Wiley: Journal of Interventional Cardiology: Table of Contents

A Comparative Analysis of Primary and Bailout ADR in CTO‐PCI

Lirui Yang, Tao Zhang, Gang Wang, Leisheng Ru, Lin Zhao, Adam Kern — Mon, 04 Nov 2024 00:00:00 -0800

Objective: To compare the efficiency and safety of primary and bailout antegrade dissection and re-entry (ADR) during percutaneous coronary intervention (PCI) for chronic total occluded (CTO) lesions.

Methods: Patients who underwent ADR procedures for CTO lesions were enrolled in this study and were divided into two groups (primary ADR and bailout ADR) based on the initiation of ADR during PCI. The success rate and major adverse cardiovascular and cerebrovascular events (MACCE) during hospitalization were assessed as the primary endpoints. Procedure time, fluoroscopy time, wire crossing time, radiation dose, and contrast volume were considered as secondary endpoints.

Results: A total of 243 patients were enrolled in this study, with 127 patients receiving primary ADR and 116 receiving bailout ADR. No differences were found in baseline parameters between the two groups. The success rate was significantly higher in the primary ADR group compared to the bailout ADR group (89.0% versus 77.6%, respectively; p = 0.017). The incidence of in-hospital MACCE was low in both groups, with no significant differences observed between them. Procedure time, radiation dose, and contrast volume were lower in the primary ADR group compared to the bailout ADR group. Cox regression analysis revealed that primary ADR and J-CTO score ≥ 3 were independent predictors of technical success in CTO-PCI.

Conclusions: Both primary and bailout ADR are safe strategies for CTO-PCI. Primary ADR significantly improves the success rate of PCI for CTO compared to bailout ADR, with shorter operation time, lower radiation dose, and reduced contrast volume.

The Effect of Electromagnetic Interference Produced by Smartphones Using 5G Network on Patients With Permanent Pacemakers (EMS5G‐PPM Study)

Sun, 27 Oct 2024 22:04:44 -0700

Background: The safety of new-generation mobile phones using 5G networks in patients with modern-generation pacemakers has not been studied.

Objectives: This study aimed to compare the risk of electromagnetic interference (EMI) generated by a new-generation mobile phone with 5G networks when positioned at the pacemaker pocket or the contralateral ear and assess the incidence of EMI with telemetry interrogation in patients with permanent pacemakers.

Methods: We enrolled 489 patients with pacemakers from three different manufacturers. The pacemaker mode was programmed for overdrive pacing and sensing mode if an intrinsic rhythm was present. A smartphone (Samsung S21 + 5G) was placed directly over the pulse generator and right ear. The phone was tested under standby mode, 5G internet connection, and incoming and outgoing calls for each location. Real-time electrocardiography (ECG) monitoring and patient symptoms were recorded to determine the occurrence of EMI. The possibility of EMI with interrogation telemetry was also investigated.

Results: A total of 4824 tests were performed on 489 patients. Most pacemakers were dual-chamber (82%) or magnetic resonance imaging (MRI)-compatible systems (83%). EMI was not detected with both mobile phone positions. Interference with telemetry was demonstrated in 11.5% of patients. Almost all incidences of interference (98.2%) occurred during incoming calls. Single-chamber pacemakers, non-MRI-compatible systems, older pulse generators, older leads, and unipolar settings were significantly related to a higher incidence of interference with interrogation telemetry.

Conclusions: The risk of EMI between modern smartphones with 5G networks and pacemakers is low. Nevertheless, interference with the interrogation telemetry may still occur.

Comparison of Sheathless and Sheathed Guiding Catheters in Transradial Percutaneous Coronary Interventions: A Systematic Review and Meta‐Analysis

Wed, 23 Oct 2024 04:19:33 -0700

Introduction: The sheathless transradial (TR) technique is a novel approach that may offer potential benefits over the conventional TR approach. We aim to comprehensively investigate the safety and efficacy of sheathless versus conventional TR percutaneous coronary interventions (PCIs).

Methods: We conducted comprehensive searches across PubMed, CENTRAL, Web of Science (WOS), Scopus, and EMBASE until July 2023. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). PROSPERO ID: CRD42023443834.

Results: We included 11 studies with 15,392 patients. The radial artery spasm (RAS) (RR: 0.26, 95% CI: [0.09, 0.77], p = 0.02) and cross-over to the femoral site (RR: 0.28, 95% CI: [0.10, 0.81], p = 0.02) were significantly lower in the sheathless group. However, radial artery occlusion (RAO) (RR: 2.84, 95% CI: [1.78, 4.54], p < 0.0001) and success rate (RR: 1.011, 95% CI: [1.004, 1.019], p = 0.002) were significantly higher in the sheathless group. Also, we did not find a significant difference between both groups in all-cause mortality (RR: 0.41, 95% CI: [0.16, 1.04], p = 0.06).

Conclusion: The sheathless TR approach showed lower rates of RAS and femoral conversion. Sheathless has a higher success rate; however, it also increased RAO. Thus, more trials are needed to confirm this technique’s long-term outcomes and complications.

