bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocardial parametric mapping in patients with suspected acute myocarditis: a prognosis study
Authors: Wang Y , Duan X , Sirajuddin A , Arai A E , Zhao S , Wang H , Md M
Published: October 2024

Background

T1 mapping and T2 mapping have become essential components of the 2018 Lake Louise criteria and obtained excellent results in diagnosing myocarditis. However, their prognostic value in acute myocarditis has not yet been well recognized or established.

Purpose

Our study aims to investigate the prognostic value of T1 mapping, T2 mapping, and extracellular volume fraction (ECV) in a large cohort of patients with suspected acute myocarditis.

Materials

Patients meeting the recommended clinical criteria for suspected acute myocarditis were consecutively enrolled. The primary endpoint is the composite of cardiac death, heart failure hospitalization, heart transplantation, sustained ventricular arrhythmia, and recurrent myocarditis, defined as major adverse cardiovascular events (MACE). All patients underwent CMR at 3.0 T scanner using a standardized, routine imaging protocol, and the three short-axis view slices (basal, mid-ventricular, and apical) were divided into 16 segments according to the American Heart Association 17-segment model (apex excluded). We also averaged the native T1 values, ECV, and T2 values of all 16 segments to get global T1 and ECV fraction values, respectively. Statistically significant parameters from univariate Cox analyses were put into multivariate Cox analysis.

Results

A total of 235 patients (150 men; 32±13 years) were enrolled in this study. During a mean follow-up of 43.0±3.6 months, MACE occurred in 37 patients (15.7%) and was univariably associated with heart failure presentation, left ventricular ejection fraction, left ventricular end-systolic volume index, left ventricular end-diastolic volume index, native T1 and ECV. Patients with MACE showed higher global native T1, ECV, and T2 values (1348±59 vs 1266±51, p=<0.001; 40.0±8.7 vs 32.8±5.9, p<0.001; 63.4±12.1 vs. 55.5±9.1, p=0.011), and were more likely to have tissue changes in the interventricular septum and anterior wall (Figure 1). In a series of nesting multivariable Cox regression models, the addition of native T1 (per 10-ms increase: HR, 1.128; 95% CI: 1.043, 1.220; p = 0.003; Harrell’s C-index = 0.833) or ECV (per 5% increase: HR, 1.382; 95% CI: 1.060, 1.802; p = 0.017; Harrell’s C-index = 0.847) improved prognostication compared with the model based on clinical variables, left ventricular ejection fraction, and septal late gadolinium enhancement (Harrell’s C-index = 0.762) (Figure 2). T2 in multivariate Cox regression analysis didn’t show predictive value, but his inclusion increased the C-index of the model to 0.814.

Conclusions

Myocardial parametric mapping not only holds substantial diagnostic value but also plays a critical role in the prognostic assessment and risk prediction of myocarditis. Their utilization in these contexts enhances the accuracy and effectiveness of clinical evaluations and decision-making processes.
Absolute coronary flow and microvascular resistance before and after TAVR
Authors: Gallinoro E , Paolisso P , Belmonte M , Bertolone D , Esposito G , Leone A , Viscusi M , Shumkova M , Penicka M , Bartunek J , Collet C , Casselman F , De Bruyne B , Vanderheyden M , Barbato E
Published: October 2024

Purpose

This study aims to investigate microcirculatory changes, both at rest and during hyperemia, using continuous intracoronary thermodilution, before TAVR, immediately post-TAVR, and at 6-month follow-up.

Methods

We included consecutive patients with high-gradient AS undergoing TAVR with non-obstructive coronary artery disease in the left anterior descending artery (LAD). Absolute coronary flow (Q) and microvascular resistance (R) were measured in the LAD using continuous intracoronary thermodilution at rest (Qrest) and during hyperemia (Qhyper) before and after TAVR, as well as at 6-month follow-up. Echocardiography and cardiac computed tomography (CCT) were used to quantify total myocardial mass and LAD-specific mass. Regional myocardial perfusion (QN) was calculated by dividing absolute coronary flow by the subtended myocardial mass.

Results

In 51 patients, absolute flow and microvascular resistance were assessed at rest and during hyperemia before and after TAVR. The mean age was 84.1 ± 5.0 years, and 35 participants were male (68.6%). Measurements were also obtained 6 months after TAVR in 20 (39%) patients. Overall, there were no significant changes in resting and hyperemic flow and resistance before and after TAVR (Qrest 68 [55-88] mL/min vs 69 [54 – 92] mL/min, p=0.776; Qhyper 158 [129 – 200] mL/min vs 172 [132, 216] mL/min, p=0.449, before and after TAVR, respectively). Consequently, coronary flow reserve (CFR) and microvascular resistance reserve (MRR) remained unchanged. At 6 months, there were no significant changes in flow and resistance both at rest and during hyperemia compared to baseline (Qrest: 72 [63-84] vs 83 [59-108] mL/min, p=0.658; Qhyper: 181 [158-200] vs 194 [167-222] mL/min, p=0.492; pre-TAVR and at 6 months follow-up, respectively), resulting in unchanged CFR and MRR. However, at follow-up, there was a noteworthy reduction in left ventricular mass of approximately 13% (from 201.9 ± 37.9g to 175.1 ± 46.6 g, p<0.001), leading to an increase in hyperemic perfusion (QN,hyper: 0.86 [0.69-1.06] vs 1.20 [0.99-1.32] mL/min/g, p=0.008; pre-TAVR and follow-up, respectively), but not in resting perfusion (QN, rest: 0.34 [0.30-0.48] vs 0.47 [0.36-0.67] mL/min/g, p=0.06).

