Circulation: Cardiovascular Interventions最新文献

{"title":"Impact of Bypass Conduit and Early Technical Failure on Revascularization for Chronic Limb-Threatening Ischemia.","authors":"Michael S Conte, Alik Farber, Andrew Barleben, Emiliano Chisci, Gheorghe Doros, Vikram S Kashyap, Ahmed Kayssi, Philippe Kolh, Carla C Moreira, Timothy Nypaver, Kenneth Rosenfield, Vincent L Rowe, Andres Schanzer, Niten Singh, Jeffrey J Siracuse, Michael B Strong, Matthew T Menard","doi":"10.1161/CIRCINTERVENTIONS.124.014716","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014716","url":null,"abstract":"<p><strong>Background: </strong>The optimal strategy for lower extremity revascularization (surgical bypass versus endovascular intervention) in patients with chronic limb-threatening ischemia (CLTI) is unclear. We examined the effectiveness of open surgical bypass using single-segment great saphenous vein conduit (SSGSV), alternative conduits (AC), or endovascular interventions (ENDO) among patients with CLTI deemed acceptable for either open surgical bypass or ENDO treatment.</p><p><strong>Methods: </strong>This was a planned as-treated analysis of the multicenter BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients With Critical Limb Ischemia) randomized controlled trial comparing open surgical bypass and ENDO for CLTI due to infrainguinal peripheral artery disease. Outcomes were tabulated based on the initial revascularization received: SSGSV bypass, AC bypass, and ENDO. Analyses were performed for all treated patients and then excluding those who experienced early technical failure. Multivariable Cox regression models were used. End points included the primary trial outcome (major adverse limb event [MALE] or all-cause death), major amputation, MALE at any time or perioperative (30-day) death, reintervention-amputation-death, and all-cause mortality.</p><p><strong>Results: </strong>Among 1780 patients with CLTI, treatments received included SSGSV bypass (n=621), AC bypass (n=236), and ENDO (n=923) procedures. There were no significant differences in 30-day mortality, major adverse cardiovascular events, or serious adverse events; subjects treated with ENDO experienced greater MALE within 30 days (13.1% versus 2.7%, 3% for SSGSV, AC; <i>P</i><0.001). On risk-adjusted analysis, SSGSV bypass was associated with reduced MALE or all-cause death (hazard ratio, 0.65 [95% CI, 0.56-0.76]; <i>P</i><0.001), major amputation (hazard ratio, 0.70 [95% CI, 0.52-0.94]; <i>P</i>=0.017), MALE or perioperative death (hazard ratio, 0.51 [0.41-0.62]; <i>P</i><0.001), and reintervention-amputation-death (hazard ratio, 0.69 [95% CI, 0.61-0.79]; <i>P</i><0.001). AC bypass was associated with reduced MALE or perioperative death and reintervention-amputation-death compared with ENDO. Significant benefits of SSGSV over ENDO remained when excluding patients who experienced early technical failure. There were no significant differences in long-term mortality by initial treatment received. When analyzed by the level of disease treated, the improved outcomes of SSGSV were greatest among patients who underwent femoropopliteal revascularization.</p><p><strong>Conclusions: </strong>Analysis of as-treated outcomes from the BEST-CLI trial demonstrates the safety and clinical superiority of bypass with SSGSV among patients with CLTI who were deemed suitable for either open surgical bypass or ENDO revascularization. Assessment of great saphenous vein quality should be incorporated into the evaluation of patients with CLTI who are surgical candidates.</p><p><stron","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014716"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656007","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":"Effects of Guiding Catheter Disengagement on Resting Indexes for the Assessment of Coronary Artery Stenoses.","authors":"Luigi Di Serafino, Maria Scalamogna, Carlo Carbone, Maria Luisa De Rosa, Lucia Mitrano, Plinio Cirillo, Eugenio Stabile, Marisa Avvedimento, Luca Ciaramella, Salvatore Monaco, Anna Franzone, Raffaele Piccolo, Carmen Anna Maria Spaccarotella, Giovanni Esposito","doi":"10.1161/CIRCINTERVENTIONS.124.014543","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014543","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014543"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078692","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":"Hybrid