Percutaneous Coronary Intervention Using the DynamX Sirolimus‐Eluting Bioadaptor: 12‐Month Clinical and Imaging Outcomes

Thu, 17 Oct 2024 02:35:37 -0700

The DynamX Bioadaptor is a novel implant with uncaging elements that disengage after polymer resorption and permits restoration of vessel function, thereby potentially reducing late adverse cardiac events. We evaluated the safety and efficacy of this novel implant with imaging follow-up at 6-months, the time point when the bioadaptor starts to uncage. This prospective study enrolled 44 patients with up to two de novo lesions at seven centers in New Zealand treated with the DynamX Bioadaptor. Follow-up was planned out to 12-months. The primary safety and efficacy endpoints were 6-month target lesion failure (TLF) and late lumen loss. Patients presented with non-ST elevation myocardial infarction in 49%. Lesions (n = 45) were 16.0 ± 6.7 mm long, and 2.81 ± 0.41 mm in diameter. Device and procedure success were 100%, and acute lumen gain was 1.93 ± 0.35 mm. At 6-months, median in-device late lumen loss was 0.09 mm (IQR:0.05–0.16). Measured by intravascular ultrasound, the vessel, lumen, and device area remained constant. By optical coherence tomography, 96.4% ± 5.9% of struts per lesion were covered. Out to 12-months, no TLF and no definite or probable device thrombosis were reported. In conclusion, this study provides evidence of the safety and performance of the DynamX Bioadaptor with excellent 12-month clinical and 6-month imaging outcomes comparable to best-in-class drug-eluting stents (DES).

Trial Registration: ClinicalTrials.gov identifier: NCT03634020, NCT05464147, NCT04562805, and NCT04192747.

Vascular Complications and Bleeding After Transfemoral TAVR With Surgical Versus Percutaneous Approach: A Contemporary Prospective Study

Mon, 14 Oct 2024 04:03:01 -0700

Background: Percutaneous (PC) access has become the first-line strategy for transfemoral (TF) transcatheter aortic valve replacement (TAVR), but surgical cutdown (SC) may be required in selected and usually challenging cases. We aimed to compare the efficacy and safety of SC versus echo-guided PC approach in TF TAVR.

Methods: Between November 2019 and December 2020, all patients undergoing TF TAVR were included in a prospective study. The choice of PC or SC strategy was left at operators’ discretion, according to predictable access site difficulties. The primary endpoint included all vascular complications (VCs) and all bleeding at 1-month follow-up according to Valve Academic Research Consortium-2 criteria.

Results: Among 225 patients, 166 (73.8%) and 59 (26.2%) underwent PC or SC approach, respectively. Median age was 82 years, EuroSCORE 2 was higher (p = 0.02), and peripheral arterial disease (p < 0.001) was more common in the SC group. Femoral access was successful in 100% in the SC group vs 97.6% in the PC group (p = 0.2). The primary endpoint was reached in 32 patients (14.2%), 5 (8.4%) in the SC group and 27 (16.2%) in the PC group (p = 0.1) with low incidence of major VC in both groups (1.7% vs 3% in the SC and PC groups respectively, p = 0.6).

Conclusion: Despite a higher risk profile of patients in the SC group, SC and PC approaches appear safe and effective in TF TAVR, with a high success rate. SC may be considered when vascular access is anticipated as complex, but this strategy might be confirmed in a randomized study.

Trial Registration: ClinicalTrials.gov identifier: NCT03865043

Effects of Drug‐Coated Balloons on Inflammatory Cytokines After Interventional Therapy for Coronary Artery Calcification

Tue, 24 Sep 2024 22:49:06 -0700

Objective: To investigate the effects of a drug-coated balloon (DCB) on inflammatory cytokines in patients with coronary artery calcification (CAC) after interventional therapy.

Methods: This study included 58 patients with coronary heart disease who underwent coronary angiography (CAG) from October 2020 to September 2021. Patients were divided into CAC and non-CAC groups, and a DCB was used to intervene in the target lesions. Ten-milliliter preoperative and postoperative blood samples were drawn from the coronary lesions in both groups to detect the expression of serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and intercellular adhesion molecule-1 (ICAM-1). All patients were subjected to a 6-month follow-up to observe the incidence of major adverse cardiac events (MACEs).

Results: No significant differences in baseline clinical data were found between the groups. Serum IL-6, TNF-α, and ICAM-1 expressions in coronary blood samples immediately before DCB were not significantly different from those after DCB in all patients. After DCB, serum TNF-α expression in the CAC group was significantly lower than that in the non-CAC group (p < 0.05). In contrast, no significant difference in serum IL-6 and ICAM-1 expression was found between the groups. During the 6-month follow-up, no significant difference in the incidence of MACE was found between both groups.

Conclusions: DCB reduced the expression of inflammatory cytokine TNF-α in CAC, which may be one of the key mechanisms underlying the treatment of CAC by DCB.

Chitosan‐Based Hemostatic Pad Reduced Vascular Complications After Transradial Coronary Intervention in Uncontrolled Hypertensive Patients: Application of Chitosan‐Based Hemostatic Pad on CAG or PCI

Tue, 17 Sep 2024 02:04:47 -0700

Background: Vascular complications after coronary angiography (CAG) or percutaneous coronary intervention (PCI) are a major concern for revascularization therapies. In this study, we investigated whether the application of a chitosan-based hemostatic pad (HP) could ameliorate vascular complications after CAG or PCI procedures.

Methods: We retrospectively analyzed patients undergoing CAG or PCI in our cardiovascular center from January 2019 to December 2021. The incidence of total vascular complications including errhysis, large hematoma, pseudoaneurysm, radial artery occlusion (RAO), blister, and pain was recorded. Subgroup analyses of patients with a history of hypertension, patients with uncontrolled hypertension, and patients with controlled hypertension were performed.

Results: Our results demonstrated that the application of chitosan-based HP had no effect on vascular complications after CAG or PCI procedures (odds ratio [OR]: 1.03 (0.84–1.26), p = 0.80). Nevertheless, chitosan-based HP treatment markedly decreased the incidence of vascular complications in uncontrolled hypertensive patients (OR: 0.32 (0.11–0.95), p = 0.04), but not in hypertensive patients with controlled blood pressure (BP) (OR: 1.09 (0.88–1.35), p = 0.42).

