01 febrero 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

15 octubre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Transcatheter Aortic Valve Replacement. Cognitive Trajectory After Transcatheter Aortic Valve Implantation

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. Transcatheter Aortic Valve Replacement. 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. Multi-Imaging Modality Assessment

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. Congenital Heart Disease. Angioplasty of Obstructed Homograft Conduits in the Right Ventricular Outflow Tract With Ultra-Noncompliant Balloons. Assessment of Therapeutic Efficacy and Conduit Tears

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. Congenital Heart Disease. 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.

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Initial Success Rate of Percutaneous Coronary Intervention for Chronic Total Occlusion in a Native Coronary Artery Is Decreased in Patients Who Underwent Previous Coronary Artery Bypass Graft Surgery

Tomohiko Teramoto, MD, PhD∗; Etsuo Tsuchikane, MD, PhD∗; Hitoshi Matsuo, MD, PhD†; Yoriyasu Suzuki, MD‡; Tsuyoshi Ito, MD∗; Tatsuya Ito, MD‡; Maoto Habara, MD∗; Kenya Nasu, MD∗; Masashi Kimura, MD, PhD∗; Yoshihisa Kinoshita, MD∗; Mitsuyasu Terashima, MD, PhD∗; Yasushi Asakura, MD∗; Tetsuo Matsubara, MD∗; Takahiko Suzuki, MD, PhD∗

Objectives: This study sought to compare the initial success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in a native coronary artery (NCA) in patients with and without previous coronary artery bypass grafting (CABG) and to assess predictive factors.

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Periprocedural Myocardial Injury in Chronic Total Occlusion Percutaneous Interventions. A Systematic Cardiac Biomarker Evaluation Study

Nathan Lo, MD∗; Tesfaldet T. Michael, MD, MPH†; Danyaal Moin, MD∗; Vishal G. Patel, MD†; Mohammed Alomar, MD†; Aristotelis Papayannis, MD†; Daisha Cipher, PhD‡; Shuaib M. Abdullah, MD†; Subhash Banerjee, MD†; Emmanouil S. Brilakis, MD, PhD†

Objectives: This study sought to evaluate the incidence, correlates, and clinical implications of periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) of chronic total occlusions (CTO).

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Comparison of Newer-Generation Drug-Eluting With Bare-Metal Stents in Patients With Acute ST-Segment Elevation Myocardial Infarction. A Pooled Analysis of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) and COMFORTABLE-AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) Trials

Manel Sabaté, MD, PhD∗; Lorenz Räber, MD†; Dik Heg, PhD‡; Salvatore Brugaletta, MD, PhD∗; Henning Kelbaek, MD, PhD§; Angel Cequier, MD, PhD‖; Miodrag Ostojic, MD, PhD¶; Andrés Iñiguez, MD, PhD#; David Tüller, MD, PhD∗∗; Antonio Serra, MD††; Andreas Baumbach, MD, PhD‡‡; Clemens von Birgelen, MD, PhD§§; Rosana Hernandez-Antolin, MD, PhD‖‖; Marco Roffi, MD, PhD¶¶; Vicente Mainar, MD##; Marco Valgimigli, MD, PhD∗∗∗; Patrick W. Serruys, MD, PhD†††; Peter Jüni, MD‡; Stephan Windecker, MD†

Objectives: This study sought to study the efficacy and safety of newer-generation drug-eluting stents (DES) compared with bare-metal stents (BMS) in an appropriately powered population of patients with ST-segment elevation myocardial infarction (STEMI).

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. The EXAMINATION Trial (Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction). 2-Year Results From a Multicenter Randomized Controlled Trial

Manel Sabaté, MD, PhD∗; Salvatore Brugaletta, MD, PhD∗; Angel Cequier, MD, PhD†; Andrés Iñiguez, MD, PhD‡; Antonio Serra, MD, PhD§; Rosana Hernádez-Antolín, MD, PhD‖; Vicente Mainar, MD, PhD¶; Marco Valgimigli, MD, PhD#; Maurizio Tespili, MD, PhD∗∗; Pieter den Heijer, MD, PhD††; Armando Bethencourt, MD, PhD‡‡; Nicolás Vázquez, MD, PhD§§; Bianca Backx, RN‖‖; Patrick W. Serruys, MD, PhD¶¶

Objectives: This study sought to assess the 2-year outcomes of the population included in the EXAMINATION (Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction) trial beyond the 1-year prescription period of dual antiplatelet therapy.

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. A Novel Noninvasive Technology for Treatment Planning Using Virtual Coronary Stenting and Computed Tomography-Derived Computed Fractional Flow Reserve

Kyung-Hee Kim, MD∗; Joon-Hyung Doh, MD†; Bon-Kwon Koo, MD∗; James K. Min, MD‡; Andrejs Erglis, MD§; Han-Mo Yang, MD∗; Kyung-Woo Park, MD∗; Hae-Young Lee, MD∗; Hyun-Jae Kang, MD∗; Yong-Jin Kim, MD∗; Sung Yun Lee, MD†; Hyo-Soo Kim, MD∗

Objectives: This study sought to determine whether computational modeling can be used to predict the functional outcome of coronary stenting by virtual stenting of ischemia-causing stenoses identified on the pre-treatment model.

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Defining the Flow-Limiting Stenosis Noninvasively for Management of Patients With Coronary Artery Disease

Tiago A. Magalhães, MD; João A.C. Lima, MD

Coronary artery disease (CAD) has become the number 1 pathological process responsible for disease burden in the world. Although traditionally the management of CAD was based on anatomic stenosis, more recently, better outcomes have been associated with revascularization of flow-limiting stenoses as opposed to indications on the basis of purely anatomic obstructions. The reference standard for defining ischemia-related coronary obstructions relies on the measurement of fractional flow reserve (FFR) in the catheterization laboratory during adenosine-induced vasodilation. Indeed, FFR-guided percutaneous coronary intervention (PCI) has become the standard of care for intermediate lesions, with a strong body of evidence now accumulated using this paradigm

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. The Absorb Bioresorbable Vascular Scaffold in Coronary Bifurcations. Insights From Bench Testing

Vladimír Džavík, MD∗; Antonio Colombo, MD†

Objectives: This study sought to evaluate the feasibility of performing contemporary bifurcation techniques with the Absorb everolimus-eluting bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, California) (BVS).

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. A Next-Generation Bioresorbable Coronary Scaffold System: From Bench to First Clinical Evaluation. 6- and 12-Month Clinical and Multimodality Imaging Results

Stefan Verheye, MD, PhD∗; John A. Ormiston, MB ChB†; James Stewart, MD†; Mark Webster, MD‡; Elias Sanidas, MD∗; Ricardo Costa, MD, PhD§; J. Ribamar Costa, MD§; Daniel Chamie, MD, PhD§; Andrea S. Abizaid, MD, PhD§; Ibraim Pinto, MD, PhD§; Lynn Morrison, MPH‖; Sara Toyloy, BS‖; Vinayak Bhat, PhD‖; John Yan, MS‖; Alexandre Abizaid, MD, PhD§

Objectives: This study sought to perform clinical and imaging assessments of the DESolve Bioresorbable Coronary Scaffold (BCS).