Journal: Circ Cardiovasc Interv

Sorted by: date / impact
Abstract
<div><h4>Percutaneous Management of High-Risk Pulmonary Embolism.</h4><i>Carroll BJ, Larnard EA, Pinto DS, Giri J, Secemsky EA</i><br /><AbstractText>Acute pulmonary embolism (PE) leads to an abrupt increase in pulmonary vascular resistance and right ventricular afterload, and when significant enough, can result in hemodynamic instability. High-risk PE is a dire cardiovascular emergency and portends a poor prognosis. Traditional therapeutic options to rapidly reduce thrombus burden like systemic thrombolysis and surgical pulmonary endarterectomy have limitations, both with regards to appropriate candidates and efficacy, and have limited data demonstrating their benefit in high-risk PE. There are growing percutaneous treatment options for acute PE that include both localized thrombolysis and mechanical embolectomy. Data for such therapies with high-risk PE are currently limited. However, given the limitations, there is an opportunity to improve outcomes, with percutaneous treatments options offering new mechanisms for clot reduction with a possible improved safety profile compared with systemic thrombolysis. Additionally, mechanical circulatory support options allow for complementary treatment for patients with persistent instability, allowing for a bridge to more definitive treatment options. As more data develop, a shift toward a percutaneous approach with mechanical circulatory support may become a preferred option for the management of high-risk PE at tertiary care centers.</AbstractText><br /><br /><br /><br /><small>Circ Cardiovasc Interv: 06 Feb 2023:e012166; epub ahead of print</small></div>
Carroll BJ, Larnard EA, Pinto DS, Giri J, Secemsky EA
Circ Cardiovasc Interv: 06 Feb 2023:e012166; epub ahead of print | PMID: 36744463
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Temporal Trends and Contemporary Outcomes After Transcatheter Aortic Valve Replacement With Evolut PRO/PRO+ Self-Expanding Valves: Insights From the NEOPRO/NEOPRO-2 Registries.</h4><i>Scotti A, Baggio S, Pagnesi M, Barbanti M, ... Latib A, NEOPRO and NEOPRO-2 Investigators‡</i><br /><b>Background</b><br />In recent years, transcatheter aortic valve replacement (TAVR) techniques and technology have continuously improved. Data regarding the impact of these advancements on outcomes in large real-world settings are still limited. The aim of this study was to investigate temporal trends and assess contemporary outcomes after TAVR with Evolut PRO/PRO+ supra-annular self-expanding valves.<br /><b>Methods</b><br />This study included patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries who underwent transfemoral TAVR with Evolut PRO/PRO+. Procedural dates (August 2017 through November 2021) were stratified in quartiles (Q) and used to investigate temporal trends in TAVR outcomes. Predischarge, 30-day Valve Academic Research Consortium-3 defined, and 1-year outcomes were evaluated.<br /><b>Results</b><br />In total, 1616 patients from 28 centers were included. Over time, patients had lower Society of Thoracic Surgeon-Predicted Risk of Mortality score (Q1-4, 4.1% [2.8-6.3%], 3.7% [2.6-5.3%], 3.3% [2.4-4.9%], 2.9% [2.2-4.3%]; <i>P</i><0.001) and more moderate or heavy valve calcification (Q1-4, 80%, 80%, 82%, 88%; <i>P</i>=0.038). Overall Valve Academic Research Consortium-3 technical success was 94.1%, with 30-day and 1-year all-cause mortality of 2.4% and 10%, respectively. Throughout the study period, procedures were associated with higher rates of 30-day device success (Q1-4, 81.2%, 82.2%, 82.0%, 88.0%; Cochran-Armitage <i>P</i>=0.023) and early safety (Q1-4, 66.8%, 67.5%, 74.0%, 77.6%; Cochran-Armitage <i>P</i><0.001), with fewer permanent pacemaker implantations (Q1-4: 15.3%, 20.0%, 12.1%, 11.6%; Cochran-Armitage <i>P</i>=0.023) and residual mild or greater paravalvular leaks (Q1-4, 50.4%, 42.1%, 36.5%, 35.8%; Cochran-Armitage <i>P</i><0.001).<br /><b>Conclusions</b><br />TAVR with Evolut PRO/PRO+ self-expanding valve is safe and effective. Despite the treatment of heavier calcified anatomies, procedural outcomes are improving over time with less need for pacemaker implantation and less significant paravalvular leaks.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 01 Jan 2023; 16:e012538</small></div>