Versus Percutaneous Left Atrial Decompression in Infants With Hypoplastic Left Heart Variants and an Intact or Highly Restrictive Atrial Septum: A Multicenter PICES Study.","authors":"Konstantin Averin, Michael D Seckeler, Holly Bauser-Heaton, Matthew C Schwartz, Paul Tannous, Cameron Seaman, Wendy Whiteside, George T Nicholson, Priti M Patel, Brent M Gordon, Ryan A Romans, Rajiv Devanagondi, Carrie E Herbert, Sarosh P Batlivala, Brian Boe, Gurumurthy Hiremath, Jeffrey D Zampi","doi":"10.1161/CIRCINTERVENTIONS.124.014243","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014243","url":null,"abstract":"<p><strong>Background: </strong>Neonates with hypoplastic left heart syndrome variants with an intact or highly restrictive atrial septum (HLH-IAS) require immediate postnatal intervention to survive. Emergent left atrial decompression (LAD) via a percutaneous or hybrid approach is standard, but the comparative effectiveness and outcomes of these approaches remain underexplored.</p><p><strong>Methods: </strong>A multicenter retrospective analysis of all neonates with HLH-IAS who underwent LAD in the first 36 hours of life from January 2009 to March 2020 at 14 North American congenital cardiac programs was conducted. Patient and procedural characteristics and patient outcomes were compared between hybrid and percutaneous LAD.</p><p><strong>Results: </strong>Among 128 patients with HLH-IAS, 105 (80%) underwent percutaneous LAD and 23 (17%) hybrid LAD. No significant differences were observed in preprocedural characteristics such as birth weight (3.1±0.6 versus 3.2±0.6 kg; <i>P</i>=0.453), presence of a baseline interatrial communication (66% versus 61%; <i>P</i>=0.659), interatrial communication gradient (14.4±6.9 versus 12.7±4.6 mm Hg; <i>P</i>=0.456), or lowest pH (7.13±0.14 versus 7.09±0.15; <i>P</i>=0.193). Hybrid LAD resulted in a shorter time from birth to procedure (120 versus 52 minutes; <i>P</i>=0.005) and to atrial septal defect creation (55 versus 29 minutes; <i>P</i>=0.002). All hybrid LAD were technically successful, although 11 (10%) percutaneous LAD were unsuccessful with 7 requiring conversion to surgical septectomy. There was a trend toward fewer serious adverse events with hybrid LAD (36% versus 17%; <i>P</i>=0.141). Most patients (67%) who underwent hybrid LAD had simultaneous pulmonary artery band placement and 21% of patients with percutaneous LAD required reoperation for pulmonary artery band. Long-term survival rates were comparably low between groups, with a 30% transplant-free survival at a median 8-month follow-up.</p><p><strong>Conclusions: </strong>In patients with HLH-IAS, hybrid LAD allows for faster atrial septal defect creation, has a higher technical success rate, and potentially fewer procedural serious adverse events compared with percutaneous LAD, alongside facilitating simultaneous pulmonary artery band. Our findings underscore the poor prognosis for patients with HLH-IAS despite intervention, highlighting the need for better treatment strategies.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014243"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656003","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":"PCI for Surgically Ineligible Patients: Another Piece of the Jigsaw.","authors":"Tim Kinnaird","doi":"10.1161/CIRCINTERVENTIONS.125.015200","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015200","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e015200"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656247","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":"Intravascular Imaging-Guided Versus Angiography-Guided Complex PCI in Patients With High Bleeding Risk: A Secondary Analysis of the RENOVATE-COMPLEX PCI Trial.","authors":"Jinhwan Jo, Sang Yoon Lee, Woochan Kwon, Seung-Jae Lee, Jong-Young Lee, Seung Hun Lee, Doosup Shin, Sang Min Kim, Kyeong Ho Yun, Jae Young Cho, Chan Joon Kim, Hyo-Suk Ahn, Chang-Wook Nam, Hyuck-Jun Yoon, Yong Hwan Park, Wang Soo Lee, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Young Bin Song, Joo-Yong Hahn, Sang Yeub Lee, Joo Myung Lee","doi":"10.1161/CIRCINTERVENTIONS.124.014952","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014952","url":null,"abstract":"<p><strong>Background: </strong>Although patients with high bleeding risk (HBR) often have complex coronary artery lesions, it is not known whether intravascular imaging-guided percutaneous coronary intervention (PCI) improves their prognosis. We sought to investigate the benefit of intravascular imaging-guided PCI for complex coronary artery lesions in patients with HBR.