bluuebunny/crossref_metadata_2025_split huggingface dataset:
A simplified bedside model for acute kidney injury prediction after percutaneous coronary intervention
Authors: Balanescu D V , Fatema K , Lewis B R , Best P J , Gulati R , Herrmann J 
Published: October 2024

Abstract

Background
Concern for acute kidney injury (AKI) after percutaneous coronary intervention (PCI) is a major determinant in the decision to pursue cardiac catheterization if otherwise indicated. A bedside AKI risk prediction model derived from the National Cardiovascular Data Registry (NCDR), most recently updated in 2023, employs relatively complex parameters for AKI prediction.

Purpose
To test the efficacy of a simplified pre-procedural 5-variable bedside score for post-PCI AKI prediction based on the NCDR model.

Methods
We analyzed our institution’s NCDR-reported catheterization laboratory registry between Q2 2022 and Q1 2023. Inclusion criteria, variable selection, and definitions were based on the NCDR model. A bedside prediction model was validated, including 5 pre-procedural variables: anemia (hemoglobin &lt;10 mg/dl), history of heart failure, stage 4 or 5 chronic kidney disease (glomerular filtration rate &lt;30 mg/dl), cardiac arrest, and shock status.

Results
We included 840 patients, of which 593 (70.6%) were men. Mean age was 69 (±12.5). Most procedures were performed on an urgent basis (444, 52.9%). AKI developed in 107 (12.7%) patients. Compared to the non-AKI group, patients who developed AKI were older (age 74±11.5 vs 68.3 ±12.5), and more frequently had anemia (23.6% vs 7.4%), diabetes (51.4% vs 35.2%), severe frailty (45.8% vs 23.7%), heart failure (62.6% vs 29.7%), cardiac arrest (13.1% vs 2.9%), CKD (30.8% vs 6%), shock (12.1% vs 1.5%), and mechanical circulatory support (7.5% vs 2.9%), p&lt;0.001. Utilizing integer scores, the simplified bedside model employing 5 pre-procedural variables demonstrated discrimination similar to the bedside NCDR model, with a C-statistic of 0.77 (0.60-0.88) and excellent calibration (intercept of 0.31 and slope of 1.03) (Figure), indicating the robust performance of the model (compared to bedside NCDR model with a C-statistic 0.793, intercept of -0.197, and slope of 0.957).

Conclusion
A simplified NCDR-based bedside score using 5 pre-procedural variables is an effective tool for predicting AKI as a complication of PCI, with comparable performance to the 2023 updated bedside NCDR AKI risk model.
Incidence and predictors of radial artery occlusion following transradial coronary procedures
Authors: Lounes M S , Allal K , Meftah A , Fedali Y , Ait Aider M , Ammari B , Allali A , Benkhedda S 
Published: October 2024

Abstract

Background
Transradial access for percutaneous coronary procedures has grown in popularity because of its advantages over the femoral approach. However, the benefit is overshadowed by an increased rate of radial artery occlusion (RAO). We aim to assess incidence and predictors of RAO after transradial catheterization. The anatomic variations of the radial artery (RA) were also studied.

Methods
This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. An ultrasound evaluation of forearm arteries was performed. In case of RAO, another ultrasound check-up was performed after 1 month and 3 months of the procedure.

Results
Our study population includes 288 patients (32.6% female). The mean age was 61.9 ± 11.1 years. RAO occured in 48 patients (11.24%), among whom spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, a younger age (OR 0.642 [CI 95%: 0.480 – 0.858], P = 0.031), low periprocedural systolic blood pressure, (OR 0.598 [CI 95%: 0.415 – 0.862], P = 0.007), a small radial diameter (OR 0.371 [CI 95%: 0.323 – 0.618], P = 0.031), insufficient anticoagulation (OR 0.287 [CI 95%: 0.163 – 0.505], P &lt; 0.001), occlusive hemostasis (OR 0.128 [CI 95%: 0.047 – 0.353], P &lt; 0.001), and a long duration of hemostasis emerged as independent predictors of radial occlusion.
The overall incidence of radial artery anatomic variations was 14,8% (n=63). Among these patients, 40 (63.5%) had a high radial origin, 18 (28.6%) had extreme radial artery tortuosity, and 5 (7.9%) had a full radioulnar loop.