Conclusions: Chitosan-based HP treatment could reduce the incidence of vascular complications in patients with uncontrolled hypertension. Nonetheless, applying chitosan-based HP treatment after CAG or PCI procedures is not recommendable for controlled hypertensive patients.

Optimizing Cardiac Resynchronization Therapy in Heart Failure Patients With Prolonged QRS Duration: Insights Into Electrical and Mechanical Dyssynchrony

Zhisheng Chen, Lois Balmer, Xuerui Tan, Toshiko Nakai — Mon, 16 Sep 2024 00:48:30 -0700

Heart failure (HF) represents a critical stage of cardiac disease, associated with high morbidity and mortality. Cardiac resynchronization therapy (CRT) has become a pivotal treatment for HF patients with prolonged QRS duration. This therapy employs a biventricular pacing system to correct cardiac electromechanical dyssynchrony, thereby improving cardiac function, symptoms, and prognosis. Numerous clinical trials have consistently highlighted the benefits of CRT in this subgroup, leading to its unanimous recommendation in clinical practice guidelines. However, a significant proportion of patients do not achieve an adequate therapeutic response, despite adherence to these guidelines. As CRT treats patients by correcting cardiac electromechanical dyssynchrony, assessing electrical and mechanical dyssynchrony is crucial in candidate selection. This review explores the evidence, recent clinical practice guidelines, and insight into electrical and mechanical dyssynchrony to optimize CRT candidate selection in HF patients with prolonged QRS duration.

Long‐Term Outcome of Left Heart Function after Catheter Ablation in Patients with Persistent Atrial Fibrillation Combined with Preserved Ejection Fraction Heart Failure

Thu, 25 Jul 2024 02:04:49 -0700

Objective. We aimed to examine the benefits of catheter ablation on left heart structure and function in patients with persistent atrial fibrillation (AF) accompanied by heart failure (HF) with preserved ejection fraction (HFpEF), in comparison with the benefits in patients with AF accompanied by HF with reduced ejection fraction (HFrEF) or patients with no HF. Methods. A total of 399 patients with nonvalvular persistent AF who underwent catheter ablation from 2015 to 2021 were retrospectively included sixty-seven patients with recurrence of AF within 1 year were excluded, as well as 53 patients who failed to be followed up at (12 ± 1) months after the procedure. Finally, 279 patients who fulfilled the criteria were included and divided into these groups: the HFpEF group (left ventricular ejection fraction (LVEF) ≥50% and N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) ≥125 pg/ml or E/e′ ≥15, n = 116), HFrEF group (LVEF <50%, n = 48), and no HF group (NT-proBNP <125 pg/ml, n = 115). The endpoints were changes in image-based functional status from baseline to 1 year, including echocardiogram and speckle-tracking echocardiography. Results. The left atrial structure of patients with HFpEF decreased significantly 1 year after catheter ablation (left atrial anteroposterior dimension: 41.48 ± 4.53 mm vs. 38.64 ± 4.40; left atrial mediolateral dimension: 41.99 ± 5.52 vs. 38.24 ± 4.63 mm; left atrial superoinferior dimension: 61.36 ± 6.73 vs. 56.44 ± 6.97 mm). The left atrial and left ventricular volumes were significantly reduced and the ejection fraction was increased in all three groups, with HFrEF patients benefiting more. In the speckle-tracking echocardiography indexes, significant improvements were observed in left atrial strain (16.83 ± 6.91 vs. 28.05 ± 9.92), left atrial storage function (0.97 ± 0.38 vs. 1.49 ± 0.58), and left atrial pump function (−1.15 ± 0.55 vs. −1.68 ± 0.75) among HFpEF patients after 1 year, with no changes in left atrial conduit function (−1.55 ± 0.62 vs. −1.50 ± 0.54). In addition to the above improvements in left atrial structure and function, there was no significant improvement in left ventricular diastolic function in patients with HFpEF (E/e′, 14.11 ± 5.52 vs. 14.30 ± 7.25, P = 0.85). Conclusion. Catheter ablation is beneficial in restoring sinus rhythm in patients with persistent AF with coexisting HFpEF, significantly decreasing the left atrial size, improving left atrial storage function and left atrial pump function, and increasing left atrial and left ventricular ejection fraction.

Role of Different Adjunctive Protective Devices to Reduce Operator Radiation Exposure in Percutaneous Coronary Procedures: The RAPTOR Study

Mon, 22 Jul 2024 01:19:45 -0700

Objective. To compare the relative effectiveness of different anti-Rx devices in terms of radiation dose absorbed by operators during percutaneous coronary procedures (diagnostic or interventional). Background. Direct comparisons among different adjunctive anti-Rx devices during percutaneous coronary procedures to reduce operator radiation exposure are lacking. Methods. We retrospectively analyzed the last 200 percutaneous procedures performed by a single operator according to the use of adjunctive protective devices (group 1) or standard anti-Rx setting (group 2). Subsequently, the procedures in group 1 have been divided according to the protective device utilized (homemade pelvic drape with under-table curtain, or RADPAD drape, or the STAR System device, or the Rampart shield). The primary endpoint was the operator radiation dose at the thorax. Results. Groups 1 and 2 did not show significant differences in terms of anthropometric data or cardiovascular risk factors. The use of adjunctive anti-Rx devices was associated with a significant reduction in operator radiation exposure compared to standard radioprotection (12.8 μSv [7–21] and 22.6 μSv [11–36], respectively; p < 0.0001). Globally, the anti-Rx devices utilized were associated with a reduced operator radiation exposure (11.7 μSv [2–19] for homemade drapes, 13.5 μSv [9–29] for RADPAD drape, 15 μSv [11–30] for STAR Board System, and 8 μSv [5–19] for Rampart; p < 0.0001) with the homemade drapes and the Rampart system showing a lower operator exposure. Conclusions. The use of anti-Rx devices during percutaneous coronary procedures is associated with a significant lower operator radiation exposure with the greater effect obtained with pelvic drapes and the Rampart system.

