Cardiovascular Intervention and Therapeutics最新文献

Compared with left heart catheterization (LHC), the pressure gradient of an aortic valve (PG_AV) measured by echocardiography during transcatheter aortic valve replacement (TAVR) in small annuli is overestimated. The purpose of this study was to improve the accuracy of PG_AV measurements by echocardiography in small annuli and to evaluate the influence of PG_AV on prognosis. The internal derivation cohort included 273 consecutive patients with aortic stenosis and a small annulus (computed tomographic scan showing an annulus circumference < 72 mm or area < 400 mm²) who underwent TAVR. Patients completed transthoracic echocardiography (TTE) and LHC measurements during TAVR, and an extreme gradient boosting (XGBoost) algorithm was trained. The primary outcome was a composite end point of all-cause mortality and readmission for heart failure. The mean PG_AV level measured by TTE was overestimated compared to the LHC measurement {52.5 [interquartile range: 47.5-57.0] mmHg vs. 42.5 (interquartile range: 38.0-46.0) mmHg, P < 0.001}. After adjustments to the XGBoost, the mean PG_AV measured by TTE could be significantly improved [Pearson correlation coefficient = 0.94, P < 0.001]. Importantly, patients with a predicted mean PG_AV ≥ 68.6 mmHg showed a significantly increased incidence of composite end points at 2 years after the procedures (40.7% vs. 16.0%, P < 0.001). The XGBoost model could effectively improve the accuracy of the mean PG_AV measured by TTE during TAVR, and the predicted mean increase in the PG_AV level may lead to a worse prognosis.Clinical Trial Registration: ClinicalTrials.gov Protocol Registration System (NCT05044338).

The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidence regarding rotational atherectomy (RA) in 2020, which was updated in 2023. Because the revascularization strategy to severely calcified lesions has been the hottest topic in contemporary percutaneous coronary intervention (PCI), many literatures related to RA have been published since 2023. Latest advancements have been incorporated in this updated expert consensus document.

Slender percutaneous coronary intervention (PCI) is a minimally invasive technique that uses smaller catheters, typically 5-French devices, to reduce bleeding complications and eliminate the need for unnecessarily large catheters. While these techniques are highly effective for non-complex lesions, they face inherent challenges, such as limitations in device compatibility and technical constraints. These challenges emphasize the importance of thorough pre-procedural planning to ensure optimal equipment selection and successful procedures. Cardiac computed tomography (CT) addresses these limitations by providing a comprehensive three-dimensional view of the coronary artery anatomy and lesion characteristics. This consensus statement outlines the role of cardiac CT in optimizing slender PCI strategies, emphasizing the importance of detailed anatomical assessments and advanced evaluations of lesion complexity. Cardiac CT enables precise measurements of vessel dimensions, identification of optimal landing zones, and accurate characterization of lesion complexity, including calcified plaque. Thin-slab maximum intensity projection reconstruction provides simultaneous longitudinal and cross-sectional views, comparable with findings of coronary angiography and intravascular imaging, facilitating interventional planning. For complex lesions, CT is essential. It accurately predicts the risk of side branch occlusion in bifurcation lesions, characterizes the distribution of calcification in heavily calcified lesions to aid in device selection, and helps in the appropriate selection of cases for chronic total occlusion lesions based on CT-derived scores and detailed morphological assessments. To systematically apply these principles, a practical pre-procedural checklist for CT-guided planning is proposed. The integration of cardiac CT into the slender PCI workflow extends beyond anatomical assessment to encompass the optimization of resource utilization, potentially enabling interventionists to proceed with appropriately minimally invasive techniques from the outset.