Journal of interventional cardiology最新文献

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Trial Registration: ClinicalTrials.gov identifier: NCT03865043

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

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

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

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

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

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

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

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

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

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

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