01 marzo 2012

JACC CARDIOVASCULAR INTERVENTIONS. A Therapeutic Window for Platelet Reactivity for Patients Undergoing Elective Percutaneous Coronary Intervention. Results of the ARMYDA-PROVE Study

Objectives: This study sought to validate the ability of the VerifyNow P2Y12 assay (Accumetrics, San Diego, California) in predicting both ischemic and bleeding events after elective percutaneous coronary intervention (PCI).

01 febrero 2012

JACC. Transient Impairment of Vasomotion Function After Successful Chronic Total Occlusion Recanalization

Alfredo R. Galassi, MD; Salvatore D. Tomasello, MD; Filippo Crea, MD; Luca Costanzo, MD; Maria Barbara Campisano, MD; Francesco Marzá, MD; Corrado Tamburino, MD

Objectives: The aim of our study was to assess coronary vasomotion after successful revascularization of chronic total occlusion (CTO).

01 marzo 2012

JACC CARDIOVASCULAR INTERVENTIONS. Cigarette Smoking Is Associated With a Dose-Response Effect in Clopidogrel-Treated Patients With Diabetes Mellitus and Coronary Artery Disease. Results of a Pharmacodynamic Study

Masafumi Ueno, MD; José Luis Ferreiro, MD; Bhaloo Desai, PhD; Salvatore D. Tomasello, MD; Antonio Tello-Montoliu, MD, PhD; Davide Capodanno, MD; Piera Capranzano, MD; Murali Kodali, MD; Kodlipet Dharmashankar, MD; Ronald K. Charlton, PhD; Theodore A. Bass, MD; Dominick J. Angiolillo, MD, PhD

Objectives: This study sought to assess the presence of a dose-response effect of cigarette smoking and its impact on high on-treatment platelet reactivity (HPR) in patients with diabetes mellitus treated with clopidogrel.

01 febrero 2012

JACC. Characteristics and Long-Term Outcomes of Percutaneous Revascularization of Unprotected Left Main Coronary Artery Stenosis in the United States. A Report From the National Cardiovascular Data Registry, 2004 to 2008

J. Matthew Brennan, MD, MPH; David Dai, PhD; Manesh R. Patel, MD; Sunil V. Rao, MD; Ehrin J. Armstrong, MD, MSc; John C. Messenger, MD; Jeptha P. Curtis, MD; Kendrick A. Shunk, MD, PhD; Kevin J. Anstrom, PhD; Eric L. Eisenstein, DBA; William S. Weintraub, MD; Eric D. Peterson, MD, MPH; Pamela S. Douglas, MD; William B. Hillegass, MD, MPH

Objectives: This study sought to assess percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis in routine U.S. clinical practice.

01 marzo 2012

JACC. The Clinical Impact of Incomplete Left Atrial Appendage Closure With the Watchman Device in Patients With Atrial Fibrillation. PROTECT AF Substudy

Juan F. Viles-Gonzalez, MD; Saibal Kar, MD; Pamela Douglas, MD; Srinivas Dukkipati, MD; Ted Feldman, MD; Rodney Horton, MD; David Holmes, MD; Vivek Y. Reddy, MD

Objectives: The purpose of this study was to investigate the frequency and clinical impact of incomplete left atrial appendage (LAA) sealing and consequent peri-device residual blood flow in patients undergoing percutaneous LAA closure with the Watchman device (Atritech, Inc., Plymouth, Minnesota).

01 marzo 2012

JACC. Randomized Trial of Optimal Treatment Strategies for In-Stent Restenosis After Drug-Eluting Stent Implantation

Hae-Geun Song, MD; Duk-Woo Park, MD; Young-Hak Kim, MD; Jung-Min Ahn, MD; Won-Jang Kim, MD; Jong-Young Lee, MD; Soo-Jin Kang, MD; Seung-Whan Lee, MD; Cheol Whan Lee, MD; Seong-Wook Park, MD; Seungbong Han, PhD; In-Whan Seong, MD; Nae-Hee Lee, MD; Bong-Ki Lee, MD; Keun Lee, MD; Seung-Wook Lee, MD; Deuk-Young Nah, MD; Seung-Jung Park, MD

Objectives: The purpose of this study is to compare the efficacy of the treatment strategies for in-stent restenosis (ISR) of drug-eluting stents (DES) according to the morphologic pattern of restenosis.