Conclusion

Immediately after TAVR, there are no changes in absolute coronary flow and coronary flow reserve. Over time, LV remodeling is associated with increased hyperemic perfusion, indicating that, in the context of the observed pathophysiological changes in coronary microcirculation in AS patients after TAVR, the reverse LV remodeling has a more significant impact than the acute LV unloading achieved by valve replacement itself.
The prognostic and incremental value of T1 mapping for predicting adverse events in hypertrophic cardiomyopathy
Authors: Wang J , Zhang J Q , Wan K , Xu Y W , Gkoutos G , Han Y C , Chen Y C
Published: October 2024

Background

In patients with hypertrophic cardiomyopathy (HCM), the prognostic value of native T1 and extracellular volume fraction (ECV) for adverse cardiovascular events has not been well defined.

Methods

Consecutive 663 participants with HCM who underwent cardiovascular magnetic resonance (CMR) were recruited. The follow-up endpoints included heart failure (HF)-related death and sudden cardiac death (SCD) or aborted SCD.

Results

During the median follow-up time of 44 months (interquartile range [IQR]: 23 to 66.0 months), 56 (8.4%) participants reached composite endpoints including 38 (5.7%) with SCD or aborted SCD, 16 (2.4%) with HF-related death and 2 (0.3%) with heart transplantation. On multivariable Cox proportional hazards regression analyses, native T1 including late gadolinium enhancement (LGE) from three short axes were significantly associated with cardiac death (basal native T1: hazard ratio [HR], 1.06 per 10 ms increase; 95% confidence interval [CI], 1.02 to 1.09; middle native T1: HR, 1.05 per 10 ms increase; 95% CI, 1.01 to 1.09; apical native T1: HR, 1.04 per 10 ms increase; 95% CI, 1.02 to 1.07; all P < 0.05) after adjustment for non-sustained ventricular tachycardia, history of syncope, the extent of LGE, left atrial size, and NYHA class. Conversely, only basal ECV was associated with cardiac death (basal ECV including LGE area: HR, 1.08 per 1% increase, 95%CI, 1.03 to 1.13, P = 0.001; basal ECV excluding LGE: HR, 1.1 per 1% increase; 95%CI, 1.04 to 1.16; P < 0.001) In addition, participants with increased mean native T1 (≥1349.4 ms) or basal ECV(≥ 29.4%) were more likely to suffer from cardiac death in the entire study cohort or the subgroup with low LGE extent (<15%) or low ESC risk score (<6%) (all P < 0.05). Furthermore, the addition of mean LV native T1 (≥1349.4 ms) or basal ECV (≥ 29.4%) to current risk factors in the guidelines could further improve prediction for the composite endpoint (C-index increased to 0.719 from 0.521 for the AHA/ACC risk model, P < 0.001; C index increased to 0.709 from 0.514 for the ESC risk model; P < 0.001).

Conclusions

In this study of patients with HCM, mean native T1 of three short axes and basal ECV were independently associated with cardiac death and added incremental value to conventional clinical predictors for patients with HCM.Figure 1.Demonstrative images.Figure 2 Incremental Value of T1 mapping
Clinical outcomes of immediate complete versus staged revascularization among STEMI patients and multivessel disease without cardiogenic shock: a meta-analysis
Authors: Lim J , Junia A T
Published: October 2024

Introduction

Multivessel disease in STEMI patients uncomplicated by cardiogenic shock is associated with adverse prognosis and recent evidence support complete revascularization in these patients. However, the optimal timing of non-culprit lesion revascularization is still debated.

Methods

A literature search from PubMed, Cochrane and Embase databases for relevant RCTs published until December 2023 were conducted. The main outcomes of interests were all-cause mortality, re-infarction, and target vessel revascularization.

Results

The search yielded 4 randomized controlled trials and the total number of patients included was 1,137 (immediate complete = 571; staged revascularization = 566). Our pooled estimated showed that immediate complete revascularization in STEMI patients and multivessel disease without cardiogenic shock, compared to staged revascularization, was associated with lower rates of re-infarction (OR 0.51, 95% CI 0.27 – 0.98, p < 0.04, I2=22%) and target vessel revascularization (OR 0.54, 95% CI 0.33 – 0.87. p = 0.01, I2=21%), with no significant difference in terms of all-cause mortality (OR 1.22, 95% CI 0.69-2.16, p <0.5, I2=0%).

Conclusion

In STEMI patients and multivessel disease without cardiogenic shock, immediate complete revascularization is associated with better outcomes in terms of reducing the rate of reinfarction and target vessel revascularization, while there was no significant difference in the outcomes of all-cause mortality between the two groups. These results challenge the current guidelines which favors staged PCI than an immediate complete revascularization approach.Abstract summary poster
Percutaneous coronary intervention versus coronary arterial bypass grafting in patients with left main coronary artery disease and chronic kidney disease: a systematic review and meta-analysis
Authors: Gialamas I , Kalogeras K , Pantelidis P , Lysandrou A , Zakynthinos G , Lytra T , Gounaridi M , Katsarou O , Roubelakis A , Oikonomou E , Siasos G , Vavouranakis M
Published: October 2024

Background

Left main coronary artery disease (LMCAD), defined as a stenosis of >50%, is a potentially lethal condition that should be treated intensively by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) depending on the anatomy. The presence of chronic kidney disease (CKD) complicates LMCAD, acting as a potential worsening factor for this group of patients, as well as impairing the effectiveness and outcomes of both revascularization treatments.

Purpose

This systematic review and meta-analysis aims to comprehensively compare the outcomes of PCI and CABG in patients with LMCAD and CKD.

Methods

A systematic search of the available literature was conducted in PubMed, Embase, and CENTRAL. Studies that compared PCI versus CABG in patients with LMCAD and CKD were included. The primary endpoints comprised major adverse cardiac and cerebrovascular events (MACCE) and all-cause death, while secondary endpoints included components of MACCE, such as myocardial infarction (MI), stroke and new revascularization events. The results were qualitatively and quantitatively synthesized and pooled hazard ratios (HR) were calculated. The statistical analysis was conducted in R.