Drug‐Coated versus Conventional Balloons to Improve Recanalization of a Coronary Chronic Total Occlusion after Failed Attempt: The Improved‐CTO Registry

Sun, 14 Jul 2024 20:19:18 -0700

Background. Chronic total occlusion (CTO) plaque modification (CTO-PM) is often used for unsuccessful CTO interventions. Methods. A multicenter, prospective study included consecutive patients with failed CTO recanalization. At the end of the failed procedure, patients received either a conventional (CB) or drug-coated balloon (DCB) for CTO-PM at the operator’s discretion and underwent a new attempt of CTO recanalization ∼3 months later. Results. A total of 55 patients were enrolled (DCB: 22; CB: 33), with a median age of 66 years. The median J-score was 3, and CCS angina classes III–IV were present in 45% of the patients. After the first CTO-PCI attempt, no in-hospital cardiac deaths were registered. The overall rate of in-hospital myocardial infarction was 3.6%, without significant differences between the DCB and CB groups (4.5% after DCB vs 3.0% after CB, p = 0.999). The success rate of the second CTO-PCI attempt was 86.8%, with a periprocedural complication rate of 5.7% and with an overall rate of in-hospital complications of 24.5%, without significant differences between the 2 groups (13.6% in the DCB group vs 32.2% in the CB group, p = 0.195). Compared with CB, in the DCB group, the second CTO-PCI required a shorter median fluoroscopy time (33 vs 60 min, p < 0.001), a lower contrast volume (170 vs 321 cc, p < 0.001), and a lower radiation dose (1.7 vs 3.3 Gy, p < 0.001). At 1-year follow-up, outcomes were comparable between the 2 strategies, target vessel failure occurred in 5.7% and major adverse cardiovascular events in 18.2% (13.6% in the DCB group vs 21.2% in the CB group, p = 0.494). Conclusions. PM after CTO recanalization failure is safe and warrants high success rates when a second attempt is performed. A DCB strategy for CTO-PM does not seem to ensure higher success or better clinical outcomes, but its use was associated with simpler staged procedures. This trial is registered with NCT05158686.

Feasibility of the Anchor‐Free Deep Learning Method in Coronary Stenosis Automatic Detection

Sat, 22 Jun 2024 00:00:00 -0700

Background. Coronary artery disease (CAD) is a type of cardiovascular disease which is one of the leading causes of death around the world. The presence of coronary stenosis is considered a pivotal indicator in the diagnosis of various CADs. The main purpose of this paper was to investigate the feasibility of an anchor-free deep learning (DL) method, fully convolutional one-stage object detection (FCOS), in coronary artery stenosis automatic detection. Methods. First, 2786 invasive coronary angiography (ICA) images from 130 patients were randomly divided into training, validation, and testing datasets using the 10-fold cross-validation approach. Then, FCOS was compared with other three widely used anchor-based DL models: single shot multibox detector (SSD), faster region-based convolutional network (Faster R-CNN), and you only look once (YOLOv3), in terms of precision, recall, F1 score, average precision (AP), and average recall (AR). Finally, the performances of different models in the detection of stenosis were compared in either single or multiple lesion scenarios using statistical tests. Results. FCOS achieved significantly superior precision (96.14% ± 0.53%), recall (94.36% ± 0.79%), F1 score (95.22% ± 0.56%), AP_0.50 (93.36% ± 0.93%), AR_0.50:0.95 (64.73% ± 1.46%), AP_small (55.04 ± 0.96%), AP_medium (59.97 ± 1.13%), and AP_large (68.09 ± 5.18%) compared to Faster R-CNN and YOLOv3. Moreover, FCOS demonstrated significantly higher AR_0.50:0.95 and AP_small compared to SSD. Regardless of the presence of single or multiple coronary stenoses in ICA images, FCOS also outperformed Faster R-CNN and YOLOv3. Furthermore, it showed significantly higher AR_0.50:0.95 compared to SSD when in the multiple stenosis scenario. Conclusions. It is feasible to use the anchor-free DL model FCOS in detecting coronary stenosis based on ICA images.

The Short‐Term and One‐Year Clinical Outcomes in Patients with Optical Coherence Tomography‐Guided Magmaris Implantation: A Real‐World Clinical Practice

Fri, 14 Jun 2024 07:33:26 -0700

Aims. We aimed to evaluate the acute performance and short- and long-term outcomes of optical coherence tomography (OCT)-guided Magmaris deployment. Methods. This was a retrospective study of 28 consecutive patients (23 men, mean age: 59.8 years) with 28 Magmaris implantations in de novo coronary lesions. OCT was performed at the baseline and after the final postdilatation. The choice of stent and postdilatation balloon size was based on OCT measurements. The following indices were determined using OCT: prestenting minimum lumen diameter and area, poststenting minimum lumen diameter and area, acute lumen area gain, residual area stenosis, eccentricity and symmetry indices, incomplete strut apposition, strut fracture, tissue prolapse, and edge dissection. Results. Before the stenting, OCT analysis revealed a minimal lumen area of 1.55 ± 0.59 mm², a minimal lumen diameter of 1.19 ± 0.38 mm, a minimal scaffold area of 6.78 ± 1.58 mm², and a minimal scaffold diameter of 2.88 ± 0.50 mm². The prolapse area was 1.2 ± 1.5 mm². The mean percentage of RAS was 13.3 ± 7.1% and 6 (21.4%) patients had scaffold RAS more than 20%. Only one proximal edge intimal dissection was noted. The mean eccentricity index was 0.86 ± 0.04 and symmetry index 0.33 ± 0.08. ISA analysis showed that the percentage of malapposed struts was 1.5%. There were no short-term cardiovascular events, and only 2 incidents of target lesion failure (TLF) occurred 13 months later. Conclusion. The Magmaris has excellent acute mechanical performance and no short-term cardiovascular events occurred. There were only 2 TLFs that occurred 13 months later. It is suitable and feasible to treat vessels using the Magmaris.