Conclusion
The incidence and prevalence of radial artery occlusion is expected to increase. Insufficient heparinization and occlusive hemostasis are the main modifiable predictors. The preventive strategy should focus primarily on these 2 predictive factors.
Radial versus femoral access for rotational atherectomy angioplasty
Authors: Carvalho M , Cabral M , Goncalves C , Vazao A , Martins A , Guardado J , Morais J 
Published: October 2024

Abstract

Introduction
The transfemoral approach (TFA) is a potentially advantageous acess site for complicated and prolonged percutaneous coronary angioplasty like rotational atherectomy (RA). Despite this, there is mounting data that suggests the transradial approach (TRA), an alternative to the TFA acess, is linked to reduced rates of mortality and access site complications.

Aim
This study was conducted with the aim of providing a quantitative appraisal of clinical outcomes of TRA for patients undergoing RA procedure.

Methods
In this retrospective study, we analyzed all RA procedures performed from March 2013 to June 2019 at our single center institution. Primary endpoints were procedural success, in-hospital mortality, and major adverse cardiovascular events (MACE) during hospitalization.

Results
Of the 98 patients undergoing RA, the TRA approach was chosen for 79% patients, and the TFA approach for 21% patients. No significant difference in procedural success rates was observed (94% vs. 91%, p=0.19). The use of RA via TRA correlated with a lower contrast volume (p=0.027) and a decreased post-procedure hospital stay (p=0.005). After multivariate adjustment, TRA demonstrated a noteworthy reduction in in-hospital mortality odds (OR: 0.62; 95% CI: 0.44 to 0.87; p = 0.003), major bleeding (OR: 0.48; 95% CI: 0.33 to 0.70; p &lt; 0.001), MACE (OR: 0.68; 95% CI: 0.51 to 0.89; p = 0.015), and 30-day mortality (OR: 0.68; 95% CI: 0.51 to 0.89; p = 0.015).

Conclusions
Even though RA is a complex procedure, employing radial access (TRA) might be associated with favorable outcomes. These include a lower contrast volume, shorter hospital stay, and reduced odds of in-hospital mortality, major bleeding, MACE, and 30-day mortality compared to femoral access (TFA).
Comparative assessment of extracellular volume metrics in predicting adverse outcomes in patients with transthyretin amyloid cardiomyopathy
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

Abstract

Introduction
The indexed total extracellular volume of the myocardium (iECV) has recently been proposed to be superior in predicting adverse outcome in severe aortic stenosis as compared to conventional extracellular volume (ECV). So far, no study has assessed the comparative predictive performance of both measures in transthyretin amyloid cardiomyopathy (ATTR-CM).

Aim
We aimed to assess and compare the predictive performance of conventional ECV against iECV in determining adverse outcomes in patients with ATTR-CM.

Methods
From 2012 to 2023, patients with ATTR-CM undergoing contrast cardiac magnetic resonance (CMR) imaging prior to any specific treatment were enrolled. Both, conventional ECV and iECV were quantified on CMR alongside left ventricular volumetrics and late gadolinium enhancement. Adverse outcome was defined as a composite endpoint of hospitalization for heart failure and/or death.

Results
Analysis of 178 patients with ATTR-CM (82% males, mean age 77±8 years) revealed a mean conventional ECV of 47±13% and a mean iECV of 46±21 mL/m2, with a median follow-up of 2.5 years (IQR: 1.00-4.08 years). Conventional ECV was significantly associated with the composite endpoint (HR=1.03, 95%CI=1.01–1.05, p=0.006), outperforming iECV (HR=1.01, 95%CI=1.00–1.02, p=0.010). On multivariate analysis, adjusted for age, sex and left ventricular function, conventional ECV remained associated with the composite endpoint (p=0.002), while iECV demonstrated a slightly less significant association (p=0.003). Kaplan-Meier analysis, stratified by conventional ECV tertiles, revealed that patients in the highest tertile (ECV ≥53%) demonstrated the highest event rate (p = 0.043 by log rank test, see Figure 1A), in contrast to iECV (p=NS, Figure 1B).