Results

A total of 767 titles were initially retrieved, with five studies finally included in the analysis (n = 2,337 patients). The pooled analysis revealed that patients treated with PCI experienced more MACCE (HR: 1.50, 95% CI: 1.26-1.78, p < 0.001), an outcome primarily driven by MI (HR: 1.75, 95% CI: 1.17-2.62, p = 0.01) and revascularization rates (Hazard Ratio: 3.66, 95% CI: 1.84-7.30, p < 0.001), while no significant difference was shown in stroke rates (HR: 0.70, 95% CI: 0.40-1.22, p = 0.21). A trend towards increased all-cause death was observed for the PCI group, although this outcome slightly failed to reach statistical significance (HR: 1.30, 95% CI: 1.00-1.68, p = 0.05).

Conclusion

The present systematic review and meta-analysis indicated that PCI appears inferior to CABG in patients with LMCAD and CKD, with respect to most long-term outcomes. This includes higher rates of MACCE, and particularly MI and new events of revascularization for patients undergoing PCI, while all-cause death was marginally higher for this group. Further randomized controlled trials are needed to provide more robust evidence for guiding revascularization strategies in this high-risk population.
Association between CMR derived hepatic T1 times, tricuspid regurgitation severity, and outcomes
Authors: Mascherbauer K , Kronberger C , Dona C , Dannenberg V , Koschutnik M , Nitsche C , Duca F , Heitzinger G , Halavina K , Beitzke D , Waldmann E , Bartko P , Mascherbauer J , Hengstenberg C , Kammerlander A A
Published: October 2024

Background

Hepatic T1 times have been shown to predict adverse clinical outcomes. However, up to date, the various causes contributing to changes in hepatic T1 times are not fully understood. So far, strong correlations with liver congestion and hepatic fibrosis have been demonstrated. Valvular heart disease, especially tricuspid regurgitation (TR), can lead to congestive hepatopathy (CH) and might significantly increase liver T1 values. In contrast, hepatic steatosis – commonly present in patients with cardiovascular disease - would result in lower T1 values. Currently, no studies are investigating the relationship between hepatic T1 times and TR.

Methods

We retrospectively measured hepatic T1-times, displayed on standard cardiac T1-maps, in an all-comer CMR cohort. Only patients, who underwent a comprehensive transthoracic echocardiogram within three weeks of CMR were included.

Results

1029 participants (67±17 y/o, 44% female) had mean hepatic T1-times of 605±79ms. Overall, 41% (417) presented with non/trace, 38% (391) mild, 13% (135) moderate, 8% (85) severe, massive, and torrential tricuspid regurgitation. Liver T1 times were significantly correlated with TR severity (no/trace: 586±72ms; mild: 601±74ms; moderate: 634±84ms; severe/massive/torrential: 665±83ms; r= 0.25, p<0.001). Additionally, when adjusted for higher NT-proBNP levels, and right ventricular function in a linear regression model, TR severity was associated with hepatic T1 times (p<0.001). During follow-up (mean 53±36months), a total of 326 (32%) events occurred. Patients with higher T1 times and more severe tricuspid regurgitation were more likely to suffer events (adj.HR 1.44 [95%CI:1.23-1.69] per 100ms increase, p<0.001).

Conclusion

Tricuspid regurgitation exerts a notable influence on hepatic T1 times which is likely attributable to hepatic congestion. Importantly, hepatic T1 times were associated with outcomes even after adjustment for NTproBNP, LVEF, and RVEF. This underscores the importance of hepatic T1 times as both a marker of tricuspid regurgitation and an independent predictor of clinical outcomes.
Safety and efficacy of aspiration thrombectomy with intracoronary tirofiban VS aspiration thrombectomy alone in patients undergoing primary PCI: a systematic review and meta-analysis
Authors: Marcellana G , Jimenez R M , Tiongco R H , Castro R T
Published: October 2024

Background

Primary percutaneous coronary intervention (PPCI) may be complicated by intracoronary thrombus accumulation in ST elevation myocardial infarction (STEMI) leading to decrease in myocardial perfusion and increase in infarct size. The utilization of aspiration thrombectomy and intracoronary tirofiban in STEMI patients undergoing PPCI hold clinical relevance by removal of thrombus burden, potentially reducing distal embolization and improving myocardial perfusion and by targeting platelet aggregation to mitigate thrombotic complications, respectively. Given the paramount importance of achieving rapid and effective reperfusion in STEMI, the evaluation of these interventions is warranted to assess overall impact on patient outcomes in terms of safety and efficacy.

Purpose

The current meta-analysis aims to investigate the clinical outcomes of aspiration thrombectomy (AT) with intracoronary tirofiban versus AT alone during PPCI.

Methods

A systematic search for randomized controlled trials that evaluate the safety and efficacy of aspiration thrombectomy with intracoronary tirofiban in STEMI patients who underwent PPCI was done using PubMed, MEDLINE, Embase, Cochrane, Clinicaltrials.gov. and Herdin PH. Studies included those between 2010 - 2023 and involved human subjects. Search terms included "Aspiration Thrombectomy", "Intracoronary Tirofiban", "Primary Percutaneous Coronary Intervention" and "STEMI patients".

Results

Four RCTs (n: 490 participants) were included in this meta-analysis comparing aspiration thrombectomy with intracoronary tirofiban versus aspiration thrombectomy alone in STEMI patients undergoing PPCI. The results revealed no statistically significant difference in ST segment resolution (RR 1.02, 95%, CI: 0.97 - 1.08, P = 0.41, I2 = 0%), myocardial blush grade 2-3, (risk ratio of 1.04, 95%, CI: 0.97 – 1.12, P = 0.22, I2 = 62%) and TIMI 3 flow (risk ratio of 1.0, 95% CI: 0.95 - 1.04, P = 0.87).

