Circulation: Cardiovascular Interventions最新文献

{"title":"Letter by Skalidis et al Regarding Article, \"Randomized Study Comparing Angiography Guidance With Physiology Guidance After PCI: The EASY-PREDICT Study\".","authors":"Ioannis Skalidis, Dorian Garin, Stephane Cook","doi":"10.1161/CIRCINTERVENTIONS.125.015619","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015619","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015619"},"PeriodicalIF":6.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Coronary Function Testing in Patients With Prior PCI Who Have Persistent ANOCA.","authors":"Vedant S Pargaonkar, Christopher C Y Wong, Yasuhiro Honda, Ingela Schnittger, Jennifer A Tremmel","doi":"10.1161/CIRCINTERVENTIONS.125.015344","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015344","url":null,"abstract":"<p><strong>Background: </strong>Patients with postpercutaneous coronary intervention (PCI) angina are challenging to manage. Comprehensive coronary function testing (CFT) can identify occult coronary abnormalities in patients with angina and nonobstructive coronary arteries. Its utility in patients with post-PCI and persistent angina who have no obstructive coronary artery disease is unexplored.</p><p><strong>Methods: </strong>We assessed 46 patients with a prior PCI experiencing persistent angina. CFT evaluated the presence of endothelial dysfunction, epicardial and microvascular spasm, low fractional flow reserve, coronary microvascular dysfunction, and myocardial bridging by intravascular ultrasound. The Seattle Angina Questionnaire measured symptom severity before and 1-year post-CFT.</p><p><strong>Results: </strong>The median age was 60 (53-69) years, with 63% being women. Pre-PCI lesion stenosis was 80 (70-90)% and pre-PCI fractional flow reserve (n=7) was 0.72 (0.67-0.74). Left anterior descending artery PCI was performed in 47.8%. The median duration between PCI and CFT was 19.5 (11.2-57.2) months. Patients reported severe anginal symptoms and poor quality of life on the Seattle Angina Questionnaire. CFT revealed a median fractional flow reserve of 0.84 (0.82-0.87), and 19.6% had a fractional flow reserve ≤0.8. Endothelial dysfunction was diagnosed in 36.9%, of whom 64.7% had moderate to severe endothelial dysfunction. Epicardial and microvascular spasm were present in 56.5% and 17.4%, respectively. Coronary microvascular dysfunction was present in 43.5%, and 63% had myocardial bridging. Patients reported significant improvement in Seattle Angina Questionnaire scores 1-year post-CFT.</p><p><strong>Conclusions: </strong>Patients with post-PCI and persistent angina have severe symptoms and poor quality of life, with the majority exhibiting endothelial dysfunction, epicardial spasm, coronary microvascular dysfunction, and myocardial bridging. Comprehensive CFT should be considered in these patients to help diagnose an underlying cause of their persistent angina and guide therapy for a better outcome.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015344"},"PeriodicalIF":6.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Validity of Acetylcholine Provocation Protocols in the Evaluation of Coronary Artery Spasm in Patients With ANOCA.","authors":"Rajan Rehan, Chinmay Khandur, Christopher C Y Wong, James Weaver, Pankaj Jain, Mark Adams, Martin K C Ng, Jennifer A Tremmel, Andy S C Yong","doi":"10.1161/CIRCINTERVENTIONS.125.015339","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015339","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery spasm (CAS) is a common cause of angina with nonobstructive coronary arteries (ANOCA). While acetylcholine provocation testing is the diagnostic gold standard, protocol variations have led to discrepancies in diagnostic accuracy. This study aimed to compare the diagnostic validity of conventional versus high-dose acetylcholine regimens in patients with ANOCA.</p><p><strong>Methods: </strong>Multivessel acetylcholine provocation testing was systematically performed in patients with ANOCA and a control cohort undergoing invasive coronary angiography for noncoronary indications. Incremental acetylcholine doses in the left (20-200 μg) and right (20-80 μg) coronary arteries were manually injected over 20 seconds to induce CAS.</p><p><strong>Results: </strong>The study included 62 ANOCA patients with typical CAS symptoms and 20 controls. Conventional-dose acetylcholine testing identified CAS in 67.1% (55/82) of patients, while high-dose testing detected CAS in 79.3% (65/82). Among patients with inducible spasm, 93.4% (61/65) had typical angina consistent with CAS. High-dose acetylcholine demonstrated significantly higher sensitivity (98% versus 87%, <i>P</i>=0.008), but a nonsignificant trend toward lower specificity (80% versus 95%, <i>P</i>=0.08). The high-dose regimen also showed a higher negative predictive value (94% versus 70%, <i>P</i>=0.01), while positive predictive values were comparable (93% versus 98%, <i>P</i>=0.12).</p><p><strong>Conclusions: </strong>High-dose acetylcholine provocation improves the detection of CAS in patients with ANOCA but may increase the risk of overdiagnosis. This approach should be reserved for patients with a high clinical suspicion of CAS, with the results interpreted within the broader clinical context.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015339"},"PeriodicalIF":6.