bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transulnar artery approach in STEMI - Best alternative to radial?
Authors: Zafirovska Taleska B , Jovkovski A , Vasilev I , Taravari H , Kitanoski D , Petkoska D , Spiroski I , Kostov J , Kedev S 
Published: November 2023

Abstract

Background
Transulnar artery approach is a valuable alternative wrist access site for percutaneous coronary interventions. Currently published data about using transulnar approach (TUA) in the STEMI setting are missing. Due to its similarities with transradial approach (TRA), TUA in STEMI (ST segment elevation myocardial infarction) procedures can help in decreasing access site bleeding and vascular complications without sacrificing procedural success.

Purpose
To assess the success and safety of Transulnar access in STEMI.

Materials and Methods
In the period from March 2011 until December 2021, 8013 consecutive STEMI patients underwent primary PCI (percutaneous coronary intervention) in our center. All consecutive patients with transulnar approach (TUA) were included in a single center prospective registry of effectiveness and safety. The primary outcome was procedural success through ulnar access. We also examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TUA.

Results
In this period, 172 STEMI patients (2.1%) underwent PPCI through transulnar approach. Mean age of patients was 60 ± 12 years with 27% females. All procedures were successfully performed through right TUA. There were no STEMI TUA cases with crossover to Transfemoral approach. In 150 patients (87%) TUA was the primary choice of puncture due to no palpable radial artery from previous radial artery occlusion. In 22 patients (12.7%) the reason for crossover from primary TRA to TUA were complex RA anomalies. Type 3 and 4 EASY Score hematoma was present in 4 patients (2.3%). 7% of patients had over 1 access site puncture. UA spasm was registered in 1.7%. Mean procedural time was 32±23 min and fluoroscopy time was 8.5±9.2 min. Ulnar artery anomalies were registered in 1% of patients.
There were no ulnar artery occlusions detected at discharge. There were no clinical or ischemic hand complications seen during clinical follow up.

Conclusion
Transulnar approach is safe and feasible alternative wrist access in the STEMI setting and can further decrease TFA crossover.
Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis
Authors: Wybraniec M , Cichon M , Kampka Z , Drabczyk M , Zielonka M , Wypych G , Grabka M , Mizia-Stec K 
Published: November 2023

Abstract

Background
Percutaneous pericardiocentesis (PP) belongs to life-saving procedures in cardiac tamponade, while it may also serve as diagnostic procedure in patients with recurrent pericardial effusion.

Purpose
The aim of the study was to evaluate the clinical characteristics and predictors of in-hospital mortality among patients subject to PP.

Methods
This single-center retrospective study comprised consecutive patients who underwent PP between 2011 and 2021 regardless of primary diagnosis. Among 132 456 patients screened, 208 patients were subject to PP [109 women, 52.4%; median age of 66 (58; 76) years] who underwent 231 procedures. Exclusion criteria involved data incompleteness regarding the etiology and outcome. The primary endpoint was in-hospital mortality.

Results
The most common indications for PP were neoplastic disease (23.1%), idiopathic effusion (14.42%), coronary artery perforation during percutaneous coronary intervention (PCI; 13.9%), viral pericarditis (11.1%), cardiac electronic device implantation (10.6%), catheter ablation (8.7%) and post-pericardiotomy syndrome (5.8%). Overall, iatrogenic cause was the most common indication for PP (41.8%). The median volume of pericardial fluid was 550 (330; 850) ml. In-hospital death was reported in 11 patients (5.3%). Univariate analysis revealed that in-hospital death was predicted by PCI-related etiology (p&lt;0.0001), history of pulmonary embolism (p=0.007) and sudden cardiac arrest (p=0.032), lower pericardial drainage volume (p=0.037), right bundle branch block (p=0.007), cardiogenic shock (p=0.003), packed red blood cells transfusion (p=0.023). Logistic regression indicated that PCI-related etiology (OR 76.1, p&lt;0.001), history of pulmonary embolism (OR 17.9, p=0.03) and recurrent/persistent cardiogenic shock in the course of in-hospital stay (OR 14.7, p=0.004) were independently associated with in-hospital mortality (AUC 0.895; Figure 1).

Conclusion
Iatrogenic etiology represents the most frequent indication for PP. PCI-related coronary perforation confers the greatest risk of in-hospital death.
Long term safety of paclitaxel coated balloon for de novo non-small coronary lesions
Authors: He X Q , Liu Y , Yin Z Y , Li F , Geuns R J , Garg S , Onuma Y , Serruys P , Gao C , Tao L 
Published: November 2023

Abstract

Background
The efficacy of drug-coated balloons (DCB) for treating de novo coronary stenoses in non-small lesions remains unclear.

