authors analyzed consecutive patients who were referred for coronary CTA at a tertiary center for the assessment of chronic coronary syndrome. The primary endpoint was MACE defined as a composite of all-cause mortality, acute myocardial infarction, or revascularization for unstable angina. Statin use was defined as annualized days on statin therapy (days on statin based on redeemed prescriptions, divided by follow-up time), and analyzed for each 10% increase in statin use over the follow-up period. Interaction analysis, adjusting for risk factors was applied to define treatment benefit across CAD phenotypes. Overall, 11,026 individuals (mean age: 58.6 ± 11.9 years, 54.7% male) were analyzed who underwent coronary CTA between January 1, 2013, and December 31, 2020. A 10% increase in statin use was associated with lower risk for MACE the stratified Cox-regression model in patients with CAD (adjusted HR [aHR]: 0.95 [95% CI: 0.92-0.99]; P = 0.006), but not in patients without CAD (aHR: 0.95 [95% CI: 0.84-1.07]; P = 0.370). In the total population using interaction analysis including CAD phenotypes, a 10% increase in statin use decreased the risk for MACE in the presence of obstructive CAD (aHR: 0.91 [95% CI: 0.85-0.97]; P = 0.006), high-risk plaque (aHR: 0.82 [95% CI: 0.68-0.98]; P = 0.026), calcium score of ≥400 (aHR: 0.93 [95% CI: 0.87-0.99]; P = 0.024), and segment involvement score of >4 (aHR: 0.89 [95% CI: 0.84-0.95]; P < 0.001), but not for any CAD (aHR: 0.95 [95% CI: 0.85-1.07]; P = 0.411). Statin efficacy to decrease MACE depends on CAD phenotypes and increases with the extent and severity of disease and in the presence of high-risk plaques. Patients without CAD have no benefit from statin therapy regarding MACE. Coronary CTA may play a pivotal role in optimizing statin allocation for personalized treatment decisions to prevent MACE.

IntroductionCryoballoon (CB) ablation is a common technique for pulmonary vein isolation (PVI) in patients with symptomatic atrial fibrillation (AF). Obesity is a well-known risk factor for AF and numerous patients undergoing PVI are obese. We aimed to evaluate the effect of severe obesity (BMI ≥35 kg/m2) on atrial arrhytmia recurrence and procedural complications following CB PVI.MethodsAll patients undergoing de novo CB PVI between January 2021 and October 2023 at a tertiary referral EP center were included in this retrospective analysis. Based on their baseline BMI two patient groups were defined (group A: BMI <35 kg/m2; group B: BMI ≥35 kg/m2); freedom from recurrent atrial arrhytmia within the first year after one PVI procedure and complication rates were compared.ResultsA total of 404 patients (60.9% male, age 60.8 ±12 years) underwent successful CB PVI. AF was paroxysmal (PAF) in 59.7% of patients, the average BMI was 30 kg/m2. 326 and 78 patients were assigned to group A and B, respectively. Persistent AF (PersAF) was more frequent in group B (38% in group A vs 51% in group B; p=0.028). Median procedure time (55 min vs 54 min; p=0.871) and fluoroscopy time (11 min vs 12 min; p=0.197) were similar in both groups, however cumulative dose was higher in patients with severe obesity (75 mGy vs 176 mGy; p<0.001). Both patient groups had comparable 1-year outcome (67.5% in group A vs 62.8% in group B; p=0.433). PersAF patients without or with severe obesity had similar one year arrhythmia-free survival rates (55.3% vs 57.5%; p=0.806). Procedural complications were numerically higher in group B compared to group A without a statistically significant difference (2.5% vs 3.8%; p=0.497).ConclusionCB ablation in AF patients with severe obesity is safe and effective with an acceptable 1-year atrial arrhytmia recurrence rate.

BackgroundPost–percutaneous coronary intervention (PCI) fractional flow reserve (FFR) is an established method to evaluate the functional result of angiographically successful PCI; however, it is rarely measured. Quantitative flow ratio (QFR) is shown to be correlated with FFR before PCI. In this observational study we sought to evaluate the correlation and relative prognostic value of post‐PCI QFR compared with post‐PCI FFR.Methods and ResultsWe analyzed the outcome of all patients who underwent FFR‐guided PCI with post‐PCI FFR measurement. Post‐PCI QFR was calculated offline, blinded to the value of post‐PCI FFR and the clinical outcome. The primary end point was target‐vessel failure (TVF) defined as the composite of cardiovascular death, target‐vessel–related nonfatal myocardial infarction, and target‐vessel repeat revascularization. The secondary end point was the composite of cardiovascular death and myocardial infarction. Median follow‐up was 50 months. QFR calculation was unsuccessful in 15.6% of the vessels; thus, 422 vessels of 365 patients were included in the analysis. Post‐PCI QFR systematically overestimated post‐PCI FFR with a mean bias of +0.052, and their correlation was poor (Pearson's r=0.424). Post‐PCI FFR was an independent predictor of TVF and cardiovascular death/myocardial infarction. Post‐PCI QFR was associated with TVF, but was not an independent predictor of either TVF or cardiovascular death/myocardial infarction. The optimal cutoff of post‐PCI FFR to predict TVF was 0.83, whereas no optimal cutoff of post‐PCI QFR could be found.ConclusionsPost‐PCI QFR has a poor correlation with and overestimates post‐PCI FFR. Whereas post‐PCI FFR is an independent predictor of clinical outcome, post‐PCI QFR is not.