The occurrence of major adverse cardiovascular events did not significantly differ between the two groups (RR 0.46, 95% CI: 0.19 – 1.09, P = 0.08, I2 = 0%). There was no statistically significant difference in terms of bleeding when combining intracoronary tirofiban to standard medical therapy (RR 1.35, 95% CI: 0.64 – 2.84, P= 0.78, 4 trials [490 patients]).

Conclusion

In primary percutaneous coronary intervention, MACE outcomes of aspiration thrombectomy with intracoronary tirofiban were similar to that for aspiration thrombectomy alone in terms of improving myocardial perfusion in STEMI patients without increasing the risk for bleeding. Our meta-analysis suggests that AT alone may be the more acceptable standard during PPCI when encountering heavy thrombus burden. Future validated studies may help further investigate the strategy of adding tirofiban during aspiration thrombectomy.1. Primary Outcomes2. Secondary Outcomes
Examining prognostic scores for short-term major adverse cardiovascular events prediction following primary PCI: a comparative analysis
Authors: Safdar U , Kumar R , Sial J , Saghir T , Karim M
Published: October 2024

Background

Accurately predicting short-term MACE (major adverse cardiac events) following primary PCI remains a clinical challenge. This study aims to assess the effectiveness of four established risk scores in predicting short-term MACE after primary PCI (percutaneous coronary intervention).

Methodology

We enrolled a cohort of consecutive adult patients diagnosed with STEMI (ST elevation myocardial infarction) undergoing primary PCI in this prospective observational study. Patients were followed at the interval of 3 months up for up to 12 months, and MACE events were recorded. Additionally, we obtained TIMI, PAMI, CADILLAC, and GRACE scores.

Results

A total of 2839 patients (79.3% male, mean age 55.6 ± 11.2 years) were included. Over a median follow-up of 244 days, the composite MACE rate was 18.3% (519). All-cause mortality was 13.5% (384), re-infarction requiring revascularization was 4.3% (121), heart failure-related re-hospitalization was 2.6% (74), stent thrombosis occurred in 5.6% (160), and CVA (cerebrovascular accident) events were documented in 1% (28). The AUC (area under the curve) for TIMI, PAMI, CADILLAC, and GRACE scores were 0.658 [0.630-0.685], 0.658 [0.632-0.684], 0.669 [0.644-0.695], and 0.675 [0.649-0.701], respectively, for the prediction of MACE. On multivariable Cox regression, medium and high-risk categories based on GRACE score were independent predictors of MACE with adjusted HR (hazard ratio) of 1.52 [1.21-1.92]; p<0.001 and 1.92 [1.34-2.75]; p<0.001, respectively.

Conclusion

A significant proportion of patients experienced short-term MACE after primary PCI. While none of the assessed scores demonstrated significant predictive power, the GRACE score exhibited comparatively better predictive ability than TIMI, PAMI, and CADILLAC scores
Both fibrosis-4 index and fibrosis-5 index can predict the prognosis of patients after percutaneous coronary intervention
Authors: Wang J Y , Hu S T , Zhang Y K , Gu T S , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K
Published: October 2024

Backgrounds: The Fibrosis-4 (FIB-4) index and Fibrosis-5 (FIB-5) index are non-invasive indicators reflecting liver fibrosis. Previous studies show their association with acute heart failure and myocardial infarction prognosis. However, there are few reports on the relationship between the two indices and the prognosis of patients after percutaneous coronary intervention (PCI).

Purpose

This study aims to explore and compare the predictive value of both indices for PCI patient prognosis.

Method

Data for this study were obtained from a retrospective cohort comprising patients admitted to and discharge d from 72 secondary and tertiary hospitals between 2010 and 2023. Inclusion criteria comprised patients undergoing PCI during hospitalization. The initial test results of these patients after admission were collected, and the FIB-4 (FIB-4 = age (years) × aspartate aminotransferase (AST [U/L]) / (platelets [10^9/L] × alanine aminotransferase [ALT {U/L}]½) and FIB-5 (FIB-5 = [albumin (g/L) × 0.3 + platelet count (10^9/L) × 0.05] - [alkaline phosphatase (U/L) × 0.014 + AST/ALT ratio × 6 + 14]) indices were calculated. Patients were divided into low (N = 83082), medium (N = 16618), and high (N = 7932) FIB-4 groups, as well as low (N = 18642), medium (N = 12106), and high (N = 76884) FIB-5 groups based on predefined cutoff values. The primary endpoint was one-year cardiovascular mortality, with secondary endpoints including one-year all-cause mortality and one-year recurrent myocardial infarction.

Results

The study included 107,632 patients after PCI whose FIB-4 index and FIB-5 index could be simultaneously calculated during hospitalization. Multivariable Cox regression analysis revealed that compared to the low FIB-4 group, both the high FIB-4 group (aHR 1.935; 95%CI 1.592-2.353) and the medium FIB-4 group (aHR 1.487; 95%CI 1.251-1.768) had an increased risk of one-year cardiovascular death (P0.05).

Conclusions

The present study indicated that both FIB-4 and FIB-5 could be used to predict the prognosis of patients after PCI. High FIB-4 index and low FIB-5 index were predictive factors for 1-year cardiovascular death, 1-year all-cause death, and 1-year recurrent myocardial infarction in patients after PCI, with no statistical difference in predictive value between the two.
Safety and efficacy of brachial approach for coronary angiography and percutaneous coronary intervention
Authors: Refaat H , Mesbah M , Ghanim I
Published: October 2024

Background

There are many feasible ways to reach the coronary arteries through a percutaneous technique. Till now, the most commonly used approach is the radial artery approach because it has the lowest risk of known vascular adverse events. However, it could not be an option in some situations as congenital radial artery hypoplasia and radial artery spasm. In these cases, the second most common access is the femoral artery access. The current literature over the brachial artery access is controversial. Our study's objective is to verify the brachial artery approach's effectiveness and safety.