Scotti A, Baggio S, Pagnesi M, Barbanti M, ... Latib A, NEOPRO and NEOPRO-2 Investigators‡
Circ Cardiovasc Interv: 01 Jan 2023; 16:e012538 | PMID: 36649387
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Five-Year Clinical Outcome of the Biodegradable Polymer Ultrathin Strut Sirolimus-Eluting Stent Compared to the Biodegradable Polymer Biolimus-Eluting Stent in Patients Treated With Percutaneous Coronary Intervention: From the SORT OUT VII Trial.</h4><i>Hansen KN, Jensen LO, Maeng M, Christensen MK, ... Veien KT, Christiansen EH</i><br /><b>Background</b><br />Biodegradable polymer drug-eluting stents were developed to improve safety and efficacy outcomes for patients undergoing percutaneous coronary intervention. However, few long-term follow-up efficacy studies are available. The study sought to investigate 5-year results from the SORT OUT VII trial (Scandinavian Organization for Randomized Trials With Clinical Outcome) comparing the biodegradable polymer ultrathin-strut sirolimus-eluting Orsiro stent (O-SES) versus the biodegradable polymer biolimus-eluting Nobori stent (N-BES).<br /><b>Methods</b><br />This registry-based, randomized, multicenter, single-blinded, noninferiority trial compared O-SES and N-BES in an all-comer population. The composite primary end point, target lesion failure, consisted of cardiac death, myocardial infarction related to the target lesion, or target lesion revascularization within 1 year. Follow-up was extended to 5 years.<br /><b>Results</b><br />Five-year follow-up was completed for 2521 patients (99.8%). Five-year target lesion failure did not differ between O-SES (12.4%) and N-BES (13.1%; rate ratio [RR], 0.94 [95% CI, 0.75-1.18]). Cardiac death (RR, 0.95 [95% CI, 0.67-1.34]), target myocardial infarction (RR, 1.14 [95% CI, 0.76-1.71]), target lesion revascularization (RR, 0.90 [95% CI, 0.67-1.21]), and definite stent thrombosis rates (RR, 0.73 [95% CI, 0.41-1.33]) did not differ significantly between the 2 stents. Within the first year, definite ST was significantly lower for O-SES (0.4%) compared to N-BES (1.2%; RR, 0.33 [95% CI, 0.12-0.92]), but no difference was from 1 through 5 years: O-SES 1.2% and N-BES 0.9% (RR, 1.28 [95% CI, 0.58-2.82]).<br /><b>Conclusions</b><br />Five years after treatment with biodegradable polymer stents, target lesion failure did not differ among O-SES and N-BES. Definite stent thrombosis was less often seen within the first year in the O-SES but the difference was not maintained after 5 years.<br /><b>Registration</b><br />URL: https://clinicaltrials.gov; Unique identifier: NCT01879358.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 01 Jan 2023; 16:e012332</small></div>
Abstract
<div><h4>Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An Analysis of 14 522 Cases From British Cardiovascular Intervention Society Database 2009 to 2017.</h4><i>Kinnaird T, Gallagher S, Farooq V, Protty M, ... Mamas MA, Curzen N</i><br /><b>Background</b><br />Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain.<br /><b>Methods</b><br />Using the United Kingdom national PCI database, we studied all patients undergoing unprotected left main stem percutaneous intervention between 2009 and 2017. We excluded patients who presented with ST-segment-elevation, cardiogenic shock, and with an emergency indication for PCI.