Purpose
To evaluate the long-term efficacy of DCB to second-generation drug eluting stent (DES) in de novo, non-small coronary lesions.

Methods
Patients treated with paclitaxel-DCB were compared with patients from two second-generation drug eluting stent (DES) registries. Only patients having DES-only or DCB-only strategies were included; those with in-stent restenosis, a device diameter&lt;2.5mm, DES bailout post-DCB treatment, or combined use of DES and DCB were excluded. The primary endpoint was a patient-oriented composite endpoint (PoCE) defined as all-cause death, any non-fatal myocardial infarction (MI), any stroke, and any revascularization at 2-year. Differences in the risk of PoCE between cohorts were compared and adjusted by inverse probability of treatment weighting (IPTW).

Results
The study included 6,284 patients with 5,399 treated with DES and 885 with DCB. The mean device diameters were 3.05 mm and 2.88 mm in the DES and DCB cohort, respectively. At 2-year follow-up, the primary endpoint occurred in 531 (9.8%) patients receiving DES and 92 (10.4%) patients treated with DCB (HRcrude:1.10, 95%CI:0.88-1.37, P=0.418; HRIPTW:1.08, 95%CI:0.79-1.47, P=0.639; Figure 1). All-cause death occurred in 230 (4.3%) patients in the DES group and 11 (1.2%) patients in the DCB group (HRIPTW:0.27, 95%CI: 0.12-0.57), any non-fatal MI occurred in 56 (1.0%) patients in the DES group and 13 (1.5%) patients in the DCB group (HRIPTW:0.94, 95%CI:0.39-2.25), any stroke occurred in 108 (2.0%) patients in the DES arm and 8 (0.9%) patients in the DCB group (HRIPTW:0.63, 95%CI: 0.29-1.39), and any repeat revascularization occurred in 199 (3.7%) patients in the DES arm and 69 (7.8%) patients in the DCB group (HRIPTW:2.10, 95%CI: 1.43-3.11).

Conclusion
We did not observe DCB to be associated with a higher rate of PoCE than DES in patients with de novo coronary lesions which were ≥2.5mm in diameter. However, DCB was associated with significantly lower mortality and significantly higher rates of repeat revascularization than DES.Figure 1
Incidence of restenosis after drug-coated balloon percutaneous coronary intervention in patients with diabetes mellitus - a single-centre experience
Authors: Hanzek A , Percin L , Loncaric F , Ostojic Z , Krcmar T , Maric-Besic K , Radic D , Dosen D , Pasalic M , Jurin H , Skoric B , Bulum J , Margetic E , Milicic D 
Published: November 2023

Abstract

Background and aim
Diabetes mellitus (DM) is related to higher rates of complications after coronary revascularization.1 The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, however data on outcomes in DM is scarce. 2 The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without DM receiving DCB PCI.

Material and methods
The registry included patients undergoing a DCB PCI at our university hospital centre from February 2011 to January 2022 (n=645). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. An FUP angiography was performed in 50% of patients (n=317), with a median FUP of 6 (interquartile range 3-17) months.

Results
Data is shown in Table 1. The cohort was 75% male, mean age 65 ± 10 years. DM was present in 35% (n=223) of patients, equally in both sexes, and was associated with a history of myocardial infarction, PCI, coronary artery bypass grafting, stroke; as well as arterial hypertension, and renal insufficiency. No age difference was noted between groups. At initial PCI, more DM patients had multivessel coronary disease and ISR as the indication for DCB (DM vs non-DM: 41% vs 31%, p=0.023). After DCB, no group difference was noted in regards to the need for a bail-out PCI. FUP was performed in an equal percentage of patients in both groups (54% vs 48%, p=0.181), with no differences seen in the incidence of restenosis (17% vs. 18%, p=0.879), the need for target lesion PCI (14% vs. 13%, p=0.863), or the use of anti-anginal drugs.

Conclusion
The findings of our single-centre analysis show that although DM is related to more advanced comorbidities it does not increase the risk of target lesion restenosis after DCB PCI. DCB PCI should be considered as a therapeutic option in candidate patients regardless of DM status.Comparison between diabetic and non diab
Coronary angiography and intervention after transcatheter aortic valve implantation (TAVI): the nationwide SWEDEHEART registry
Authors: Nilsson K , Shahim B , Settergren M , James S 
Published: November 2023

Abstract

Background
Coronary access after transcatheter aortic valve implantation (TAVI) can be challenging and complicate percutaneous coronary intervention (PCI). Therefore, pre-existing severe coronary stenosis is usually treated either before or during the TAVI procedure. However, due to the progressive nature of coronary artery disease (CAD), some patients require urgent or elective coronary angiography and intervention after their TAVI procedure.

