Journal of the Society for Cardiovascular Angiography & Interventions最新文献

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Time-Dependent Changes in the Coronary Circulation Triggered by CTO Revascularization: Insights From Intracoronary Physiology

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102452

Marco Lombardi MD , Emil Nielsen Holck MD , Adrian Jerónimo MD , Pablo Salinas MD, PhD , Nieves Gonzalo MD, PhD , Evald Høj Christiansen MD, PhD , Javier Escaned MD, PhD

Background

Physiological changes in the coronary circulation associated with percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remain largely unknown. This systematic review and meta-analysis aimed to investigate physiological changes in the CTO and donor vessel before and immediately after PCI, as well as at follow-up.

Methods

A comprehensive search of PubMed/MEDLINE and Embase identified relevant studies. The primary end point was the mean difference (MD) between fractional flow reserve myocardium (FFR_myo) of the primary donor vessel before and after CTO revascularization. Secondary outcomes included the difference in FFR_myo, FFR collateral (FFR_coll), FFR coronary (FFR_cor), absolute coronary blood flow, coronary flow velocity reserve, and microvascular resistance before and after CTO revascularization and/or at the follow-up.

Results

A total of 17 studies were included. The myocardial blood flow in the donor vessel increased after CTO revascularization (FFR_myo: MD, 0.04; 95% CI, 0.02-0.06; P < .01), as well as in the CTO vessel (MD, 0.45; 95% CI, 0.27-0.64; P < .01). At follow-up, CTO PCI was associated with a significant shift in collateral (FFR_coll: MD, −0.16; 95% CI, −0.18 to −0.15; P < .01) and epicardial blood supply (FFR_cor: MD, 0.09; 95% CI, −0.01 to 0.20; P = .06). Time-dependent changes in the microcirculatory domain of the CTO vessel were observed in terms of improved arteriolar dynamicity and decreased microvascular resistance.

Conclusion

Available evidence suggests that CTO revascularization leads to an immediate and long-term improvement in blood supply to downstream myocardium, mediated in part by a favorable time-dependent shift in epicardial vessel, collateral, and microcirculatory function.

{"title":"Time-Dependent Changes in the Coronary Circulation Triggered by CTO Revascularization: Insights From Intracoronary Physiology","authors":"Marco Lombardi MD , Emil Nielsen Holck MD , Adrian Jerónimo MD , Pablo Salinas MD, PhD , Nieves Gonzalo MD, PhD , Evald Høj Christiansen MD, PhD , Javier Escaned MD, PhD","doi":"10.1016/j.jscai.2024.102452","DOIUrl":"10.1016/j.jscai.2024.102452","url":null,"abstract":"<div><h3>Background</h3><div>Physiological changes in the coronary circulation associated with percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remain largely unknown. This systematic review and meta-analysis aimed to investigate physiological changes in the CTO and donor vessel before and immediately after PCI, as well as at follow-up.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed/MEDLINE and Embase identified relevant studies. The primary end point was the mean difference (MD) between fractional flow reserve myocardium (FFR<sub>myo</sub>) of the primary donor vessel before and after CTO revascularization. Secondary outcomes included the difference in FFR<sub>myo</sub>, FFR collateral (FFR<sub>coll</sub>), FFR coronary (FFR<sub>cor</sub>), absolute coronary blood flow, coronary flow velocity reserve, and microvascular resistance before and after CTO revascularization and/or at the follow-up.</div></div><div><h3>Results</h3><div>A total of 17 studies were included. The myocardial blood flow in the donor vessel increased after CTO revascularization (FFR<sub>myo</sub>: MD, 0.04; 95% CI, 0.02-0.06; <em>P</em> < .01), as well as in the CTO vessel (MD, 0.45; 95% CI, 0.27-0.64; <em>P</em> < .01). At follow-up, CTO PCI was associated with a significant shift in collateral (FFR<sub>coll</sub>: MD, −0.16; 95% CI, −0.18 to −0.15; <em>P</em> < .01) and epicardial blood supply (FFR<sub>cor</sub>: MD, 0.09; 95% CI, −0.01 to 0.20; <em>P</em> = .06). Time-dependent changes in the microcirculatory domain of the CTO vessel were observed in terms of improved arteriolar dynamicity and decreased microvascular resistance.</div></div><div><h3>Conclusion</h3><div>Available evidence suggests that CTO revascularization leads to an immediate and long-term improvement in blood supply to downstream myocardium, mediated in part by a favorable time-dependent shift in epicardial vessel, collateral, and microcirculatory function.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 1","pages":"Article 102452"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143168861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessment of Left Ventricular Function After Percutaneous Coronary Intervention for Chronic Total Occlusion