<br /><b>Results</b><br />Between 2009 and 2017, in the study-indicated population, 14 522 unprotected left main stem percutaneous intervention procedures were performed. Significant temporal changes in baseline demographics were observed with increasing patient age and comorbid burden. Procedural complexity increased over time, with the number of vessels treated, bifurcation PCI, number of stents used, and use of intravascular imaging and rotational atherectomy increased significantly through the study period. After adjustment for baseline differences, there were significant temporal reductions in the occurrence of peri-procedural myocardial infarction (P<0.001 for trend), in-hospital major adverse cardiac or cerebrovascular events (P<0.001 for trend), and acute procedural complications (P<0.001 for trend). In multivariable analysis examining the associates of in-hospital major adverse cardiac or cerebrovascular events, while age per year (odds ratio, 1.02 [95% CIs, 1.01-1.03]), female sex (odds ratio, 1.47 [1.19-1.82]), 3 or more stents (odds ratio, 1.67 [05% [1.02-2.67]), and patient comorbidity were associated with higher rates of in-hospital major adverse cardiac or cerebrovascular events, by contrast use of intravascular imaging (odds ratio, 0.56 [0.45-0.70]), and year of PCI (odds ratio, 0.63 [0.46-0.87]) were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events.<br /><b>Conclusions</b><br />Despite trends for increased patient and procedural complexity, in-hospital patient outcomes have improved after unprotected left main stem percutaneous intervention over time.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 01 Jan 2023; 16:e012350</small></div>
Kinnaird T, Gallagher S, Farooq V, Protty M, ... Mamas MA, Curzen N
Circ Cardiovasc Interv: 01 Jan 2023; 16:e012350 | PMID: 36649390
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Real-World Multiple Comparison of Transcatheter Aortic Valves: Insights From the Multicenter OBSERVANT II Study.</h4><i>Costa G, Barbanti M, Rosato S, Seccareccia F, ... D\'Errigo P, OBSERVANT II Research Group</i><br /><b>Background</b><br />Head-to-head comparisons of devices for transcatheter aortic valve implantation (TAVI) are mostly limited to 2-arm studies so far. The aim of this study was to compare simultaneously outcomes of the most used, second- and third-generation transcatheter aortic valves in a real-world population.<br /><b>Methods</b><br />A total of 2728 patients undergoing TAVI with different second- and third-generation devices, and enrolled in the multicenter, prospective OBSERVANT II study (Observational Study of Effectiveness of TAVI With New Generation Devices for Severe Aortic Stenosis Treatment) from December 2016 to September 2018 were compared according to the transcatheter aortic valve received. Outcomes were adjudicated through a linkage with administrative databases, and adjusted using inverse propensity of treatment weighting. The primary end point was the composite of all-cause death, stroke and rehospitalization for heart failure at 1-year. Rates were reported consecutively for Evolut R, Evolut PRO, SAPIEN 3, ACURATE neo, and Portico groups.<br /><b>Results</b><br />The primary end point did not differ among groups (23.9% versus 24.7% versus 21.5% versus 23.7% versus 27.4%, respectively, <i>P</i>=0.56). Permanent pacemaker implantation was significantly lower for patients receiving SAPIEN 3 (19.9% versus 19.3% versus 12.5% versus 14.7% versus 22.1%, respectively, <i>P</i><0.01) at 1 year. The SAPIEN 3 had lower rates of paravalvular regurgitation (moderate-to-severe grade 10.1% versus 5.0% versus 2.1% versus 13.1% versus 10.8%, respectively, <i>P</i><0.01) but higher transprosthetic gradients (median mean gradients 7.0 versus 6.0 versus 10.0 versus 7.0 versus 8.0 mm Hg, respectively, <i>P</i><0.01) after TAVI.<br /><b>Conclusions</b><br />Data from real-world practice showed low and comparable rates of complications after TAVI considering all the available devices. Patients receiving SAPIEN 3 valve had lower rates of paravalvular regurgitation and permanent pacemaker implantation, but higher transprosthetic gradients.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 09 Dec 2022:e012294; epub ahead of print</small></div>
