Journal of interventional cardiology最新文献

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.

Background. Chronic total occlusion (CTO) plaque modification (CTO-PM) is often used for unsuccessful CTO interventions. Methods. A multicenter, prospective study included consecutive patients with failed CTO recanalization. At the end of the failed procedure, patients received either a conventional (CB) or drug-coated balloon (DCB) for CTO-PM at the operator’s discretion and underwent a new attempt of CTO recanalization ∼3 months later. Results. A total of 55 patients were enrolled (DCB: 22; CB: 33), with a median age of 66 years. The median J-score was 3, and CCS angina classes III–IV were present in 45% of the patients. After the first CTO-PCI attempt, no in-hospital cardiac deaths were registered. The overall rate of in-hospital myocardial infarction was 3.6%, without significant differences between the DCB and CB groups (4.5% after DCB vs 3.0% after CB, p = 0.999). The success rate of the second CTO-PCI attempt was 86.8%, with a periprocedural complication rate of 5.7% and with an overall rate of in-hospital complications of 24.5%, without significant differences between the 2 groups (13.6% in the DCB group vs 32.2% in the CB group, p = 0.195). Compared with CB, in the DCB group, the second CTO-PCI required a shorter median fluoroscopy time (33 vs 60 min, p < 0.001), a lower contrast volume (170 vs 321 cc, p < 0.001), and a lower radiation dose (1.7 vs 3.3 Gy, p < 0.001). At 1-year follow-up, outcomes were comparable between the 2 strategies, target vessel failure occurred in 5.7% and major adverse cardiovascular events in 18.2% (13.6% in the DCB group vs 21.2% in the CB group, p = 0.494). Conclusions. PM after CTO recanalization failure is safe and warrants high success rates when a second attempt is performed. A DCB strategy for CTO-PM does not seem to ensure higher success or better clinical outcomes, but its use was associated with simpler staged procedures. This trial is registered with NCT05158686.

Background. Coronary artery disease (CAD) is a type of cardiovascular disease which is one of the leading causes of death around the world. The presence of coronary stenosis is considered a pivotal indicator in the diagnosis of various CADs. The main purpose of this paper was to investigate the feasibility of an anchor-free deep learning (DL) method, fully convolutional one-stage object detection (FCOS), in coronary artery stenosis automatic detection. Methods. First, 2786 invasive coronary angiography (ICA) images from 130 patients were randomly divided into training, validation, and testing datasets using the 10-fold cross-validation approach. Then, FCOS was compared with other three widely used anchor-based DL models: single shot multibox detector (SSD), faster region-based convolutional network (Faster R-CNN), and you only look once (YOLOv3), in terms of precision, recall, F1 score, average precision (AP), and average recall (AR). Finally, the performances of different models in the detection of stenosis were compared in either single or multiple lesion scenarios using statistical tests. Results. FCOS achieved significantly superior precision (96.14% ± 0.53%), recall (94.36% ± 0.79%), F1 score (95.22% ± 0.56%), AP_0.50 (93.36% ± 0.93%), AR_0.50:0.95 (64.73% ± 1.46%), AP_small (55.04 ± 0.96%), AP_medium (59.97 ± 1.13%), and AP_large (68.09 ± 5.18%) compared to Faster R-CNN and YOLOv3. Moreover, FCOS demonstrated significantly higher AR_0.50:0.95 and AP_small compared to SSD. Regardless of the presence of single or multiple coronary stenoses in ICA images, FCOS also outperformed Faster R-CNN and YOLOv3. Furthermore, it showed significantly higher AR_0.50:0.95 compared to SSD when in the multiple stenosis scenario. Conclusions. It is feasible to use the anchor-free DL model FCOS in detecting coronary stenosis based on ICA images.

Aims. We aimed to evaluate the acute performance and short- and long-term outcomes of optical coherence tomography (OCT)-guided Magmaris deployment. Methods. This was a retrospective study of 28 consecutive patients (23 men, mean age: 59.8 years) with 28 Magmaris implantations in de novo coronary lesions. OCT was performed at the baseline and after the final postdilatation. The choice of stent and postdilatation balloon size was based on OCT measurements. The following indices were determined using OCT: prestenting minimum lumen diameter and area, poststenting minimum lumen diameter and area, acute lumen area gain, residual area stenosis, eccentricity and symmetry indices, incomplete strut apposition, strut fracture, tissue prolapse, and edge dissection. Results. Before the stenting, OCT analysis revealed a minimal lumen area of 1.55 ± 0.59 mm², a minimal lumen diameter of 1.19 ± 0.38 mm, a minimal scaffold area of 6.78 ± 1.58 mm², and a minimal scaffold diameter of 2.88 ± 0.50 mm². The prolapse area was 1.2 ± 1.5 mm². The mean percentage of RAS was 13.3 ± 7.1% and 6 (21.4%) patients had scaffold RAS more than 20%. Only one proximal edge intimal dissection was noted. The mean eccentricity index was 0.86 ± 0.04 and symmetry index 0.33 ± 0.08. ISA analysis showed that the percentage of malapposed struts was 1.5%. There were no short-term cardiovascular events, and only 2 incidents of target lesion failure (TLF) occurred 13 months later. Conclusion. The Magmaris has excellent acute mechanical performance and no short-term cardiovascular events occurred. There were only 2 TLFs that occurred 13 months later. It is suitable and feasible to treat vessels using the Magmaris.

