Clinical Research in Cardiology最新文献

{"title":"Left ventricular systolic function after percutaneous coronary intervention: patterns of change and prognosis according to clinical presentation of coronary artery disease.","authors":"Gjin Ndrepepa, Salvatore Cassese, Michael Joner, Hendrik B Sager, Sebastian Kufner, Erion Xhepa, Karl-Ludwig Laugwitz, Heribert Schunkert, Adnan Kastrati","doi":"10.1007/s00392-024-02588-y","DOIUrl":"10.1007/s00392-024-02588-y","url":null,"abstract":"<p><strong>Background: </strong>Whether there are differences in the left ventricular ejection fraction change (ΔLVEF) after percutaneous coronary intervention (PCI) and its association with long-term prognosis according to coronary artery disease (CAD) presentations is unknown. We assessed ΔLVEF after PCI and its association with 5-year mortality in various CAD presentations.</p><p><strong>Methods: </strong>This study included 8181 patients with paired (before and 6-8 months after PCI) angiographic LVEF measurements: 4582 patients with chronic coronary disease (CCD), 1972 patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and 1627 patients with ST-segment elevation myocardial infarction (STEMI). ΔLVEF (LVEF at 6-8 months minus baseline LVEF) was classified as follows: decline (ΔLVEF < 0), moderate improvement (ΔLVEF > 0 to < 10%) and large improvement (ΔLVEF ≥ 10%). The primary endpoint was 5 year mortality.</p><p><strong>Results: </strong>In patients with CCD, NSTE-ACS and STEMI, ΔLVEF (median [25th-75th percentiles]) was 0.0% [- 3.0%; 4.0%], 1.0% [- 2.0%; 5.0%] and 3.0% [- 2.0%; 10.0%], respectively (P < 0.001). In patients with a decline, moderate improvement and large improvement of LVEF, 5-year mortality was 10.0%, 10.4% and 12.3% in patients with CCD, 10.8%, 10.7% and 18.1% in patients with NSTE-ACS and 10.6%, 8.2% and 5.2% in patients with STEMI. After adjustment, ΔLVEF was associated with 5-year mortality in patients with CCD (adjusted hazard ratio [HR] = 0.90, 95% confidence interval [0.83-0.97]) and STEMI (adjusted HR = 0.85 [0.75-0.95]) but not in patients with NSTE-ACS (adjusted HR = 0.97 [0.85-1.10]), with all 3 risk estimates calculated for 5% increment in the ΔLVEF.</p><p><strong>Conclusions: </strong>The type of CAD presentation appears to impact both LVEF change after PCI and its association with 5-year mortality.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1030-1040"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year outcome of robotical vs. manual percutaneous coronary intervention.","authors":"Constantin von Zur Mühlen, Marvin Jeuck, Timo Heidt, Thomas Maulhardt, Tau Hartikainen, Alexander Supady, Ingo Hilgendorf, Dennis Wolf, Klaus Kaier, Dirk Westermann, Jonathan Rilinger","doi":"10.1007/s00392-024-02524-0","DOIUrl":"10.1007/s00392-024-02524-0","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted percutaneous coronary intervention (R-PCI) is a promising technology for optimizing the treatment of patients with coronary heart disease. For a better understanding of the potential of R-PCI in clinical routine compared to conventional manual PCI (M-PCI) both initial treatment success of the index procedure and long-term outcome have to be analysed.</p><p><strong>Methods: </strong>Prospective evaluation from the FRiK (DRKS00023868) registry of all R-PCI cases with the CorPath GRX Cardiology by Siemens Healthineers and Corindus in the Freiburg University Heart Center between 04/2022 and 03/2023. Index procedure success and safety, radiation dose of patients and personnel, and 1-year outcome will be reported. Findings will be compared to a prospective control group of M-PCI patients treated by the same team of interventionalists during the same observation period.</p><p><strong>Results: </strong>Seventy patients received R-PCI and were included in the registry. PCI success rate was 100%, with 19% requiring manual assistance. No complications (MACE-major adverse cardiovascular events) occurred. Compared with 70 matched-pair M-PCI patients, there was a higher median procedural time (103 min vs. 67 min, p < 0.001) and fluoroscopy time (18 min vs. 15 min, p = 0.002), and more contrast volume was used (180 ml vs. 160 ml, p = 0.041) in R-PCI vs. M-PCI patients. However, there was no significant difference of the dose-area product (4062 vs. 3242 cGycm², p = 0.361). One year after the intervention, there was no difference in mortality, rehospitalisation, unscheduled PCI or target vessel failure. Health-related quality of life evaluation 6 and 12 months after the index procedure (NYHA, CCS, SAQ7 and EQ-5D-5L) was similar in both groups.</p><p><strong>Conclusion: </strong>R-PCI is feasible and safe. Compared to M-PCI, index procedure success rate is high, safety profile is favourable, and manual assistance was required in only few cases. At 1-year follow-up results for R-PCI vs. M-PCI considering mortality, rehospitalisation, morbidity and target vessel failure were equal.