</p><p><strong>Methods: </strong>This was a secondary analysis of the RENOVATE-COMPLEX-PCI trial (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) in which patients with complex coronary artery lesions undergoing PCI were enrolled at 20 sites in Korea from May 2018 through May 2021. Patients were randomized to receive intravascular imaging-guided PCI or angiography-guided PCI and classified according to the presence of HBR. The primary end point was target vessel failure, which was a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.</p><p><strong>Results: </strong>Of 1639 trial population, 478 patients met HBR criteria. There was no significant difference in the risk of the primary end point between HBR and non-HBR patients (11.8% versus 8.2%; adjusted hazard ratio [HR], 1.05 [95% CI, 0.72-1.54]; <i>P</i>=0.790). However, patients with HBR were at higher risk for cardiac death or spontaneous target vessel-related myocardial infarction (adjusted HR, 2.04 [95% CI, 1.09-3.80]; <i>P</i>=0.025), all-cause death (adjusted HR, 3.30 [95% CI, 1.93-5.62]; <i>P</i><0.001), and cardiac death (adjusted HR, 2.36 [95% CI, 1.10-5.09]; <i>P</i>=0.028). Intravascular imaging-guided PCI showed a lower risk of the primary end point compared with angiography-guided PCI in both HBR patients (9.7% versus 15.8%; adjusted HR, 0.57 [95% CI, 0.31-1.02]; <i>P</i>=0.060) and non-HBR patients (6.9% versus 10.8%; adjusted HR, 0.65 [95% CI, 0.43-0.99]; <i>P</i>=0.045), without significant interaction (<i>P</i> for interaction=0.796).</p><p><strong>Conclusions: </strong>Patients with HBR were associated with an increased risk of adverse cardiovascular events after complex PCI compared with those without HBR. Intravascular imaging-guided PCI showed a lower risk of the target vessel failure without significant interaction between treatment strategy and the presence of HBR in patients undergoing complex PCI.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 3","pages":"e014952"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656186","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 Real-Time Fluoroscopic Assessment Method of THV Expansion Following Balloon-Expandable TAVR.","authors":"Ali Husain, Georgios Tzimas, Mariama Akodad, Julius Jelisejevas, Sophie Offen, Kevin Millar, Jonathon A Leipsic, Philipp Blanke, David A Wood, Stephanie L Sellers, John G Webb, David Meier, Janarthanan Sathananthan","doi":"10.1161/CIRCINTERVENTIONS.124.014617","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014617","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter heart valve (THV) underexpansion after transcatheter aortic valve replacement may be associated with worse outcomes. THV expansion can be assessed fluoroscopically using a pigtail for calibration; however, the accuracy of this technique specific to transcatheter aortic valve replacement is unknown. We assessed the accuracy and reproducibility of a novel fluoroscopic method to assess THV expansion using the THV commissural post for calibration.</p><p><strong>Methods: </strong>Patients who underwent transcatheter aortic valve replacement with a SAPIEN 3 (S3) THV had documented 3 cusp and cusp overlap views, and post-implant computed tomography was identified. THV expansion was fluoroscopically assessed in the 3 cusp and cusp overlap views using the S3 commissural post height and the pigtail as a reference for calibration. The correlation between the 2 methods and computed tomography was evaluated.</p><p><strong>Results: </strong>Forty patients were included. On the bench, the commissural post height measured 3.3, 3.5, 4.0, and 4.5 mm for the 20 mm S3, 23 mm S3, 26 mm S3, and 29 mm S3, respectively. The Pearson correlation coefficient (r) with computed tomography for measuring the inflow, mid-portion, and outflow THV diameter was 0.98, 0.97, and 0.98 for the commissural post height method and 0.82, 0.81, and 0.78 for the pigtail method, respectively. Unlike the pigtail method, the correlation between the commissural post height method and computed tomography remained strong across all THV sizes and in both the 3 cusp and cusp overlap views.