Methods

We studied 300 patients who underwent elective coronary angiography and percutaneous angioplasty in our institution with failed radial access between August 2022 and February 2023. They were classified into two groups; 150 patients in a group with brachial access and 150 in a group with femoral access. Baseline clinical and demographic traits of all enrolled patients were obtained from hospital records and the cardiovascular risk factors were identified. Venous blood samples, resting 12-lead electrocardiogram and transthoracic echocardiography were done before the coronary angiography. Access, procedural and fluoroscopy times were recorded. Doppler evaluations of both brachial and femoral arteries were done the day after the procedure. All patients were examined carefully immediately after the procedure and before discharge to assess any complications.

Results

Our data showed that no statistically significant difference between the studied groups regarding the cardiovascular risk factors, demographic, clinical and laboratory characteristics. Left brachial access was used more frequently than left femoral access (32.7% vs. 22.7%, p= 0.05), but no significant difference regarding right sided or bilateral access. Procedure time, fluoroscopy time, and contrast volume did not differ significantly (p=0.19, 0.06 and 0.1 respectively). However, brachial group had shorter access time (2.6 ±1.1 vs. 3.4 ± 0.7 minutes, p=0.05) and shorter hospital stay (3.5 ± 1.1 vs. 5.9 ± 1.3 days, p<0.001). Regarding complications, both major and minor complications were significantly lower in the brachial arm (p=0.04 and 0.05, respectively).

Conclusion

Brachial artery access is a safe, efficient alternative and non-inferior to the femoral route for coronary intervention whenever radial access is not an option.
Biolimus A9 DEB for the Treatment of In-Stent Restenosis. 1-year outcomes of the REFORM trial
Authors: Durand R , Alonso F , Hahn J Y , Cortese B , Toelg R , Sabate M , Morice M C , O'kane P , Trevelyan J , Rai H , Stefanini G , Oldroyd K , Byrne R A
Published: October 2024

Background

In recent years, drug-coated balloons (DCB) have established themselves as another tool in the arsenal of interventional cardiology devices for the treatment of in-stent restenosis (ISR) lesion.

Aims

The study was designed to compare the biolimus DCB to the paclitaxel-coated SeQuent PleaseTM DCB.

Method

This was a prospective, non-inferiority, randomized, multicenter, study conducted at 20 centers in 6 countries. The primary endpoint was in-segment % diameter stenosis (%DS) at six months. The study was powered to enrol 201 patients in at 2:1 randomization to either the biolimus DCB (BCB) or the SeQuent PleaseTM DCB (SQP). Key secondary endpoints included, late-lumen loss, binary restenosis, and target lesion failure (TLF) and myocardial infarction at 1 year.

Results

A total of 202 patients were randomised with 135 in the BCB group and 67 in the SQP group. Mean patient age was 68.9 ± 9.9 years in the BCB group compared to 68.2 ± 10.5 years in the SQP group. At 6 months, %DS was 41.8 ± 21.3 in the BCB group compared to 31.4 ± 17.7 in the SQP group (95% confidence for the difference: 3.5-16.9, p-value for non-inferiority 0.32). At 12 months, TLF was 23.74%, in the BCB group vs 17.07% in the control group, hazard ratio (HR) of 1.44 [95% CI: 0.72-2.88], p=0.28. There were more clinically driven revascularization in the BCB group (21.61%) compared to SQP (15.61%) [HR: 1.46, 95% CI: 0.71-3.01], p=0.29. More myocardial infarction were observed in the SQP group (BCB: 7.59% vs SQP: 3.77%, [HR: 0.48, 95% CI: 0.14-1.68], p=0.24)(see Figure).

Conclusions

In ISR patients, the REFORM study was not able to demonstrate non-inferioirity of the biolimus DCB compared to the SeQuent Please DCB.
Image quality of the non-contrast BOOST cardiac magnetic resonance sequence to visualize the pulmonary veins in patients with atrial fibrillation
Authors: Dohy Z , Kiss M , Suhai F I , Orban G , Kunze K , Neji R , Drobni Z , Czimbalmos C , Szabo L , Botnar R , Prieto C , Geller L , Merkely B , Szegedi N , Vago H
Published: October 2024

Background

In patients with atrial fibrillation (AF), imaging examinations have an important role in planning ablation by imaging the pulmonary veins (PV). The PV anatomy is conventionally assessed before ablation using computer tomography (CT) or 3 dimensional (3D) contrast-enhanced cardiac magnetic resonance (CMR) imaging. The new 3-dimensional, free-breathing BOOST (Bright-blood and black-blOOd phase SensiTive inversion recovery) cardiac magnetic resonance (CMR) sequence is suitable for imaging the left atrium without the addition of contrast agent.

Purpose

The aim of our study was to investigate the BOOST sequence for the imaging of PVs, and the effect of heart rate and rhythm on image quality.

Methods

Forty-seven patients underwent and BOOST CMR before ablation, 25 of them had also left atrial CT angiography (CTA). The BOOST sequence was performed using T2 preparation pre-pulse (T2prep) and magnetization transfer preparation (MTC) techniques. The image quality was analyzed using a subjective Likert scale and quantitatively by determining the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Heart rate and rhythm were assessed by 12-lead ECG.