01 marzo 2012

JACC. Diagnosis of Spontaneous Coronary Artery Dissection by Optical Coherence Tomography

Fernando Alfonso, MD, PhD; Manuel Paulo, MD; Nieves Gonzalo, MD, PhD; Jaime Dutary, MD; Pilar Jimenez-Quevedo, MD, PhD; Vera Lennie, MD; Javier Escaned, MD, PhD; Camino Bañuelos, MD; Rosana Hernandez, MD, PhD; Carlos Macaya, MD, PhD

Objectives: This study sought to assess the diagnostic value of optical coherence tomography (OCT) in patients with suspected spontaneous coronary artery dissection (SCAD).

01 marzo 2012

JACC. Morphometric Assessment of Coronary Stenosis Relevance With Optical Coherence Tomography. A Comparison With Fractional Flow Reserve and Intravascular Ultrasound

Nieve Gonzalo, MD, PhD; Javier Escaned, MD, PhD; Fernando Alfonso, MD, PhD; Christian Nolte, MD; Vera Rodriguez, BSc; Pilar Jimenez-Quevedo, MD, PhD; Camino Bañuelos, MD; Antonia Fernández-Ortiz, MD, PhD; Eulogio Garcia, MD; Rosana Hernandez-Antolin, MD, PhD; Carlos Macaya, MD, PhD

Objectives: The study sought to assess the diagnostic efficiency of optical coherence tomography (OCT) in identifying hemodynamically severe coronary stenoses as determined by fractional flow reserve (FFR). Concomitant OCT and intravascular ultrasound (IVUS) area measurements were performed in a subgroup of patients to compare the diagnostic efficiency of both techniques.

01 marzo 2012

JACC. The Clinical Emergence of Optical Coherence Tomography. Defining a Role in Intravascular Imaging⁎

Sotirios Tsimikas, MD; Anthony N. DeMaria, MD

Given the well-accepted limitations of coronary angiography, investigators and clinicians have had a strong interest in developing new approaches to defining the luminal encroachment, composition, and functional consequences of coronary atheromas. Intracoronary imaging techniques such as intravascular ultrasound (IVUS) were the initial techniques applied for this purpose (1). The validation of fractional flow reserve (FFR) as a measure of the functional significance of intermediate coronary stenoses has also provided an important advance in our ability to determine appropriate application of percutaneous coronary intervention (PCI) (2). More recently, advanced imaging techniques, such as virtual histology-intravascular ultrasound (VH-IVUS) to define high-risk plaques and necrotic cores by their ultrasound characteristics, and near infrared spectroscopy (NIRS) to detect lipid-rich plaques by their cholesterol ester composition, have also been developed. Despite these advances, limitations have continued in the evaluation of coronary atherosclerosis, and techniques such as angioscopy, palpography, shear stress imaging, and Raman and fluorescence spectroscopy are being actively studied (3). With its recent commercialization, optical coherence tomography (OCT) holds the potential to make significant contributions to this field.

01 marzo 2012

JACC. Aortic Regurgitation Index Defines Severity of Peri-Prosthetic Regurgitation and Predicts Outcome in Patients After Transcatheter Aortic Valve Implantation

Jan-Malte Sinning, MD; Christoph Hammerstingl, MD; Mariuca Vasa-Nicotera, MD; Viktoria Adenauer, MD; Sisa Josefina Lema Cachiguango, MD; Anne-Cathérine Scheer, MD; Sven Hausen, MD; Alexander Sedaghat, MD; Alexander Ghanem, MD; Cornelius Müller, MD; Eberhard Grube, MD; Georg Nickenig, MD; Nikos Werner, MD

Patients (N = 146) underwent TAVI with use of the third-generation CoreValve prosthesis (Medtronic, Minneapolis, Minnesota) and were included into this prospective study after written informed consent. Before TAVI, annulus dimension was evaluated with 3-dimensional transesophageal echocardiography (TEE), angiography of the aortic root, and multi-slice computed tomography. The TAVI was performed with biplane fluoroscopy under local anesthesia in combination with a sedative/analgesic treatment. Intraprocedural TEE was not routinely performed, and the procedure was predominantly guided by angiographic control.

01 abril 2012

JACC. Cross-Sectional Computed Tomographic Assessment Improves Accuracy of Aortic Annular Sizing for Transcatheter Aortic Valve Replacement and Reduces the Incidence of Paravalvular Aortic Regurgitation

Hasan Jilaihawi, BSc (Hons), MBChB; Mohammad Kashif, MD; Gregory Fontana, MD; Azusa Furugen, MD, PhD; Takahiro Shiota, MD; Gerald Friede, BS, MS; Rakhee Makhija, MD; Niraj Doctor, MBBS; Martin B. Leon, MD; Raj R. Makkar, MD

Objectives: In an effort to define the gold standard for annular sizing for transcatheter aortic valve replacement (TAVR), we sought to critically analyze and compare the predictive value of multiple measures of the aortic annulus for post-TAVR paravalvular (PV) regurgitation and then assess the impact of a novel cross-sectional computed tomographic (CT) approach to annular sizing.

