Publications by authors named "Eric Buffle"
Cancer and left atrial enlargement in patients with ischemic stroke.
J Stroke Cerebrovasc Dis
December 2024
Article Synopsis
- Cancer increases the risk of atrial fibrillation, but its relationship with atrial cardiopathy—linked to a higher ischemic stroke risk—was studied to see if it’s also significant.
- A study of 1,104 patients hospitalized for acute ischemic stroke found that while 10% had active cancer and 47% had atrial cardiopathy, no significant association was found between active cancer and atrial cardiopathy overall or in patients with embolic stroke of undetermined source (ESUS).
- Even when considering any history of cancer, results showed no strong link to atrial cardiopathy, indicating cancer may not significantly influence this specific heart condition in stroke patients.
Article Synopsis
- Cancer patients have a higher risk of acute ischemic stroke (AIS) and may have a cardiac right-to-left shunt (RLS), but the relationship between RLS and cancer in AIS is unclear.
- In a study of 2,236 AIS patients, only 4.6% had active cancer, and RLS was found less frequently in these patients compared to those without cancer.
- The findings suggest that arterial causes could be more significant than paradoxical embolism in cancer-related strokes, indicating a need for further research on treatment options like patent foramen ovale (PFO) closure for these patients.
Novel para-aortic cardiac assistance using a pre-stretched dielectric elastomer actuator.
Interdiscip Cardiovasc Thorac Surg
March 2024
Objectives: We propose an evolution of a dielectric elastomer actuator-based cardiac assist device that acts as a counterpulsation system. We introduce a new pre-stretched actuator and implant the device in a graft bypass between the ascending and descending aorta to redirect all blood through the device (ascending aorta clamped). The objective was to evaluate the influence of these changes on the assistance provided to the heart.
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- The study focused on evaluating the reliability of measuring aortic valve area (AVA) using 3D transesophageal echocardiography compared to other methods, specifically the continuity equation (CE).
- It involved 119 patients with varying severity of aortic stenosis and utilized different approaches: the standard CE, a modified CE using 3D reconstruction, and direct 3D measurement.
- Results showed that while the 3D measurements (AVA-3D) were significantly higher than standard and modified CE methods, in patients with smaller AVAs, the differences were negligible, indicating that the new method aligns well with traditional measurements and is reliable for clinical use.
Article Synopsis
- - The study examines how the flow of blood (Q) relates to the area of the aortic valve opening (AVA) through different echocardiographic stress tests, particularly low-dose dobutamine stress echocardiography (DSE), to distinguish between pseudo-severe and true severe aortic stenosis.
- - Three progressively intense stress maneuvers (passive leg raise, maximal dobutamine infusion, and their combination) were tested on 45 patients, revealing that while Q increased significantly, AVA showed signs of saturation, evidenced by a decrease in AVA and valve compliance.
- - The analysis indicated that the relationship between Q and AVA conforms more closely to a saturating model rather than a linear one
Background: The number of patients treated by ventricular assist devices (VAD) and the duration of VAD treatment is increasing. One of the main complications in terms of morbidity and mortality for VAD patients are microbial infections. With this study, we aimed to investigate the epidemiology and microbiological characteristics of infections occurring in a VAD population to identify modifiable factors.
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- This study investigated if a new blood test called the T50 test could predict the progression of aortic sclerosis, focusing on calcification in the heart valves.
- A total of 129 patients underwent clinical exams and echocardiographic evaluations, revealing no significant overall disease progression during the one-year follow-up.
- Although the T50 test wasn't a strong independent predictor of disease progression, it did show potential to identify patients with significant stenosis progression, particularly for T50 values less than or equal to 242 minutes.
Article Synopsis
- The study investigates how the area of the aortic valve opening (AVA) relates to flow rate (Q) in aortic stenosis, suggesting a sigmoid model instead of the traditional linear model for better accuracy.
- Researchers conducted experiments using porcine aortic valves at various stiffness levels and flow rates to collect data on AVA and Q, comparing linear and sigmoid models for predictions.
- Results showed that the sigmoid model provided a more accurate prediction of AVA than the linear model, indicating it could improve clinical assessments of aortic stenosis through the development of "isostiffness-lines."
Background: Dobutamine stress echocardiography is used to increase transvalvular flow in patients with low-flow, low-gradient aortic stenosis (AS). Dobutamine fails to increase the stroke volume index (SVI) in one third of patients. The aim of this study was to test whether passive leg raise (PLR) added to dobutamine could increase SVI and transvalvular flow in patients with severe paradoxical low-flow, low-gradient AS.
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- The study investigates a new method to predict hidden cancers in patients who have suffered acute ischemic strokes (AIS) using a biomarker-based scoring system.
- Researchers analyzed data from AIS patients, identifying specific factors that correlate with the presence of occult malignancy, which is cancer that has not yet been diagnosed.
- The resulting OCCULT-5 score includes five key variables and could help doctors improve diagnosis and treatment outcomes for patients with possible underlying cancers following a stroke.
Article Synopsis
- A study was conducted to assess the effectiveness of transthoracic (TTE) and transesophageal echocardiography (TEE) in diagnosing high-risk findings in patients who experienced ischemic stroke or transient ischemic attack and had a need for direct oral anticoagulants.
- Out of 424 patients, 292 underwent echocardiography, with TTE revealing 14% and TEE showing 16% of patients with management-relevant health issues, mainly related to coronary artery disease and valvular problems.
