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Management of Coronary Artery Disease in the Context of Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis of Percutaneous Coronary Intervention Timing and an Algorithmic Approach to Management. 经导管主动脉瓣植入术中冠状动脉疾病的管理:经皮冠状动脉介入时机的系统回顾和荟萃分析以及管理的算法方法。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-06-19 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.51
Cian Murray, Caoimhe Ryan, Michael Cronin, Hugo Temperley, Niall O'Sullivan, Stephen O'Connor, Andrew Maree, Mark Hensey

Background: Transcatheter aortic valve implantation (TAVI) is widely performed for severe aortic stenosis (AS), often accompanied by coronary artery disease (CAD). The optimal management of CAD in TAVI patients remains uncertain. This study reviews the evidence on percutaneous coronary intervention (PCI) timing in TAVI, and proposes an algorithmic approach for CAD management.

Methods: A comprehensive search of PubMed, EMBASE and Cochrane identified studies comparing PCI timing strategies in TAVI patients.

Results: Thirteen studies with 15,412 participants were included. Mortality at 30 days (OR 5.70; 95% CI [1.34-24.36]) and 2 years (OR 4.40; 95% CI [2.60-7.44]) were significantly higher in the combined pre-TAVI and concomitant PCI group than in the post-TAVI cohort. Rates of other periprocedural complications, such as stroke and bleeding, varied across studies.

Conclusion: There is no clear consensus on PCI timing in TAVI due to a lack of high-quality randomised data. An individualised, algorithmic approach is proposed for managing CAD in patients undergoing TAVI.

背景:经导管主动脉瓣植入术(TAVI)广泛用于重度主动脉瓣狭窄(AS),通常伴有冠状动脉疾病(CAD)。TAVI患者CAD的最佳治疗仍不确定。本研究回顾了经皮冠状动脉介入治疗(PCI)时机的证据,并提出了一种CAD管理的算法方法。方法:综合检索PubMed, EMBASE和Cochrane,确定比较TAVI患者PCI时间策略的研究。结果:纳入13项研究,15412名参与者。30天死亡率(OR 5.70;95% CI[1.34-24.36])和2年(OR 4.40;tavi前合并PCI组的95% CI[2.60-7.44]显著高于tavi后组。其他围手术期并发症的发生率,如中风和出血,在不同的研究中有所不同。结论:由于缺乏高质量的随机数据,对TAVI的PCI时机没有明确的共识。提出了一种个性化的算法方法来管理TAVI患者的CAD。
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引用次数: 0
Transcatheter Aortic Valve Implantation Indications and Patient Selection. 经导管主动脉瓣植入术指征及患者选择。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-06-10 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.44
Jonathan Curio, Henning Guthoff, Stephan Nienaber, Hendrik Wienemann, Stephan Baldus, Matti Adam, Victor Mauri

Transcatheter aortic valve implantation (TAVI) has evolved from an alternative therapy for high-surgical risk patients with symptomatic severe aortic stenosis (AS) into the main treatment modality for most patients with severe AS. The indication for TAVI was initially based mainly on surgical risk profiles, but following positive trial results in intermediate- and low-risk patients, clinical decision pathways regarding the optimal treatment modality for AS patients, either TAVI or surgical valve replacement, changed considerably and a lifetime management approach incorporating several other additional patient characteristics evolved. This review aims to elucidate the evolution of TAVI and surgical valve replacement indications over the past two decades. Relevant clinical aspects beyond surgical risk including age, life expectancy, comorbidities, aortic anatomy and patient preference influencing decision-making regarding the modality of intervention in patients with severe AS, will be discussed in the context of lifetime management of AS.

经导管主动脉瓣植入术(Transcatheter aortic valve implantation, TAVI)已经从一种治疗有症状的严重主动脉瓣狭窄(aortic stenosis, AS)的高危手术患者的替代疗法,发展成为大多数严重主动脉瓣狭窄患者的主要治疗方式。TAVI的适应症最初主要基于手术风险特征,但随着在中低风险患者中的积极试验结果,关于AS患者最佳治疗方式的临床决策途径,是TAVI还是手术瓣膜置换术,发生了很大变化,并且结合其他一些患者特征的终身管理方法也在发展。这篇综述旨在阐明过去二十年TAVI和外科瓣膜置换术适应症的演变。除手术风险外的相关临床方面,包括年龄、预期寿命、合并症、主动脉解剖和患者偏好,影响严重AS患者干预方式的决策,将在AS终生管理的背景下进行讨论。
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引用次数: 0
Evaluation of the UK Intervention Subspecialty Programme: The Trainees' Experience. 英国干预亚专业项目的评估:学员的经验。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-06-10 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.54
Samuel McGrath, Holly Morgan, Douglas Muir, David Hildick-Smith

Background: Interventional cardiology (IC) is a competitive and oversubscribed subspecialty. The UK cardiology programme is currently in a state of transition of curricula, and concerns have arisen about the impact of this change on the standard of training. This study aimed to provide a snapshot of UK IC training at present.

