Circulation: Cardiovascular Interventions最新文献

{"title":"Comparison of Coronary Physiological Indices in Identifying Functionally Significant Myocardial Bridges in ANOCA.","authors":"Hisao Otsuki, Akihiro Yoshida, Vedant Satish Pargaonkar, Kuniaki Takahashi, Yasuhiro Honda, Peter J Fitzgerald, Ingela Schnittger, Jennifer A Tremmel","doi":"10.1161/CIRCINTERVENTIONS.124.014824","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014824","url":null,"abstract":"<p><strong>Background: </strong>A functionally significant myocardial bridge (MB) is an important cause of angina with nonobstructive coronary arteries. However, distinguishing a functionally significant versus incidental MB remains challenging. Resting and hyperemic intracoronary functional indices are available, but no studies have compared their diagnostic performance in MBs.</p><p><strong>Methods: </strong>We prospectively studied 64 patients with angina and nonobstructive coronary arteries, all of whom had an MB confirmed by intravascular ultrasound. We evaluated the diagnostic performance of instantaneous wave-free ratio (iFR) and resting full-cycle ratio (RFR) under dobutamine stress, with dobutamine diastolic fractional flow reserve (dFFR) as a reference standard. Dobutamine iFR and dobutamine RFR were assessed in the first 18 patients, while only dobutamine RFR was assessed in the remaining 46. dobutamine dFFR ≤0.76 was considered indicative of a functionally significant MB.</p><p><strong>Results: </strong>There was a strong correlation between dobutamine iFR (<i>R</i>²=0.67, <i>P</i><0.001) and dobutamine RFR (<i>R</i>²=0.80, <i>P</i><0.001) with dobutamine dFFR. Receiver operating characteristics curve analysis to identify the cutoff for dobutamine dFFR ≤0.76 was 0.81 for dobutamine iFR (area under the curve 0.961) and 0.76 for dobutamine RFR (area under the curve 0.996). The diagnostic accuracy of dobutamine iFR was 94.4%, with a sensitivity of 100% and specificity of 85.7%. For dobutamine RFR, the diagnostic accuracy was 96.9%, with a sensitivity of 95.8% and specificity of 100%.</p><p><strong>Conclusions: </strong>In patients with angina and nonobstructive coronary arteries and an MB confirmed by intravascular ultrasound, dobutamine iFR and dobutamine RFR may serve as alternatives to dobutamine dFFR in identifying a functionally significant MB, with dobutamine RFR having superior diagnostic accuracy.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014824"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962111","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":"Contemporary TAVR for Patients With Bicuspid Aortic Valve: Importance of Specific Bicuspid Phenotypes, Raphe, Calcification, and a Lifetime Management Intention.","authors":"Hector I Michelena, Dhairya Patel, Raj R Makkar, Hasan Jilaihawi","doi":"10.1161/CIRCINTERVENTIONS.125.015442","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015442","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 6","pages":"e015442"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316026","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":"Letter by Shah Regarding Article, \"Patent Foramen Ovale Closure in Patients With and Without Nickel Hypersensitivity: A Randomized Trial\".","authors":"Ashish H Shah","doi":"10.1161/CIRCINTERVENTIONS.125.015497","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015497","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015497"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993287","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 to Letter Regarding Article, \"Patent Foramen Ovale Closure in Patients With and Without Nickel Hypersensitivity: A Randomized Trial\".","authors":"Anastasios Apostolos, Stamatios Gregoriou, Konstantinos Toutouzas","doi":"10.1161/CIRCINTERVENTIONS.125.015514","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015514","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015514"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109844","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":"10-Year Outcomes of Deferred or Conventional Stent Implantation in Patients With STEMI (DANAMI-3-DEFER).","authors":"Jasmine Melissa Marquard, Thomas Engstrøm, Henning Kelbæk, Rasmus Paulin Beske, Utsho Islam, Dan Eik Høfsten, Lene Holmvang, Frants Pedersen, Christian Juhl Terkelsen, Evald