Results

MTC-BOOST images were suitable for PVs analysis in all cases, whereas the assessment of PVs on T2prep-BOOST images was inadequate in the majority of cases due to artifacts. CTA showed the same PV anatomy as assessed with BOOST CMR. Based on the operating electrophysiologists’ subjective opinion, the quality of the CTA scans was better compared with BOOST sequence. Still, they found the CMR images appropriate for procedural planning in 43 out of 47 cases (91%). SNR and CNR values of the MTC-BOOST bright-blood images were higher if patients had sinus rhythm. We found a significant or nearly significant negative correlation between heart rate and the SNR and CNR values of MTC-BOOST bright-blood images.

Conclusions

MTC-BOOST images are suitable for visualisation of PVs, producing diagnostic image quality in 100% of cases. In the majority of cases, MTC-BOOST images were appropriate for procedural planning before ablation. Image quality is affected by the patients' heart rate and frequency.

Figure 1: MTC BOOST bright blood image of the left atrium and the right pulmonary veins (arrows)
Catheter-induced ostial coronary artery dissection during percutaneous coronary intervention assessed by intravascular ultrasound
Authors: Kishimoto H , Ikuta A , Tamai R , Shirasaki N , Fukushima M , Tada T , Tanaka H , Fuku Y , Kadota K
Published: October 2024

Background

Catheter-induced ostial coronary artery dissection is one of the possible complications of percutaneous coronary intervention (PCI), sometimes resulting in serious consequences. The incidence of catheter-induced ostial coronary artery dissection has been assessed by coronary angiography, but rarely by intravascular ultrasound (IVUS). Prognosis of ostial coronary artery dissection is also unclear.

Purpose

To determine the incidence and prognosis of catheter-induced ostial coronary artery dissection during PCI by IVUS assessment.

Methods

The study population consisted of 1468 consecutive patients undergoing PCI at our institution between January 2019 and March 2020. Patients who had previously received a stent in the ostial coronary artery to be treated and patients who were scheduled to receive a stent in the ostial coronary artery during the procedure were excluded. The analysis was performed on 246 patients undergoing IVUS assessment of the ostial coronary artery at the end of the procedure. The 1-year cumulative rates of all-cause death, nonfatal myocardial infarction, and any revascularization procedure were compared between patients with and without ostial coronary artery dissection (dissection and nondissection groups).

Results

Ostial coronary artery dissection was detected by coronary angiography in 13 patients (5.2%) and by IVUS in 49 patients (19.9%). There were no significant differences between the dissection and nondissection groups (49 patients vs. 197 patients) in the percentage of the treated coronary artery (right coronary artery: 34.7% vs. 36.0%, p = 0.86), acute coronary syndrome (30.6% vs. 41.6%, p = 0.15), or the use of a backup catheter (32.7% vs. 20.8%, p = 0.09). The dissection group had more moderate to severe calcified lesions than the nondissection group (42.9% vs. 22.3%, p<0.01). There were no significant differences between the dissection and nondissection groups in the 1-year cumulative incidence of all-cause death (6.1% vs. 6.6%, p = 0.88), nonfatal infarction (6.1% vs. 4.1%, p = 0.54), or any revascularization procedure (10.2% vs. 8.6%, p = 0.72). Eight patients (16%) in the dissection group received additional intervention for ostial coronary artery dissection and had a significantly higher rate of dissection detected by coronary angiography than conservatively treated patients (75.0% vs. 17.1%, p<0.01). In addition, no conservatively treated patients received additional intervention for worsening dissection within one year of the index procedure.

Conclusion

IVUS may be more useful than coronary angiography in detecting ostial coronary artery dissection. With proper management, ostial coronary artery dissection may not lead to worse 1-year outcomes, and many dissections detected by IVUS may not require additional intervention.
Association between J-scores and ostial lesions: quantifying the effects of ostial lesions in chronic total occlusion percutaneous interventions
Authors: Salloum B , Cheikh Ibrahim M
Published: October 2024

Aims

We aimed to evaluate the influence of ostial lesions on the predicted probability of success in patients undergoing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs).

Methods

245 patients underwent CTO PCIs at our center, Germany. Of these patients, 197 (80.4%) without an ostial lesion and 48 (19.6%) with an ostial lesion were evaluated. Logistic regression models were used to estimate the interaction effect between the presence of ostial lesions and J-score.

Results

The ostial lesion group exhibited significantly higher pro-B-type natriuretic peptide levels (1644 pg/ml vs. 963 pg/ml, p=0.034) than the non-ostial lesion group. The final success rate was lower in the ostial lesion group than in the non-ostial lesion group (64.6% vs. 81.7%, p=0.018). The ostial lesion group had higher J-scores than the non-ostial lesion group, indicating more complex lesions (median: 2.5 vs. 2.0, p=0.005). Technical details revealed less antegrade (68.8% vs. 89.8%, p=0.001) and more retrograde access (33.3% vs. 7.6%, p<0.001) in the ostial lesion group than in the non-ostial lesion group. An ordered logistic regression with J-score as an outcome showed a statistically significant association between higher J-scores and ostial lesions (OR, 2.4; p=0.003). Investigating the association between ostial lesion and J-score categories (<3 and ≥3) revealed that ostial lesions were associated with lower success rates, especially in cases with higher J-scores (≥3), although the interaction effect was not statistically significant (p=0.506).

Conclusion

The presence of ostial CTO is associated with higher lesion complexity and lower technical and procedural success rates. Further studies, based on our retrospective and the previous studies, require the inclusion of the presence of ostial CTO as a factor in the currently used CTO scores to predict the difficulty of CTO procedure.Interaction EffectPredicted Probability
Single arterial access versus standard access in TAVI: results from a large multicenter registry
Authors: Grundmann D , Kim W , Renker M , Kellner C , Adam M , Braun D , Tamm A , Sedaghat A , Leistner D , Dreger H , Bleiziffer S , Vorpahl M , Frank D , Rudolph T , Seiffert M
Published: October 2024

Background

The transfemoral approach has become the gold standard primary access for transcatheter aortic valve implantation (TAVI) due to low complication rates. An additional secondary access (ScA) is used for angiographic guidance of the procedure. Recently, small, single-center studies demonstrated feasibility of single-access for transfemoral TAVI without a secondary access. However, comparative and large-scale data are missing.