- The research found that more severe stroke symptoms, diabetes, and certain biomarkers (like NT-proBNP and troponin levels) were linked to these high-risk findings, highlighting potential indicators for increased stroke
Background: Rheumatic heart disease (RHD) accounts for the highest number of deaths from valvular heart disease globally. Yet, rheumatic aortic stenosis (AS) was excluded from landmark studies investigating the safety and efficacy of transcatheter aortic valve implantation (TAVI). We aimed to describe the clinical and anatomical characteristics of patients with rheumatic AS undergoing TAVI, and to compare procedural and clinical outcomes with patients undergoing TAVI for degenerative AS.
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- * They acknowledge that while there were no strong statistical correlations found, the overlapping confidence intervals indicate a potential trend worth noting, and suggest that changes in LA size might be linked to structural remodeling.
- * The authors agree with critiques that variations in LA dimensions could relate to recurrence mechanisms and state that further research is needed, particularly in the form of prospective studies.
Article Synopsis
- Pulmonary vein isolation (PVI) is the primary treatment for paroxysmal atrial fibrillation (PAF), but sometimes extra-PV ablation is necessary for sustained AF or during repeat procedures.
- A study of 587 patients showed that patients undergoing only PVI had shorter RF ablation times initially, while those needing more procedures had longer extra-PV ablation times, and a larger left atrial (LA) size influenced the need for additional procedures.
- Longer RF ablation times and smaller LA sizes were linked to higher chances of AF recurrence, with LA size changing based on the timing of re-interventions, indicating a relationship between atrial remodeling and procedural outcomes.
Article Synopsis
- The study investigates the relationship between radial artery collateral function and the occurrence of radial artery occlusion (RAO) after transradial access (TRA) catheterization in patients undergoing coronary angiography.* -
- It measures collateral flow using pressure signals and finds that only 4% of patients exhibited signs of RAO, with complete occlusion being even rarer at 2% after three months.* -
- Those with RAO had a higher collateral flow index, suggesting that well-developed collateral circulation may be associated with RAO, rather than indicating poor vascular health.*
Article Synopsis
- The study compares the effectiveness of echocardiography and cardiovascular MRI (CMR) in diagnosing structural causes of embolism in ischemic stroke patients, using data from various sources including non-stroke populations.
- Out of 27 studies involving 2,525 patients, it was found that both diagnostic methods had similar yields for detecting left ventricular thrombus but CMR outperformed echocardiography in non-stroke patients; however, it was less effective for detecting persistent foramen ovale in stroke populations.
- Despite the insights gained, the actual clinical impact of these diagnostic findings on patient management remains unclear, indicating a need for more randomized controlled trials to better understand their benefits.
Function of naturally existing internal mammary artery (IMA)-to-coronary artery anastomoses has been shown by augmented blood supply to the coronary collateral circulation in response to IMA occlusion. Theoretically, this beneficial functional connection is invertible and can be linked to coronary steal, the verification of whose hypothesis would provide alternate proof to the mentioned functional evidence. This was an observational study including 40 patients with chronic coronary syndrome, distal IMA occlusion, and upper limb hyperemia (verum group), and 40 propensity score matched controls (placebo group) without IMA occlusion or hyperemia.
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- - The study compared outcomes of transcatheter left atrial appendage closure (LAAC) procedures done under conscious sedation (CS) versus general anesthesia (GA) in 521 patients between 2012 and 2018 at two hospitals in Germany.
- - After matching patients based on similar characteristics, safety outcomes (major complications and pneumonia) and device success rates were similar between those who received CS (196 patients) and those who had GA (115 patients).
- - The findings suggest that both anesthesia methods are equally effective and safe for LAAC, allowing for flexibility based on patient needs and hospital resources.
Amplatzer left atrial appendage closure: Single versus combined procedures.
Catheter Cardiovasc Interv
June 2021
Objectives: This study compares procedural and late clinical outcomes of left atrial appendage closure (LAAC) with Amplatzer devices as a single versus a combined procedure with other structural or coronary interventions.
Background: Multiple cardiac conditions are frequent among elderly patients and invite simultaneous treatment to ensure a favorable patient outcomes.
Methods: 559 consecutive patients (73.
Article Synopsis
- This study aimed to compare long-term outcomes of left atrial appendage closure (LAAC) using AMPLATZER occluders for preventing strokes in patients with atrial fibrillation (AF) against traditional medical therapy.
- Researchers analyzed 500 patients who underwent LAAC and 500 receiving medical therapy, focusing on the rates of stroke, embolism, and deaths over an average follow-up of 2.7 years.
- Results showed that LAAC led to lower rates of strokes and mortality compared to medical therapy, suggesting a net clinical benefit for using AMPLATZER devices.
Article Synopsis
- Subclinical hypothyroidism has potential links to heart failure, but small studies have previously looked at whether levothyroxine treatment affects heart function in these patients.
- A study involving Swiss participants aged 65 and older found no significant differences in heart function between those treated with levothyroxine and those given a placebo after 18 months of treatment.
- The conclusion is that for older adults with mild subclinical hypothyroidism, levothyroxine does not improve systolic or diastolic heart function compared to a placebo.
Late clinical outcomes of lambre versus amplatzer occluders for left atrial appendage closure.
J Cardiovasc Electrophysiol
April 2020
Introduction: The LAmbre (LifeTech Scientific, Shenzhen, China) is a novel occluder for left atrial appendage closure (LAAC) in patients with atrial fibrillation. This study compares late clinical outcomes of LAmbre and the established Amplatzer devices (Abbott, St Paul, MN).
Methods: Between 2012 and 2018, 265 consecutive patients underwent LAAC with LAmbre and Amplatzer devices at a single center.
Aims: This study compares clinical outcomes of Watchman vs. Amplatzer devices for left atrial appendage closure (LAAC).
Methods And Results: Of two real-world registries, the Watchman registry Lichtenfels, Germany, and the Amplatzer registry Bern-Zurich, Switzerland, 303 and 333 consecutive patients, respectively, were included.