Purpose
To assess the indication, the incidence, and feasibility of coronary angiography and intervention after TAVI.

Methods
All patients undergoing TAVI between 2008 and 2021 from the Swedish Transcatheter Cardiac Intervention Registry (SWENTRY) were included. SWENTRY was further linked to the Swedish Coronar Angiography and Angioplasty Registry (SCAAR) and the National Cause of Death Registry.

Results
Among 8819 patients undergoing TAVI, 697 angiograms were performed in 515 patients (5.8%) after TAVI (43.1 % after balloon-expandable bioprosthesis, 49.5 % after self-expandable bioprosthesis) at a median follow up of 841 days (interquartile range: 346 to 1457 days). PCI was performed in 347 patients (49.8%) with a success rate of 92.5% with no significant differences between patients implanted with balloon-expandable and self-expandable bioprostheses (93.0% vs.91.5%; p=0.62). The most common indications for PCI after TAVI were non-ST elevation acute coronary syndrome (NSTE-ACS) (45.8%), chronic coronary syndrome (30.3%), ST elevation myocardial infarction (6.9%) and congestive heart failure (3.5%). The cumulative incidence of angiograms with or without PCI at 30 days, 1 year, 2 years and 5 years were 6.9, 37.2, 60.2 and 90.2 percent of the total number of angiograms respectively (Figure).

Conclusion
Coronary angiogram and interventions after TAVI are rare, with an incidence declining over time after TAVI. The main indication for coronary angiogram and PCI was NSTE-ACS. PCIs were successfully performed after TAVI, with no apparent differences between balloon-expandable and self-expandable bioprostheses.
Clinical outcomes of isolated tricuspid valve surgery: a systematic review
Authors: Chick W , Alkhalil M , Egred M , Gorog D , Malik I , Zaman A , Khawaja S , Lucarelli C , Khokhar A , Mikhail G , Farag M 
Published: November 2023

Abstract

Background/Introduction
Patients with isolated tricuspid valve (ITV) disease have a poor prognosis with no consensus on their management. Transcatheter ITV intervention is emerging as a valid option in patients with prohibitive surgical risk.

Purpose
We aimed to analyse the characteristics and clinical outcomes of patients who underwent ITV surgery to inform the clinical decision making in patients undergoing transcatheter ITV intervention and to advance the development of future technologies.

Methods
Digital databases were searched from inception through to 2022 for studies reporting clinical outcomes on ITV surgeries, namely ITV repair, ITV replacement with a bioprosthetic valve (ITVR-B), or ITV replacement with a mechanical valve (ITVR-M). Overall estimates of treatment effect were calculated with a random-effects model.

Results
Twenty-seven studies involving 10,478 patients (4,931 ITV repair, 3,821 ITVR-B, 1,713 ITVR-M) were included. Overall, early mortality occurred in 9.0% of patients and did not differ between different ITV surgical approaches. Late mortality was 27.1% at a median follow-up of 3.9 (3.0-6.0) years and was significantly higher for all ITV replacement surgeries (30.2% vs. 24.7%, RR 1.18, 95% CI 1.05-1.31, P=0.004) compared to ITV repair. Late mortality did not differ between ITVR-B and ITVR-M. Early and late clinical outcomes after ITV surgery differed according to the surgery performed. Compared to all ITV replacement surgeries and despite its favourable late mortality outcomes, ITV repair was observed to have a relatively higher risk of cerebrovascular accidents or need for permanent pacemaker implantation in the post-operative period, as well as TV regurgitation recurrence after 1 year.

Conclusions
Amongst ITV surgeries, ITV repair has favourable long-term mortality compared to ITV replacements. This supports the development and refinement of transcatheter ITV repair approaches in suitable patients.
Role of right ventricular remodeling in functional status and prognosis after transcatheter tricuspid valve repair
Authors: Iliadis C , Ehrenfels M A , Fretter C , Von Stein J , Koerber M I , Baldus S , Pfister R 
Published: November 2023

Abstract

Background
Severe tricuspid regurgitation (TR) is associated with chronic volume overload and right ventricular remodeling (RVR). Transcatheter tricuspid valve repair (TTVr) reduces TR and can improve quality of life (QoL), but the role of preprocedural RVR on functional and clinical outcomes after TTVr remains unclear.

