01 octubre 2012

JACC: CARDIOVASCULAR INTERVENTIONS. The Impact of Sex Differences on Fractional Flow Reserve–Guided Percutaneous Coronary Intervention A FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) Substudy

Hyun-Sook Kim, MD; Pim A.L. Tonino, MD, PhD; Bernard De Bruyne, MD, PhD; Andy S.C. Yong, MBBS, PhD; Jennifer A. Tremmel, MD, MS; Nico H.J. Pijls, MD, PhD; William F. Fearon, MD

Objectives This study sought to evaluate the impact of sex differences on fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI). J Am Coll Cardiol Intv. 2012;5(10):1037-1042. doi:10.1016/j.jcin.2012.06.016. Copyright © 2012 by the American College of Cardiology Foundation

01 octubre 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Clinical and Physiological Outcomes of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Serial Stenoses Within One Coronary Artery

Hack-Lyoung Kim, MD; Bon-Kwon Koo, MD, PhD; Chang-Wook Nam, MD, PhD; Joon-Hyung Doh, MD, PhD; Ji-Hyun Kim, MD; Han-Mo Yang, MD, PhD; Kyung-Woo Park, MD, PhD; Hae-Young Lee, MD, PhD; Hyun-Jae Kang, MD, PhD; Young-Seok Cho, MD, PhD; Tae-Jin Youn, MD, PhD; Sang-Hyun Kim, MD, PhD; In-Ho Chae, MD, PhD; Dong-Ju Choi, MD, PhD; Hyo-Soo Kim, MD, PhD; Byung-Hee Oh, MD, PhD; Young-Bae Park, MD, PhD

Objectives This study was performed to evaluate the physiological and clinical outcomes of fractional flow reserve (FFR)-guided revascularization strategy with drug-eluting stents in serial stenoses within the same coronary artery. J Am Coll Cardiol Intv. 2012;5(10):1013-1018. doi:10.1016/j.jcin.2012.06.017. Copyright © 2012 by the American College of Cardiology Foundation

01 octubre 2012

JACC: CARDIOVASCULAR INTERVENTIONS. The Impact of Downstream Coronary Stenoses on Fractional Flow Reserve Assessment of Intermediate Left Main Disease

Objectives The aim of this study was to assess the validity of measuring fractional flow reserve (FFR) of the left main (LM) coronary artery in the setting of concomitant left anterior descending (LAD) or left circumflex (LCX) stenoses. J Am Coll Cardiol Intv. 2012;5(10):1021-1025. doi:10.1016/j.jcin.2012.07.005. Copyright © 2012 by the American College of Cardiology Foundation

01 octubre 2012

JACC: CARDIOVASCULAR INTERVENTIONS. The Complexity Involved in Assessment of Left Main Coronary Artery Disease

Michael Ragosta, MD

About the size of the average cigarette butt, the left main coronary artery is a relatively small vessel, yet it is arguably 1 of the most valuable sections of real estate within the body. Since Herrick s description 100 years ago, we are well aware of the lethality of left main disease (1). Stenosis of the left main coronary is 1 of the few, specific coronary lesions in which revascularization reduces the likelihood of death compared with medical therapy ((2),(3),4). Thus, seeking out and revascularizing left main disease has become established as 1 of the tenets of modern cardiology. J Am Coll Cardiol Intv. 2012;5(10):1026-1028. doi:10.1016/j.jcin.2012.07.006. Copyright © 2012 by the American College of Cardiology Foundation

26 junio 2011

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Impact of Coronary Plaque Morphology Assessed by Optical Coherence Tomography on Cardiac Troponin Elevation in Patients With Elective Stent Implantation

Tetsumin Lee, MD, Taishi Yonetsu, MD, Kenji Koura, MD, Keiichi Hishikari, MD, Tadashi Murai, MD, Toshiyuki Iwai, MD, Takamitsu Takagi, MD, Yoshito Iesaka, MD, Hideomi Fujiwara, MD, Mitsuaki Isobe, MD and Tsunekazu Kakuta, MD

