Journal of interventional cardiology最新文献

Aim: Mitral regurgitation (MR) is a prevalent cardiovascular condition, and its treatment remains challenging, especially in high-risk patients. The fourth-generation MitraClip system (NTW and XTW) offers enhanced capabilities for repairing mitral valves (MVs) with complex anatomies. This study evaluates the haemodynamic function of MVs after edge-to-edge with wide MitraClip under physical stress induced by handgrip exercise stress echocardiography.

Methods: This prospective study included 27 patients with severe MR. All patients underwent successful MitraClip implantation, and handgrip stress echocardiography was performed predischarge. The primary endpoint was a postprocedure mean transmitral gradient (TMG) < 5 mmHg under stress. A machine learning (ML) model using logistic regression as the learner and advanced data augmentation techniques, including random splitting of data into training and testing subsets and repeating the process 50 times, were employed to ensure robustness.

Results: MitraClip implantation reduced MR severity from 3.02 ± 0.22 to 0.98 ± 0.43 (p < 0.0001). Stress-induced increases in heart rate, blood pressure and TMG were significant (TMG: 3.04 ± 0.90 mmHg at rest vs. 4.11 ± 1.53 mmHg under stress, p < 0.0001). Thirty-seven percent of patients exhibited TMG ≥ 5 mmHg during stress. Predictors of elevated TMG included secondary MR, BMI, and multiple clip implantation (AUC = 0.90; 95% CI: 0.79–0.96). Despite increased TMG, no patients experienced significant symptoms or pathological MR.

Conclusion: Wide MitraClips effectively reduce MR with satisfactory haemodynamic performance. Handgrip stress echocardiography is a feasible and valuable tool for assessing postprocedure valve function. Larger cohorts are necessary to confirm the impact of secondary MR and use of multiple clips on increased TMG under stress.

Background: The inverse association between HDL-cholesterol (HDL-C) levels and the risk of cardiovascular diseases is evident.

Hypothesis: Our hypothesis was that higher levels of HDL-C predisposed patients with coronary artery disease (CAD) to chronic coronary syndromes (CCS) rather than acute coronary syndrome (ACS), which has not clearly been demonstrated yet.

Aim: To determine, in an unselected population of patients treated with percutaneous coronary intervention (PCI), if HDL-C levels are independently higher in subjects presenting with CCS compared with those with ACS.

Methods and Results: In this retrospective study, we identified 4215 patients who underwent PCI in the Cardio-FR database. A total of 2942 patients met the selection criteria and completed at least a 1-year follow-up: 1686 suffered an ACS whereas 1256 presented with CCS. We found that low HDL-C levels were significantly associated with ACS and high HDL-C levels with CCS. This was consistent across all BMI categories in both genders. In addition, higher HDL-C levels reduced the likelihood of CAD subjects developing ACS. Specifically, each mmol/L increase in HDL-C decreased the odds of ACS by 79%. Interestingly, the CCS group had more polymorbid subjects than the ACS group. At 2-year follow-up, no difference in patient-oriented composite endpoint was seen between high and low HDL-C groups.

Conclusion: In an unselected population of coronary patients, HDL-C levels were consistently lower in individuals presenting with ACS compared with CCS, independently of BMI and gender. This finding strengthens the hypothesis that HDL-C plays a role in long-term protection against atherosclerotic plaque vulnerability. Considering HDL-C level still makes sense.

Trial Registration: ClinicalTrials.gov identifier: NCT04185285

Percutaneous closure of patent fossa ovalis in patients with paradoxical embolism has gradually emerged as an increasingly compelling alternative to prolonged medical therapy. In particular, in recent years, percutaneous suture-mediated “deviceless” patent fossa ovalis closure has emerged as a revolutionary technique, offering feasibility across diverse septal anatomies and improved safety compared to implantable devices, while ensuring substantially comparable efficacy in achieving patent fossa ovalis closure. The innovative nature of percutaneous suture-mediated patent fossa ovalis closure offers a number of advantages that suggest it as the preferred primary treatment choice for patent fossa ovalis closure when feasible. Although the need for long-term follow-up data remains, controlled studies are ongoing to provide a deeper understanding of its efficacy and durability. In addition, percutaneous suture-mediated patent fossa ovalis closure has promising prospects beyond preventive indications in patients with a history of migraine, the elderly, and divers. The evolving landscape of percutaneous suture-mediated patent fossa ovalis closure is transformative, demonstrating a paradigm shift in patient care options and redefining therapeutic approaches for patent fossa ovalis–related conditions.