Høj Christiansen, Hans-Henrik Tilsted, Charlotte Glinge, Reza Jabbari, Ashkan Eftekhari, Bent Raungaard, Peter Clemmensen, Hans Erik Bøtker, Lisette Okkels Jensen, Lars Køber, Jacob Thomsen Lønborg","doi":"10.1161/CIRCINTERVENTIONS.125.015369","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015369","url":null,"abstract":"<p><strong>Background: </strong>Primary percutaneous coronary intervention (PCI) with stenting is recommended in ST-segment-elevation myocardial infarction. Immediate stenting may cause distal embolization, microvascular damage, and flow disturbances, leading to adverse outcomes. We report the 10-year clinical outcomes of deferred stenting versus conventional PCI in patients with ST-segment-elevation myocardial infarction.</p><p><strong>Methods: </strong>We conducted a 10-year follow-up study of the open-label, randomized DANAMI-3-DEFER trial (Third Danish Study of Optimal Acute Treatment of Patients With STEMI - Deferred Stent Implantation Versus Conventional Treatment), conducted in 4 PCI centers in Denmark. Patients with ST-segment-elevation myocardial infarction and acute chest pain <12 hours were randomized to deferred stenting >24 hours after the index procedure or conventional PCI with immediate stenting. In the deferred group, immediate stable Thrombolysis in Myocardial Infarction flow II to III was established, and intravenous administration of either a glycoprotein IIb/IIIa antagonist or bivalirudin for >4 hours after the index procedure was recommended. The primary outcome was a composite of hospitalization for heart failure or all-cause mortality. Key secondary outcomes included individual components of the primary outcome and target vessel revascularization.</p><p><strong>Results: </strong>Of 1215 patients, 603 were randomized to deferred stenting and 612 to conventional PCI. After 10 years, deferred stenting did not significantly reduce the primary composite outcome (hazard ratio, 0.82 [95% CI, 0.67-1.02]; <i>P</i>=0.08). In the deferred group, 124 (24%) died versus 150 (25%) in the conventional PCI group (hazard ratio, 0.95 [95% CI, 0.75-1.19]). Hospitalization for heart failure was lower in patients treated with deferred stenting compared with conventional PCI (odds ratio, 0.58 [95% CI, 0.39-0.88]). Target vessel revascularization was similar in both groups (odds ratio, 1.20 [95% CI, 0.81-1.79]).</p><p><strong>Conclusions: </strong>Deferred stenting did not reduce all-cause mortality or the composite primary outcome after 10 years but reduced hospitalization for heart failure compared with conventional PCI.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01435408.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015369"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Year Clinical Outcomes in Female and Male Patients After Sirolimus-Coated Balloon Angioplasty for Coronary Artery Disease.","authors":"Pier Pasquale Leone, Luca Testa, Antonio Greco, Lee C Yan, Diego Milazzo, Susanna Benincasa, Dario Gattuso, Bernardo Cortese","doi":"10.1161/CIRCINTERVENTIONS.124.014814","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014814","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014814"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763206","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 Contrast-Derived Indices of Coronary Microvascular Function: Potential Clinical and Cost Benefits.","authors":"Daniel T Y Ang, Damien G Collison, Ross J McGeoch, David Carrick, Robert A Sykes, Conor Bradley, Anna L Kamdar, Andy Jong, Richard A Brogan, David A MacDougall, Peter J McCartney, J Paul Rocchiccioli, Andrew P Apps, C Aengus Murphy, Keith E Robertson, Aadil Shaukat, Angie Ghattas, Francis R Joshi, Arvind Sood, Richard I S Good, Brian O'Rourke, Hany Eteiba, M Mitchell Lindsay, Alex McConnachie, Colin Berry","doi":"10.1161/CIRCINTERVENTIONS.124.015058","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.015058","url":null,"abstract":"<p><strong>Background: </strong>Intravenous adenosine induces stable myocardial hyperemia for coronary microvascular function testing. Iodinated radiographic contrast media induce transient, submaximal hyperemia. We assessed the feasibility, diagnostic value, and potential cost-effectiveness of contrast-derived indices of microvascular function.