01 abril 2012

JACC. 3-Dimensional Aortic Annular Assessment by Multidetector Computed Tomography Predicts Moderate or Severe Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement. A Multicenter Retrospective Analysis

Alexander B. Willson, MBBS, MPH; John G. Webb, MD; Troy M. LaBounty, MD; Stephan Achenbach, MD; Robert Moss, MBBS; Miriam Wheeler, MBBS; Christopher Thompson, MD; James K. Min, MD; Ronen Gurvitch, MBBS; Bjarne L. Norgaard, MD; Cameron J. Hague, MD; Stefan Toggweiler, MD; Ronald Binder, MD; Melanie Freeman, MBBS; Rohan Poulter, MBBS; Steen Poulsen, MD; David A. Wood, MD; Jonathon Leipsic, MD

Objectives: This study sought to analyze multidetector computed tomography (MDCT) 3-dimensional aortic annular dimensions for the prediction of paravalvular aortic regurgitation (PAR) following transcatheter aortic valve replacement (TAVR).

01 abril 2012

JACC. Effects of Atrial Fibrillation on Treatment of Mitral Regurgitation in the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) Randomized Trial

Howard C. Herrmann, MD; Zachary M. Gertz, MD; Frank E. Silvestry, MD; Susan E. Wiegers, MD; Y. Joseph Woo, MD; James Hermiller, MD; Douglas Segar, MD; David Heimansohn, MD; William Gray, MD; Shunichi Homma, MD; Michael Argenziano, MD; Andrew Wang, MD; James Jollis, MD; Mark B. Lampert, MD; John Alexander, MD; Laura Mauri, MD; Elyse Foster, MD; Donald Glower, MD; Ted Feldman, MD

Objectives: The purpose of this study was to characterize patients with mitral regurgitation (MR) and atrial fibrillation (AF) treated percutaneously using the MitraClip device (Abbott Vascular, Abbott Park, Illinois) and compare the results with surgery in this population.

15 abril 2012

JACC. Role of Endothelial Shear Stress in Stent Restenosis and Thrombosis

Konstantinos C. Koskinas, MD, MSc; Yiannis S. Chatzizisis, MD, PhD; Antonios P. Antoniadis, MD, PhD; George D. Giannoglou, MD, PhD

Restenosis and thrombosis are potentially fatal complications of coronary stenting with a recognized multifactorial etiology. The effect of documented risk factors, however, cannot explain the preponderance of certain lesion types, stent designs, and implantation configurations for the development of these complications. Local hemodynamic factors, low endothelial shear stress (ESS) in particular, are long known to critically affect the natural history of atherosclerosis. Increasing evidence now suggests that ESS may also contribute to the development of restenosis and thrombosis upon stenting of atherosclerotic plaques, in conjunction with well-appreciated risk factors. In this review, we present in vivo and mechanistic evidence associating ESS with the localization and progression of neointimal hyperplasia and in-stent clotting.

01 febrero 2012

CIRCULATION. Atrioesophageal Fistula After Percutaneous Transcatheter Ablation of Atrial Fibrillation

Ivan Tancevski, MD; Florian Hintringer, MD; Markus Stuehlinger, MD; Eva-Maria Gassner, MD; Nikolaos Bonaros, MD; Ludwig C. Mueller, MD; Johannes Mair, MD

A 45-year-old white man presented to the emergency department because of fever and fluctuating neurological symptoms including weakness and sensory loss of the right limbs. Six weeks before admittance, the patient had undergone percutaneous transcatheter ablation of drug-refractory atrial fibrillation. Laboratory examination showed markedly elevated white cell count and inflammatory markers, as well as moderately increased cardiac troponin T; however, no chest pain or gastrointestinal symptoms were reported, and the ECG was normal. Computed tomography (CT) scan of the chest revealed a fistula between the left atrium and the esophagus (Figure, A and B)1; the abdominal CT scan showed multiple renal and splenic infarctions. Subsequent cerebral magnetic resonance imaging revealed left temporoparietal and multifocal occipital ischemia and infarction.