Impact of Using a Scoring Balloon for Main Branch Predilatation on the Incidence of Side Branch Compromise in Bifurcation Lesion PCI

Wed, 05 Jun 2024 10:48:30 -0700

Background. Side branch (SB) compromise represents a frequent challenge encountered during percutaneous coronary intervention (PCI) for bifurcation lesions. Numerous techniques have emerged for predilating the main branch (MB), aiming to mitigate the occurrence of SB compromise. Among these approaches, scoring balloons have gained recognition for their ability to reduce carina shift and migration, consequently lowering the risk of SB compromise. However, the optimal treatment strategy remains a topic of debate. Thus, the current study is designed to investigate and compare effects of using scoring versus nonscoring balloons for MB predilatation on the incidence of SB compromise. Methods. A total of 102 patients who underwent elective PCI were enrolled at Jakarta Heart Center, Jakarta, Indonesia, from July 2022 to July 2023. Patients were randomized into two arms, i.e., scoring balloon predilatation arm (n = 52) and nonscoring balloon predilatation arm (n = 50). Outcome was measured as a composite endpoint of reduced thrombolysis in myocardial infarction (TIMI) flow in SB after MB stenting, SB intervention needed, and new or progressing ostial SB stenosis more than 50% compared to baseline. Results. Both study arms were comparable in various aspects, including gender distribution with a male majority, the predominant involvement of the left anterior descending (LAD) vessel, the presence of minimal to mild calcification, type A lesion, SB diameter, SB angulation, and the use of SB wire protection. In-depth analysis was conducted that revealed no significant differences between encompassed factors such as TIMI flow, the necessity for SB intervention, new or progression of ostial SB stenosis exceeding 50% when compared to the baseline, as well as the composite endpoint. Furthermore, these confounding factors did not exhibit any association with the incidence of SB compromise. Conclusion. Our study revealed that employing either scoring or nonscoring balloon predilatation in the MB has equivalent effects on SB compromise.

30‐Day and 1‐Year Mortality after Transcatheter Aortic Valve Replacement: The Impact of Balloon Aortic Valvuloplasty as a Bridging Therapy in a Portuguese Tertiary Center

Thu, 23 May 2024 00:00:00 -0700

Introduction. Since the advent and development of transcatheter aortic valve replacement (TAVR) in the contemporary era, balloon aortic valvuloplasty (BAV) has seen renewed interest. We aimed to compare 30-day and 1-year all-cause mortality between patients submitted to BAV as a bridging therapy before definite TAVR and patients submitted directly to TAVR. Methods. This was an observational, retrospective study of patients who underwent TAVR between 2009 and 2022 in a tertiary center. Patients with severe aortic stenosis (SAS) who underwent TAVR without prior BAV (woBAV group) and patients who were performed TAVR with prior BAV (wBAV group) as a bridging therapy were included. Primary endpoint was all-cause mortality at 30 days and 1 year after TAVR between wBAV and woBAV groups. Results. 800 patients were included, of which 767 were in woBAV group and 33 were in wBAV group. 30-day all-cause mortality rate was 21% in wBAV group compared to 4.4% in woBAV (unadjusted hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.3–11.7, p < 0.001). At 1-year, all-cause mortality rate was 27% in wBAV group compared to 12% in woBAV group (unadjusted HR, 2.55; 95% CI, 1.28–5.10, p = 0.007). After covariate adjustments, mortality remained significantly higher in wBAV group. Conclusion. This study provides valuable insights into the outcomes of patients undergoing TAVR with prior BAV as bridging therapy, as these patients had higher mortality at 30 days and 1 year compared to patients direct to TAVR.

Visfatin Related to the Severity of Non‐ST‐Segment Elevation Acute Coronary Syndrome: A Retrospective Study of 164 Patients at a Tertiary Chest Pain Center

Meifan Zheng, Zhongwei Wu, Chaoquan Liu, Fei Xiao, Thach N. Nguyen — Thu, 23 May 2024 00:00:00 -0700

Acute coronary syndrome (ACS) poses a pervasive threat to individuals grappling with cardiovascular afflictions, manifesting as unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), or sudden cardiac death, depending on vascular obstruction’s extent and location. NSTEMI, closely linked to substantial morbidity and mortality, has become the primary cause of hospitalization in ischemic heart disease patients. Swift prognostication of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is crucial, necessitating the identification of precise markers. This study, conducted from January 2020 to March 2021, explored the correlation between serum visfatin levels and NSTE-ACS severity. A total of 164 patients undergoing coronary angiography were enrolled, with a control group (n = 55) exhibiting less than 50% coronary stenosis. NSTE-ACS patients were categorized based on angiography outcomes into single-vessel (n = 41), double-vessel (n = 28), and multivessel (n = 40) groups. Serum visfatin levels, meticulously quantified, showed significant elevation in NSTE-ACS patients (n = 109) compared to the control group (n = 55) (P < 0.01). Visfatin correlated positively with the GRACE score (r = 0.397, P < 0.01). In the multivessel disease group, visfatin levels were notably higher (P < 0.01). After adjusting for cardiovascular risk factors, visfatin emerged as an independent predictor of affected coronary arteries (OR 0.205; 95% CI 0.032–0.378; P = 0.02). Receiver-operating characteristic (ROC) curves demonstrated enhanced prognostic ability when combining visfatin with age, hypertension, and diabetes for multivessel disease (AUC: 0.839, sensitivity: 65.0%, specificity: 89.7%, P < 0.001). Elevated serum visfatin in NSTE-ACS patients suggests its role as an independent harbinger for the number of affected coronary arteries, potentially indicating severity in NSTE-ACS patients.