</p><p><strong>Methods: </strong>Coronary flow reserve, index of microvascular resistance, and microvascular resistance reserve were assessed using a diagnostic guidewire. Intracoronary bolus thermodilution injections were performed at rest, immediately after an 8-mL bolus of iohexol, repeated after a second 8-mL bolus, and during intravenous adenosine infusion. Receiver operating characteristic analyses assessed the discriminatory ability of the contrast-derived indices (contrast-derived coronary flow reserve, contrast-derived index of microcirculatory resistance, contrast-derived microvascular resistance reserve) to detect abnormal adenosine-derived indices (coronary flow reserve <2.0, index of microvascular resistance ≥25, and microvascular resistance reserve <2.1).</p><p><strong>Results: </strong>Among 106 coronary arteries from 93 patients (median age 63 years; 62% women; 13% with diabetes), 88% of assessments were undertaken in the left anterior descending artery. Median fractional flow reserve was 0.88 (interquartile range, 0.85-0.92). Contrast-derived coronary flow reserve <2.0 (area under the curve 0.81; sensitivity 67%, specificity 80%, positive predictive value 40%, negative predictive value 92%), contrast-derived index of microcirculatory resistance >47 (area under the curve 0.82; 80%, 79%, 60%, 91%), and contrast-derived microvascular resistance reserve <1.9 (area under the curve 0.82; 67%, 89%, 35%, 97%) were best for predicting their adenosine-derived counterpart indices. There was good correlation on repeatability testing from the second contrast bolus. A hybrid approach reduced adenosine use by 40%, saving $30 800 (USA) or £8000 (UK) per 1000 vessels assessed.</p><p><strong>Conclusions: </strong>Contrast-derived indices have high specificity and negative predictive value, enabling rapid exclusion of microvascular dysfunction. This method is feasible, clinically useful and cost-saving compared with routine adenosine testing.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04674449.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015058"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985517","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":"Optimal Oversizing With the New-Generation Evolut (PRO/PRO+/FX) Self-Expanding Valves: A Multicenter Study.","authors":"Silvia Mas-Peiro, Alberto Alperi, Ander Regueiro, Ignacio Cruz-Gonzalez, Domenico Angellotti, Francisco Campelo-Parada, Marina Urena, Pablo Avanzas, Pablo Vidal-Cales, Gilles Jose Barreira de Sousa, Giovanni Esposito, Mehdi Tamir, Gaspard Suc, Anthony Poulin, Siamak Mohammadi, Marisa Avvedimento, Josep Rodés-Cabau","doi":"10.1161/CIRCINTERVENTIONS.124.014916","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014916","url":null,"abstract":"<p><strong>Background: </strong>Paravalvular leaks (PVLs) after transcatheter aortic valve replacement have a significant prognostic impact, and valve oversizing, particularly with self-expanding valves, may prevent postprocedural PVL occurrence. Recent iterations of the Evolut valve system are intended to reduce PVL, but the effects of oversizing with such valves on PVL are largely unknown. We aimed to assess, in a real-world contemporary setting, the impact of Evolut valve oversizing on PVL after transcatheter aortic valve replacement.</p><p><strong>Methods: </strong>This was a multicenter observational ambispective study of patients undergoing transcatheter aortic valve replacement with the Evolut PRO/PRO+/FX valves. Aortic annulus perimeter, as determined by multidetector computed tomography, was used to estimate the oversizing degree. The primary end point was the presence of PVL (mild/moderate-severe), as determined by echocardiography at hospital discharge. Secondary end points included in-hospital outcomes as defined by the Valve Academic Research Consortium-3 recommendations.</p><p><strong>Results: </strong>A total of 762 patients were included (Evolut PRO/PRO+/FX, 55.5%/34.8%/9.7%), and the median valve oversizing was 20 (17-25)%, with no differences in baseline characteristics between low (≤20%, n=381) and high (>20%, n=381) valve oversizing recipients. In-hospital mortality and stroke rates were 2.4% and 4.3%, respectively, with no oversizing-related differences in clinical outcomes. Permanent pacemaker rates were similar in patients with low (19.4%) and high (15.8%) valve oversizing, <i>P</i>=0.21. PVL was found in 35.6% of patients (mild: 32.6%, moderate-severe: 3.0%), with a higher incidence of PVL in patients with low (40.9%) versus high (30.2%) oversizing, <i>P</i>=0.002. In a multivariable analysis, a higher oversizing degree was associated with a lower risk of PVL (odds ratio, 0.95 [0.92-0.99] for each 1% increase in oversizing, <i>P</i>=0.006).