Background—Mild elevations of cardiac troponin frequently occur after percutaneous coronary intervention (PCI), and patients with elevated post-PCI biomarkers have a worse prognosis. We used optical coherence tomography (OCT) to study the relationship between pre-PCI plaque morphology and post-PCI cardiac troponin I elevations. Circulation: Cardiovascular Interventions. 2011; 4: 378-386 Published online before print July 26, 2011, doi: 10.1161/​CIRCINTERVENTIONS.111.962506. Copyright © 2011 American Heart Association, Inc.

14 julio 2011

STROKE. Dual-Enhanced Cardiac CT for Detection of Left Atrial Appendage Thrombus in Patients With Stroke A Prospective Comparison Study With Transesophageal Echocardiography

Jin Hur, MD; Young Jin Kim, MD; Hye-Jeong Lee, MD; Ji Eun Nam, MD; Jong-Won Ha, MD; Ji Hoe Heo, MD; Hyuk-Jae Chang, MD; Hua Sun Kim, MD; Yoo Jin Hong, MD; Hee Yeong Kim, MD; Kyu Ok Choe, MD; Byoung Wook Choi, MD, PhD

Background and Purpose—A noninvasive method with high reliability and accuracy comparable to transesophageal echocardiography for identification of left atrial appendage thrombus would be of significant clinical value. The aim of this study was to assess the diagnostic performance of a dual-enhanced cardiac CT protocol for detection of left atrial appendage thrombi and for differentiation between thrombus and circulatory stasis in patients with stroke. Copyright © 2011 American Heart Association, Inc. All rights reserved.

04 agosto 2011

STROKE. Patent Foramen Ovale May Be Causal for the First Stroke but Unrelated to Subsequent Ischemic Events

Marie-Luise Mono, MD; Laura Geister, BSc; Aekaterini Galimanis, MD; Simon Jung, MD; Fabien Praz, MD; Marcel Arnold, MD; Urs Fischer, MD; Stefan Wolff, MD; Oliver Findling, MD; Stephan Windecker, MD; Andreas Wahl, MD; Bernhard Meier, MD; Heinrich P. Mattle, MD; Krassen Nedeltchev, MD

Background and Purpose—Studies with very long follow-up are scarce in patients with cryptogenic stroke and patent foramen ovale (PFO). Little is known about the etiology of recurrent cerebrovascular events (CVE) in PFO patients. Stroke. 2011; 42: 2891-2895 Published online before print August 4, 2011, doi: 10.1161/​STROKEAHA.111.619577. Copyright © 2011 American Heart Association, Inc. All rights reserved.

28 mayo 2011

EUROPEAN HEART JOURNAL.Timing and potential mechanisms of new conduction abnormalities during the implantation of the Medtronic CoreValve System in patients with aortic stenosis

Rutger-Jan Nuis, Nicolas M. Van Mieghem, Carl J. Schultz, Apostolos Tzikas, Robert M. Van der Boon, Anne-Marie Maugenest, Jin Cheng, Nicolo Piazza, Ron T. van Domburg, Patrick W. Serruys and Peter P. de Jaegere

Aims New-onset left bundle branch block (LBBB) and complete atrioventricular block (AV3B) frequently occur following transcatheter aortic valve implantation (TAVI). We sought to determine the timing and potential mechanisms of new conduction abnormalities (CAs) during TAVI, using the Medtronic CoreValve System (MCS). Eur Heart J (2011) 32 (16): 2067-2074. doi: 10.1093/eurheartj/ehr110 First published online: May 28, 2011. Published on behalf of the European Society of Cardiology. All rights reserved. Copyright © The Author 2011

18 marzo 2011

EUROPEAN HEART JOURNAL. Novel oral anticoagulants: focus on stroke prevention and treatment of venous thrombo-embolism