Purpose

We assessed vascular and bleeding complications of ScA and Single access (SA) approaches in a large multicenter registry to evaluate both strategies.

Methods

The PULSE registry (Plug or sUture based vascuLar cloSurE after TAVI) retrospectively evaluated data of 10,120 patients who underwent transfemoral TAVI at 10 high-volume German heart centers from 2016 to 2021. In 9,457 patients who qualified for analysis ScA (80.7% femoral, 19.3% radial) were performed in 8709 (92%) and SA in 748 (8%). Outcomes were evaluated in accordance with the Valve Academic Research Consortium (VARC-3) definitions.

Results

Median age was 81.9[IQR 78.2, 85.1] years and 48.9% of patients were female (median logistic EuroSCORE II: 3.3% [IQR 2.1, 5.6]). Peripheral artery disease was comparable between groups (13.5 vs. 14.0%, p=0.73). While overall major access-related vascular complications did not differ significantly (6.1% vs. 4.8%, p=0.20), there was a higher incidence of minor complications for ScA compared to SA (9.0% vs. 2.8%, p<0.001). Secondary access complications amounted to 2.7% in the ScA group and were mainly characterized as bleeding (1.2%) and pseudoaneurysms (1.2%) mostly treated conservatively (1.2%), yet in some cases surgical repair was needed (0.8%). No significant difference was observed regarding type III/IV bleeding (4.1% vs. 4.3%, p=0.91), stroke rate (2.4% vs. 3.6%, p=0.05), stage III/IV acute kidney injury (2.4% vs. 2.4%, p=1.00) or all-cause 30-day mortality (5.8% and 5.7%, p=0.99) for ScA compared to SA groups.

Conclusion

In patients treated with transfemoral TAVI, a single access approach was associated with lower rates of minor access-related vascular complications without compromising overall outcomes, suggesting potential benefits of a minimally-invasive TAVI approach with the omission of additional vascular access.
CMR-derived pulmonary artery to aorta ratio as a predictor of adverse outcome in patients with cardiac transthyretin amyloidosis
Authors: Kronberger C , Willixhofer R , Ermolaev N , Poledniczek M , Duca F , Rettl R , Binder-Rodriguez C , Mascherbauer K , Dona C , Koschutnik M , Nitsche C , Badr Eslam R , Bergler-Klein J , Kastner J , Kammerlander A
Published: October 2024

Introduction

Cardiac transthyretin amyloidosis (ATTR) represents a heart failure phenotype often accompanied by pulmonary hypertension. The pulmonary artery to aorta ratio (PA/Ao), as assessed on cardiac computed tomography or cardiac magnetic resonance (CMR), has demonstrated to indicate risk for adverse events in a variety of cardiovascular diseases, particularly in heart failure and pulmonary hypertension. However, its prognostic value in cardiac ATTR remains unknown.

Aim

We aimed to investigate the prognostic value of the PA/Ao ratio in patients with cardiac ATTR.

Methods

Data of consecutive patients diagnosed with cardiac ATTR undergoing CMR were prospectively collected. PA/Ao ratios were measured from CMRs using axial images (Figure 1A). Adverse outcome, defined as heart failure related hospitalizations and/or mortality, was recorded during follow-up.

Results

Among the 190 confirmed cardiac ATTR patients (mean age 76±11 years, 79% males), encompassing hereditary transthyretin (vATTR, n=22) and senile (wtATTR, n=168) types, the median pulmonary artery diameter was 28mm (IQR 25-31) and the median ascending aorta diameter was 35mm (IQR 33-39). Over the median follow-up period of 28 months (IQR 11-50 months), 84 (44%) patients experienced an adverse event. Kaplan Meier curves demonstrated an increased risk for adverse outcome in patients with PA/Ao ratios above the median of ≥0.8 (p<0.001 by log rank test, see Figure 1B). In univariate analysis, a high PA/Ao ratio was associated with adverse outcome (HR=10.3, 95% CI=2.59–41.1, p<0.001). When adjusted for age, sex, body mass index and right ventricular function, the PA/Ao ratio remained significantly related to adverse outcome (adj. HR=10.8, 95% CI=1.76–65.8, p=0.010).

Conclusion

A PA/Ao ratio ≥0.8 on CMR is associated with heart failure hospitalization and death in patients with cardiac ATTR. This threshold, notably lower than the commonly reported ≥1.0 in other patient populations, holds promise for future risk stratification.
Enhanced diagnostic accuracy of cardiovascular magnetic resonance in identifying heart failure with preserved ejection fraction through assessment of right ventricular systolic dysfunction
Authors: Lin T , Huang K C H , Wu W C K
Published: October 2024

Backgrounds

Right ventricular maladaptive response to increased afterload affects exercise performance in heart failure with preserved ejection fraction (HFpEF). We investigated its role in the diagnosis of early stage of HFpEF with cardiac magnetic resonance (CMR) and invasive cardiopulmonary exercise testing (iCPET).

Methods

One hundred forty-five patients with suspected HFpEF were prospectively recruited from two centers and 113 of them completely underwent echocardiography, iCPET, and CMR. The diagnosis of HFpEF was based on the result of iCPET (pulmonary capillary wedge pressure > 15mmHg at resting and >25mmHg at peak exercise). Area under the curve (AUC) was determined by comparing HFpEF with non-HFpEF patients.