</p><p><strong>Conclusions: </strong>In transcatheter aortic valve replacement with recent Evolut valve iterations (PRO/PRO+/FX), a higher oversizing degree was associated with a lower frequency of PVL without increasing the risk of other complications (including permanent pacemaker). These data suggest that a low degree of valve oversizing should probably be avoided when using Evolut valves, particularly in borderline cases.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014916"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990407","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":"Impact of Calcified Raphe on TAVR in Bicuspid Patients: Predicting Redo-TAVR Feasibility and Virtual Planning Implications.","authors":"Pavan Reddy, Fernando J Rodriguez-Weisson, Giorgio A Medranda, Ilan Merdler, Matteo Cellamare, Paul Gordon, Afshin Ehsan, Puja Parikh, Thomas Bilfinger, Maurice Buchbinder, David Roberts, Nicholas Hanna, Itsik Ben-Dor, Lowell F Satler, Hector M Garcia-Garcia, Federico M Asch, Gaby Weissman, Anita Sadeghpour, Christian C Schults, Ron Waksman, Toby Rogers","doi":"10.1161/CIRCINTERVENTIONS.124.014802","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014802","url":null,"abstract":"<p><strong>Background: </strong>Patients with bicuspid aortic stenosis who receive transcatheter aortic valve replacement (TAVR) may require subsequent valve interventions in their lifetime; however, the feasibility of redo-TAVR in this population is uncertain. We aimed to assess redo-TAVR feasibility in bicuspid patients and develop a predictive virtual valve planning algorithm.</p><p><strong>Methods: </strong>We studied computed tomography scans of bicuspid patients who received a balloon-expandable transcatheter heart valve (THV) in the LRT trial (Low Risk TAVR). Redo-TAVR feasibility, determined by valve-to-coronary and valve-to-aorta measurements on 30-day computed tomography, was assessed according to raphe location and calcification. A virtual valve planning algorithm was developed using baseline and 30-day computed tomography scans.</p><p><strong>Results: </strong>Among 42 patients (left/right cusp fusion: n=34; right/noncusp fusion: n=4; 2-sinus: n=4), redo-TAVR was feasible in 64%, while 36% would likely require leaflet modification to prevent coronary obstruction. Patients with left/right fusion and calcified raphe had higher redo-TAVR feasibility (88% versus 35%, <i>P</i><0.001) due to favorable shifting of the THV away from the coronary ostia. A bicuspid virtual planning algorithm accounting for 83.4% THV underexpansion, resulting in an 11.9% taller frame and translation of the THV away from the calcified raphe (mean valve shift 6.6 mm) achieved 86.7% sensitivity and 88.9% specificity for predicting redo-TAVR feasibility.</p><p><strong>Conclusions: </strong>Calcified raphe in left/right cusp fusion shifts the THV away from the coronary ostia, reducing coronary obstruction risk during redo-TAVR. Underexpansion causing increased THV frame height and valve shifting is common in bicuspid patients; a virtual planning algorithm accounting for these aspects can accurately assess redo-TAVR risk.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02628899.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014802"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964051","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":"Evolution of Cardiac Damage Following SAVR in Asymptomatic Severe Aortic Stenosis.","authors":"Simon Jacob, Sébastien Hecht, Lionel Tastet, Marie-Ange Fleury, Kathia Abdoun, Jérémy Bernard, Mylène Shen, Romain Capoulade, Marie Arsenault, Élisabeth Bédard, Nancy Côté, Marie-Annick Clavel, Philippe Généreux, Philippe Pibarot","doi":"10.1161/CIRCINTERVENTIONS.124.014860","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014860","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014860"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763204","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}