Methods: A 68-question survey was disseminated through the British Cardiovascular Interventional Society mailing list in November 2023 to all UK intervention trainees across both curricula. Questions included procedural numbers, exposure to adjunct techniques and confidence in the transition to consultancy.

Results: The survey was completed by 60 participants, providing a response rate of 38% for training grades. A total of 87% of participants were men, and 78% remained on the 2010 curriculum. For the 2010 curriculum trainees, the median number of first-operator percutaneous coronary intervention was 101-200 in their first year. Confidence levels were higher for radial (98%) than femoral (62%) access. A total of 83% felt comfortable or confident using intravascular lithotripsy (83%) compared with 23% for rotational atherectomy. Comfort was higher with intravascular ultrasound (82%) compared with optical coherence tomography (53%). Half felt unprepared for consultancy, citing insufficient procedural experience. To address this, 65% plan to extend training with a fellowship year. Overall, 72% rated the programme as excellent or good, and 10% as poor.

Conclusion: While many trainees report a positive experience with UK IC training, several areas need improvement, including procedural volume and requirement for extended training. Moving forward, it will be crucial to monitor the impact of the 2022 curriculum on IC training.

背景:介入心脏病学(IC)是一个竞争激烈且供不应求的亚专科。英国心脏病学计划目前正处于课程过渡的状态,人们对这一变化对培训标准的影响感到担忧。本研究旨在提供目前英国IC培训的概况。方法:一份68个问题的调查于2023年11月通过英国心血管介入学会的邮件列表分发给所有英国干预课程的受训人员。问题包括程序数字、接触辅助技术和对向咨询过渡的信心。结果:调查共有60人完成,培训成绩的回复率为38%。总共有87%的参与者是男性,78%的人继续学习2010年的课程。对于2010年课程的学员,第一年第一操作者经皮冠状动脉介入治疗的中位数为101-200。桡骨(98%)置信度高于股骨(62%)置信度。总的来说,83%的患者对血管内碎石术(83%)感到舒适或有信心,而旋转动脉粥样硬化切除术的这一比例为23%。与光学相干断层扫描(53%)相比,血管内超声(82%)的舒适度更高。一半的人认为咨询没有准备好,理由是程序经验不足。为了解决这个问题,65%的人计划用奖学金年来延长培训。总体而言,72%的人认为该项目优秀或良好,10%的人认为差。结论:虽然许多受训者报告了英国IC培训的积极经验,但有几个方面需要改进,包括程序数量和延长培训的要求。展望未来,监测2022年课程对集成电路培训的影响至关重要。
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引用次数: 0
Role of Transcatheter Treatment in Intermediate-to High-risk Pulmonary Embolism. 经导管治疗在中高危肺栓塞中的作用。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-05-23 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.47
Federica Fumarola, Francesco Colombo, Claudio Corsaro, Lucia Savi, Riccardo Mangione, Daniele Savio, Giacomo Boccuzzi, Mario Iannaccone

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.

肺栓塞(PE)是西方国家心血管死亡的第三大原因。高危PE,由血流动力学不稳定定义,需要立即再灌注治疗。中高危患者虽然病情稳定,但容易迅速恶化,因此需要密切监测。为了准确地对这些患者进行分类,预测死亡率,并确定那些可能从更积极的治疗中受益的患者,必须考虑各种临床和影像学参数。导管定向治疗(CDT)已被证明可以减少凝块负担和右心室负荷,与全身溶栓相比,出血并发症更少。在肺栓塞反应小组的专业知识指导下,CDT在PE管理方面的临床应用不断扩大,确保针对每个患者的风险和临床情况量身定制多学科方法。随着PE管理的进步,正在进行的研究和大规模试验对于验证CDT在降低中高危PE病例发病率和死亡率方面的作用至关重要。本综述旨在为中高危PE提供更深入的视角。
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引用次数: 0
Sex Differences in Heart Failure: A Step Forward. 心力衰竭的性别差异:向前迈进了一步。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-05-23 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.30
Sachintha Wijesinghe, Marie-Luise Dikou, Ioannis Kasouridis, Francois Deharo, Curtis Page, Sharon Olubakin, Edoardo Zancanaro, Aditya Bhalla, Camelia Demetrescu, Ritu Thamman, Julia Grapsa, Ali Vazir

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.

心力衰竭是一种危及生命的疾病,对女性和男性的影响不同。由于患者平均年龄的增加,心力衰竭的患病率和死亡率预计将迅速增加。心力衰竭的特点是一种综合征,导致个体患者的疾病负担高,并增加了与再住院相关的社会医疗保健费用。这篇综述强调了心力衰竭整个谱系的性别差异。
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引用次数: 0
Aortic Valve Calcium: A Narrative Review of its Role in the Assessment of Aortic Stenosis and as a Predictor of Post-transcatheter Aortic Valve Implantation Outcomes. 主动脉瓣钙:其在主动脉狭窄评估中的作用和作为经导管主动脉瓣植入术后结果的预测因子的叙述性综述。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-05-02 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.17
James Krzowski, Jonathan Weir-McCall, Luigia D'Errico, Charis Costopoulos, Pierluigi Costanzo

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.