Costa G, Barbanti M, Rosato S, Seccareccia F, ... D'Errigo P, OBSERVANT II Research Group
Circ Cardiovasc Interv: 09 Dec 2022:e012294; epub ahead of print | PMID: 36484239
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>BioMatrix Versus Orsiro Stents for Coronary Artery Disease: A Multicenter, Randomized, Open-Label Study.</h4><i>Yoon CH, Kwun JS, Choi YJ, Park JJ, ... Kim SH, Chae IH</i><br /><b>Background</b><br />Comparative studies of ultrathin-strut biodegradable polymer sirolimus-eluting stent (BP-SES) have reported promising results and validated its excellent outcomes in terms of safety and efficacy. However, there are limited studies comparing BP drug-eluting stents with struts of different thicknesses. We compared the long-term clinical outcomes of patients treated with an ultrathin-strut BP-SES or a thick-strut biodegradable polymer biolimus-eluting stent (BP-BES).<br /><b>Methods</b><br />The BIODEGRADE trial (Biomatrix and Orsiro Drug-Eluting Stents in Angiographic Result in Patients With Coronary Artery Disease) is a multicenter prospective randomized study comparing coronary revascularization in patients with ultrathin-strut BP-SES and thick-strut BP-BES with the primary end point of target lesion failure at 18 months posttreatment. We performed the prespecified analysis of 3-year clinical outcomes.<br /><b>Results</b><br />In total, 2341 patients were randomized to receive treatment with ultrathin-strut BP-SES (N=1175) or thick-strut BP-BES (N=1166). The 3-year incidence rate of target lesion failure was 3.2% for BP-SES and 5.1% for BP-BES (<i>P</i>=0.023). The difference was primarily due to differences in ischemia-driven target lesion revascularization (BP-SES, 1.5%; BP-BES, 2.8%; <i>P</i>=0.035) between groups. A landmark analysis of the late follow-up period showed significant differences in target lesion failure, with outcomes being better in BP-SES. Cardiac death and target lesion revascularization were significantly lower in the BP-SES group.<br /><b>Conclusions</b><br />In a large, randomized trial, the long-term clinical outcome of target lesion failure at 3 years was significantly better among patients treated with the ultrathin-strut BP-SES. The results indicate the superiority of the ultrathin-strut BP-SES compared with the thick-strut BP-BES.<br /><b>Registration</b><br />URL: https://clinicaltrials.gov; Unique identifier: NCT02299011.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 07 Dec 2022:e012307; epub ahead of print</small></div>
Yoon CH, Kwun JS, Choi YJ, Park JJ, ... Kim SH, Chae IH
Circ Cardiovasc Interv: 07 Dec 2022:e012307; epub ahead of print | PMID: 36475473
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Device-Sizing and Associated Complications With Left Atrial Appendage Occlusion: Findings From the NCDR LAAO Registry.</h4><i>Sandhu A, Varosy PD, Du C, Aleong RG, ... Friedman DJ, Hess PL</i><br /><b>Background</b><br />Left atrial appendage occlusion is an important alternative to anticoagulation in select patients with nonvalvular atrial fibrillation. Trends in real-world device sizing and associated short-term complications have not been characterized.<br /><b>Methods</b><br />Using the National Cardiovascular Data Left Atrial Appendage Occlusion (NCDR LAAO) Registry, patients who underwent left atrial appendage occlusion with a Watchman 2.5 device from January 1, 2016, to June 30, 2020, were identified. Patients were stratified by device size based on left atrial appendage orifice size, and categorized as receiving a device that was undersized, oversized, or per manufacturer recommendation. Relationships between device sizing and short-term outcomes, including pericardial effusion, device embolism, and significant leak, were assessed.