30 septiembre 2014

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Structural Heart Disease. Impact of Aortic Annulus Size on Valve Hemodynamics and Clinical Outcomes After Transcatheter and Surgical Aortic Valve Replacement

Josep Rodés-Cabau, MD, Philippe Pibarot, DVM, PhD, Rakesh M. Suri, MD, DPhil, Susheel Kodali, MD, Vinod H. Thourani, MD, Wilson Y. Szeto, MD, Lars G. Svensson, MD, PhD, Eric Dumont, MD, Ke Xu, PhD, Rebecca T. Hahn, MD and Martin B. Leon, MD

Background: The objective was to evaluate the effects of aortic annulus size on valve hemodynamics and clinical outcomes in those patients included in the Placement of Aortic Transcatheter Valves (PARTNER) randomized controlled trial cohort A and the nonrandomized continued access cohort.

07 octubre 2014

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Spontaneous Coronary Artery Dissection. Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes

Jacqueline Saw, MD, Eve Aymong, MD, Tara Sedlak, MD, Christopher E. Buller, MD, Andrew Starovoytov, MD, Donald Ricci, MD, Simon Robinson, MD, Tycho Vuurmans, MD, PhD, Min Gao, PhD, Karin Humphries, PhD and G.B. John Mancini, MD

Background: Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described.

01 diciembre 2014

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Percutaneous Coronary Interventions in ST-Segment–Elevation Myocardial Infarction. Shifting Paradigms and Future Perspectives

Dominick J. Angiolillo, MD, PhD and Theodore A. Bass, MD

Acute ST-segment–elevation myocardial infarction (STEMI) is a major cause of morbidity, mortality, and disability worldwide. For the past years, the management of patients with STEMI has considerably evolved in terms of reperfusion strategies, adjunctive antithrombotic therapy, technical approaches, and development of coordination systems of care. This effort has not only led to a marked reduction in clinical event rates, but also resulted in continuous paradigm shift on our approach to treating these patients. The rapidity with which new information from pivotal trials and registries becomes available makes it a challenge for clinical guidelines to stay current because these documents inevitably lag behind the most recent reported findings in the field. This also presents a challenge for physicians because it is not always clear on how such emerging evidence should be embraced in clinical practice without endorsement from our professional societies. In this Editorial viewpoint, we put into perspective some of the recent pivotal data that have emerged and influences our clinical practice in the percutaneous management of patients with STEMI.1–3 In particular, areas that have evolved in percutaneous management of patients with STEMI include appropriate device use, revascularization strategies in the catheterization laboratory, and setting up optimal benchmarks and systems of care.

01 diciembre 2014

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Left Ventricular Dysfunction

Emanuele Barbato, MD, PhD and William Wijns, MD, PhD

Symptomatic patients with aortic stenosis and reduced left ventricular ejection fraction (LVEF) represent a particularly difficult subset of patients to diagnose and to treat. These patients, in fact, pose important diagnostic dilemmas because of the symptoms that may derive primarily from the LV dysfunction, rather than from the stenotic valve, or from the combination of both. According to the current guidelines,1 severe aortic stenosis is characterized by peak aortic jet velocity >4.0 m/s, mean gradient >40 mm Hg, or when the aortic valve area is <1.0 cm2. In the presence of these echocardiographic findings, a symptomatic patient or a patient with reduced LVEF (<50%) is candidate for aortic valve replacement (AVR; class I recommendation).2,3 Yet, patients with LV dysfunction often present with an aortic valve area <1.0 cm2 but with low peak aortic jet velocity (<4.0 m/s). Performance of dobutamine stress echocardiography might help to distinguish those patients with true severe aortic stenosis, who will derive most of the benefit from AVR, from those with moderate aortic stenosis and primary LV dysfunction. In addition, dobutamine stress echocardiography provides strong prognostic information because the lack of contractile reserve is associated with high cardiovascular mortality regardless of treatment.4,5 Myocardial fibrosis is among the factors contributing to the lack of contractile reserve and can be detected and quantified by cardiac MRI. When present, myocardial fibrosis is associated with an adverse prognosis.6,7

01 diciembre 2014

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Neurological Injury After Transcatheter Aortic Valve Implantation

Jeffrey N. Browndyke, PhD and Joseph P. Mathew, MD, MHSc

Subcortical ischemic damage occurs in 62% to 82% of patients who undergo transcatheter aortic valve implantation (TAVI), leaving clinicians and researchers with the difficult task of understanding the functional consequences of these often silent strokes.1 Furthermore, the patients for whom TAVI is the best option typically have additional age-associated systemic health complications, making it more difficult to determine the impact of such an injury on short- and long-term recovery. Repeat neurological examination, diffusion-weighted magnetic resonance imaging (DW-MRI), and neuropsychological assessment, as performed by Ghanem et al,2 in this issue of Circulation: Cardiovascular Interventions are certainly helpful. In 111 patients with TAVI, they report cerebral embolization in 64% of the imaged subjects but early cognitive decline was diagnosed in only 5.4%, and late cognitive decline occurred at an even lower rate. However, in considering these silent infarcts, we start by asking whether it is appropriate to prioritize overall cognition (the forest) over individual cognitive domains (the trees) when assessing the effects of DW-MRI–detected embolization, a phenomenon that is usually random throughout the subcortex, neurologically subclinical, and often complicated by many perisurgical and postsurgical factors.