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102460

Yasser M. Sammour MD, MSc, Rody G. Bou Chaaya MD, Chloe Kharsa MD, Jerrin Philip MD, Taha Hatab MD, Sahar Samimi MD, Joseph Elias MD, Momin Islam MD, Gal Sella MD, Joe Aoun MD, Sachin S. Goel MD, Neal S. Kleiman MD, Alpesh R. Shah MD

Background

The impact of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) on left ventricular ejection fraction (LVEF) remains controversial.

Methods

We included patients who underwent CTO PCI (2018-2022) with reported baseline and follow-up LVEF (window 1-18 months). Stratified analyses according to procedural success, baseline LVEF, and target vessel were performed. Logistic regression analysis was performed to assess predictors of LVEF improvement.

Results

We included 142 patients with available LVEF data, of whom 121 had successful CTO PCI (85.2%). Overall, mean age was 65.4 ± 10.3 years, 76.1% were men, and 81.0% were White. The attempted CTO vessel was left anterior descending in 31.7%, left circumflex in 17.6%, and right coronary artery in 50.0% of patients. The median time from PCI to follow-up echocardiogram was 8.4 months (IQR, 4.4-12.4). After successful CTO PCI, mean LVEF increased from a baseline of 48.2% ± 15.4% to 51.8% ± 14.2% (ΔLVEF 3.6%; P < .001). Among patients with depressed baseline LVEF <50%, there was greater improvement in LVEF from 32.6% ± 9.7% to 40.0% ± 12.9% (ΔLVEF 7.6%; P < .001), including 48.0% with ≥10% improvement. There was no change in LVEF after unsuccessful CTO PCI (54.6% ± 10.6% vs 55.2% ± 8.6%; P = .746). The ΔLVEF after successful CTO PCI to the left anterior descending, left circumflex, and right coronary artery was 2.6%, 4.0%, and 4.4%, respectively, overall, and 9.4%, 6.3%, 7.3% in patients with depressed baseline LVEF. Reduced baseline LVEF <50% was a strong independent predictor of LVEF improvement after successful CTO PCI (adjusted odds ratio, 5.60; 95% CI, 2.27-13.84; P < .001).

Conclusions

Successful CTO PCI seems to be associated with modest LVEF improvement, which is more pronounced in patients with reduced baseline LVEF.

{"title":"Assessment of Left Ventricular Function After Percutaneous Coronary Intervention for Chronic Total Occlusion","authors":"Yasser M. Sammour MD, MSc, Rody G. Bou Chaaya MD, Chloe Kharsa MD, Jerrin Philip MD, Taha Hatab MD, Sahar Samimi MD, Joseph Elias MD, Momin Islam MD, Gal Sella MD, Joe Aoun MD, Sachin S. Goel MD, Neal S. Kleiman MD, Alpesh R. Shah MD","doi":"10.1016/j.jscai.2024.102460","DOIUrl":"10.1016/j.jscai.2024.102460","url":null,"abstract":"<div><h3>Background</h3><div>The impact of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) on left ventricular ejection fraction (LVEF) remains controversial.</div></div><div><h3>Methods</h3><div>We included patients who underwent CTO PCI (2018-2022) with reported baseline and follow-up LVEF (window 1-18 months). Stratified analyses according to procedural success, baseline LVEF, and target vessel were performed. Logistic regression analysis was performed to assess predictors of LVEF improvement.</div></div><div><h3>Results</h3><div>We included 142 patients with available LVEF data, of whom 121 had successful CTO PCI (85.2%). Overall, mean age was 65.4 ± 10.3 years, 76.1% were men, and 81.0% were White. The attempted CTO vessel was left anterior descending in 31.7%, left circumflex in 17.6%, and right coronary artery in 50.0% of patients. The median time from PCI to follow-up echocardiogram was 8.4 months (IQR, 4.4-12.4). After successful CTO PCI, mean LVEF increased from a baseline of 48.2% ± 15.4% to 51.8% ± 14.2% (ΔLVEF 3.6%; <em>P</em> < .001). Among patients with depressed baseline LVEF <50%, there was greater improvement in LVEF from 32.6% ± 9.7% to 40.0% ± 12.9% (ΔLVEF 7.6%; <em>P</em> < .001), including 48.0% with ≥10% improvement. There was no change in LVEF after unsuccessful CTO PCI (54.6% ± 10.6% vs 55.2% ± 8.6%; <em>P</em> = .746). The ΔLVEF after successful CTO PCI to the left anterior descending, left circumflex, and right coronary artery was 2.6%, 4.0%, and 4.4%, respectively, overall, and 9.4%, 6.3%, 7.3% in patients with depressed baseline LVEF. Reduced baseline LVEF <50% was a strong independent predictor of LVEF improvement after successful CTO PCI (adjusted odds ratio, 5.60; 95% CI, 2.27-13.84; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Successful CTO PCI seems to be associated with modest LVEF improvement, which is more pronounced in patients with reduced baseline LVEF.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 1","pages":"Article 102460"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143168857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patient Characteristics and Outcomes of Radial to Femoral Access-Site Crossover