<br /><b>Results</b><br />Of the 68 456 patients, 6539 (10.5%) of patients received undersized devices, 17 791 (26.0%) according to manufacturer recommendations, and 44 126 (64.4%) received an oversized device. The 27-mm device was most commonly deployed [21 736 (31.8%)], whereas the smallest and largest devices (21 and 33 mm) were least commonly deployed [7695 (11.2%) and 9077 (13.3%), respectively]. Compared with manufacturer recommended sizing, there was no difference in the odds of pericardial effusion for either undersized (1.048 [95% CI\' 0.801-1.372]; <i>P=</i>0.733) or oversized (1.101 [95% CI\' 0.933-1.298]; <i>P=</i>0.254) devices. Similarly, relative to manufacturer recommended sizing, the odds of a composite adverse outcome of device migration or embolization and significant peridevice leak at 45 days were similar among undersized devices (1.030 [95% CI\' 0.735-1.444]; <i>P=</i>0.863) and favorable for oversized devices (0.701 [95% CI\' 0.561-0.876]; <i>P=</i>0.002) devices, primarily driven by lower odds of leak. Selection of oversized devices increased significantly over the study period (from 60.3% in 2016 to 66.0% in 2020; <i>P</i><0.001).<br /><b>Conclusions</b><br />Among patients undergoing left atrial appendage occlusion with the first-generation Watchman device, receipt of oversized devices was common and increased over time. The high prevalence of oversizing was associated with lower odds of significant leak or device embolization without increased odds of other adverse events.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 06 Dec 2022:e012183; epub ahead of print</small></div>
Sandhu A, Varosy PD, Du C, Aleong RG, ... Friedman DJ, Hess PL
Circ Cardiovasc Interv: 06 Dec 2022:e012183; epub ahead of print | PMID: 36472194
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation.</h4><i>Costa G, Pilgrim T, Amat Santos IJ, De Backer O, ... Barbanti M, REVASC-TAVI Registry</i><br /><b>Background</b><br />The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence.<br /><b>Methods</b><br />The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years.<br /><b>Results</b><br />Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio\' 0.88 [95% CI, 0.66-1.18]; <i>P</i>=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio\' 0.97 [95% CI, 0.76-1.24]; <i>P</i>=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all <i>P</i> values for interaction >0.10).<br /><b>Conclusions</b><br />The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 01 Dec 2022; 15:e012417</small></div>
Costa G, Pilgrim T, Amat Santos IJ, De Backer O, ... Barbanti M, REVASC-TAVI Registry
Circ Cardiovasc Interv: 01 Dec 2022; 15:e012417 | PMID: 36538579
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Rehospitalization Events After Aortic Valve Replacement: Insights From the PARTNER Trial.</h4><i>Huded CP, Arnold SV, Chhatriwalla AK, Saxon JT, ... Leon MB, Cohen DJ</i><br /><b>Background</b><br />Rehospitalization is a common end point in clinical trials of structural heart interventions, but whether rehospitalization is clinically and prognostically relevant in these patients is uncertain. The aim of this study was to evaluate the risk of rehospitalization events after aortic valve replacement (AVR) and their association with mortality and health status.<br /><b>Methods</b><br />The study population included patients who underwent transcatheter or surgical AVR in the PARTNER I\' II\' and III trials (Placement of Aortic Transcatheter Valves). Health status was assessed with the Kansas City Cardiomyopathy Questionnaire-overall summary score. The primary analysis focused on heart failure hospitalization within 1 year after AVR and its association with mortality, poor outcome (death, Kansas City Cardiomyopathy Questionnaire-overall summary score <60 or decrease by ≥10), and health status at 1 year using adjusted models. Secondary analyses examined the prognostic associations of rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes.<br /><b>Results</b><br />Among 3403 patients treated with AVR (2008 transcatheter AVR, 1395 surgical AVR), the 1-year incidence was 6.7% for heart failure hospitalization and 9.7% for rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes. Heart failure hospitalization after AVR was associated with increased risk of 1-year mortality (hazard ratio, 3.97 [2.48 to 6.36]; <i>P</i><0.001), poor outcome (OR, 2.76 [1.73 to 4.40]; <i>P</i><0.001), and worse health status (Kansas City Cardiomyopathy Questionnaire-overall summary mean difference -9.8 points [-13.8 to -5.8]; <i>P</i><0.001). Rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes was similarly associated with increased 1-year mortality (hazard ratio, 4.64 [3.11 to 6.92]; <i>P</i><0.001), poor outcome (OR, 2.06 [1.38 to 3.07]; <i>P</i>=0.0004), and worse health status (Kansas City Cardiomyopathy Questionnaire-overall summary mean difference -8.8 points [-11.8 to -5.7]; <i>P</i><0.001). There was no effect modification by treatment type (transcatheter AVR versus surgical AVR) for these associations.<br /><b>Conclusions</b><br />Heart failure hospitalization and rehospitalization after AVR are associated with increased risk of mortality and worse 1-year health status. These findings confirm the clinical and prognostic relevance of rehospitalization end points for trials of AVR.<br /><b>Registration</b><br />URL: https://www.<br /><b>Clinicaltrials</b><br />gov; Unique identifier: NCT00530894.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 01 Dec 2022; 15:e012195</small></div>
Huded CP, Arnold SV, Chhatriwalla AK, Saxon JT, ... Leon MB, Cohen DJ
Circ Cardiovasc Interv: 01 Dec 2022; 15:e012195 | PMID: 36538580
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability.</h4><i>Ryan M, De Silva K, Morgan H, O\'Gallagher K, ... Chiribiri A, Perera D</i><br /><b>Background</b><br />Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging.<br /><b>Methods</b><br />Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery.<br /><b>Results</b><br />Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m<sup>-2</sup> s<sup>-1</sup>, <i>P</i><0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, <i>P</i>=0.649); a threshold of -2500 W m<sup>-2</sup> s<sup>-1</sup> had 86% sensitivity and 76% specificity.<br /><b>Conclusions</b><br />Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 01 Dec 2022; 15:e012394</small></div>
Ryan M, De Silva K, Morgan H, O'Gallagher K, ... Chiribiri A, Perera D
Circ Cardiovasc Interv: 01 Dec 2022; 15:e012394 | PMID: 36538582
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Native and Post-Repair Residual Mitral Valve Prolapse Increases Forces Exerted on the Papillary Muscles: A Possible Mechanism for Localized Fibrosis?</h4><i>Park MH, van Kampen A, Melnitchouk S, Wilkerson RJ, ... Levine RA, Woo YJ</i><br /><b>Background</b><br />Recent studies have linked mitral valve prolapse to localized myocardial fibrosis, ventricular arrhythmia, and even sudden cardiac death independent of mitral regurgitation or hemodynamic dysfunction. The primary mechanistic theory is rooted in increased papillary muscle traction and forces due to prolapse, yet no biomechanical evidence exists showing increased forces. Our objective was to evaluate the biomechanical relationship between prolapse and papillary muscle forces, leveraging advances in ex vivo modeling and technologies. We hypothesized that mitral valve prolapse with limited hemodynamic dysfunction leads to significantly higher papillary muscle forces, which could be a possible trigger for cellular and electrophysiological changes in the papillary muscles and adjacent myocardium.<br /><b>Methods</b><br />We developed an ex vivo papillary muscle force transduction and novel neochord length adjustment system capable of modeling targeted prolapse. Using 3 unique ovine models of mitral valve prolapse (bileaflet or posterior leaflet prolapse), we directly measured hemodynamics and forces, comparing physiologic and prolapsing valves.