12 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Transcatheter Aortic Valve Replacement. Outcomes of Transcatheter and Surgical Aortic Valve Replacement in High-Risk Patients With Aortic Stenosis and Left Ventricular Dysfunction

Sammy Elmariah, MD, MPH, Igor F. Palacios, MD, Thomas McAndrew, MS, Irene Hueter, PhD, Ignacio Inglessis, MD, Joshua N. Baker, MD, Susheel Kodali, MD, Martin B. Leon, MD, Lars Svensson, MD, Philippe Pibarot, DVM, PhD, Pamela S. Douglas, MD, William F. Fearon, MD, Ajay J. Kirtane, MD, SM, Hersh S. Maniar, MD and Jonathan J. Passeri, MD on behalf of the PARTNER Investigators

Background: The Placement of Aortic Transcatheter Valves (PARTNER) trial demonstrated similar survival after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) in high-risk patients with symptomatic, severe aortic stenosis. The aim of this study was to evaluate the effect of left ventricular (LV) dysfunction on clinical outcomes after TAVR and SAVR and the impact of aortic valve replacement technique on LV function.

15 octubre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS.

Alexander Ghanem, MD, PhD*, Justine Kocurek, MD*, Jan-Malte Sinning, MD, PhD, Michael Wagner, MD, PhD, Benjamin V. Becker, MS, Marieke Vogel, MS, Thomas Schröder, MS, Steffen Wolfsgruber, MS, Mariuca Vasa-Nicotera, MD, PhD, Christoph Hammerstingl, MD, PhD, Jörg O. Schwab, MD, PhD, Daniel Thomas, MD, PhD, Nikos Werner, MD, PhD, Eberhard Grube, MD, PhD, Georg Nickenig, MD, PhD and Andreas Müller, MD

Background: Transcatheter aortic valve implantation (TAVI) is known to be associated with silent cerebral injury, which could contribute to cognitive impairment. Considering its increasing use, thorough longitudinal investigation of cognitive trajectory after TAVI is pivotal.

26 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Prevalence, Factors Associated With, and Prognostic Effects of Preoperative Anemia on Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Rutger-Jan Nuis, MD, MSc, PhD, Jan-Malte Sinning, MD, Josep Rodés-Cabau, MD, Michael Gotzmann, MD, Leen van Garsse, MD, Joelle Kefer, MD, PhD, Johan Bosmans, MD, PhD, Gerald Yong, MD, PhD, Antonio E. Dager, MD, Ana Revilla-Orodea, MD, PhD, Marina Urena, MD, Georg Nickenig, MD, PhD, Nikos Werner, MD, PhD, Jos Maessen, MD, PhD, Parla Astarci, MD, Sergio Perez, MD, Luis M. Benitez, MD, Ignacio J. Amat-Santos, MD, Javier López, MD, PhD, Eric Dumont, MD, Nicolas van Mieghem, MD, Teun van Gelder, MD, PhD, Ron T. van Domburg, PhD and Peter P. de Jaegere, MD, PhD

Background: There is scant information on the prevalence and factors associated with preoperative anemia in patients undergoing transcatheter aortic valve implantation (TAVI) and whether it is associated with mortality. We sought to determine the prevalence and factors associated with preoperative anemia in addition to the prognostic effects of the various levels of preoperative hemoglobin level on mortality in patients undergoing TAVI.

19 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Angioplasty. Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Luis Nombela-Franco, MD, Marina Urena, MD, Miguel Jerez-Valero, MD, Can Manh Nguyen, MD, Henrique Barbosa Ribeiro, MD, Yoann Bataille, MD, Josep Rodés-Cabau, MD and Stéphane Rinfret, MD, SM

Background: Chronic total occlusion (CTO) recanalization is a complex and technically challenging procedure. The J-CTO score has been proposed to stratify case complexity and procedural success rates. However, the score has never been tested outside the setting of the original study. Moreover, its predictive value when using a hybrid antegrade or retrograde approach is unknown. We investigated the performance of the J-CTO score for predicting procedure complexity and success in an independent contemporary cohort.