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102450

Revathy Sampath-Kumar MD, Ehtisham Mahmud MD, Kerem Korkmaz, Lawrence Ang MD, Belal Al Khiami MD, Anna Melendez MSN, RN, Ryan Reeves MD, Ori Ben-Yehuda MD

Background

The need for radial to femoral access-site crossover (RFC) remains a limitation of radial percutaneous coronary intervention (PCI) with unknown implications.

Methods

The UC San Diego Health internal National Cardiovascular Data Registry CathPCI Registry was used to obtain data on patients who underwent PCI from January 2018 to September 2022 for any indication. Coronary artery bypass graft patients were excluded. Patient- and procedure-level predictors of RFC, complications, and all-cause mortality within 1-year post-PCI were assessed.

Results

A total of 3054 patients were included with a mean age of 67 ± 12 years, and 43.2% had acute coronary syndrome. Of these patients, 109 required RFC, 2287 had successful radial access (RA), and 658 had successful femoral access. There were no differences in comorbidities between the RFC and RA groups. Patients who required RFC had 29% longer fluoroscopy time and 16% more contrast volume compared to patients who had RA. Independent predictors of RFC were age >70 years (OR, 2.68; 95% CI, 1.79-4.01; P < .001), vasopressor support at the time of PCI (OR, 2.87; 95% CI 1.33-6.20; P = .007), and dialysis dependence (OR, 3.05; 95% CI, 1.34-6.93; P = .008). Patients who required RFC had higher 30-day all-cause mortality (3.7% vs 1.0%, P = .028), bleeding complications (8.3% vs 2.6%, P = .003), and need for blood products (7.3% vs 1.4%, P < .001) compared to patients who had RA. There was no difference in all-cause mortality or complications between the RFC and femoral access groups.

Conclusions

Radial to femoral access-site crossover was associated with higher short-term mortality and bleeding complications compared to RA. Age greater than 70 years, vasopressor support, and dialysis dependence were associated with RFC.