</p><p><strong>Conclusions: </strong>The commissural post height method is a novel real-time fluoroscopic tool that has the potential to assess THV expansion and guide further optimization after balloon-expandable transcatheter aortic valve replacement.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014617"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028077","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":"Putting the Cart Before the Horse: Intravascular Imaging as a Performance Measure.","authors":"Adam S Vohra, Dmitriy N Feldman","doi":"10.1161/CIRCINTERVENTIONS.124.015004","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.015004","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015004"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028079","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":"Three-Dimensional CT for Preprocedural Planning of PCI for Ostial Right Coronary Artery Lesions: A Randomized Controlled Pilot Trial.","authors":"Deborah M F van den Buijs, Ella M Poels, Endry Willems, Daan Cottens, Kevin Dotremont, Karen De Leener, Evelyne Meekers, Bert Ferdinande, Mathias Vrolix, Joseph Dens, Koen Ameloot","doi":"10.1161/CIRCINTERVENTIONS.123.013584","DOIUrl":"10.1161/CIRCINTERVENTIONS.123.013584","url":null,"abstract":"<p><strong>Background: </strong>Geographic stent-ostium mismatch is an important predictor of target lesion failure after percutaneous coronary intervention of an aorto-ostial right coronary artery lesion. Optimal visualization of the aorto-ostial plane is crucial for precise stent implantation at the level of the ostium. This study investigates whether preprocedural 3-dimensional computed tomography (3DCT), with determination of the optimal viewing angle, would allow for more precise stent implantation and reduce procedure time, contrast, and radiation dose.</p><p><strong>Methods: </strong>In this single-center, prospective, open-label, core-laboratory blinded trial, a total of 30 patients with an aorto-ostial right coronary artery lesion were randomly assigned to either percutaneous coronary intervention with a preprocedural 3DCT or angiography-guided percutaneous coronary intervention. The optimal working view angle was determined by 3DCT in the intervention group and by the operators' discretion in the control group. The primary end point was the percentage of patients without geographic mismatch, as determined by intravascular ultrasound.</p><p><strong>Results: </strong>3DCT-determined C-arm angles were heterogenous but, in general, more extreme left anterior oblique projections were used (<i>P</i><0.0001). While stent implantation was in the optimal position in all patients randomized to the intervention group, geographic mismatch was present in 5 (33%) patients randomized to the control group (<i>P</i>=0.06). The mean amount of procedural contrast (<i>P</i><0.0001), mean radiation (<i>P</i>=0.03), and median procedure time (<i>P</i>=0.03) were significantly lower in the intervention group. The 3DCT scan was able to predict the calcium arc (<i>P</i><0.0001) and minimal lumen area by intravascular ultrasound (<i>P</i>=0.003).</p><p><strong>Conclusions: </strong>Preprocedural 3DCT planning for percutaneous coronary intervention of aorto-ostial right coronary artery lesions allows for optimal stent positioning while reducing procedure time, contrast, and radiation dose.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05172323.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e013584"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058103","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":"Residual Mitral Regurgitation Interacts With Transmitral Mean Pressure Gradient to Modify the Association With Mortality Following Transcatheter Edge-to-Edge Repair.","authors":"Neal M Duggal, Milo Engoren, Paul Sorajja, D Scott Lim, Jason H Rogers, Scott M Chadderdon, Firas E Zahr, Evelio Rodriguez, M Andrew Morse, Enrique Garcia-Sayan, Nishtha Sodhi, Marcella A Calfon Press, Gorav Ailawadi","doi":"10.1161/CIRCINTERVENTIONS.124.014843","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014843","url":null,"abstract":"<p><strong>Background: </strong>The association, if any, between the transmitral mean pressure gradient (TMPG) after mitral transcatheter edge-to-edge repair and 1-year mortality is controversial in patients undergoing mitral transcatheter edge-to-edge repair with the MitraClip system. We sought to estimate the association between intraoperatively measured residual mitral regurgitation (rMR) and TMPG and 1-year mortality among patients undergoing mitral transcatheter edge-to-edge repair to facilitate decisions on additional devices.