01 agosto 2013

JACC. Rare Variant of Pulmonary Arteriovenous Fistula

Achyut Sarkar, MBBS, MD, DM; Naveen Chandra G S, MBBS, MD; Bhuban Majhi, MBBS, MD, DM; Saroj Mandal, MBBS, MD, DM; Arindam Pande, MBBS, MD; Imran Ahmed, MBBS, MD

A 24-year-old man presented for the evaluation of progressive bluish discoloration of the lips and hands that he had noticed since childhood and recurrent bouts of hemoptysis. Systemic examination was unremarkable except for central cyanosis and clubbing. Resting oxygen saturation was 60% in room air. Electrocardiogram and echocardiogram were essentially normal. Contrast echocardiogram was performed and showed bubble contrast in the left chambers, raising suspicion of pulmonary arteriovenous fistula (Online Video 1). Diagnostic pulmonary angiography was done (Online Videos 2 and 3) and revealed a large communication between the right pulmonary artery to the left atrium. A computed tomography pulmonary angiogram with 3-dimensional reconstruction was obtained and showed a large pulmonary arteriovenous fistula, directly communicating the right pulmonary artery to the left atrium (A, B, C), along with aortopulmonary collaterals in the form of a large tortuous and dilated bronchial artery supplying the right pulmonary artery (D, E, arrows). This is a rare variant of pulmonary arteriovenous fistula, and association with aortopulmonary collaterals is extremely rare. ART = artery; DSC = descending; RT = right.

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. An Updated Bleeding Model to Predict the Risk of Post-Procedure Bleeding Among Patients Undergoing Percutaneous Coronary Intervention

Sunil V. Rao, MD∗; Lisa A. McCoy, MS∗; John A. Spertus, MD, MPH†; Ronald J. Krone, MD‡; Mandeep Singh, MD§; Susan Fitzgerald, MS, RN‖; Eric D. Peterson, MD, MPH∗

Objectives: This study sought to develop a model that predicts bleeding complications using an expanded bleeding definition among patients undergoing percutaneous coronary intervention (PCI) in contemporary clinical practice.

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Clinical Outcomes of the Resolute Zotarolimus-Eluting Stent in Patients With In-Stent Restenosis

Gert Richardt, MD∗; Matthias Leschke, MD†; Mohamed Abdel-Wahab, MD∗; Ralph Toelg, MD∗; Mohamed El-Mawardy, MD∗; Patrick W. Serruys, MD, PhD‡; Sigmund Silber, MD, PhD§; Stephan Windecker, MD‖; Jorge A. Belardi, MD¶; Franz-Josef Neumann, MD, PhD#; Petr Widimsky, MD, DrSc∗∗

Objectives: This study sought to assess the clinical safety and effectiveness of the Resolute zotarolimus-eluting stent (R-ZES) in patients with in-stent restenosis (ISR) from 2 large trials.

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Meta-Analysis of Everolimus-Eluting Versus Paclitaxel-Eluting Stents in Coronary Artery Disease

George D. Dangas, MD∗; Patrick W. Serruys, MD, PhD‡; Dean J. Kereiakes, MD§; James Hermiller, MD‖; Ali Rizvi, MD‖; William Newman, MD¶; Krishnankutty Sudhir, MD, PhD#; Robert S. Smith, PhD#; Sherry Cao, MS#; Kleanthis Theodoropoulos, MD∗; Donald E. Cutlip, MD∗∗; Alexandra J. Lansky, MD††; Gregg W. Stone, MD†

Objectives: This study sought to investigate whether the everolimus-eluting stent (EES) is superior to the paclitaxel-eluting stent (PES) with respect to long-term individual clinical outcomes.

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of Kissing Balloon Inflation on the Main Vessel Stent Volume, Area, and Symmetry After Side-Branch Dilation in Patients With Coronary Bifurcation Lesions

Shahid Rahman, MD∗; Tara Leesar∗; Mehmet Cilingiroglu, MD∗; Mohamed Effat, MD∗; Imran Arif, MD∗; Tarek Helmy, MD∗; Massoud A. Leesar, MD†

Objectives: Intravascular ultrasound (IVUS) was performed to investigate the impact of kissing balloon inflation (KBI) on the main vessel (MV) stent volume, area, and symmetry after side-branch (SB) dilation in patients with coronary bifurcation lesions (CBL).