Midterm Experience with the Self‐Expandable Venus P‐Valve™ for Percutaneous Pulmonary Valve Replacement in Large Right Ventricular Outflow Tracts

Wed, 22 May 2024 00:00:00 -0700

Background. Preliminary results with the recently certified self-expandable Venus P-Valve™ designed for percutaneous pulmonary valve implantation in patients with dilated right ventricular outflow tracts are encouraging, but experience is limited. We therefore assessed our early and midterm outcomes with the Venus P-Valve™. Methods. Twenty patients who underwent Venus P-Valve™ implantation in our institution were included in this retrospective study. Procedural data and clinical, imaging, and hemodynamic data at baseline and last follow-up were recorded and analyzed. Results. Mean patient age was 35.0 ± 16.8 years, and five patients were <18 years of age. Procedural success was 100%, and there was no major valve-related procedural complication. At last follow-up (median 0.5 (range 0.1–6.6) years), valve function was excellent in all patients. Two patients had mild regurgitation after 6.2 and 6.6 years, respectively, while all other patients had no or only trace regurgitation. Flow was unobstructed with a mean gradient estimated by echocardiography of 12 ± 4 mmHg. NYHA functional class improved significantly (p = 0.009), and right ventricular dimensions significantly decreased (right ventricular end-diastolic diameter 56±9 mm vs. 44±8 mm) (p < 0.001). Transient benign ventricular arrhythmias were frequent. One patient experienced a severe arrhythmia with sustained ventricular tachycardia during follow-up. Conclusions. Early and midterm results with the Venus P-Valve™ are excellent. It considerably extends the interventional options and offers a safe and effective alternative to surgery in patients with large right ventricular outflow tracts. Larger multi-institutional studies with longer follow-up duration are required to reliably assess the long-term performance and possible long-term complications of the Venus P-Valve™.

Value of Intracardiac Echocardiography in the Interventional Closure of Patent Foramen Ovale with Adjacent Atrial Septal Defect

Boqian Zhu, Tao Zhu, Jianing Fan, Xiaochun Zhang, David G. Iosseliani — Mon, 13 May 2024 00:00:00 -0700

Objective. This study aimed to investigate the application value of intracardiac echocardiography (ICE) in transcatheter closure of a patent foramen ovale (PFO) combined with an adjacent atrial septal defect (ASD). Methods. This retrospective study included five patients with PFO combined with adjacent ASD who underwent transcatheter closure and were admitted to the Zhongshan Hospital of Fudan University from June to September 2023. General conditions, ultrasound and ICE findings, and operative data were recorded and followed up for 2–6 months. Results. Of the five patients, two and three had embolic stroke of undetermined source and migraine, respectively, aged 45.6 ± 12.0 years. All patients underwent successful transcatheter closure via the PFO tunnel under the guidance of ICE, without complications or new stroke, and showed significantly reduced migraine at the follow-up. Conclusion. In patients with PFO combined with adjacent ASD, closure of a PFO tunnel could be successfully achieved under ICE guidance; its clinical efficacy was accurate and worthy of promotion.

Radiation Awareness and X‐Ray Use in Cardiology: An International Independent Web‐Based Survey

Fri, 10 May 2024 00:00:00 -0700

Background. Cardiologists are today exposed to a growing dose of ionising radiation in their practice. Radiation awareness and correct management of X-ray use are the cornerstone to comply with the principles of exposure optimization and justification. Methods and Results. An investigator-initiated international voluntary-based survey including 28 questions was conducted across 19 European countries. 228 cardiologists participated in the survey. Invasive cardiology subspecialties were the most represented (83.6%). Radiation exposure is the cause of personal protective equipment-related orthopaedic injuries (personally or in coworkers) or anxiety in 68.5% and 62.9% of cases, respectively. 38.4% of participants have encountered difficulties in having their institutions recognizing periods off work for exceeding radiation exposure limit (16.3% usually and 22.1% on rare occasions). Gender was not associated with any difference in the answers. Age older than 40 years old was associated with an increased knowledge of personal dosimeter data (71.6% vs. 51.3%, p = 0.008). Invasive cardiologists more frequently suffer from orthopaedic injuries (73.0% vs. 44.8%, p = 0.006) and show greater participation to radioprotection courses (78.4 vs. 27.6%, p < 0.001). Conclusion. European cardiologists show appropriate awareness of the risks associated with X-ray use in medical practice and of the principles guiding a proper management of radiation hazard. However, there is still room for improvement, and institutions should promote risk education policies, which are the basis for the creation and diffusion of a community consciousness on radiation hazard.