{"title":"Patient Characteristics and Outcomes of Radial to Femoral Access-Site Crossover","authors":"Revathy Sampath-Kumar MD, Ehtisham Mahmud MD, Kerem Korkmaz, Lawrence Ang MD, Belal Al Khiami MD, Anna Melendez MSN, RN, Ryan Reeves MD, Ori Ben-Yehuda MD","doi":"10.1016/j.jscai.2024.102450","DOIUrl":"10.1016/j.jscai.2024.102450","url":null,"abstract":"<div><h3>Background</h3><div>The need for radial to femoral access-site crossover (RFC) remains a limitation of radial percutaneous coronary intervention (PCI) with unknown implications.</div></div><div><h3>Methods</h3><div>The UC San Diego Health internal National Cardiovascular Data Registry CathPCI Registry was used to obtain data on patients who underwent PCI from January 2018 to September 2022 for any indication. Coronary artery bypass graft patients were excluded. Patient- and procedure-level predictors of RFC, complications, and all-cause mortality within 1-year post-PCI were assessed.</div></div><div><h3>Results</h3><div>A total of 3054 patients were included with a mean age of 67 ± 12 years, and 43.2% had acute coronary syndrome. Of these patients, 109 required RFC, 2287 had successful radial access (RA), and 658 had successful femoral access. There were no differences in comorbidities between the RFC and RA groups. Patients who required RFC had 29% longer fluoroscopy time and 16% more contrast volume compared to patients who had RA. Independent predictors of RFC were age >70 years (OR, 2.68; 95% CI, 1.79-4.01; <em>P</em> < .001), vasopressor support at the time of PCI (OR, 2.87; 95% CI 1.33-6.20; <em>P</em> = .007), and dialysis dependence (OR, 3.05; 95% CI, 1.34-6.93; <em>P</em> = .008). Patients who required RFC had higher 30-day all-cause mortality (3.7% vs 1.0%, <em>P</em> = .028), bleeding complications (8.3% vs 2.6%, <em>P</em> = .003), and need for blood products (7.3% vs 1.4%, <em>P</em> < .001) compared to patients who had RA. There was no difference in all-cause mortality or complications between the RFC and femoral access groups.</div></div><div><h3>Conclusions</h3><div>Radial to femoral access-site crossover was associated with higher short-term mortality and bleeding complications compared to RA. Age greater than 70 years, vasopressor support, and dialysis dependence were associated with RFC.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 1","pages":"Article 102450"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143168860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Myocardial Infarction and Multivessel Disease: Complete Revascularization at the Right Time

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102512

Goran Stankovic MD, PhD

引用次数: 0

Cover

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/S2772-9303(24)02240-3

引用次数: 0

Revascularization Strategies for Multivessel Disease in Acute Coronary Syndrome: Network Meta-analysis

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102449

Khaled M. Harmouch MD , Mohammad Hamza MD , Nomesh Kumar MD , Zarghoona Wajid MD , Neel Patel MD , Masooma Naseem MD , Jawad Basit MBBS , Prakash Upreti MD , Manoj Kumar MD , Waqas Ullah MD , Yasar Sattar MD, MS , Timir K. Paul MD, PhD, MPH , Emmanouil Brilakis MD, PhD , M. Chadi Alraies MD, MPH

Background

The optimal revascularization strategy for patients with acute coronary syndrome (ACS) and multivessel disease (MVD) remains debated. This study compares the efficacy and safety of different revascularization strategies in these patients.

Methods

We included 20 studies comparing staged, complete, and culprit-only (CO) revascularization strategies in patients with ACS and MVD. We divided the revascularization strategies into 3 distinct strategies: CO, complete index procedure (CIP), and complete staged procedure (CSP). We then compared CIP and CSP with CO. Outcomes studied are all-cause mortality, cardiac death, recurrent myocardial infarction (MI), need for revascularization, bleeding, contrast-induced nephropathy (CIN), stroke, bleeding, and stent thrombosis.

Results

Compared with the CO group, both the CIP group (relative risk [RR], 0.42; 95% CI, 0.26-0.69; P < .001) and the CSP group (RR, 0.53; 95% CI, 0.35-0.82; P < .001) showed a lower need for revascularization. The CSP group had a lower incidence of cardiac death (RR, 0.67; 95% CI, 0.48-0.94; P = .02). The CIP group experienced fewer recurrent MI (RR, 0.58; 95% CI, 0.35-0.94; P = .03). There was no statistically significant difference in all-cause mortality, bleeding, CIN, stroke, or stent thrombosis between the CIP group and the CSP group compared with the CO group.

Conclusions

Our findings support complete revascularization (CIP or CSP) over CO for patients with ACS and MVD. Both CIP and CSP are associated with lower needs for future revascularization. CSP was associated with lower cardiac deaths. CIP was associated with fewer recurrent MI. Additionally, both strategies were safe with no differences noted in bleeding, CIN, stroke, and stent thrombosis.

