Cardiovascular Intervention and Therapeutics最新文献

Transcatheter heart valve (THV) distortion is a commonly observed phenomenon during transcatheter aortic valve implantation (TAVI). However, the influence of the initial expansion position of the THV on its distortion has not been discussed. In a single-center study, patients who underwent TAVI with a balloon-expandable valve were enrolled. Patients were divided into the NCC (non-coronary cusp) group and the non-NCC group based on the initial position of valve expansion. The relationship between initial valve position and the degree of THV distortion was analyzed. Degree of THV distortion was defined as the "L/N ratio" (L: stent length on the left-coronary cusp (LCC) side; N: stent length on the NCC side). Furthermore, patients were also divided into distorted valve group and non-distorted valve group (distorted valve: L/N ratio < 0.95 or > 1.05). We also assessed the prognostic impact of initial valve position and THV distortion. Among a total of 116 patients, 72 patients were classified into NCC group and 44 patients into the non-NCC group. The NCC group had a significantly lower L/N ratio than the non-NCC group, indicating greater distortion in the NCC group (0.93 ± 0.06 vs. 0.99 ± 0.07, p < 0.01). There were no significant differences in three-year all-cause mortality or heart failure rehospitalization between the groups. Additionally, post-operative transthoracic echocardiography parameters showed no significant differences between the groups. The initial expansion position of the THV was associated with the valve distortion, which did not affect mid-term clinical outcomes following TAVI.

Residual cardiovascular risk after percutaneous coronary intervention (PCI) remains a concern despite optimal low-density lipoprotein cholesterol (LDL-C) management. The LDL-C/apolipoprotein B (ApoB) ratio is a potential marker for LDL particle size and atherogenicity. This study investigated the prognostic value of the pre-treatment LDL-C/ApoB ratio for major adverse cardiac events (MACE) in patients with coronary artery disease who underwent PCI. Among 2116 consecutive patients enrolled between 2015 and 2022 in the Fukuoka University PCI prospective registry, this study analyzed 1682 individuals who were divided into two groups according to their LDL-C/ApoB ratio (< 1.2 vs. ≥ 1.2). The primary outcome was 3-year MACE. After propensity score matching (315 pairs), the low LDL-C/ApoB ratio (< 1.2) was associated with higher MACE (Adjusted HR 1.50, 95% CI 1.04-2.16, p = 0.030). Restricted cubic spline analysis in the matched cohort revealed a significant continuous inverse association between the LDL-C/ApoB ratio and MACE risk. Notably, this predictive value persisted even after propensity score matching balanced for triglyceride-rich lipoprotein-related markers (triglycerides, remnant-like particle cholesterol) and HDL-C. The pre-treatment LDL-C/ApoB ratio is an independent predictor of MACE after PCI, demonstrating a continuous inverse relationship with risk, even when accounting for other atherogenic lipoproteins. This easily calculable ratio may enhance risk stratification by identifying residual risk associated with LDL particle characteristics.

Percutaneous coronary intervention (PCI) has evolved significantly with technological advances, allowing for higher procedural success rates and improved patient outcomes. However, the growing complexity of cases involving severely calcified lesions, tortuous vessels, and chronic total occlusions has increased procedural challenges. In such scenarios, the guide extension catheter (GEC, or guiding catheter extension) plays a critical role by enhancing device passage and providing additional backup support, making it indispensable in modern PCI. Various types of GECs offer distinct characteristics that influence their selection based on lesion type, device compatibility, and procedural requirements. The GEC is used for multiple purposes, including backup support, deep engagement, imaging device insertion, stent protection, thrombectomy, and foreign body removal. Despite its utility, GEC use is associated with potential complications, including vessel injury, thrombosis, air embolism, and hemodynamic instability. Careful technique and proper selection are critical to minimizing risks. Overall, the GEC is an essential tool in complex PCI procedures, offering significant advantages in improving procedural success.

The objective was to assess the effect of preprocedural arterial stiffness on long-term blood pressure (BP) reduction following renal sympathetic denervation (RDN). In this prospective, single-arm pilot study, patients with systolic office BP ≥ 140 mmHg and mean 24-h systolic ambulatory blood pressure (ABP) ≥ 130 mmHg despite being on a minimum of 3 antihypertensive drugs underwent radiofrequency RDN. The primary efficacy outcome was the temporal evolution of mean 24-h systolic ABP throughout 5 years post RDN. Effect modification of the primary outcome was studied for baseline magnetic resonance pulse wave velocity (MR-PWV), MR aortic distensibility (MR-AoD), ultrasound carotid femoral pulse wave velocity (CF-PWV) and clinical parameters. Analyses were performed using linear mixed-effects models to account for repeated BP measurements. A total of 30 patients were enrolled, 50% were female, mean age was 62.5 ± 10.7 years. Baseline mean 24-h ABP was 146.7/80.8 ± 13.7/12.0 despite a median of 5.0 ± 2.4 defined daily doses (DDD) of antihypertensive drugs. Baseline median MR-PWV was 6.8 [25th-75th percentile: 6.1-11.0] m/s, median MR-AoD was 1.4 × 10^-3 mmHg^-1 [25th-75th percentile: 0.9-1.8] and mean CF-PWV was 8.5 ± 2.1 m/s. Throughout 5 years following RDN, the change in mean 24-h systolic ABP was - 11.5 [95% CI - 17.0, - 5.9] mmHg (p = <0.001). MR-PWV emerged as the sole significant independent effect modifier of the change in mean 24-h systolic ABP throughout 5 years following RDN (+ 1.8 [95% CI 0.7, 2.8] mmHg per m/s per 5 years; p = 0.001). A higher level of preprocedural arterial stiffness, as measured using MR-PWV, was associated with a smaller BP lowering effect 5 years post-RDN.