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1000-1007"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-coated balloon versus drug-eluting stent for treating de novo large vessel coronary artery disease: a systematic review and meta-analysis of 13 studies involving 2888 patients.","authors":"Rodolfo Caminiti, Giampiero Vizzari, Alfonso Ielasi, Giampaolo Vetta, Antonio Parlavecchio, Domenico Giovanni Della Rocca, Carolina Montonati, Dario Pellegrini, Mariano Pellicano, Maurizio Tespili, Antonio Micari","doi":"10.1007/s00392-024-02481-8","DOIUrl":"10.1007/s00392-024-02481-8","url":null,"abstract":"<p><strong>Introduction: </strong>Drug-coated balloon (DCB) is an established treatment option for in-stent restenosis and small vessel, de novo, coronary artery disease (CAD). Although the use of this tool is increasing in everyday practice, data regarding performance in the treatment of de novo, large vessel CAD (LV-CAD) is still lacking. A systematic review and meta-analysis were conducted to evaluate the efficacy and safety of DCB versus drug-eluting stent (DES) in this setting.</p><p><strong>Methods: </strong>A comprehensive literature search was performed including Medline, Embase, and Cochrane electronic databases up to January 24, 2024, for studies which compared the efficacy and safety of DCB versus DES in the treatment of de novo lesions in large vessels (≥ 2.5 mm), reporting at least one clinical outcome of interest (PROSPERO ID: CRD42023470417). The analyzed outcomes were cardiovascular death (CVD), myocardial infarction (MI), target lesion revascularization (TLR), all-cause death (ACD), and late lumen loss (LLL) at follow-up. The effect size was estimated using a random effects model as risk ratio (RR) and mean difference (MD) and relative 95% confidence interval (CI).</p><p><strong>Results: </strong>A total of 13 studies (6 randomized controlled trials and 7 observational studies) involving 2888 patients (DCB n = 1334; DES n = 1533) with de novo LV-CAD were included in this meta-analysis following our inclusion criteria. No differences were observed between DCB and DES in terms of CVD (RR 0.49; 95% CI [0.23-1.03]; p = 0.06), MI (RR 0.48; 95% CI [0.16-1.45]; p = 0.89), TLR (RR 0.73; 95% CI [0.40-1.34]; p = 0.32), ACD (RR 0.78; 95% CI [0.57-1.07]; p = 0.12), and LLL (MD - 0.14; 95% CI [- 0.30 to 0.02]; p = 0.10) at follow-up. DES proved a higher mean acute gain versus DCB [1.94 (1.73, 2.14) vs 1.31 (1.02, 1.60); p = 0.0006].</p><p><strong>Conclusion: </strong>Our meta-analysis showed that DCB PCI might provide a promising option for the management of selected, de novo LV-CAD compared to DES. However, more focused RCTs are needed to further prove the benefits of a \"metal-free\" strategy in this subset of CAD.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"978-990"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory risk and clinical outcomes according to polyvascular atherosclerotic disease status in patients undergoing PCI.","authors":"Benjamin Bay, Birgit Vogel, Raman Sharma, Samantha Sartori, Pier Pasquale Leone, Mashal Nathani, Angelo Oliva, Kenneth F Smith, Amit Hooda, Joseph Sweeny, George Dangas, Annapoorna Kini, Prakash Krishnan, Samin K Sharma, Roxana Mehran","doi":"10.1007/s00392-024-02471-w","DOIUrl":"10.1007/s00392-024-02471-w","url":null,"abstract":"<p><strong>Background: </strong>Individuals suffering from polyvascular atherosclerotic disease (PolyVD) face a higher likelihood of adverse cardiovascular events. Additionally, inflammation, assessed by high-sensitivity C-reactive protein (hsCRP), affects residual risk following percutaneous coronary intervention (PCI). We aimed to explore the interplay between PolyVD and hsCRP in terms of clinical outcomes after PCI.</p><p><strong>Methods: </strong>Patients undergoing PCI for chronic coronary disease at a tertiary center between January 2012 and February 2020 were included for the current analysis. PolyVD was defined by additional history of cerebrovascular and/or peripheral artery disease. HsCRP levels were defined as elevated when the measured baseline concentration was > 3 mg/L. The primary outcome of interest was major adverse cardiovascular events (MACE), a composite of all-cause mortality, spontaneous MI, or target vessel revascularization.