{"title":"Revascularization Strategies for Multivessel Disease in Acute Coronary Syndrome: Network Meta-analysis","authors":"Khaled M. Harmouch MD , Mohammad Hamza MD , Nomesh Kumar MD , Zarghoona Wajid MD , Neel Patel MD , Masooma Naseem MD , Jawad Basit MBBS , Prakash Upreti MD , Manoj Kumar MD , Waqas Ullah MD , Yasar Sattar MD, MS , Timir K. Paul MD, PhD, MPH , Emmanouil Brilakis MD, PhD , M. Chadi Alraies MD, MPH","doi":"10.1016/j.jscai.2024.102449","DOIUrl":"10.1016/j.jscai.2024.102449","url":null,"abstract":"<div><h3>Background</h3><div>The optimal revascularization strategy for patients with acute coronary syndrome (ACS) and multivessel disease (MVD) remains debated. This study compares the efficacy and safety of different revascularization strategies in these patients.</div></div><div><h3>Methods</h3><div>We included 20 studies comparing staged, complete, and culprit-only (CO) revascularization strategies in patients with ACS and MVD. We divided the revascularization strategies into 3 distinct strategies: CO, complete index procedure (CIP), and complete staged procedure (CSP). We then compared CIP and CSP with CO. Outcomes studied are all-cause mortality, cardiac death, recurrent myocardial infarction (MI), need for revascularization, bleeding, contrast-induced nephropathy (CIN), stroke, bleeding, and stent thrombosis.</div></div><div><h3>Results</h3><div>Compared with the CO group, both the CIP group (relative risk [RR], 0.42; 95% CI, 0.26-0.69; <em>P</em> < .001) and the CSP group (RR, 0.53; 95% CI, 0.35-0.82; <em>P</em> < .001) showed a lower need for revascularization. The CSP group had a lower incidence of cardiac death (RR, 0.67; 95% CI, 0.48-0.94; <em>P</em> = .02). The CIP group experienced fewer recurrent MI (RR, 0.58; 95% CI, 0.35-0.94; <em>P</em> = .03). There was no statistically significant difference in all-cause mortality, bleeding, CIN, stroke, or stent thrombosis between the CIP group and the CSP group compared with the CO group.</div></div><div><h3>Conclusions</h3><div>Our findings support complete revascularization (CIP or CSP) over CO for patients with ACS and MVD. Both CIP and CSP are associated with lower needs for future revascularization. CSP was associated with lower cardiac deaths. CIP was associated with fewer recurrent MI. Additionally, both strategies were safe with no differences noted in bleeding, CIN, stroke, and stent thrombosis.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 1","pages":"Article 102449"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143168865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gilding the (Vascular) Ring

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102401

Grace Sunah Lee MD , Danish Vaiyani MD , Muhammad Nuri MD , Michael L. O’Byrne MD, MSCE

引用次数: 0

To Adhere to Guidelines, Must All Aortic Stenosis Patients <65 Years Have Surgery?

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102430

Megan Coylewright MD, MPH , Kendra J. Grubb MD, MHA

引用次数: 0

Inflow-to-Outflow Stent Frame Expansion, Ellipticity, and Decoupling in Evolut TAVR: Implications for Mid-term Hemodynamic Performance

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102448

Rishi Puri MD, PhD , Julianne Spencer PhD , Didier Tchétché MD , Nicolas M. Van Mieghem MD, PhD , John K. Forrest MD , Michael J. Reardon MD , Jorge Zhingre Sanchez PhD , Andres Caballero PhD , Philipp Blanke MD , Jonathon A. Leipsic MD , Paul Sorajja MD , G. Michael Deeb MD , Shinichi Fukuhara MD , Lindsay M. Lucas MSc , Taofik Oyekunle MSc , Gilbert H.L. Tang MD, MSc, MBA

Background

The native aortic annulus for self-expanding transcatheter aortic valve replacement (TAVR) has variable ellipticity. A noncircular and underexpanded transcatheter aortic valve (TAV) may impact hemodynamic performance. This study aimed to quantify Evolut TAV (Medtronic) frame ellipticity and expansion 30 days post-TAVR and evaluate their impact on 1-year hypoattenuating leaflet thickening and 4-year hemodynamics.

Methods

We retrospectively evaluated 184 patients from the Evolut Low Risk substudy with high-quality computed tomography images. Frame ellipticity ratio and percent expansion were quantified at each frame node level 30 days after TAVR. Variables associated with frame deformation, 1-year hypoattenuating leaflet thickening, and 4-year hemodynamics were identified.

Results

Mean Evolut frame ellipticity was highest at the inflow (1.18 ± 0.08) and lowest at the functional leaflet region (1.05 ± 0.03) and frame outflow (1.04 ± 0.03). Frame expansion was lowest at the inflow (83.8% ± 4.9%) and highest at the functional leaflet region (97.8% ± 1.7%). TAV frame circularity and expansion significantly increased from the annular level to the leaflet region (P < .001). Mean gradient, effective orifice area, and paravalvular regurgitation at 4 years were not affected by Evolut TAV's relative noncircularity and underexpansion at the frame inflow. Frame underexpansion at the leaflet region, however, was associated with a smaller effective orifice area at 4 years.