<br /><b>Results</b><br />We found that bileaflet prolapse significantly increases papillary muscle forces by 5% to 15% compared with an optimally coapting valve, which are correlated with statistically significant decreases in coaptation length. Moreover, we observed significant changes in the force profiles for prolapsing valves when compared with normal controls.<br /><b>Conclusions</b><br />We discovered that bileaflet prolapse with the absence of hemodynamic dysfunction results in significantly elevated forces and altered dynamics on the papillary muscles. Our work suggests that the sole reduction of mitral regurgitation without addressing reduced coaptation lengths and thus increased leaflet surface area exposed to ventricular pressure gradients (ie, billowing leaflets) is insufficient for an optimal repair.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 01 Dec 2022; 15:e011928</small></div>
Park MH, van Kampen A, Melnitchouk S, Wilkerson RJ, ... Levine RA, Woo YJ
Circ Cardiovasc Interv: 01 Dec 2022; 15:e011928 | PMID: 36538583
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Prognosis and the Effect of De-Escalation of Antiplatelet Therapy After Nuisance Bleeding in Patients With Myocardial Infarction.</h4><i>Choo EH, Choi IJ, Lim S, Moon D, ... Chang K, TALOS-AMI Investigators</i><br /><b>Background</b><br />Data regarding prognosis and management after nuisance bleeding (NB) is limited. The purpose was to examine the prognostic significance of NB in patients receiving potent dual antiplatelet treatment (DAPT) after acute myocardial infarction and the impact of de-escalation of DAPT on clinical outcomes thereafter.<br /><b>Methods</b><br />From the TALOS-AMI trial (Ticagrelor Versus Clopidogrel in Stabilized Patients With Acute Myocardial Infarction)\' 2583 patients were used to investigate the clinical impact of NB (defined as Bleeding Academic Research Consortium [BARC] 1 bleeding) during 1-month treatment with ticagrelor-based DAPT after acute myocardial infarction. We assessed the associations between NB within 1 month and BARC 2, 3, or 5 bleeding and major adverse cardiovascular event (a composite of cardiovascular death, myocardial infarction, stroke) from 1 to 12 months. We also evaluated the effect of de-escalation to clopidogrel in patients with or without NB.<br /><b>Results</b><br />NB occurred in 416 patients (16.7%) after 1 month of ticagrelor-based DAPT. At 1 year, NB was not associated with increase in BARC 2, 3, or 5 bleeding (hazard ratio [HR]\' 1.29 [95% CI\' 0.7-2.14]) and major adverse cardiovascular event (HR\' 1.72 [95% CI\' 0.87-3.39]). However, patients with NB had an increased risk of BARC 2, 3, or 5 bleeding at 6 months (HR, 1.94 [95% CI, 1.08-3.48]; <i>P</i>=0.026), which diminished over the next 6 months. De-escalation from ticagrelor to clopidogrel reduced the incidence of BARC 2, 3, or 5 bleeding compared with ticagrelor plus aspirin in NB (HR\' 0.31 [95% CI\' 0.10-0.92]) and non-NB patients (HR\' 0.58 [95% CI\' 0.37-0.90]) without heterogeneity (<i>P</i> interaction=0.291). There was no increase in major adverse cardiovascular event after DAPT de-escalation, irrespective of NB.<br /><b>Conclusions</b><br />NB was frequent in patients with acute myocardial infarction on 1-month ticagrelor-based DAPT and was associated with an early increase of bleeding. DAPT de-escalation after NB may reduce bleeding without increasing ischemic events.<br /><b>Registration</b><br />URL: https://www.<br /><b>Clinicaltrials</b><br />gov; Unique identifier: NCT02018055.<br /><br /><br /><br /><small>Circ Cardiovasc Interv: 16 Nov 2022:e012157; epub ahead of print</small></div>
Choo EH, Choi IJ, Lim S, Moon D, ... Chang K, TALOS-AMI Investigators
Circ Cardiovasc Interv: 16 Nov 2022:e012157; epub ahead of print | PMID: 36382599
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:

This program is still in alpha version.