Background. Side branch (SB) compromise represents a frequent challenge encountered during percutaneous coronary intervention (PCI) for bifurcation lesions. Numerous techniques have emerged for predilating the main branch (MB), aiming to mitigate the occurrence of SB compromise. Among these approaches, scoring balloons have gained recognition for their ability to reduce carina shift and migration, consequently lowering the risk of SB compromise. However, the optimal treatment strategy remains a topic of debate. Thus, the current study is designed to investigate and compare effects of using scoring versus nonscoring balloons for MB predilatation on the incidence of SB compromise. Methods. A total of 102 patients who underwent elective PCI were enrolled at Jakarta Heart Center, Jakarta, Indonesia, from July 2022 to July 2023. Patients were randomized into two arms, i.e., scoring balloon predilatation arm (n = 52) and nonscoring balloon predilatation arm (n = 50). Outcome was measured as a composite endpoint of reduced thrombolysis in myocardial infarction (TIMI) flow in SB after MB stenting, SB intervention needed, and new or progressing ostial SB stenosis more than 50% compared to baseline. Results. Both study arms were comparable in various aspects, including gender distribution with a male majority, the predominant involvement of the left anterior descending (LAD) vessel, the presence of minimal to mild calcification, type A lesion, SB diameter, SB angulation, and the use of SB wire protection. In-depth analysis was conducted that revealed no significant differences between encompassed factors such as TIMI flow, the necessity for SB intervention, new or progression of ostial SB stenosis exceeding 50% when compared to the baseline, as well as the composite endpoint. Furthermore, these confounding factors did not exhibit any association with the incidence of SB compromise. Conclusion. Our study revealed that employing either scoring or nonscoring balloon predilatation in the MB has equivalent effects on SB compromise.

Introduction. Since the advent and development of transcatheter aortic valve replacement (TAVR) in the contemporary era, balloon aortic valvuloplasty (BAV) has seen renewed interest. We aimed to compare 30-day and 1-year all-cause mortality between patients submitted to BAV as a bridging therapy before definite TAVR and patients submitted directly to TAVR. Methods. This was an observational, retrospective study of patients who underwent TAVR between 2009 and 2022 in a tertiary center. Patients with severe aortic stenosis (SAS) who underwent TAVR without prior BAV (woBAV group) and patients who were performed TAVR with prior BAV (wBAV group) as a bridging therapy were included. Primary endpoint was all-cause mortality at 30 days and 1 year after TAVR between wBAV and woBAV groups. Results. 800 patients were included, of which 767 were in woBAV group and 33 were in wBAV group. 30-day all-cause mortality rate was 21% in wBAV group compared to 4.4% in woBAV (unadjusted hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.3–11.7, p < 0.001). At 1-year, all-cause mortality rate was 27% in wBAV group compared to 12% in woBAV group (unadjusted HR, 2.55; 95% CI, 1.28–5.10, p = 0.007). After covariate adjustments, mortality remained significantly higher in wBAV group. Conclusion. This study provides valuable insights into the outcomes of patients undergoing TAVR with prior BAV as bridging therapy, as these patients had higher mortality at 30 days and 1 year compared to patients direct to TAVR.

Acute coronary syndrome (ACS) poses a pervasive threat to individuals grappling with cardiovascular afflictions, manifesting as unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), or sudden cardiac death, depending on vascular obstruction’s extent and location. NSTEMI, closely linked to substantial morbidity and mortality, has become the primary cause of hospitalization in ischemic heart disease patients. Swift prognostication of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is crucial, necessitating the identification of precise markers. This study, conducted from January 2020 to March 2021, explored the correlation between serum visfatin levels and NSTE-ACS severity. A total of 164 patients undergoing coronary angiography were enrolled, with a control group (n = 55) exhibiting less than 50% coronary stenosis. NSTE-ACS patients were categorized based on angiography outcomes into single-vessel (n = 41), double-vessel (n = 28), and multivessel (n = 40) groups. Serum visfatin levels, meticulously quantified, showed significant elevation in NSTE-ACS patients (n = 109) compared to the control group (n = 55) (P < 0.01). Visfatin correlated positively with the GRACE score (r = 0.397, P < 0.01). In the multivessel disease group, visfatin levels were notably higher (P < 0.01). After adjusting for cardiovascular risk factors, visfatin emerged as an independent predictor of affected coronary arteries (OR 0.205; 95% CI 0.032–0.378; P = 0.02). Receiver-operating characteristic (ROC) curves demonstrated enhanced prognostic ability when combining visfatin with age, hypertension, and diabetes for multivessel disease (AUC: 0.839, sensitivity: 65.0%, specificity: 89.7%, P < 0.001). Elevated serum visfatin in NSTE-ACS patients suggests its role as an independent harbinger for the number of affected coronary arteries, potentially indicating severity in NSTE-ACS patients.