在发达国家,退行性主动脉瓣疾病是导致心脏病的第三大常见原因。钙化沉积在瓣膜内皮中,导致瓣膜孔进行性狭窄。越来越多的经导管主动脉瓣植入术被用来代替手术治疗主动脉瓣狭窄,特别是对于那些被认为手术风险高的患者。尽管超声心动图仍然是主动脉瓣狭窄诊断和分级的金标准,但人们对主动脉瓣钙化评分在这些领域的作用越来越感兴趣。在这篇综述中,作者评估了主动脉瓣钙评分作为超声心动图分级的辅助手段,以及作为具有挑战性病例的预后指标的现有证据。他们还探讨了钙评分预测经导管主动脉瓣植入术后预后的能力。
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引用次数: 0
Predilation in Primary Percutaneous Coronary Intervention. 原发性经皮冠状动脉介入治疗中的预扩张。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-04-17 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.12
Mahmoud Tantawy, Marwan Saad, Sherif Hussien, Ghada Selim, Ahmed Tamara

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.

背景:在初级经皮冠状动脉介入治疗(pPCI)中,球囊预扩张经常在支架置入前进行,但缺乏关于球囊最佳尺寸以及球囊尺寸对手术和临床结果影响的数据。目的:本研究比较小球囊预扩张(≤近端血管直径的50%)和大球囊预扩张(≤近端血管直径的50%)在pPCI中的应用。方法:这项多中心前瞻性观察研究包括在埃及三个三级中心接受pPCI的连续ST段抬高心肌梗死(STEMI)患者。收集所有患者的人口学、临床和血管造影资料。主要结果是手术结束时无再流,次要结果包括手术并发症-无再流、夹层、血管突然关闭、透视时间和手术时间-和临床结果-住院左室射血分数(LVEF)、心源性休克、支架血栓形成、心室颤动、中风、死亡、PCI术后1小时st段分辨率bbb50 %和出院时LVEF。结果:共纳入384例pPCI手术。小球囊组(n=222)和大球囊组(n=162)在基线特征方面具有可比性。大球囊组无血流再流发生率明显高于小球囊组(n=23 [14.2%] vs . n=6[2.7%]),小球囊组PCI术后p50%发生率更高(n=182 [81.98%] vs . n=109[67.28%])。结论:本研究表明,在pPCI中使用较小球囊进行预扩张可改善冠状动脉血流,减少手术并发症,改善st段分辨率。
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引用次数: 0
Mitral Transcatheter Edge-to-edge Repair: British Cardiovascular Intervention Society Position Statement. 二尖瓣经导管边缘到边缘修复:英国心血管介入学会立场声明。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-04-07 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2025.01
Jonathan Byrne, Mamta Buch, Michael Mullen, Alison Duncan, Sam Dawkins, Adnan Nadir, Jim Newton, Tiffany Patterson, Rob Smith, Angie Ghattas, Daniel J Blackman, David Hildick-Smith

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.

经导管二尖瓣小叶修复是一种用于治疗严重二尖瓣反流的非手术技术。自商业化引入以来,该技术已经显著成熟,随着设备的更新和操作人员经验的增加,它现在是传统二尖瓣手术高风险患者的重要治疗选择。随机临床试验已经确定了该技术在治疗原发性和继发性二尖瓣反流方面的安全性和有效性,并于2019年获得了国家卫生与护理卓越研究所的批准。本立场声明总结了该手术的临床证据和适应症,并就患者选择、手术和术后护理方面的最佳实践提供了专家共识。还描述了关于小组组成、最小病例量和收集程序和结果数据的标准。
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引用次数: 0
Coronary Calcification: Types, Morphology and Distribution. 冠状动脉钙化:类型、形态和分布。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-04-07 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.03
Michelle C Morris, Rolf P Kreutz

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.

随着新的成像方式和钙修饰技术的出现,冠状动脉钙化的发展和进展越来越受到关注,这些技术可以促进复杂经皮冠状动脉介入治疗(PCI)的最佳结果。冠状动脉粥样硬化疾病通常在内膜内开始,伴有病理性内膜增厚和微钙化(>0.5 μm和
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引用次数: 0
Corrigendum to: Coronary Artery Ectasia in Acute Coronary Syndrome: The Role of Non-vitamin K Antagonist Oral Anticoagulants in Management. 急性冠脉综合征的冠状动脉扩张:非维生素K拮抗剂口服抗凝剂在治疗中的作用。
IF 0.2 0 PHILOSOPHY Pub Date : 2025-04-02 eCollection Date: 2025-01-01 DOI: 10.15420/icr.2024.25.co1
Mahmoud Izraiq, Nail Alshoubaki, Omran A Abu-Dhaim, Sarah Al-Qalalweh, Raed Aqel

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

[这更正了文章DOI: 10.15420/icr.2024.25.]。
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引用次数: 0
期刊
Interventional Cardiology Review
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