Conclusions
High conventional ECV, among CMR fibrosis markers, is linked to heart failure hospitalizations and death in ATTR-CM, demonstrating superior prognostic value compared to iECV. Conventional ECV measurements may offer enhanced risk stratification for patients with ATTR-CM.
Side branch interventions late after MFM implantation
Authors: Polomski P , Petrov I , Stankov Z 
Published: October 2024

Abstract

Background
MFM prostheses were developed for the endovascular treatment of aortic and great vessel aneurysms. Implanted between two healthy segments of arterial vessel, they centralize blood flow and trough Bernoulli's principle. Thereby hemodynamic stress into the aneurismal sac is reduced. Meantime, the porosity along entire prosthesis length preserves all side branches (SB) patent. Results from real clinical practice confirm the high success rate (nearly 100%) of MFM prostheses regarding side branch preservation at one-year follow-up [1,2]. However, late after MFM implantation SB intervention may be required (due to atherosclerosis or others). The access to SB covered by MFM is challenging due to: impossible ostial engagement of the guiding catheter, distance between target vessel ostium and prosthesis, the necessary for all devices used to cross MFM mesh.

Materials and methods
For the period 2016-2020 we implanted a specific type of MFM prosthesis in order to treat aneurysm of the abdominal aorta in 34 patients. A total of 129 side branches was covered. Within a mean follow-up period of 5 years, 129 side branches were preserved and 7 affected by stenosis or occlusion (two of them asymptomatic). Intervention on the branch covered by the MFM prosthesis was necessary in 5 patients (two males, two females; mean age 68 years). One patient had endovascular celiac trunk stenosis, one patient had both celiac trunk and superior mesenteric artery stenoses, one patient had superior mesenteric artery stenosis, and one patient had left renal artery stenosis. All lesions were intervened through radial or brachial approach. Guiding 6F Judkins right catheter was navigated close to the target branch ostium and the MFM mesh was crossed with .014¨ coronary wire. When guidewire was placed into target vessel small low-profile, coronary balloon is advanced across the mesh of the multilayer stent. Anchor balloon technique was used in order for guiding catheter to cross the mesh gradually. Once the guiding catheter is engaged, the lesion was treated with balloon pre-dilation and implantation of a low-profile, high radial force stent.

Results
All 4 patients and 5 affected vessels were successfully endovascularly intervened. We did not observe any procedure complications. Immediate resolution of clinical symptoms was achieved. At 1 year follow-up with CT scan all treated branch arteries were patent.

Conclusions
In patients with previously implanted multilayer stents, the mesh can be crossed safely with readily available coronary devices together with the balloon anchor technique. As such, endovascular treatment of stent-covered visceral and renal arteries is possible without open surgery.Catheter stabilizationSMA successfully treated
Insights into retroperitoneal hemorrhage management: result from a tertiary cardiovascular center prospective cohort
Authors: Ghaffari Jolfayi A , Rezaeian A , Elahifar A , Bahadori M J , Sheibani M , Bashghareh P , Mehdizadeh K , Shahinfar H , Mohebbi B , Alemzadeh-Ansari M J , Khalilipur E , Farmani D , Pouraliakbar H R , Firouzi A , Sadeghipour P 
Published: October 2024

Abstract

Background
Although rare, retroperitoneal hemorrhage (RPH) during percutaneous cardiovascular interventions is still potentially fatal, poses a critical challenge, often necessitating swift and precise management strategies. Its management is still controversial, and available recommendations are mostly based on expert opinion, and not updated according to recent advancement in the field of interventional cardiology.

Purpose
To present the rate, clinical characteristics and modern management of patients complicating with RPH in a large tertiary cardiovascular center

Method
We collected prospectively all consecutive RPH events encountered in the catheterization laboratories of a large tertiary cardiovascular center during 2014-2022. Procedural data from all the diagnostic and therapeutic procedures performed in the same time period, were retrieved from electronic hospital records (EHR).

Results
Among 89,361 percutaneous cardiovascular diagnostic or therapeutic procedures performed on 69596 patients, 52 (0.058%) episodes (patients) of RPH, (mean age of 56.37±16.84 years with female sex predominance of 36 (69.23%)). Also 2 (3.8%) patients died due to RPH. Non-contrast abdominopelvic CT scan was the most common primary imaging modality for RPH diagnosis, followed by DSA angiography. Of note, 13 (25 %) of patients returned directly to catheterization laboratory for RPH evaluation. Thirty-one (59.6%) patients were ultimately treated conservatively and no patient treated surgically. Structural and peripheral procedures were more prone to RPH. Still a median time of 7.5 hours was needed for RPH diagnosis. Contralateral access was the dominant approach for treating RPH, and although balloon tamponade was used in 11 (52.4 %) patients, 17 (80.9 %) patients were treated ultimately with covered stents; deep femoral and internal iliac arteries were covered in 1 (5.9%) and 2 (11.8%) patients, respectively. Patients treated endovascularly for RPH had higher acute kidney injury and longer hospital stays. Further comprehensive analysis regarding the potential risk factors of RPH are pending.