</p><p><strong>Methods: </strong>In patients with severe secondary (functional) MR, we analyzed registry data using generalized estimating equations. Both rMR and TMPG were nonlinearly transformed using fractional polynomials.</p><p><strong>Results: </strong>We studied 570 patients with secondary MR who underwent mitral transcatheter edge-to-edge repair in 11 centers. Most patients were men (61%) and averaged 72±12 years of age. Most (78%) patients had TMPG <5 mm Hg and 22% had TMPG ≥5 mm Hg. Postprocedural MR severity improved substantially, being ≤2+ in 95% (with ≤1+ in 76%), 3+ in 3%, and 4+ in 2%. 1-year mortality was 20%. After adjustment for confounders, rMR (odds ratio, 2.10 [95% CI, 1.88-2.35]; <i>P</i><0.001 for rMR^.5) and TMPG remained associated with mortality, with odds ratios of 1.26 (95% CI, 1.19-1.32), 1.84 (1.58-2.10), and 3.13 (2.31-3.98) for TMPG values of 4, 6, and 8, respectively, compared with TMPG=2 mm Hg at rMR=1+.</p><p><strong>Conclusions: </strong>Both rMR and TMPG were nonlinearly associated with 1-year mortality. At low levels of rMR, changes in TMPG are associated with only small changes in the risk of death. Conversely, at higher levels of rMR, even small changes in TMPG are associated with larger changes in the absolute risk of death.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014843"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051866","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":"Effect of Balloon Pulmonary Angioplasty and Riociguat on Right Ventricular Afterload and Function in CTEPH: Insights From the RACE Trial.","authors":"Christian Gerges, Mitja Jevnikar, Philippe Brenot, Laurent Savale, Antoine Beurnier, Hélène Bouvaist, Olivier Sitbon, Elie Fadel, Athénaïs Boucly, Denis Chemla, Gérald Simonneau, Marc Humbert, David Montani, Xavier Jaïs","doi":"10.1161/CIRCINTERVENTIONS.124.014785","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014785","url":null,"abstract":"<p><strong>Background: </strong>Riociguat and balloon pulmonary angioplasty (BPA) improve hemodynamics in inoperable chronic thromboembolic pulmonary hypertension. Importantly, comparative effects of riociguat and BPA on different components of right ventricular (RV) afterload and function remain not fully elucidated.</p><p><strong>Methods: </strong>We conducted a post hoc analysis including patients from the RACE trial (Riociguat Versus Balloon Pulmonary Angioplasty in Non-Operable Chronic Thromboembolic Pulmonary Hypertension) with complete data for the primary end point assessment (49 riociguat and 51 BPA). Symptomatic patients with a residual pulmonary vascular resistance >4 WU received add-on riociguat after BPA (n=18) or add-on BPA after riociguat (n=36) and were included in an ancillary 26-week follow-up study with hemodynamic reassessment at week 52.</p><p><strong>Results: </strong>Cardiac output, stroke volume, and RV afterload improved significantly with riociguat and BPA, and the relative changes in RV afterload from baseline to week 26 were more pronounced in the BPA group (all <i>P</i><0.001). Change in RV afterload was primarily mediated by decreased mean pulmonary arterial pressure in the BPA group, while increased cardiac output was the main driver in the riociguat group. Key parameters of RV function (RV stroke work and right atrial pressure) improved only in the BPA group. The ancillary follow-up study confirmed that relative change in RV afterload from week 26 to week 52 was more pronounced with add-on BPA, and improved RV function was only observed in the add-on BPA group.</p><p><strong>Conclusions: </strong>Both riociguat and BPA are effective in improving RV afterload in inoperable chronic thromboembolic pulmonary hypertension. However, BPA provided a more substantial impact on RV afterload reduction, and RV function only improved with BPA.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02634203.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 2","pages":"e014785"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448240","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}