Purpose
Aim of this study was to investigate the role of RVR on functional and clinical outcomes after TTVr for severe TR.

Methods
RVR was defined as dilation of right ventricular mid-level diameter (&gt;35 mm) according to current guidelines. In 226 patients undergoing TTVr (edge-to-edge repair or annuloplasty) for severe TR with heart failure (HF), outcomes were compared between 139 patients with RVR and 87 patients without RVR. Functionality and QoL were evaluated using NYHA class, Minnesota Living With Heart Failure Questionnaire (MLHFQ), 36-Item Short-Form Health Survey (SF-36), and 6-Minute-Walking-Distance (6MWD) 30 days after TTVr. Clinical outcome was assessed through one-year and long-term mortality, HF rehospitalization and need for repeat TV intervention.

Results
Symptomatic improvement of at least one NYHA class was achieved regardless of RVR (58% vs. 66% of patients with vs. without RVR). Functionality and QoL improved without statistical difference in both groups, with clinically relevant 6MWD improvement of ≥50m in 34% vs. 36% of patients with vs. without RVR; clinically relevant MLHFQ improvement of ≥5 points was present in 70% vs. 81% of patients with vs. without RVR; and clinically relevant SF-36 improvement of ≥2.5 points in 65% vs. 69% with vs. without RVR. One-year mortality after TTVr was 24% vs. 8% in patients with RVR vs. without RVR (p=0.02). One-year HF rehospitalization after TTVr was 30% vs. 13% in patients with vs. without RVR (p=0.04), whereas need for repeat TTVr was not associated with RVR. Long-term follow-up was available after 457±403 days. In multivariable analysis, RVR remained an independent predictor of long-term mortality (HR 2.3, 95%CI [1.03-5.1], p=0.04) and of the combined endpoint of long-term mortality or HF rehospitalization (HR 2.4, 95%CI [1.06-5.5], p=0.04).

Conclusion
TTVr resulted in clinically relevant improvement of functionality and QoL in patients with HF already after one month, irrespective of RVR. Patients with preprocedural RVR had higher rates of one-year mortality and HF hospitalization. However, preprocedural RVR should not be considered as marker of TTVr futility.
Comparative analysis between transcranial doppler and transesophageal echocardiogram in diagnosing residual shunt after persistent foramen ovale closure
Authors: Jang A Y , Shin Y H , Lee J P , Won Y S , Yang T I , Kim J H , Kang W C 
Published: November 2023

Abstract

Background
The degree of residual shunt (RS) after patent foramen ovale (PFO) closure is a potent predictor for the recurrence of stroke. Evaluating the extent of residual shunt grade is thus essential. Currently, there is no gold standard on guidelines of how to evaluate RS. Although transesophageal echocardiography (TEE) is known to be most accurate in evaluating RS, it is not routinely performed due to its invasiveness and expensive costs. Conversely, the transcranial doppler (TCD) test is a less invasive convenient test for detecting RS. Accordingly, we sought to comparatively analyze the accuracy of TCD compared to TEE on assessing RS after PFO closure.

Methods
We analyzed patients who underwent PFO closure for cryptogenic stroke (CS), who received a TCD and TEE test within 1 year of procedure. All patients received TEE and TCD on the same day within one year (288±38 days) after PFO closure.

Results
We analyzed a total of 55 patients (age: 55.2 ± 11.1, male sex: 74.2%, PFO grade ≥ moderate: 83.6%, follow up duration: 28.9 ± 14.9 months). RS was confirmed in 24 (44%) and 23 (42%) of patients in the TCD and TEE test, respectively. The sensitivity and specificity of TCD was 0.77 and 0.96 for predicting the presence of RS, respectively. The predictive performance of TCD was consistent over age ≤65 (sensitivity 0.73, specificity 0.96) and RS≤mild (sensitivity 0.83, specificity 0.96) subgroups. Positive TCD (adjusted odds ratio 101.2; 95%CI, 9.5-1074.8; p&lt;0.0001) was a highly significant independent predictor for the presence of RS.