</p><p><strong>Results: </strong>Overall, 10,359 participants were included in the current study, with 17.4% affected by PolyVD and 82.6% included in the non-PolyVD subgroup. Patients with PolyVD had higher hsCRP levels than those without. Among the PolyVD group, a larger proportion (33.6%) exhibited elevated hsCRP compared to the non-PolyVD group (24.7%). Patients with both PolyVD and elevated hsCRP levels had significantly higher adverse event rates than all other subgroups at 1-year follow-up. Furthermore, an independent association between elevated hsCRP and MACE was observed within the PolyVD population, while this was not the case for individuals without PolyVD.</p><p><strong>Conclusion: </strong>A residual risk of adverse outcomes after PCI linked to inflammation appears to be present among individuals with PolyVD. This could help define further target populations for anti-inflammatory treatment options.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"969-977"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intentional coronary revascularization versus conservative therapy in patients after peripheral artery revascularization due to critical limb ischemia: the INCORPORATE trial.","authors":"Gabor G Toth, Marianne Brodmann, Sadeek S Kanoun Schnur, Stanislaw Bartus, Mislav Vrsalovic, Oleg Krestianinov, Petr Kala, Jacek Bil, Robert Gil, Jan Kanovsky, Luigi Di Serafino, Luca Paolucci, Emanuele Barbato, Fabio Mangiacapra, Zoltan Ruzsa","doi":"10.1007/s00392-024-02487-2","DOIUrl":"10.1007/s00392-024-02487-2","url":null,"abstract":"<p><strong>Objectives: </strong>INCORPORATE trial was designed to evaluate whether default coronary-angiography (CA) and ischemia-targeted revascularization is superior compared to a conservative approach for patients with treated critical limb ischemia (CLI). Registered at clinicaltrials.gov (NCT03712644) on October 19, 2018.</p><p><strong>Background: </strong>Severe peripheral artery disease is associated with increased cardiovascular risk and poor outcomes.</p><p><strong>Methods: </strong>INCORPORATE was an open-label, prospective 1:1 randomized multicentric trial that recruited patients who had undergone successful CLI treatment. Patients were randomized to either a conservative or invasive approach regarding potential coronary artery disease (CAD). The conservative group received optimal medical therapy alone, while the invasive group had routine CA and fractional flow reserve-guided revascularization. The primary endpoint was myocardial infarction (MI) and 12-month mortality.</p><p><strong>Results: </strong>Due to COVID-19 pandemic burdens, recruitment was halted prematurely. One hundred eighty-five patients were enrolled. Baseline cardiac symptoms were scarce with 92% being asymptomatic. Eighty-nine patients were randomized to the invasive approach of whom 73 underwent CA. Thirty-four percent had functional single-vessel disease, 26% had functional multi-vessel disease, and 90% achieved complete revascularization. Conservative and invasive groups had similar incidences of death and MI at 1 year (11% vs 10%; hazard ratio 1.21 [0.49-2.98]). Major adverse cardiac and cerebrovascular events (MACCE) trended for hazard in the Conservative group (20 vs 10%; hazard ratio 1.94 [0.90-4.19]). In the per-protocol analysis, the primary endpoint remained insignificantly different (11% vs 7%; hazard ratio 2.01 [0.72-5.57]), but the conservative approach had a higher MACCE risk (20% vs 7%; hazard ratio 2.88 [1.24-6.68]).</p><p><strong>Conclusion: </strong>This trial found no significant difference in the primary endpoint but observed a trend of higher MACCE in the conservative arm.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"991-999"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma chemokines indicate enhanced bleeding in patients with chronic coronary syndrome undergoing percutaneous coronary stenting.","authors":"Tobias Harm, Shqipdona Lahu, Katharina Mayer, Dominik Rath, Tobias Geisler, Karin Anne Lydia Müller, Marion Janisch, Kristin Adler, Götz Münch, Steffen Massberg, Adnan Kastrati, Meinrad Paul Gawaz","doi":"10.1007/s00392-025-02675-8","DOIUrl":"10.1007/s00392-025-02675-8","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronary artery disease (CAD) are at increased risk of developing ischemic events and contemporary antiplatelet therapy often leads to bleeding events following percutaneous coronary intervention (PCI). Glycoprotein VI (GPVI) is the key receptor of collagen-dependent thrombus formation and crucial for platelet homeostasis.</p><p><strong>Methods: </strong>We analysed the influence of GPVI inhibition with revacept in a randomized double-blinded trial enrolling 334 patients with CAD undergoing elective PCI. Ex vivo platelet function analyses were assessed alongside plasma chemokine concentrations. We then elucidate changes of GPVI-dependent chemokine concentrations in patients with bleeding events during the 30-day clinical follow-up.