Outcomes of Drug‐Eluting Stents in comparison to Bare Metal Stents in Cancer Patients with Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis

Tue, 30 Apr 2024 00:00:00 -0700

Background. Studies have demonstrated poor prognosis in cancer patients who undergo percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Cancer patients receiving PCI are at increased risk of in-stent thrombosis, bleeding, hospital readmissions, and cardiovascular and noncardiovascular mortality when compared to patients without cancer. It is unclear if the poor outcomes in cancer patients are related to the stent type utilized for PCI. This meta-analysis attempts to identify differences in efficacy and safety outcomes when comparing drug-eluting stents (DESs) with bare metal stents (BMSs) in cancer patients. Methods. This meta-analysis is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the Modified Newcastle-Ottawa scale and Cochrane risk of bias tool. The primary outcomes of interest were in-stent thrombosis, bleeding, and mortality. Results. Four studies comprising of 54,414 patients met the inclusion criteria. There was no difference in in-stent thrombosis (odds ratio (OR): 0.79; 95% confidence interval (CI): 0.58–1.07), bleeding events (OR: 1.38; 95% CI: 0.77–2.49), or in-hospital mortality (OR: 1.92; 95% CI: 0.83–4.43) when comparing cancer patients who underwent PCI with DES vs BMS. Conclusions. This meta-analysis demonstrates no difference in mortality, bleeding, or in-stent thrombosis between revascularization with BMS vs DES in patients with cancer and CAD. Cancer patients included in this meta-analysis experienced higher rates of mortality, bleeding, and in-stent thrombosis after PCI compared to all-comers described in the literature.

Minimally Invasive Approach versus Sternotomy for Bentall Procedure: A Single‐Center Experience

Wed, 27 Mar 2024 00:00:00 -0700

Background. The need for minimally invasive Bentall surgery for the treatment of aortic lesions with aortic insufficiency is increasing; however, comparative studies on the safety of the minimally invasive Bentall procedure and sternotomy Bentall procedure are lacking. Methods. Clinical data of 56 patients who underwent the Bentall procedure performed by the same surgical team at our center between December 2018 and December 2021 were retrospectively analyzed and followed up for 6 months after discharge. After dividing the patients into a right anterior chest minimally invasive Bentall surgery (RAT-Bentall) group (n = 13) and a conventional sternotomy Bentall surgery (C-Bentall) group (n = 43), intraoperative and early postoperative clinical data and echocardiography at 6 months after discharge were compared. Results. Compared with the C-Bentall group, the RAT-Bentall group had a lower postoperative visual analogue scale (VAS) pain score [(3.00 ± 2.08) VS (5.77 ± 1.84), P < 0.001] and a shorter CSICU hospital stay [(1.90 ± 0.52) VS (2.51 ± 1.58) d, P < 0.001] and postoperative hospital stay [(7.62 ± 1.81) VS (10.42 ± 2.45) d, P = 0.035]. The incidence of postoperative complications and echocardiographic at 6-month follow-up after discharge was not statistically different between the two groups. Conclusion. The RAT-Bentall procedure is safe and effective. Compared with the sternotomy Bentall procedure, it can reduce postoperative pain as well as patients’ CSICU and postoperative hospital stay. Therefore, this technology is worth promoting and applying.

Meta‐Analysis of Randomized Trials: Efficacy and Safety of Colchicine for Secondary Prevention of Cardiovascular Disease

Tue, 12 Mar 2024 00:00:00 -0700

Background. Colchicine has shown potential cardioprotective effects owing to its broad anti-inflammatory properties. We performed a meta-analysis to assess its safety and efficacy in secondary prevention in patients with established coronary artery disease (CAD). Methods. We searched Ovid Healthstar, MEDLINE, and Embase (inception to May 2022) for randomized controlled trials (RCTs) evaluating the cardiovascular effects of colchicine compared with placebo or usual care in patients with CAD. Study-level data on efficacy and safety outcomes were pooled using the Peto method. The primary outcome was the composite of cardiovascular (CV) death, myocardial infarction (MI), or stroke. Results. A total of 8 RCTs were included with a follow-up duration of ≥1 month, comprising a total of 12,151 patients. Compared with placebo or usual care, colchicine was associated with a significant risk reduction in the primary outcome (odds ratio (OR) 0.70, 95% CI 0.60 to 0.83, P < 0.0001; I ² = 52%). Risks of MI (OR 0.75, 95% CI 0.62 to 0.91, P = 0.003; I ² = 33%), stroke (OR 0.47, 95% CI 0.30 to 0.74, P = 0.001; I ² = 0%), and unplanned coronary revascularization (OR 0.67, 95% CI 0.55 to 0.82, P = 0.0001; I ² = 58%) were all reduced in the colchicine group. Rates of CV and all-cause mortality did not differ between the two groups, but there was an increase in noncardiac deaths with colchicine (OR 1.54, 95% CI 1.10 to 2.15, P = 0.01; I ² = 51%). The occurrence of all other adverse events was similar between the two groups, including GI reactions (OR 1.06, 95% CI 0.94 to 1.20, P = 0.35; I ² = 42%) and infections (OR 1.04, 95% CI 0.84 to 1.28, P = 0.74; I ² = 53%). Conclusions. Colchicine therapy may reduce the risk of future cardiovascular events in patients with established CAD; however, there remains a concern about non-CV mortality. Further trials are underway that will shed light on non-CV mortality and colchicine NCT03048825, and NCT02898610.