Jan Steffel and Eugene Braunwald

Anticoagulation for the long-term treatment and prevention of thrombo-embolic diseases as well as for stroke prevention in atrial fibrillation (AF) has been accomplished by vitamin K antagonists for the last half century. Although effective under optimal conditions, the imminent risk of a recurrent event vs. the risk of bleeding due to the narrow therapeutic window, numerous food- and drug interactions, and the need for regular monitoring complicate the long-term use of these drugs and render treatment with these agents complicated. As a result, novel anticoagulants which selectively block key factors in the coagulation cascade are being developed. The efficacy and safety of the direct thrombin inhibitor dabigatran etexilate, as well as of the selective factor Xa inhibitors rivaroxaban and apixaban, have been demonstrated in Phase III trials for stroke prevention in AF and the treatment and secondary prophylaxis of venous thrombo-embolism. This review summarizes the results from recently published pivotal clinical trials and discusses the opportunities as well as uncertainties in the clinical applications of these novel agents. Eur Heart J (2011) 32 (16): 1968-1976. doi: 10.1093/eurheartj/ehr052 First published online: March 18, 2011. Published on behalf of the European Society of Cardiology. All rights reserved. Copyright © The Author 2011

01 octubre 2012

JACC. The Problem With Asymptomatic Cerebral Embolic Complications in Vascular Procedures

Daryl R. Gress, MD

Cerebral embolic events related to carotid and cardiac disease have been known for decades. Recently, cerebral embolic events have become a focus of clinical importance as complications of vascular procedures. Further, the development of new technologies and procedures has increased the overall clinical significance. Although the relative safety of these procedures is usually defined by acute stroke risk, it is also becoming clear that far more subclinical events are occurring. Recent reports provided substantial evidence of memory loss, cognitive decline, and dementia related to these so-called silent infarcts. Literature reports of magnetic resonance imaging events lead to an estimate of as many as 600,000 patients with new brain injury each year in the United States alone. Given the magnitude of the numbers involved, the impact of accelerated cognitive loss and premature senescence in a vulnerable at-risk population could well be significant. J Am Coll Cardiol. 2012;60(17):1614-1616. doi:10.1016/j.jacc.2012.06.037. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

27 septiembre 2011

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Transarterial Medtronic CoreValve System Implantation for Degenerated Surgically Implanted Aortic Prostheses

Fleur Descoutures, MD, Dominique Himbert, MD, Costin Radu, MD, Bernard Iung, MD, Caroline Cueff, MD, David Messika-Zeitoun, MD, PhD, Gregory Ducrocq, MD, Eric Brochet, MD, Patrick Nataf, MD and Alec Vahanian, MD

Background—To assess the results of transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve System (MCS), through the transarterial approach, in high-risk patients with degenerated surgically implanted aortic bioprostheses (SP). Circulation: Cardiovascular Interventions. 2011; 4: 488-494 Published online before print September 27, 2011, doi: 10.1161/​CIRCINTERVENTIONS.111.962589. Copyright © 2011 American Heart Association, Inc.

28 febrero 2011

EUROPEAN HEART JOURNAL. Relationship between risk stratification at admission and treatment effects of early invasive management following fibrinolysis

Andrew T. Yan, Raymond T. Yan, Warren J. Cantor, Bjug Borgundvaag, Eric A. Cohen, David H. Fitchett, Vladimir Dzavik, John Ducas, Mary Tan, Amparo Casanova and Shaun G. Goodman for the TRANSFER-AMI Investigators

Aims We sought to determine the effectiveness of early routine percutaneous coronary intervention (PCI) post-fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to baseline risk status. Eur Heart J (2011) 32 (16): 1994-2002. doi: 10.1093/eurheartj/ehr008 First published online: February 8, 2011. Published on behalf of the European Society of Cardiology. All rights reserved. Copyright © The Author 2011.