Conclusion
We demonstrate for the first time that TCD may be a reliable non-invasive test for substituting TEE in evaluating RS. Physicians may be able to rule out the presence of RS and minimize the prescription of TEE when TCD test is negative due to the high specificity.
Association of high normal blood pressure defined by different criteria with all-cause and cardiovascular mortality
Authors: Zhang Y I , Zhao Y , Li M O R A N , Han J U N 
Published: November 2023

Abstract

By grouping population according to guideline definition, in terms of all-cause mortality and cardiovascular death, there was no significant difference between population with normal blood pressure (NT) and with high normal blood pressure (HNBP). But both groups had significantly lower risk compared with hypertension group (HTN). Multivariate Cox regression results indicated the lowest risk of all-cause mortality in the HNBP group and no difference in risk of all-cause mortality between the NT and HTN groups, which was illogical and inconsistent with real-world clinical practice.
By grouping population according to SBP, we found that the grouping could better distinguish the all-cause and cardiovascular mortality among groups. Multivariate COX regression analysis found that NT and HNBP groups had no difference in risk of all-cause and cardiovascular death.
The restricted cubic spline curve of DBP showed the lowest HR were found when DBP was between 83 and 95 mmHg, which were defined as high normal blood pressure or hypertension according to guideline-directed classification. This result may be the primary reason for the difference between guideline and SBP-directed classification.

Conclusion and clinical significance
In this study, our analysis showed that the blood pressure classification based on SBP had a higher association with both all-cause mortality and cardiovascular mortality than the guide-directed definition. DBP inclusion could be a confounding factor for the classification. People with high normal blood pressure did not show a worse prognosis than those with normal blood pressure.abstract figure
Kidney subclinical lesions in hypertension phenotypes defined by Home Blood Pressure Monitoring among young adults enrolled in a Family Health Strategy unit
Authors: Neno J O G , Mello T S , Moura C A P M , Tostes F R C , Bandeira H O M R , De Castro R B , Junqueira L L M B , Falcao M F , Brazil L M A , Lopes C C , Guimaraes K S , Boghossian R B , Maselli G F F , Muxfeldt E S , Pecly I M D 
Published: November 2023

Abstract

Introduction
The association between kidney lesion, hypertension (HTN) and cardiovascular risk (CV) is well established. Asymptomatic patients with decreased glomerular filtration rate (GFR) and/or increased albuminuria seem to have increased CV risk. The refinement of HTN diagnosis using Home Blood Pressure Monitoring (HBPM) allows to identify individuals with different phenotypes: normotension, sustained HTN (SHT), masked HTN (MHT) and white-coat HTN (WHT), increasing diagnostic accuracy.

Objective
To assess kidney subclinical lesions among different hypertension (HTN) phenotypes identified by Home Blood Pressure Monitoring (HBPM) in an adult population enrolled in a Family Health Strategy unit.
Design and Methods: Cross-sectional, populational study with adults between 20-50 years old enrolled in a Family Health Strategy unit in a metropolis. Sociodemographic, anthropometric and CV risk factors were registered. Office blood pressure (BP) was the average of two consecutive measurements, and HBPM followed a 7-day protocol. HBPM &lt; 135x85 mmHg and office BP &lt; 140x90mmHg were considered normal, identifying four phenotypes: normotension (controlled office BP and HBPM); white-coat hypertension (uncontrolled office BP and controlled HBPM); masked hypertension (controlled office BP and uncontrolled HBPM) and sustained hypertension (uncontrolled office BP and HBPM). Albuminuria was dosed in an isolated urine sample whereas glomerular filtration rate was calculated by CKD Epi formula using serum creatinine.

Results
A total of 483 individuals were evaluated (39% male; mean age: 37.6 ± 8.8 years). More often, individuals with white-coat hypertension (9.3%) are male, with greater neck circumference and higher prevalence of metabolic syndrome. Individuals with masked hypertension (10%) are more obese, with increased neck and waist circumferences whereas those who present sustained hypertension are predominantly male, more obese, with increased neck and waist circumferences and higher prevalence of diabetes and metabolic syndrome. Analyzing four phenotypes, a progressive albuminuria increase was observed among normotensive patients: white-coat hypertension 4.0 ± 2.2; masked hypertension 5.3 ± 3.4 and sustained hypertension 7.1 ± 1.4 mg/g creatinine. We also observed an increased serum creatinine and decreased GFR: white-coat hypertension 0.74 ± 0.16/132 ± 34; masked hypertension 0.79 ± 0.17/123 ± 28; sustained hypertension 0.81 ± 0.32/120 ± 59, respectively, although without statistical significance.

Conclusion
The performance of HBPM refined HTN diagnosis and was able to early identify a progressive worsening of kidney function parameters in the different phenotypes.