Background: In patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), the benefit of complete revascularization (CR) with respect to hard endpoints (death or myocardial infarction [MI]) and the role of invasive physiological assessment remains uncertain.

Methods: This systematic review and meta-analysis included randomized trials comparing CR with culprit only revascularization (COR) or immediate versus delayed CR in patients with STEMI and MVD. Random-effects meta-analysis was performed comparing clinical outcomes in individual groups. The primary endpoint was the composite of death or MI.

Results: Sixteen trials were identified including a total of 15,160 patients. Compared to a COR strategy, CR significantly reduced the risk of death/MI (RR: 0.68, CI = 0.54–0.85). Angiography-guided CR significantly reduced the risk of death/MI compared to a COR approach (RR: 0.57, CI = 0.40–0.83, p < 0.05). Seven trials evaluated physiology-guided CR and did not demonstrate a significant difference for death/MI compared to a COR approach (RR: 0.74, CI = 0.54–1.01, p = 0.06). Meta-regression showed that age was significantly associated with death/MI (p = 0.026), and the timing of CR was associated with a reduced risk of ischemia-driven revascularization (p = 0.045).

Conclusion: CR was associated with a lower risk of death or MI compared to COR. Compared to COR, angiography-guided CR was associated with a lower incidence of death or MI; however, these benefits were not observed in the physiology-guided CR group. There is a need for further head-to-head studies investigating the role of physiology-guided risk-stratification of nonculprit stenoses.

Aims: This study aimed to compare 6-month survival and complication rates of patients undergoing high-risk percutaneous coronary intervention (PCI) supported by either iVAC2L mechanical circulatory support (MCS) or intra-aortic balloon pump (IABP).

Methods and Results: In this retrospective cohort analysis, we included 54 patients who underwent a high-risk PCI for an unprotected left main, 3-vessel disease or a last remaining vessel stenosis with temporary MCS. Patients received either iVAC2L (n = 24) or IABP (n = 30) during PCI. The primary endpoint was 6-month all-cause mortality. Secondary endpoints included vascular complications, repeat revascularization, and stroke. The groups had similar baseline characteristics, with the ejection fraction being 34.4 ± 9.5% in the iVAC2L group and 37.9 ± 9.4% in the IABP group (p = 0.177). The 6-month mortality rate was lower in the iVAC2L group (8.3%) compared to the IABP group (16.7%), though the difference was not statistically significant (p = 0.365). Access site vascular complications were numerically higher in the iVAC2L group (12.5% vs. 3.3%; p = 0.201). Repeat revascularization rates (iVAC2L 4.2% vs. IABP 6.7%, p = 0.690) and stroke rates (iVAC2L 4.2% vs. IABP 3.3%, p = 0.872) were similar in both groups.

Conclusion: Patients with iVAC2L MCS had higher 6-month survival compared to IABP in high-risk PCI, albeit without statistically significant differences. Both devices provided effective hemodynamic support during the intervention with no periprocedural mortality. Vascular complications were numerically more frequent with iVAC2L, highlighting the need for skilled vascular access management. Larger prospective studies are needed to confirm these findings and guide optimal MCS device selection for high-risk PCI.

Introduction: Plaque modifying-debulking devices are the most effective initial strategy for percutaneous coronary intervention of severely calcified lesions including left main coronary artery. There are limited data comparing the short- and long-term clinical outcomes of these devices in left main lesions.

Methods: A retrospective analysis of patients with calcified left main lesions treated with percutaneous intervention with adjunctive plaque modifying device at a large tertiary center between 2008 and 2021. The primary endpoint was long-term mortality at documented longest follow-up. Secondary endpoints included procedural complications and in-hospital clinical outcome.

Results: A total of 302 patients with calcified left main lesions treated with rotational atherectomy (RA) (n = 240), intracoronary lithotripsy (n = 30), or excimer laser coronary atherectomy (n = 32) were included. Out of all patients, 55% presented with acute coronary syndromes. Technical success was achieved in 98.7% of the patients and procedural success was achieved in 95.4% of the patients. At a median follow-up of 42 (19–62) months, there was no difference in mortality between the 3 devices (RA 54/240 [23.4%] vs. lithotripsy 1/30 [3.3%] vs. laser 5/32 [15.6%], p = 0.128). Likewise, in-hospital clinical outcomes were similar. However, procedural complications were higher in the laser group.