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Adjunctive Cilostazol Versus Double-Dose Clopidogrel After Drug-Eluting Stent Implantation. The HOST-ASSURE Randomized Trial (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis–Safety & Effectiveness of Drug-Eluting Stents & Anti-platelet Regimen)

Kyung Woo Park, MD, PhD∗; Si-Hyuck Kang, MD∗; Jin Joo Park, MD∗; Han-Mo Yang, MD, PhD∗; Hyun-Jae Kang, MD, PhD∗; Bon-Kwon Koo, MD, PhD∗; Byoung-Eun Park, MD, PhD†; Kwang Soo Cha, MD, PhD‡; Jay Young Rhew, MD, PhD§; Hui-Kyoung Jeon, MD, PhD‖; Eun Seok Shin, MD, PhD¶; Ju Hyeon Oh, MD, PhD#; Myung-Ho Jeong, MD, PhD∗∗; Sanghyun Kim, MD, PhD††; Kyung-Kuk Hwang, MD, PhD‡‡; Jung-Han Yoon, MD, PhD§§; Sung Yun Lee, MD, PhD‖‖; Tae-Ho Park, MD, PhD¶¶; Keon Woong Moon, MD, PhD##; Hyuck-Moon Kwon, MD, PhD∗∗∗; In-Ho Chae, MD, PhD†††; Hyo-Soo Kim, MD, PhD∗

Objectives: This study sought to test the noninferiority of triple antiplatelet therapy (TAT) versus double-dose clopidogrel dual antiplatelet therapy (DDAT) in patients undergoing percutaneous coronary intervention (PCI).

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Elevated Levels of Systemic Pentraxin 3 Are Associated With Thin-Cap Fibroatheroma in Coronary Culprit Lesions

Seiji Koga, MD∗; Satoshi Ikeda, MD∗; Takeo Yoshida, MD∗; Tomoo Nakata, MD∗; Masayoshi Takeno, MD∗; Nobuhito Masuda, PhD†; Yuji Koide, MD∗; Hiroaki Kawano, MD∗; Koji Maemura, MD∗

Objectives: This study sought to determine whether systemic levels of pentraxin 3 (PTX3), a novel inflammatory marker, are associated with thin-cap fibroatheroma (TCFA).

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Automated 3-Dimensional Aortic Annular Assessment by Multidetector Computed Tomography in Transcatheter Aortic Valve Implantation

Yusuke Watanabe, MD; Marie-Claude Morice, MD; Erik Bouvier, MD; Tora Leong, MD, PhD; Kentaro Hayashida, MD, PhD; Thierry Lefèvre, MD; Thomas Hovasse, MD; Mauro Romano, MD; Bernard Chevalier, MD; Patrick Donzeau-Gouge, MD; Arnaud Farge, MD; Bertrand Cormier, MD; Philippe Garot, MD

Objectives: This study sought to evaluate the accuracy, reproducibility, and predictive value for post-procedural aortic regurgitation (AR) of an automated multidetector computed tomography (MDCT) post-processing imaging software, 3mensio Valves (version 5.1.sp1, 3mensio Medical Imaging BV, the Netherlands), in the assessment of patients undergoing transcatheter aortic valve implantation (TAVI).

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Preparatory Balloon Aortic Valvuloplasty During Transcatheter Aortic Valve Implantation for Improved Valve Sizing

Polykarpos C. Patsalis, MD∗; Fadi Al-Rashid, MD∗; Till Neumann, MD∗; Björn Plicht, MD∗; Heike A. Hildebrandt, MD∗; Daniel Wendt, MD†; Matthias Thielmann, MD†; Heinz G. Jakob, MD†; Gerd Heusch, MD‡; Raimund Erbel, MD∗; Philipp Kahlert, MD∗

Objectives: This study sought to evaluate whether supra-aortic angiography during preparatory balloon aortic valvuloplasty (BAV) improves valve sizing.