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiologic Assessment of Left Main Disease: Still a Complex Art.","authors":"Jung-Min Ahn, William F Fearon","doi":"10.1161/CIRCINTERVENTIONS.125.015519","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015519","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015519"},"PeriodicalIF":6.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Brilakis to Letter Regarding Article, \"Chronic Total Occlusion Percutaneous Coronary Intervention: Present and Future\".","authors":"Emmanouil S Brilakis, Yader Sandoval, Stephane Rinfret","doi":"10.1161/CIRCINTERVENTIONS.125.015584","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015584","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015584"},"PeriodicalIF":6.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Artery Disease Evaluation on Pre-TAVR Computed Tomography Angiography: The New Standard of Care.","authors":"Dhaval Kolte, Sandeep Hedgire, Arminder Jassar","doi":"10.1161/CIRCINTERVENTIONS.125.015566","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015566","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015566"},"PeriodicalIF":6.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Antithrombotic Strategies After Surgical Bioprosthetic Valve Replacement.","authors":"Nicolas M Van Mieghem, Tsuyoshi Kaneko","doi":"10.1161/CIRCINTERVENTIONS.125.015520","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015520","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015520"},"PeriodicalIF":6.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Bioprosthetic Valve Dysfunction in the SMART Randomized Clinical Trial.","authors":"Howard C Herrmann, Daniel J Blackman, Guilherme F Attizzani, Mohamed Abdel-Wahab, Wayne B Batchelor, Linda D Gillam, Toby Rogers, Jae K Oh, Andrew D Althouse, Roxana Mehran, Didier Tchétché","doi":"10.1161/CIRCINTERVENTIONS.125.015202","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015202","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015202"},"PeriodicalIF":6.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Nature of the Hyperemic Continuum.","authors":"Pim A L Tonino, Nils P Johnson","doi":"10.1161/CIRCINTERVENTIONS.125.015406","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015406","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015406"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenosine Contrast Correlations in Evaluating Revascularization: The (ACCELERATION) Study.","authors":"Rajesh V Swaminathan, Guillaume Marquis-Gravel, Laurie-Anne Boivin-Proulx, Daniel K Benjamin, Aruna Rikhi, Ganesh Raveendran, Jeff W Chambers, Arnold H Seto, Jayant Bagai, Roseann White, Jorge Antonio Gutierrez, Thomas J Povsic, Sunil V Rao, Mitchell W Krucoff","doi":"10.1161/CIRCINTERVENTIONS.125.015240","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015240","url":null,"abstract":"<p><strong>Background: </strong>Injection of contrast media for rapid measurement of contrast fractional flow reserve (cFFR) obviates the side effects and time requirements of adenosine fractional flow reserve (aFFR) and improves diagnostic performance relative to nonhyperemic pressure ratios. However, studies of cFFR have had variable delivery of contrast. We evaluated the diagnostic performance of cFFR using an automated contrast injector with a standardized volume and rate of delivery of contrast to the reference standard aFFR.</p><p><strong>Methods: </strong>The ACCELERATION study (Adenosine Contrast Correlations in Evaluating Revascularization) is an investigator-initiated, multicenter, prospective, single-arm trial conducted in 5 sites across the United States. cFFR and aFFR were measured in patients with stable coronary artery disease and intermediate stenosis (40% to 70%) using the ACIST CVi automated contrast injector (iopamidol; left coronary: rate of 4 mL/s, volume of 10 cm³ and right coronary: rate of 3 mL/s, volume of 6 cm³) and RXi/Navvus FFR microcatheter. The diagnostic performance of cFFR was assessed using a 0.83 cutoff value based on published literature. Optimal cFFR cutoffs were also determined and illustrated using Bland-Altman analysis.</p><p><strong>Results: </strong>A total of 192 lesions from 178 patients were included in the per-protocol analysis (69 with an aFFR ≤0.80 and 109 with an aFFR >0.80). Using a cFFR cutoff value of ≤0.83, the accuracy, sensitivity, and specificity of cFFR were 0.89 (95% CI, 0.83-0.93), 0.70 (95% CI, 0.58-0.81), and 0.99 (95% CI, 0.95-1.00), respectively. The mean difference between cFFR and aFFR was 0.05 (-0.04 to 0.13). A cFFR threshold of ≤0.85 had the highest accuracy in predicting aFFR ≤0.80 with accuracy, sensitivity, and specificity equaling 0.90 (95% CI, 0.84-0.94), 0.87 (95% CI, 0.77-0.94), and 0.91 (95% CI, 0.84-0.95), respectively.</p><p><strong>Conclusions: </strong>cFFR utilizing standardized parameters for contrast delivery leads to clinically acceptable levels of diagnostic performance compared with traditional aFFR to identify physiologically significant intermediate lesions. Future data evaluating the impact on clinical outcomes of cFFR-guided percutaneous coronary intervention are warranted.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03557385.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015240"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}