Effect of Neutrophil‐to‐Lymphocyte Ratio on Post‐TAVR Mortality and Periprocedural Pulmonary Hypertension

Tue, 20 Feb 2024 00:00:00 -0800

Aims. To evaluate the impact of neutrophil-to-lymphocyte ratio (NLR) on periprocedural pulmonary hypertension (PH) and 3-month all-cause mortality in patients with aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) and to develop a nomogram for predicting the mortality for these patients. Methods and Results. 124 patients undergoing TAVR were categorized into three groups according to systolic pulmonary artery pressure (sPAP): Group I (no PH, n = 61) consisted of patients with no pre- and post-TAVR PH; Group II (improved PH, n = 35) consisted of patients with post-TAVR systolic pulmonary artery pressure (sPAP) decreased by more than 10 mmHg compared to pre-TAVR levels; and Group III (persistent PH, n = 28) consisted of patients with post-TAVR sPAP no decrease or less than 10 mmHg, or new-onset PH after the TAVR procedure. The risk of all-cause mortality within 3 months tended to be higher in Group II (11.4%) and Group III (14.3%) compared to Group I (3.3%) (P = 0.057). The multinomial logistic regression analysis demonstrated a positive correlation between NLR and both improved PH (OR: 1.182, 95% CI: 1.036–1.350, P = 0.013) and persistent PH (OR: 1.181, 95% CI: 1.032–1.352, P = 0.016). Kaplan–Meier analysis revealed a significant association between higher NLR and increased 3-month all-cause mortality (16.1% vs. 3.1% in lower NLR group, P = 0.021). The multivariable Cox regression analysis confirmed that NLR was an independent predictor for all-cause mortality within 3 months, even after adjusting for clinical confounders. A nomogram incorporating five factors (BNP, heart rate, serum total bilirubin, NLR, and comorbidity with coronary heart disease) was developed. ROC analysis was performed to discriminate the ability of the nomogram, and the AUC was 0.926 (95% CI: 0.850–1.000, P < 0.001). Conclusions. Patients with higher baseline NLR were found to be at an increased risk of periprocedural PH and all-cause mortality within 3 months after TAVR.

Examining the Outcomes of Hybrid Coronary Revascularization in Acute STEMI Patients from 2015 to 2022

Thu, 08 Feb 2024 00:00:00 -0800

Background. The global rise of chronic diseases, especially cardiovascular disease (CVD), poses a significant public health challenge, being a leading cause of death and disability worldwide. In Iran, the surge in CVD incidence and its risk factors, along with a decrease in the age of onset, has notably increased the reliance on coronary artery bypass grafting (CABG) as a life-saving intervention. Staged hybrid coronary revascularization (HCR), which combines percutaneous coronary intervention with delayed CABG, offers a novel approach for patients with complex coronary artery disease, potentially improving survival and reducing complications. Considering the newness of this treatment method and the limitations of previous studies, we investigated the results of staged HCR in acute ST-elevation myocardial infarction (STEMI) patients in this study. Methods. This observational study was performed on consecutive patients with acute STEMI who underwent staged HCR and were referred to Valiasr and Razi hospitals in Birjand from 2015 to 2022. The required information (demographic information, angiography result, and operation side effects) was collected in a checklist. If necessary, the patients were contacted by phone. After collecting the data, they were entered into SPSS version 16 software. Results. This study was conducted on 33 patients with a mean age of 64.88 ± 9.24 years (69.7% male). The average hospital stay was 11.6 ± 8.9 days (3 to 72 days). The mean ejection fraction and syntax score were 36.5% ± 10.2% and 31.21 ± 6.7, respectively. Following surgery and during hospitalization, arrhythmias were observed, including 33.3% with premature ventricular contractions, 18.1% with atrial fibrillation, and 3.1% with ventricular tachycardia. The average number of pack cells (red blood cells that have been separated for blood transfusion) and creatinine changes before and after hybrid surgery were 640.9 ± 670.9 cc and 0.055 ± 0.07. In the follow-up, 9.09% of patients had late mortality, 6.1% of patients had urinary tract infections during hospitalization, 6.1% of patients had surgical site infections, 3.1% needed dialysis, and none of the studied patients had premature death or need for reintervention. Conclusions. The results of our study indicated that staged HCR performed early after an ACS is not associated with significant mortality or complications. Therefore, it is advisable to consider staged HCR as a surgical option in appropriate cases.

Clinical and Laboratory Predictors of Long‐Term Outcomes after Catheter Ablation for a Ventricular Electrical Storm

Mon, 05 Feb 2024 00:00:00 -0800

Background. Ventricular electrical storm (VES) is characterized by the occurrence of multiple episodes of sustained ventricular arrhythmias (VA) over a short period of time. Radiofrequency ablation (RFA) has been reported as an effective treatment in patients with ventricular tachycardia (VT). Objective. The aim of the present study was to indicate the short-term and long-term predictors of recurrent VA after RFA was performed due to VES. Methods. A retrospective, single-centre study included patients, who had undergone RFA due to VT between 2012 and 2021. In terms of the short-term (at the end of RFA) effectiveness of RFA, the following scenarios were distinguished: complete success: inability to induce any VT; partial success: absence of clinical VT; failure: inducible clinical VT. In terms of the long-term (12 months) effectiveness of RFA, the following scenarios were distinguished: effective ablation: no recurrence of any VT; partially successful ablation: VT recurrence; ineffective ablation: VES recurrence. Results. The study included 62 patients. Complete short-term RFA success was obtained in 77.4% of patients. The estimated cumulative VT-free survival and VES-free survival were, respectively, 28% and 33% at the 12-month follow-up. Ischemic cardiomyopathy and complete short-term RFA success were predictors of long-term RFA efficacy. Neutrophil to lymphocyte ratio (NLR) and GFR <60 mL/min/1.73 m² were associated with VES recurrence. NLR ≥2.95 predicted VT and/or VES recurrence with a sensitivity of 66.7% and specificity of 72.2%. Conclusion. Ischemic cardiomyopathy and short-term complete success of RFA were predictors of no VES recurrence during the 12-month follow-up, while NLR and GFR <60 ml/min/1.73 m² were associated with VES relapse.