10 julio 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Comparison of Resolute Zotarolimus-Eluting Stents and Sirolimus-Eluting Stents in Patients With De Novo Long Coronary Artery Lesions A Randomized LONG-DES IV Trial

Tim P. van de Hoef, MD, Froukje Nolte, MSc, Peter Damman, MD, Ronak Delewi, MD, Matthijs Bax, MD, Steven A.J. Chamuleau, MD, PhD, Michiel Voskuil, MD, PhD, Maria Siebes, PhD, Jan G.P. Tijssen, PhD, Jos A.E. Spaan, PhD, Jan J. Piek, MD, PhD and Martijn Meuwissen, MD, PhD

Background—The assessment of functional coronary lesion severity using intracoronary physiological parameters such as coronary flow velocity reserve and the more widely used fractional flow reserve relies critically on the establishment of maximal hyperemia. We evaluated the diagnostic accuracy of the stenosis resistance index during nonhyperemic conditions, baseline stenosis resistance index, compared with established hyperemic intracoronary hemodynamic parameters, because achievement of hyperemia can be cumbersome in daily clinical practice. Circulation: Cardiovascular Interventions. 2012; 5: 508-514 Published online before print July 10, 2012, doi: 10.1161/​CIRCINTERVENTIONS.111.965707. Copyright © 2012 American Heart Association, Inc. All rights reserved.

06 agosto 2012

JACC. Transcatheter Aortic Valve Replacement With the St. Jude Medical Portico Valve First-in-Human Experience

Alexander B. Willson, MBBS, MPH; Josep Rodès-Cabau, MD; David A. Wood, MD; Jonathon Leipsic, MD; Anson Cheung, MD; Stefan Toggweiler, MD; Ronald K. Binder, MD; Melanie Freeman, MBBS; Robert DeLarochellière, MD; Robert Moss, MBBS; Luis Nombela-Franco, MD; Eric Dumont, MD; Karolina Szummer, MD; Gregory P. Fontana, MD; Raj Makkar, MD; John G. Webb, MD

Objectives The purpose of this study was to demonstrate the feasibility and procedural outcomes with a new self-expanding and repositionable transcatheter heart valve. J Am Coll Cardiol. 2012;60(7):581-586. doi:10.1016/j.jacc.2012.02.045. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 octubre 2011

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Intravascular Volume Expansion Before Primary Angioplasty for Prevention of Acute Kidney Injury

Charanjit S. Rihal, MD and Kianoush B. Kashani, MD

In this issue of Circulation: Cardiovascular Interventions, Maioli and colleagues, from Florence, Italy, report the results of a 450-patient, prospective, randomized trial of patients with ST-elevation–myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).1 Patients with STEMI are at high risk of the development of contrast-induced acute kidney injury (CI-AKI). Accordingly, the authors randomly assigned patients into 1 of 3 groups: early hydration with a bolus of sodium bicarbonate started in the emergency room followed by a 12-hour infusion; postprocedural hydration with a normal saline drip started after PCI; and last, no specific hydration protocol. Patients enrolled were fairly typical of those presenting with STEMI, with a mean age in the mid-60s; almost a quarter were over 75 years of age, and the majority were male. Slightly more than 22% were diabetic, about 40% presented with anterior myocardial infarction, and almost 40% had an ejection fraction of <0.40. The incidence of shock was 5%, but intra-aortic balloon pumps were used liberally in almost 20% of cases. More than a quarter of patients had an estimated glomerular filtration rate (eGFR) of ≤60 mL/min. Although the mean door-to-balloon time of 85 minutes could be criticized, such values were not unusual in the mid-2000s, when the study was performed. Overall, clinical outcomes were acceptable, with 16 deaths, 6 strokes, and a cumulative number of adverse cardiac events of 45 (10%). The main finding of the trial was a significantly lower incidence of CI-AKI, no matter which definition was used, among patients randomly assigned to the early hydration group. Circulation: Cardiovascular Interventions. 2011; 4: 405-406 doi: 10.1161/​CIRCINTERVENTIONS.111.964304 Copyright © 2011 American Heart Association, Inc.