Results

Seventy-two HFpEF (68±10 years) and forty-one non-HFpEF (66±11 years) were identified. The resting pulmonary artery compliance was significantly reduced in HFpEF. CMR right ventricle longitudinal strain and left atrial reservoir strain had the highest diagnostic accuracy (AUCs 0.805 and 0.776, respectively). There is a sex disparity in the diagnosis accuracy of left atrial (LA) reservoir strain, with male patients exhibiting a significantly increased AUC (0.801) compared to females (AUC 0.559).

Conclusions

Right ventricular systolic dysfunction is an early indicator of HFpEF, accompanied by impaired LA filling. The diminished LA filling may be more prevalent in male patients, suggesting distinct early pathophysiological progressions between genders.
Severe aortic stenosis is associated with left atrial prothrombotic flow changes that persists despite successful aortic valve replacement
Authors: Spartera M , Stracquadanio A , Bognoni L , Casadei B , Wijesurendra R , Ferreira V M , Rider O , Neubauer S , Rigolli M , Myerson S
Published: October 2024

Background

Severe aortic stenosis (AS) is associated with ischaemic stroke independently of atrial fibrillation (AF) or other causes. Even after aortic valve replacement (AVR), patients remain affected by up to 15% five-year rate of incident ischaemic strokes independently of AVR-related complications and with knowledge gaps in the underlying pathophysiology.

Purpose

To assess whether severe AS leads to prothrombotic left atrial (LA) flow changes with reduction of LA velocities and vorticity which do not normalise after AVR.

Methods

Seventy-seven participants without history of AF were recruited in this study: N=40 with severe AS (60% male; age 73 ±10 years, BMI 28 ±5 Kg/m2, median CHA2DS2VASc = 3) and N=37 controls with similar clinical risk profile (51% male; age 71 ±6 years, BMI 28 ±5 Kg/m2, median CHA2DS2VASc = 3). All participants underwent a cardiovascular magnetic resonance (CMR) scan to quantify left ventricular (LV) volumes, mass, and ejection fraction (LVEF), LV global longitudinal strain (GLS) as a sensitive marker of longitudinal dysfunction, LA maximum volume and emptying fraction (LAEF), LA blood flow peak velocity and vorticity by 4-dimensional flow CMR. Out of the 40 patients with severe AS, N=23 (58%) underwent a successful AVR and were followed-up with a repeat CMR scan at approximately 6 months after surgery.

Results

When compared to matched controls, patients with severe AS displayed significantly higher LV mass, smaller LA and LV volumes (i.e. concentric LV hypertrophy), significantly reduced GLS but higher (more hyperdynamic) LVEF (all p<0.05), as expected. LAEF (i.e. global LA function) was not significantly different from controls but despite this, severe AS was associated with slightly lower LA peak flow velocity (mean 0.25 vs. 0.28 m/sec respectively) and lower LA flow vorticity (mean 16.6 vs. 21.1 radians) compared to controls (both p<0.05).

Successful AVR led to complete regression of LV hypertrophy (p<0.05) with LV mass that was no longer different from controls (p>0.05). Nevertheless, post-AVR patients displayed a persistent adverse morpho-functional phenotype characterised by persistently smaller LA and LV volumes, persistently hyperdynamic LV function with reduced GLS (all p<0.05), as well as adverse LA flow changes with significantly lower velocity (mean 0.24 vs 0.28 m/sec, p=0.003) and vorticity when compared to controls (17.1 vs 21.1 radians, p<0.001).

Conclusions

Patients with severe AS display adverse LA physiology and structure (prothrombotic LA flow characteristics in smaller LA size) and LV changes (smaller size with reduced longitudinal function and hyperdynamic function), which persist after successful AVR despite normalisation of the LV hypertrophy.Figure 1
Role of sumoylation modification of sirtuin 3 in hypertension-associated
Authors: Runmin S , Wang Q Y , Yu J
Published: October 2024

Objective

The present study was designed to investigate whether mitochondrial dysfunction and oxidative stress in HTN-injured cardiomyocytes are associated with SIRT3 SUMOylation and whether SIRT3 deSUMOylation can ameliorate the related cardiomyocyte injury.

Design and method

The human cardiomyocyte AC16 cell line was used for the study. The SIRT3-K288R cell line was constructed by lentiviral transfection;The expression of SOD2, acetyl-SOD2 (MnSOD), protein acetylation level, inflammatory vesicle NLRP3, etc. in different subgroups were detected by Western Blot, and the roles of SUMOylation modification and SIRT3 deacetylation in HTN-associated cell injury were investigated by flow cytometry.

Results

(1) Western Blot results showed that compared to the HTN cell injury model, the cardiomyocytes in the SIRT3-K288R intervention group had increased Acetyl- SOD2/SOD2 levels were increased (p < 0.05) and protein acetylation levels were decreased in the SIRT3-K288R intervention group compared with the HTN cell injury model, indicating that SIRT3 increased the deacetylation effect on mitochondria and increased cellular antioxidant stress enzyme activity;

(2) Western Blot results showed that compared with the HTN cell injury model, cardiomyocytes in the SIRT3-K288R intervention group NLRP3 and NOX4 levels were significantly reduced, indicating that SIRT3 deSUMOylation could improve the inflammatory response to Ang-II-related cell injury.

(3) Flow cytometry results showed that K288R transfection ameliorated the reduction of cellular membrane potential, suggesting that deSUMOylation modification of SIRT3 reduces Ang-II damage to mitochondrial membrane potential.

Conclusions

In the HTN-associated cell injury model, the removal of SUMOylation modification by viral transfection could improve oxidative stress, protein acetylation levels and associated inflammatory responses in HTN-injured cardiomyocytes, indicating that SIRT3 SUMOylation may play an important mechanism in HTN-associated cell injury, and reducing SIRT3 SUMOylation modification may be a possible direction for future research.