01 septiembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Prospective Randomized Trial of Transthoracic Echocardiography Versus Transesophageal Echocardiography for Assessment and Guidance of Transcatheter Closure of Atrial Septal Defects in Children Using the Amplatzer Septal Occluder

Sergio Bartakian, MD; Howaida G. El-Said, MD, PhD; Beth Printz, MD, PhD; John W. Moore, MD, MPH

Objectives: This study sought to determine whether transthoracic echocardiography (TTE) can provide safety and efficacy equivalent to transesophageal echocardiography (TEE) for assessment and guidance of transcatheter atrial septal defect (ASD) closure in pediatric patients.

01 agosto 2014

AMERICAN HEART JOURNAL. A critical review of hemodynamic changes and left ventricular remodeling after surgical aortic valve replacement and percutaneous aortic valve replacement

Shin-Jae Kim, MD, Zainab Samad, MD, Gerald S. Bloomfield, MD, MPH, Pamela S. Douglas, MD

Background: The introduction of transcatheter aortic valve replacement (TAVR) in clinical practice has widened options for symptomatic patients at high surgical risk; however, it is not known whether TAVR has equivalent or prolonged benefits in terms of left ventricular (LV) remodeling.

01 agosto 2014

AMERICAN HEART JOURNAL. Does optical coherence tomography optimize results of stenting? Rationale and study design

Nicolas Meneveau, MD, PhD, Fiona Ecarnot, MSc, Geraud Souteyrand, MD, Pascal Motreff, MD, PhD, Christophe Caussin, MD, Eric Van Belle, MD, PhD, Patrick Ohlmann, MD, PhD, Olivier Morel, MD, PhD, Alain Grentzinger, MD, Michael Angioi, MD, Romain Chopard, MD, François Schiele, MD, PhD

Background: To date, no randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of coronary angioplasty for non–ST-segment elevation acute coronary syndromes.

01 agosto 2013

THE AMERICAN JOURNAL OF CARDIOLOGY. Prevalence and Prognosis of Aortic Valve Disease in Subjects Older than 85 Years of Age

David Leibowitz, MD, Jochanan Stessman, MD, Jeremy M. Jacobs, MBBS, Irit Stessman-Lande, BMedSci, Dan Gilon, MD

Although degenerative aortic valve disease is common with increasing age, limited data exist regarding prevalence and prognosis of aortic valve disease among the oldest old. Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home in 498 randomly selected subjects. Subjects were divided into 3 groups; normal subjects, subjects with valve calcium but without stenosis (AVC), and subjects with aortic stenosis (AS). Survival status at 5-year follow-up was assessed via the centralized population registry. AVC was noted in 55% of the study subjects and AS was seen in 8.2%. There were no significant differences between the 3 groups in any of the clinical parameters examined including risk factors for atherosclerotic heart disease. Of the 498 subjects, 107 (21%) had died at the time of 5-year follow-up. Five-year mortality was similar among the normal (17%) and AVC (20%) subjects but was significantly higher among the subjects with AS (46%; p <0.0001). AS was associated with a nearly fourfold increased likelihood of mortality (hazard ratio 3.7, 95% confidence interval 1.4 to 9.3). In conclusion, among subjects ≥85 years of age, the prevalence of AS is higher than previously reported and not associated with traditional vascular risk factors. AS but not AVC alone was independently predictive of 5-year mortality.

05 junio 2013

EUROPEAN HEART JOURNAL. The human coronary collateral circulation: development and clinical importance

Christian Seiler, Michael Stoller, Bertram Pitt, Pascal Meier

Abstract: Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20–25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

14 septiembre 2013

EUROPEAN HEART JOURNAL. Unmet needs in pre-hospital care of acute cardiovascular disease and organization of intensive cardiac care and coronary care units

Maddalena Lettino, Christiaan Vrints

The Acute Cardiovascular Care Association (ACCA) of the ESC recently organized its second summit (supported by an unrestricted educational grant from Astra Zeneca) with the aim of bringing together representatives of national cardiac societies specifically involved in acute cardiac care and of sharing various experiences that health professionals may face when taking care of patients with acute cardiac diseases.