Background: Stent thrombosis (ST) remains a serious complication after percutaneous coronary intervention, leading to acute myocardial infarction (AMI) in over 70% of cases. And it has been reported that the prognosis for ST is worse than for de-novo AMI. While the use of second-generation drug-eluting stents (G2-DES) has reduced ST incidence, ST remains a concern, and its incidence and prognosis in the G2-DES era have not been well studied.

Aims: To evaluate the incidence and prognosis of AMI due to ST in the G2-DES era compared with de-novo AMI.

Methods: From January 2013 to November 2022, we analyzed 6273 consecutive AMI patients from the Mie ACS Registry, including 78 ST and 6195 de-novo type 1 AMI (de-novo AMI) after exclusion of the other type of AMI. The primary endpoint was all-cause mortality, and target lesion revascularization (TLR) was the secondary endpoint.

Results: ST occurred in 1.2% (n = 78) of AMI, predominantly as very late ST (79.5%, n = 62). Thirty-day mortality was marginally lower in ST (2.6%) than de-novo AMI (6.7%, p = 0.16), with ST not being an independent predictor of 30-day mortality (HR 0.39, p = 0.19). However, ST patients had a higher 2-year TLR rate (21.4% vs. 11.9%, p = 0.02), confirmed as an independent predictor (HR 2.03, p = 0.01). Compared to previous clinical data, the reduced incidence of ST and the improved prognosis was observed.

Conclusions: While ST-related AMI prognosis has improved, with mortality comparable to de-novo AMI, the higher TLR rate in ST patients persists, and an optimized revascularization strategy is still needed.

Transradial access (TRA) is increasingly used in endovascular therapy (EVT) due to its favorable safety profile. However, its procedural efficiency compared to transfemoral access (TFA) remains under investigation. We retrospectively analyzed 132 consecutive EVT procedures for iliac artery lesions performed between April 2020 and March 2024. After excluding 11 dialysis-dependent and 3 urgent cases, 118 elective cases were included (TRA: 65; TFA: 53). Four procedural time intervals were assessed: (1) room entry to local anesthesia, (2) local anesthesia to sheath removal, (3) sheath removal to room exit, and (4) total room time. In the primary analysis, 45 matched pairs were created using propensity score matching based on five covariates: chronic total occlusion (CTO), bilateral calcification, TASC C/D lesions, stent occlusion, and covered stent use. A secondary analysis was performed in 19 matched CTO cases using three covariates. In the matched cohort, TRA demonstrated significantly shorter total room time compared to TFA (75 [60-115] vs. 105 [74-163] min, p = 0.003). Sheath removal to room exit time was also consistently shorter in the TRA group (7 [5-10] vs. 14 [12-17] min, p < 0.001). Similar findings were observed in the CTO-matched subgroup (93 [77-163] vs. 160 [110-220] min, p = 0.012). TRA significantly reduces procedural time compared to TFA in iliac artery EVT. The consistent reduction across all phases, including the post-procedural period, highlights TRA as an efficient and practical access strategy in peripheral vascular interventions.

Patients with severe aortic stenosis (AS) and small aortic annulus pose diagnostic and therapeutic challenges. To investigate the frequency of discordant grading of severe AS in patients with a small aortic annulus and to evaluate the outcomes after transcatheter aortic valve implantation (TAVI). Patients with severe AS, an aortic annulus diameter of < 21 mm on echocardiography, a mean annulus diameter of < 23 mm, and an area ≤ 4.3 cm² on cardiac computed tomography, who underwent TAVI, were retrospectively analyzed. The frequency of low-gradient severe AS was assessed. Patients were followed up for the occurrence of the composite endpoint of all-cause mortality, rehospitalizations for heart failure, non-fatal myocardial infarction, and non-fatal stroke. Among 230 patients with severe AS and a small aortic annulus (age 82 ± 6 years, 85% female), 52 (23%) had low gradient, while 120 (52%) exhibited normal flow-high gradient and 58 (25%) had low flow-high gradient. During a median follow-up of 2 years, the composite endpoint occurred in 29% of the total cohort. Patients with low-gradient severe AS experienced the worse outcome (HR = 2.46; 95% CI: 1.13-5.33; p = 0.023). Almost one-fourth of patients with severe AS and small annulus have low gradient AS. These patients experienced worse outcomes, likely reflecting advanced myocardial remodeling due to delayed referral and the diagnostic challenges posed by small annular dimensions.