Conclusions

Evolut frame deformation at the inflow did not affect the circularity and expansion of the stent at the functional leaflet region. Mid-term (4-year) Evolut hemodynamic performance does not appear to be impacted by frame inflow geometry.

{"title":"Inflow-to-Outflow Stent Frame Expansion, Ellipticity, and Decoupling in Evolut TAVR: Implications for Mid-term Hemodynamic Performance","authors":"Rishi Puri MD, PhD , Julianne Spencer PhD , Didier Tchétché MD , Nicolas M. Van Mieghem MD, PhD , John K. Forrest MD , Michael J. Reardon MD , Jorge Zhingre Sanchez PhD , Andres Caballero PhD , Philipp Blanke MD , Jonathon A. Leipsic MD , Paul Sorajja MD , G. Michael Deeb MD , Shinichi Fukuhara MD , Lindsay M. Lucas MSc , Taofik Oyekunle MSc , Gilbert H.L. Tang MD, MSc, MBA","doi":"10.1016/j.jscai.2024.102448","DOIUrl":"10.1016/j.jscai.2024.102448","url":null,"abstract":"<div><h3>Background</h3><div>The native aortic annulus for self-expanding transcatheter aortic valve replacement (TAVR) has variable ellipticity. A noncircular and underexpanded transcatheter aortic valve (TAV) may impact hemodynamic performance. This study aimed to quantify Evolut TAV (Medtronic) frame ellipticity and expansion 30 days post-TAVR and evaluate their impact on 1-year hypoattenuating leaflet thickening and 4-year hemodynamics.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated 184 patients from the Evolut Low Risk substudy with high-quality computed tomography images. Frame ellipticity ratio and percent expansion were quantified at each frame node level 30 days after TAVR. Variables associated with frame deformation, 1-year hypoattenuating leaflet thickening, and 4-year hemodynamics were identified.</div></div><div><h3>Results</h3><div>Mean Evolut frame ellipticity was highest at the inflow (1.18 ± 0.08) and lowest at the functional leaflet region (1.05 ± 0.03) and frame outflow (1.04 ± 0.03). Frame expansion was lowest at the inflow (83.8% ± 4.9%) and highest at the functional leaflet region (97.8% ± 1.7%). TAV frame circularity and expansion significantly increased from the annular level to the leaflet region (<em>P</em> < .001). Mean gradient, effective orifice area, and paravalvular regurgitation at 4 years were not affected by Evolut TAV's relative noncircularity and underexpansion at the frame inflow. Frame underexpansion at the leaflet region, however, was associated with a smaller effective orifice area at 4 years.</div></div><div><h3>Conclusions</h3><div>Evolut frame deformation at the inflow did not affect the circularity and expansion of the stent at the functional leaflet region. Mid-term (4-year) Evolut hemodynamic performance does not appear to be impacted by frame inflow geometry.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 1","pages":"Article 102448"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143170025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Understanding Right Heart Flow: Implications for Interatrial Shunt Device Therapy in Heart Failure

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2025-01-01 DOI: 10.1016/j.jscai.2024.102439

Raviteja Guddeti MD , Pankaj Garg MD , Dean J. Kereiakes MD , João L. Cavalcante MD , Marcus Carlsson MD, PhD , Santiago Garcia MD

Elevation in left atrial pressure with subsequent pulmonary congestion is central to the pathology of heart failure. Interatrial shunts have emerged as a potential therapeutic strategy in patients with heart failure, especially those with diastolic dysfunction. These devices decrease left atrial pressure by shunting blood into the right atrium. Normal right heart flow is characterized by a predominant vortex formation in the right atrium, which then enters the right ventricle as a direct flow that preserves kinetic energy and right ventricular work efficiency. Examining the abnormal right heart blood flow patterns in naturally occurring interatrial shunts using 4-dimensional flow magnetic resonance imaging can improve our understanding of the effects of various interatrial shunt devices currently being investigated for heart failure management.

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

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Journal of the Society for Cardiovascular Angiography & Interventions

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