</p><p><strong>Results: </strong>Changes in platelet function occur in patients with revacept treatment and are associated with a characteristic alteration of circulating chemokine concentrations. Further, patients with adverse bleeding events share a distinct fingerprint of chemokines that is associated with modulation of in vitro platelet functions. In addition, assessment of GPVI-associated changes in chemokine signalling and platelet functions demonstrated an increased diagnostic value in patients with CAD and might improve early risk discrimination for bleeding events.</p><p><strong>Conclusion: </strong>The composition of platelet-derived chemokines correlated with platelet functions following antiplatelet treatment. Thus, assessment of chemokines may offer the perspective to identify patients at increased risk for bleeding events. Likewise, modulation of platelet chemokines in patients with revacept treatment contributes to the efficacy of antiplatelet treatment and might attenuate pathophysiological cascades leading to haemorrhagic diathesis in patients with CAD.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1071-1083"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New avenues for the assessment of stable ischemic heart disease.","authors":"Peter Ong, Johanna McChord, Valeria Martínez Pereyra, Udo Sechtem, Raffi Bekeredjian, Andreas Seitz","doi":"10.1007/s00392-024-02483-6","DOIUrl":"10.1007/s00392-024-02483-6","url":null,"abstract":"<p><p>Myocardial ischemia is a complex condition which may result from epicardial and/or microvascular causes involving functional and structural mechanisms. These mechanisms may overlap in a given patient illustrating the difficulties for appropriate management. Assessment of myocardial ischemia can be performed using noninvasive and invasive tools. However, despite living in the era of individualized precision medicine, these tools are not yet used in a broader fashion. Emerging noninvasive techniques such as quantitative perfusion cardiac magnetic resonance imaging (CMR) and stress perfusion computed tomography (CT) or photon-counting CT techniques may contribute to new standards in the assessment of stable angina patients. Invasive evaluation of myocardial ischemia should not only focus on hemodynamically relevant epicardial disease but also involve coronary vasomotor function testing (coronary spasm, coronary flow reserve, and microvascular resistance) where appropriate. Optimal patient management will depend on accurate and comprehensive diagnostic evaluation of myocardial ischemia and development of new treatment options in the future.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"945-951"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of complex PCI criteria in drug-coated balloon angioplasty.","authors":"Francesco Tartaglia, Mauro Gitto, Pier Pasquale Leone, Mauro Chiarito, Gianmaria Calamita, Gianluca Mincione, Gabriele Gasparini, Bernhard Reimers, Ottavia F Cozzi, Marco L Rossi, Giulio G Stefanini, Damiano Regazzoli, Antonio Mangieri, Antonio Colombo","doi":"10.1007/s00392-025-02664-x","DOIUrl":"10.1007/s00392-025-02664-x","url":null,"abstract":"<p><strong>Background: </strong>Procedural complexity during percutaneous coronary interventions (PCI) with drug-eluting stent (DES) has been associated with adverse events, especially in case of long and multiple stents implantation.</p><p><strong>Objective: </strong>This study aims to validate contemporary complex PCI criteria for drug coated balloon (DCB)-based PCI.</p><p><strong>Methods: </strong>Consecutive patients undergoing DCB angioplasty at 2 Italian centers from 2018 to 2023 were retrospectively enrolled. Complex DCB-PCI was defined as the presence of at least 1 of the 6 following features: 3 vessels treated; ≥ 3 lesions treated; ≥ 3 devices (DES or DCB) used; bifurcation treated with 2 devices; total device length (DES + DCB) > 60 mm; CTO as target lesion. The primary endpoint was the 2 year incidence of target lesion failure (TLF), a composite of target lesion revascularization (TLR), target vessel-myocardial infarction and cardiac death, at time-to-first event analysis.</p><p><strong>Results: </strong>A total of 1279 patients were included, of whom 642 (50.2%) met complex PCI criteria. The most frequently met criteria was \"total device length > 60 mm\" (71.6% in the complex PCI group). The proportion of in-stent restenosis (ISR) was 30.8% in the complex DCB-PCI group and 43.8% in the non-complex PCI group (p < 0.001). After adjusting for relevant clinical covariates and for the presence of ISR, patients undergoing complex PCI had a higher incidence of TLF at 2 years as compared to those undergoing non-complex PCI (16.7 vs. 11.4%; adj. hazard ratio 1.73, 95% confidence interval 1.16-2.59, p = 0.007). However, such difference was significant only in the ISR subgroup, while outcomes of complex and non-complex PCI for de novo lesions were similar.