Interventional Cardiology Review最新文献

Pulmonary embolism (PE) is the third major cause of cardiovascular death in western countries. High-risk PE, defined by haemodynamic instability, necessitates immediate reperfusion therapy. Intermediate-high-risk patients, although stable, are vulnerable to rapid deterioration and therefore require intensive monitoring. To accurately stratify these patients, predict mortality and identify those who may benefit from more aggressive therapies, it is essential to consider various clinical and imaging parameters. Catheter-directed therapy (CDT) has been shown to reduce clot burden and right ventricle overload with fewer bleeding complications than systemic thrombolysis. CDT's clinical utility in the management of PE continues to expand, guided by the expertise of pulmonary embolism response teams, ensuring a multidisciplinary approach tailored to each patient's risk and clinical profile. As PE management advances, ongoing research and large-scale trials are essential for validating CDT's role in reducing morbidity and mortality in intermediate-high-risk PE cases. This review aims to provide a more in-depth perspective on intermediate-high-risk PE.

Heart failure is a life-threatening condition that affects women and men differently. Due to increases in mean patient age, heart failure prevalence and mortality rates are expected to increase rapidly. Heart failure is characterised as a syndrome leading to a high burden of disease for the individual patient and increased healthcare costs for society related to rehospitalisation. This review highlights sex differences across the entire spectrum of heart failure.

Degenerative aortic valve disease is the third most common cause of heart disease in the developed world. Calcific deposits accrue in the valve endothelium causing progressive stenosis of the orifice. Increasingly, transcatheter aortic valve implantation is being used in place of surgery as treatment for aortic stenosis, particularly for patients who are considered high surgical risk. Although echocardiography remains the gold standard for the diagnosis and grading of aortic valve stenosis, there is an increasing interest in the role that aortic valve calcification scoring may play in these areas. In this review, the authors evaluate the current evidence for aortic valve calcium scoring as an adjunct to echocardiography in grading, and as a prognostic marker in challenging cases. They also explore the ability of calcium scoring to predict outcomes following transcatheter aortic valve implantation.

Background: In primary percutaneous coronary intervention (pPCI), balloon predilation is frequently carried out before stenting but there is a lack of data regarding optimal balloon size and the effect of balloon size on procedural and clinical outcomes.

Aims: This study compares small balloon predilation (≤50% of proximal vessel diameter) with large balloon predilation (>50% of proximal vessel diameter) in pPCI.

Methods: This multicentre prospective observational study included consecutive ST elevation MI (STEMI) patients undergoing pPCI at three tertiary centres in Egypt. Demographic, clinical and angiographic data were collected for all the patients. The primary outcome was the presence of no reflow at the conclusion of the procedure and secondary outcomes included procedural complications - no reflow, dissection, abrupt vessel closure, fluoroscopy time and procedural time - and clinical outcomes - in-hospital left ventricular ejection fraction (LVEF), cardiogenic shock, stent thrombosis, ventricular fibrillation, stroke, death, ST-segment resolution >50% 1 hour after PCI and LVEF at discharge.

Results: A total of 384 pPCI procedures were included. The small balloon group (n=222) and the large balloon group (n=162) were comparable in terms of baseline characteristics. The large balloon group had a significantly higher incidence of no reflow (n=23 [14.2%] versus n=6 [2.7%], p<0.001), procedural complications: n=31 [19.4%] versus n=10 [4.5%], p<0.001) and contrast volume (190.4 ± 40.2 ml versus 177.4 ± 29.4 ml, p=0.0003) compared to the small balloon group. ST-segment resolution >50% after PCI was more frequent in the small balloon group (n=182 [81.98%] versus n=109 [67.28%], p<0.001).

Conclusion: This study suggests that using a smaller balloon size for predilation in pPCI is associated with improved coronary flow, reduced procedural complications and better ST-segment resolution.

Transcatheter mitral leaflet repair is a non-surgical technique used to treat severe mitral regurgitation. The technique has matured significantly since its commercial introduction, and with device iteration and increasing operator experience, it is now an important treatment option for patients at higher risk for conventional mitral valve surgery. Randomised clinical trials have established the safety and efficacy of the technique in the treatment of primary and secondary mitral regurgitation, and its use was approved by the National Institute for Health and Care Excellence in 2019. This position statement summarises the clinical evidence and indications for the procedure and provides expert consensus on best practice in terms of patient selection, the procedure and post-procedure care. Standards are also described with respect to team composition, minimum case volume and collection of procedural and outcome data.

The development and progression of coronary calcification is of growing interest with the emergence of new imaging modalities and calcium modifying technologies that can facilitate optimal results during complex percutaneous coronary intervention (PCI). Coronary atherosclerotic disease typically begins within the intima with pathological intimal thickening and microcalcifications (>0.5 μm and <15 μm). These microcalcifications can coalesce into larger areas of calcification, including sheet calcium, which is typically seen in fibrocalcific plaque, nodular calcification and calcified nodules. Calcified nodules typically protrude into the vessel lumen. Erosive calcified nodules lack the coverage of protective anti-aggregatory endothelium and frequently show adherence of intraluminal thrombus. Greater calcification within coronary plaque does not correlate with an increased risk of acute coronary syndrome, however, coronary calcium can lead to challenges with stent delivery and full stent expansion during PCI. An understanding of plaque morphology, distribution of calcium, degree of calcification and underlying shape will enable interventional cardiologists to appropriately interpret intravascular ultrasound and optical coherence tomography imaging findings and optimise results during complex PCI.

[This corrects the article DOI: 10.15420/icr.2024.25.].

Acute MI (AMI) is a leading cause of mortality globally. Swift diagnosis is imperative, with timely reperfusion crucial to minimise adverse outcomes. Revascularisation strategies include culprit-vessel-only therapy, staged complete revascularisation or immediate complete revascularisation. Evidence from randomised trials strongly favours complete revascularisation in ST-elevation MI (STEMI). Data regarding immediate complete revascularisation compared to a staged approach are limited, with uncertainties regarding the advantages of physiology-guided treatment compared to angiographic assessment alone. Non-STEMI (NSTEMI) patients with multivessel disease are often complex and current guidelines offer limited recommendations for this patient group, emphasising the need for individualised treatment. Observational studies have sought to find the optimal approach, yet conflicting data prevails. Dedicated trials for this issue in NSTEMI patients are currently unavailable. To enhance the decision-making processes for patients with AMI, future trials should consider the inclusion of functional health status and health-related quality of life outcomes. The existing gaps in knowledge underscore the intricacies of managing AMI and the ongoing necessity for comprehensive research to refine treatment strategies.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis characterised by multiorgan pathological histiocytic infiltration. Cardiac involvement occurs in 40-75% of patients and increases mortality. A 55-year-old woman with chest pain and dyspnoea was found to have an interatrial septal mass and aortitis suspicious for ECD without other organ involvement. After two inadequate transcatheter interatrial biopsies were obtained using ultrasound guidance alone, diagnostic samples were successfully obtained using intraprocedural frozen section examination. The patient started genotype-targeted treatment with good response. Biopsy confirmation of ECD is required to guide treatment; however, cardiac biopsies are uncommonly performed when other organs are affected. Our unique case of isolated cardiovascular involvement highlights how frozen sectioning with multimodal intraprocedural imaging guidance can improve diagnostic yield of endomyocardial biopsies. It also highlights how diagnosis of rare conditions requires careful multidisciplinary evaluation of affected organs, procedural risk and diagnostic yield. The use of frozen sectioning can improve diagnostic yield of endomyocardial biopsies.