19 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Angioplasty. Serial Observation of Drug-Eluting Absorbable Metal Scaffold

Ron Waksman, MD, Francesco Prati, MD, Nico Bruining, PhD, Michael Haude, MD, Dirk Böse, MD, Hironori Kitabata, MD, PhD, Paul Erne, MD, Stefan Verheye, MD, Hubertus Degen, MD, Paul Vermeersch, MD, Luca Di Vito, MD, Jacques Koolen, MD and Raimund Erbel, MD

Background: The drug-eluting absorbable metal scaffold has demonstrated feasibility, safety, and promising clinical and angiographic outcomes at 12 months in human coronary arteries. This study aimed to evaluate the degradation rate and long-term vascular responses to drug-eluting absorbable metal scaffold.

19 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS.

Jason M. Tarkin, MBBS, Sukhjinder Nijjer, MBChB, Sayan Sen, MBBS, Ricardo Petraco, MD, Mauro Echavarria-Pinto, MD, Kaleab N. Asress, BM BCh, MA, Tim Lockie, MBChB, PhD, Muhammed Z. Khawaja, MBBS, Jamil Mayet, MBChB, MD, Alun D. Hughes, MBBS, PhD, Iqbal S. Malik, MBBS, PhD, Ghada W. Mikhail, MBBS, PhD, Christopher S. Baker, MBBS, PhD, Rodney A. Foale, MD, Simon Redwood, MBBS, MD, Darrel P. Francis, MB BChir, MA, MD, Javier Escaned, MD, PhD and Justin E. Davies, MBBS, PhD

Background: We studied the hemodynamic response to intravenous adenosine on calculation of fractional flow reserve (FFR). Intravenous adenosine is widely used to achieve conditions of stable hyperemia for measurement of FFR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially.

22 octubre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Coronary Hemodynamics. Sex-Related Differences in Fractional Flow Reserve–Guided Treatment

Jing Li, MD, PhD, Charanjit S. Rihal, MD, Yoshiki Matsuo, MD, PhD, Muhamad Y. Elrashidi, MD, Andreas J. Flammer, MD, Moo-Sik Lee, MD, PhD, Andrew Cassar, MD, Ryan J. Lennon, MS, Joerg Herrmann, MD, Malcolm R. Bell, MD, David R. Holmes, MD, John F. Bresnahan, MD, Qi Hua, MD, PhD, Lilach O. Lerman, MD, PhD and Amir Lerman, MD

Background: Sex-specific differences affect the evaluation, treatment, and prognosis of coronary artery disease. We tested the hypothesis that long-term outcomes of fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) are different between women and men.

19 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Congenital Heart Disease. Angioplasty of Obstructed Homograft Conduits in the Right Ventricular Outflow Tract With Ultra-Noncompliant Balloons

Michael R. Hainstock, MD, Audrey C. Marshall, MD, James E. Lock, MD and Doff B. McElhinney, MD

Background: Angioplasty and stent placement in right ventricle-to-pulmonary artery (RV-PA) conduits have been shown to prolong the functional lifespan of a conduit. Safety and efficacy of angioplasty of obstructed RV-PA homografts using ultra-noncompliant (UNC) or ultrahigh-pressure balloons are unknown.

03 diciembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Impact of Transcatheter Pulmonary Valve Replacement on Biventricular Strain and Synchrony Assessed by Cardiac Magnetic Resonance Feature Tracking

David M. Harrild, MD, PhD, Edward Marcus, MS, Babar Hasan, MD, Mark E. Alexander, MD, Andrew J. Powell, MD, Tal Geva, MD and Doff B. McElhinney, MD

Background: Transcatheter pulmonary valve (TPV) replacement is an emerging therapy intended to restore pulmonary valve function in patients with right ventricular outflow tract conduit dysfunction; the impact of this technique on ventricular strain and synchrony is not known.

24 septiembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Clinical and Procedural Characteristics Associated With Higher Radiation Exposure During Percutaneous Coronary Interventions and Coronary Angiography

Ronak Delewi, MD, Loes P. Hoebers, MD, Truls Råmunddal, MD, PhD, José P.S. Henriques, MD, PhD, Oskar Angerås, MD, Jason Stewart, MD, Lotta Robertsson, MD, Magnus Wahlin, MD, Petur Petursson, MD, Jan J. Piek, MD, PhD, Per Albertsson, MD, PhD, Göran Matejka, MD, PhD and Elmir Omerovic, MD, PhD

Background: We aim to study the clinical and procedural characteristics associated with higher radiation exposure in patients undergoing percutaneous coronary interventions (PCIs) and coronary angiography.