</p><p><strong>Conclusions: </strong>In a real-world cohort of patients undergoing DCB angioplasty, complex PCI criteria were frequently met and associated with higher risk of TLF. However, their prognostic impact was limited in patients with de novo coronary lesions treated with DCB.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1059-1070"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subtle echocardiographic markers of CAD: looking beyond the LV ejection fraction in stable angina patients.","authors":"Harshit Khare, Satyendra Tewari, Ankit Sahu, Prabhaker Mishra, Roopali Khanna, Sudeep Kumar, Naveen Garg, Aditya Kapoor","doi":"10.1007/s00392-024-02561-9","DOIUrl":"10.1007/s00392-024-02561-9","url":null,"abstract":"<p><strong>Background: </strong>A routine echocardiogram aims at identifying only regional wall motion abnormality (RWMA) or left ventricle diastolic dysfunction (LVDD) for coronary artery disease (CAD). When absent, a study is often labeled \"normal.\" This creates an unmet need to identify and add subtle markers of CAD to the routine echocardiogram to increase the diagnostic yield.</p><p><strong>Methods: </strong>Left ventricle (LV) systolic and diastolic parameters, along with left atrium (LA) strain parameters, were assessed using echocardiography in one hundred three patients of stable angina undergoing coronary angiography and compared with their SYNTAX score-II (SS-II).</p><p><strong>Results: </strong>The left ventricle global longitudinal strain (LV-GLS) and LA Volume indexed (LAVi) did not correlate significantly with the SS-II. The LA filling pressures reflected by the ratio of early mitral inflow velocity with early mitral annular velocity (E/e`), however, increased significantly with SS-II, with a cut-off value >10.39 for significant CAD (pvalue <0.001). The LA reservoir function parameters, peak atrial longitudinal strain (PALS), and peak global systolic strain rate (LAsSR) decreased significantly with increasing SS-II (p values of 0.011 and 0.001, respectively). The values < 23.56 for PALS and less than 1.15 for LAsSR, showed a significant association with CAD. The LA conduit function parameter, peak global early diastolic strain rate (LAeSR), also increased significantly with increasing SS-II (p-value <0.001), with values > 1.09 having a good correlation with CAD.</p><p><strong>Conclusion: </strong>Besides RWMA and LV-GLS, the LV diastolic and LA strain parameters can be potential echocardiographic markers for CAD in stable angina patients.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1019-1029"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes after complex and high-risk percutaneous coronary intervention according to baseline chronic kidney disease.","authors":"Francesca Maria Di Muro, Samantha Sartori, Birgit Vogel, Yihan Feng, Mauro Gitto, Angelo Oliva, Prakash Krishnan, Benjamin Bay, Joseph Sweeny, Pedro Moreno, Parasuram Krishnamoorthy, George Dangas, Annapoorna Kini, Samin Sharma, Roxana Mehran","doi":"10.1007/s00392-025-02618-3","DOIUrl":"10.1007/s00392-025-02618-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, its prognostic role in patients undergoing complex high-risk PCI (CHIP) remains unexplored, prompting our investigation.</p><p><strong>Methods: </strong>Consecutive CHIP patients treated at a tertiary care center from 2012 to 2022 were included in the current analysis. CHIP was identified by the presence of at least one patient and one procedural criterion from a validated score. Patients were stratified by CKD status, with CKD defined as eGFR < 60 ml/min/1.73m². The primary endpoint was one-year incidence of major adverse cardiovascular events (MACE), including all-cause mortality, spontaneous myocardial infarction (MI), and stroke. A multivariable Cox regression model was computed adjusted for relevant baseline risk factors and comorbidities.</p><p><strong>Results: </strong>Among 4855 CHIP patients, 39.6% (n = 1925) had CKD at baseline. CKD patients were older, with more comorbidities, and complex CAD. After multivariable adjustment, CKD was associated with increased 1-year risks of MACE (primarily driven by all-cause mortality and MI rates), and bleeding. In-hospital adjusted hazards for ischemic and bleeding events were similar between the two cohorts, while CA-AKI occurred twice as often in CKD patients compared to non-CKD ones.</p><p><strong>Conclusions: </strong>In CHIP patients, CKD is a strong predictor of ischemic and bleeding events at one-year follow-up and doubles the risk of post-procedural CA-AKI, underscoring the need for tailored risk assessment and management of this vulnerable population.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1049-1058"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}