Conclusion
Our preliminary analysis from a large tertiary cardiovascular center database, showed RPH is still rare, with acceptable mortality rate of 3.83%. Our data showed the necessity of more precise probability assessment tools to improve the diagnostic time.
How different types of cardiomyopathy with hypertrophic phenotype affect left atrial remodeling and function
Authors: De Raffele M , Teis A , Weerts J , Conte C , Junca G , Ferrer Sistach E , Cediel G , Bertini M , Bayes-Genis A , Delgado V 
Published: October 2024

Abstract

Background
Left atrial (LA) dysfunction is a common feature in hypertrophic cardiomyopathies. How the underlying etiology and pathophysiology of different cardiomyopathies affects LA remodeling and function remains unexplored.

Purpose
The aim of our study is to investigate the influence of various cardiomyopathies with hypertrophic phenotype on LA remodeling and function.

Methods
Patients with left ventricular (LV) hypertrophic phenotype who underwent cardiac magnetic resonance (CMR) were included. A group of patients with a normal CMR was included as a control group. CMR acquisitions used for clinical indication of heart failure diagnosis and etiology were retrospectively analyzed to obtain LA reservoir, conduit, and booster strain, left atrioventricular coupling index (LACI) and LA sphericity. Differences between groups were assessed. To investigate the independent clinical associates of LA reservoir, conduit and booster strain, multivariable linear regression analyses were performed.

Results
A total of 375 individuals were analyzed including 321 patients diagnosed with LV hypertrophy and 54 patients with a normal CMR. Of the 321 patients with LV hypertrophy, 148 were diagnosed with hypertrophic cardiomyopathy (HCM), 35 with cardiac amyloidosis (CA), 41 with hypertensive cardiomyopathy (HTN) and 97 with severe asymptomatic aortic stenosis (AS). CMR LA characteristic and strain analysis results are summarized in Figure 1. The indexed LA end-systolic volume (iLAVmax), indexed LA end-diastolic volume (iLAVmin) and LA sphericity were larger in patients with CA when compared to other groups (all p&lt;0.05). CA patients displayed more left atrioventricular uncoupling (lower LACI) when compared to individuals with HCM, HTN, AS, and controls (all p&lt;0.001), while no significant differences were observed across other groups. CA patients exhibited lower LA reservoir and booster strains compared to the other groups (all p&lt;0.05), whereas no significant differences were observed across other hypertrophic phenotype diseases. Age, iLAVMax and LACI were independently associated with all the three LA strain components (Figure 2, all p&lt;0.05).

Conclusions
LA remodeling and function are affected differently across the various etiologies of LV hypertrophy. CA patients exhibit more pronounced atrial involvement, whereas those with HCM, asymptomatic AS, and HTN display similar patterns of atrial dysfunction and remodeling. Additionally, CMR-derived iLAVmax and LACI are independently correlated with LA function.
Intravascular lithotripsy in the management of underexpanded stents
Authors: Sagris M , Soulaidopoulos S S , Vlachakis P V , Papanikolaou A P , Ktenopoulos N K , Tousoulis D T , Toutouzas K T , Tsioufis K T 
Published: October 2024

Abstract

Introduction
Stent underexpansion significantly heightens the risk of major adverse cardiac events (MACE), and available treatment options for this condition remain limited. Intravascular Lithotripsy (IVL) technology disrupts superficial and deep calcium by using localized pulsative sonic pressure waves, emerges as a promising tool for underexpanded stents.

