CVIA Journal

Highlighted papers in the issue are as follows:

Efficacy and Renal Tolerability of Ultrafiltration in Acute Decompensated Heart Failure: A Meta-analysis and Systematic Review of 19 Randomized Controlled Trials

 By Yajie Liu and Xin Yuan (DOI 10.15212/CVIA.2021.0020).

In this important Review paper, the authors discuss, the importance of acute decompensated heart failure (ADHF)  which is a life-threatening and costly disease. Controversy remains regarding the efficacy and renal tolerability of ultrafiltration for treating ADHF.  The authors performed a meta-analysis to evaluate this clinical issue. A search of PubMed, EMBASE, and the Cochrane database of controlled trials was performed from inception to March 2021 for relevant randomized controlled trials. The quality of the included trials and outcomes was evaluated with the use of the risk of bias assessment tool and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, respectively. The risk ratio and the standardized mean difference (SMD) or weighted mean difference (WMD) were computed and pooled with fixed-effects or random-effects models. Results: This meta-analysis included 19 studies involving 1281 patients. Ultrafiltration was superior to the control treatments for weight loss (WMD 1.24 kg, 95% confidence interval [CI] 0.38–2.09 kg, P = 0.004) and fluid removal (WMD 1.55 L, 95% CI 0.51–2.59 l, P = 0.003) and was associated with a significant increase in serum creatinine level compared with the control treatments (SMD 0.15 mg/dL, 95% CI 0.00–0.30 mg/dL, P = 0.04). However, no significant effects were found for serum N-terminal prohormone of brain natriuretic peptide level, length of hospital stay, all-cause mortality, or all-cause rehospitalization in the ultrafiltration group. Conclusions: The use of ultrafiltration in patients with ADHF is superior to the use of the control treatments for weight loss and fluid removal but has adverse renal effects and lacks significant effects on long-term prognosis, indicating that this approach to decongestion in ADHF patients is efficient for fluid management but less safe renally.

Clinical Characteristics and Durations of Hospitalized Patients with COVID-19 in Beijing: A Retrospective Cohort Study

By Wen Zhao, Xiangyi Zha, Ning Wang, Dongzeng Li, Aixin Li and Shikai Yu (DOI 10.15212/CVIA.2021.0019)

In this important research paper, the authors provide information on clinical characteristics and different durations of COVID-19 and identify the potential risk factors for longer hospitalization of patients with COVID-19. In this retrospective study, the researchers enrolled 77 patients (age 52 ± 20 years; 44.2% males) with laboratory confirmed COVID-19 admitted to Beijing YouAn Hospital between January 21 and February 8, 2020. Epidemiological, clinical, and radiological data on admission were collected; complications and outcomes were followed up until February 26, 2020. The end point of the study was discharge alive within 2 weeks. Cox proportional-hazards regression was performed to identify risk factors for longer hospitalization. Results: Of 77 patients, there were 34 males (44.2%), 24 (31.2%) with comorbidities, 22 (28.6%) with lymphopenia, 20 (26.0%) with severe COVID-19, and 28 (36.4%) with complications. By the end of follow-up, 64 patients (83.1%) were discharged home, eight remained in hospital, and five had died. Thirty-six patients (46.8%) were discharged within 14 days and thus reached the study end point, including 34 of the 57 patients with nonsevere COVID-19 (59.6%) and two of the 20 patients with severe COVID-19 (10%). The overall cumulative probability of the end point was 48.3%. Hospital length of stay and the duration from exposure to discharge for the 64 discharged patients were 13 (10–16.5) days and 23 (18–24.5) days, respectively. A multivariable stepwise Cox regression model showed that bilateral pneumonia on CT scan, shorter time from illness onset to admission, severity of disease, and lymphopenia were independently associated with longer hospitalization. Conclusions: COVID-19 has a shorter duration of disease and hospital length of stay than severe acute respiratory syndrome. Bilateral pneumonia on CT scan, shorter period from illness onset to admission, lymphopenia, and severity of disease are the risk factors for longer hospitalization of patients with COVID-19.

CTO (Chronic Total Occlusion)

By Charles Richard Conti and Calvin Choi (DOI 10.15212/CVIA.2021.0015)

In this important Commentary paper,  the authors consider the problem of CTO. There are no studies in patients with non-viable myocardium subtending a CTO to show improvement of regional wall motion after opening of the CTO. Patients without symptomatic multivessel CAD or no symptoms of angina have not been evaluated since there was no indication for study in the catheterization laboratory. CTO of collateral vessels that feed viable myocardium may lead to improvement in regional

myocardial wall motion and thus potentially a decrease in mortality. CTO recanalization in patients with active angina improve symptoms despite limited ability to demonstrate an improvement in wall motion.