Conclusions: In patients with calcified left main lesions treated with percutaneous intervention, adjunctive plaque-modifying devices appear safe with survival exceeding 80% at long-term follow-up with no difference between the devices in relation to in-hospital clinical outcomes or long-term mortality risk.

Introduction: Currently, there are 2 types of third generation bioprostheses that can be used in patients with aortic stenosis with a large aortic annulus (LAA): the 29-mm Sapien 3 (S3; Edwards Lifesciences LLC, Irvine, CA) and the 34-mm Evolut-R (ER; Medtronic, Inc, Dublin, Ireland). The objective of this trial was to compare long-term hemodynamic and clinical outcomes of these two valves in patients with LAA and to determine the effect of aortic annulus size on these two outcomes.

Method: We conducted a retrospective, monocentric study (CHU Rangueil–Toulouse) in patients who underwent transcatheter aortic valve implantation (TAVI) for aortic stenosis between 04/01/2018 and 31/12/2020. We included all patients with severe aortic stenosis (SAS) who were diagnosed based on clinical and echocardiographic criteria. All clinical, anatomical, and procedural characteristics were recorded.

Results: We included 172 patients: 110 received a 29-mm S3 prosthesis and 62 patients a 34-mm ER prosthesis. The average area of the aortic annulus was 595 ± 67 mm². The average aortic perimeter was 87.5 ± 5.1 cm for the S3 and 584 ± 72 mm² and 86.4 ± 6.3 cm for the ER. The aortic regurgitation (AR) rate was higher with the ER than with the S3 (18.3% vs. 3.9%; p = 0.002) but the mean transvalvular gradient was lower with the ER (7.1 ± 2.8 mmHg vs. 9.9 ± 3.8 mmHg; p < 0.001). At Day 30, there were 4 deaths in the S3 group and 1 death in the ER group. The mean duration of follow-up was 22.7 months. No differences in cardiovascular mortality were observed between the two devices, with a rate of 2.7 deaths per 100 person-years for the ER vs. 3.9 deaths per person-years for the S3 group (p = 0.208). Subgroup analysis according to the LAA size showed a higher rate of AR in patients with the largest annulus dimensions.

Conclusion: In patients with a LAA who require a TAVI, the 34-mm ER and 29-mm S3 prostheses demonstrate significant differences in hemodynamics with no impact on cardiovascular mortality.

Background: Cardiovascular diseases evolve over time; this may affect treatment. We investigated angiographic trends in patients presenting with de novo left main coronary artery (LM) stenosis over a decade.

Methods: Clinical records and all consecutive coronary angiograms performed in our Institution between 2011 and 2020 were reviewed to identify subjects with newly diagnosed significant (≥ 50% lumen diameter reduction by quantitative angiography) LM stenosis. Values of the overall SYNTAX score (SS), LM lesion SS (LM-SS) and SS for lesion(s) beyond LM (non-LM-SS) were assessed as per angiographic core labolatory protocol.

Results: Out of 12,524 coronary angiograms in de novo referrals, 372 (2.97%) showed significant LM stenosis; the proportion varied from 2.30% to 3.48% annually. LM patients’ mean age was 69.12 ± 9.75 years (22.95% women). No temporal age/gender trends could be identified. Overall, SS decreased from a mean value of 35 to 27 (Spearman correlation coefficient, SC = −0.17, p = 0.001). This was driven by reduction in non-LM-SS (SC = −0.18, p < 0.001) while LM-SS was not changing in time (SC = 0.04, p = 0.40). No temporal trends were present in LM stenosis segmental location (ostial/mid/bifurcation, p > 0.05 for all), its angiographic severity (< 70% vs. ≥ 70%; p = 0.35) or in the number of LM segments affected (p = 0.19). Isolated LM stenosis presentations increased over time (Z = 2.07, p = 0.039). The reduction in non-LM-SS was associated primarily with a trend towards reduction in number of coexisting non-LM lesions requiring revascularization (SC = −0.09, p = 0.07).

Conclusions: In consecutive patients presenting with de novo LM stenosis, angiographic SS showed a statistically significant negative trend over a decade, driven primarily by a reduction in non-LM-SS. Our findings are consistent with an increase in the proportion of patients presenting with LM stenosis amenable to first-line percutaneous (rather than surgical) management (LM-EVOLUTION study).