Methods
Following PRISMA guidelines, we systematically explored PubMed, SCOPUS, and Cochrane databases up to September 3, 2023, for studies evaluating IVL's safety and efficacy in treating underexpanded stents. We gathered angiographic (QCA) and intracoronary imaging (OCT or IVUS) data, examining the stent's minimal diameter stenosis (MDS), minimal lumen diameter (MLD), minimal stent area (MSA), and minimal lumen area (MLA) pre- and post-IVL application. Procedural success constituted the efficacy endpoint, while peri-procedural complications, in-hospital-30-days and long-term mortality, and MACE were safety endpoints

Results
This meta-analysis comprised 21 studies including 669 patients and 673 treated lesions in underexpanded stent. The mean age was 73.2 ± 2.1 years, with an overall IVL procedural success rate of 93% [(95% Confidence Interval (CI): 88%-96%, I2=29%), while the in-hospital-30-days and long-term mortality incidence were 1% (95% CI: 1%-3%, I2=0%) and 3% (95% CI: 2%-6%, I2=0), respectively. The 30-days target lesion revascularization (TLR) was approximately 6% (95% CI: 3%-12%, I2=50%). There was a significant increase in the MDS [Standardized Mean Difference (SMD): +50.52%, 95% CI: 39.4-61.6, I2=94%)] and in MSA (SMD: +3.52, 95% CI: 2.47 to -4.58, I2=83%) immediately after IVL application. It was observed a significant increase in MLD (SMD: +1.54, 95% CI: 1.09 to 1.98, I2=95%) and in the MLA (SMD: +3.64, 95% CI: 2.62-4.66, I2=5%). Major procedural and device related complications were 3% (95% CI: 1%-6%, I2=0%) and 1% (95% CI: 0%-2%, I2=85%) respectively. Notably low rates were observed for stent thrombosis (0%, 95% CI: 0%-2%, I2=0%), dissections (1%, 95% CI: 1%-4%, I2=0%), perforations (1%, 95% CI: 1%-3%, I2=0%) and no-reflow (0%, 95% CI: 0%-1%, I2=0%).

Conclusions
IVL demonstrates promise as a safe and effective strategy for underexpanded stent treatment, characterized by low rates of periprocedural complications. Future prospective studies are now warranted to compare IVL to other lesion preparation strategies.30day All-Cause Mortality after IVL use.Minimum Stent Diameter after IVL use.
TAVI-related vascular access complications: are Viabahn stents a good option?
Authors: Ferreira A , Teixeira R , Rodrigues I , Grazina A , Teixeira B , Castelo A , Mendonca T , Morais L , Ramos R , Fiarresga A , Ferreira R C , Cacela D 
Published: October 2024

Abstract

Background
Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). Historically, concerns regarding stent placement in flexing points have been a deterrent to the percutaneous treatment of VACs, due to the potential development of claudication over time. The Viabahn stent, being a covered stent that offers flexibility and conformability, may be well-suited for deployment in these anatomies.

Purpose
This study aimed to evaluate the safety and efficacy of the iliofemoral Viabahn stenting for treating TAVI-related VACs.

Methods
Retrospective analysis of patients submitted to Viabahn stenting in the iliofemoral sector for TAVI-related VACs in a single tertiary centre between January 2017 and October 2023. Baseline characteristics, procedure data and complications were noted according to the Valve Academic Research Consortium-2.

Results
A total of 722 patients were submitted to transfemoral TAVI during the study period. Of these, 25 (3.6%) underwent Viabahn stenting to treat TAVI-related VACs and were included in this study. Patient mean age was 82.1±6.13 years, 61.2% were male. At the baseline, patients had a mean Euroscore II of 2.73±1.91. A unilateral access approach was used in 40% of cases. The median size of the main access sheath was 14 Fr [IQ 14-16], and the closure devices deployed were Manta® in 72%, and Perclose® in 28%. The Viabahn stent treated different types of VACS, including vessel rupture in 56%, acute dissection in 28% (12% with no antegrade flow), and failed sealing in 16%. The complicated artery was the common femoral in 82%, and the external iliac in 18%. Percutaneous treatment with Viabahn stenting was successful in 92% of cases. In two cases (8%), one of acute occlusion and one of vessel rupture, vascular surgery was required. During the hospital stay, there were no further vascular or hemorrhagic complications. After a mean follow-up of 15 months, 20% of patients were evaluated by Doppler which showed no signs of restenosis or stent complications. Only one patient experienced lower limb claudication at 1 year due to stent restenosis detected in the CT scan, which was managed with medical therapy. There were no other adverse vascular events during follow-up.

Conclusion
Our study suggests that Viabahn stenting emerges as a valuable therapeutic option, ensuring long-term safety and efficacy, in the complex realm of TAVI-related vascular complications.