JACC. Cardiovascular interventions最新文献

{"title":"Coronary Physiological Indexes to Evaluate Myocardial Ischemia in Patients With Aortic Stenosis Undergoing Valve Replacement.","authors":"Lennert Minten, Keir McCutcheon, Maarten Vanhaverbeke, Laurine Wouters, Stéphanie Bézy, Pierluigi Lesizza, Sander Jentjens, Pascal Frederiks, Tijs Bringmans, Jens-Uwe Voigt, Tom Adriaenssens, Walter Desmet, Peter Sinnaeve, Steven Jacobs, Peter Verbrugghe, Bart Meuris, Stefan Janssens, William F Fearon, Johan Bennett, Christophe Dubois","doi":"10.1016/j.jcin.2024.10.024","DOIUrl":"10.1016/j.jcin.2024.10.024","url":null,"abstract":"<p><strong>Background: </strong>The evaluation of myocardial ischemia in patients with aortic valve stenosis (AS) with concomitant coronary artery disease (CAD) and possible microvascular dysfunction (MVD) is challenging because fractional flow reserve (FFR) and the resting full-cycle ratio (RFR) have not been validated in this clinical setting.</p><p><strong>Objectives: </strong>The objectives of this study in patients with AS and CAD were: 1) to describe the relationship between hyperemic and resting indexes; 2) to investigate the acute and long-term effects of aortic valve replacement (AVR) on epicardial indexes and microvascular function; 3) to assess the impact of these changes on clinical decision making; and 4) to determine FFR/RFR ischemia cutoff points in AS.</p><p><strong>Methods: </strong>In this prospective multicentric study, we performed serial measurements of FFR and RFR and evaluated MVD by means of coronary flow reserve, the index of microvascular resistance, and microvascular resistance reserve in patients with severe AS and intermediate to severe CAD before and 6 months after AVR. Patients underwent myocardial perfusion single-photon emission computed tomography before AVR.</p><p><strong>Results: </strong>In total, 146 coronary lesions in 116 patients were included. Before AVR, we observed high FFR/RFR discordance according to standard cutoff values (FFR negative [>0.80]/RFR positive [≤0.89] in 42.3% [68/137] of these lesions). Acutely after AVR, FFR decreased significantly (-0.0120 ± 0.0192; P = 0.0045), whereas RFR remained stable (0.0140 ± 0.0673; P = 0.3089). Six months after AVR, FFR decreased (-0.0279 ± 0.0368), whereas RFR increased significantly (+0.0410 ± 0.0487) (P < 0.0001 for both), resulting in 21.5% (21/98) and 39.8% (39/98) of lesions crossing traditional FFR and RFR cutoff lines, respectively. Left ventricular mass decreased significantly (153.68 ± 44.22 g before vs 134.66 ± 37.26 g after; P < 0.0001). MVD was frequently observed at baseline (32.1% abnormal index of microvascular resistance and 68.6% abnormal microvascular resistance reserve) with all microvascular parameters improving after AVR. The most accurate cutoffs to predict ischemia were FFR ≤0.83 and RFR ≤0.85 with comparable accuracy (75%-80%).</p><p><strong>Conclusions: </strong>In patients with severe AS and CAD, FFR ≤0.83 and RFR ≤0.85 appear to predict myocardial ischemia more accurately. Six months after AVR, FFR decreases, whereas RFR increases significantly with a simultaneous decrease of left ventricular mass and an improvement of microvascular function.</p>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545512","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":"Bleeding After Transcatheter Structural Valve Interventions","authors":"Roxana Mehran MD ,&nbsp;Mauro Gitto MD","doi":"10.1016/j.jcin.2024.09.036","DOIUrl":"10.1016/j.jcin.2024.09.036","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 20","pages":"Pages 2350-2352"},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535112","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":"Toward Effective EVT for ALI","authors":"Osamu Iida MD, PhD,&nbsp;Yoshiharu Higuchi MD, PhD","doi":"10.1016/j.jcin.2024.09.037","DOIUrl":"10.1016/j.jcin.2024.09.037","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 20","pages":"Pages 2391-2393"},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535116","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":"Trends, Predictors, and Outcomes of Bleeding Complications After Mitral Transcatheter Edge-to-Edge Repair","authors":"Nickpreet Singh MD ,&nbsp;David J. Cohen MD, MSc ,&nbsp;Miloni A. Shah MPH, MSc ,&nbsp;Andrzej S. Kosinski PhD ,&nbsp;Leo Brothers MPH ,&nbsp;Sreekanth Vemulapalli MD ,&nbsp;Sammy Elmariah MD, MPH","doi":"10.1016/j.jcin.2024.09.035","DOIUrl":"10.1016/j.jcin.2024.09.035","url":null,"abstract":"<div><h3>Background</h3><div>Bleeding events after arterial transcatheter procedures are associated with increased morbidity and mortality. The frequency and clinical implications of bleeding after mitral transcatheter edge-to-edge repair (M-TEER) have not been well-studied.</div></div><div><h3>Objectives</h3><div>The authors sought to explore the association of in-hospital bleeding events after M-TEER with patient outcomes.</div></div><div><h3>Methods</h3><div>Patients undergoing M-TEER who were included in the TVT (Transcatheter Valve Therapy) Registry between 2013 and 2022 were included. Rates of the primary endpoint, the composite of death or hospital readmission at 30 days, were compared between patients who experienced in-hospital major or life-threatening bleeding vs those without bleeding. Secondary analyses examined the association between in-hospital bleeding and death or readmission at 1 year, as well as independent predictors of major in-hospital bleeding.</div></div><div><h3>Results</h3><div>Over the study period, in-hospital major bleeding occurred in 1,205 (2.3%) of 51,533 patients. Rates of bleeding decreased over time (from 7.1% in 2013 to 2.0% in 2021; <em>P</em> &lt; 0.001). In-hospital bleeding was associated with increased rates of death or readmission at both 30 days (adjusted OR: 2.15 [95% CI: 1.81-2.54]; <em>P</em> &lt; 0.0001) and 1 year (adjusted HR: 1.43 [95% CI: 1.27-1.60]; <em>P</em> &lt; 0.0001). The strongest correlates of in-hospital bleeding included female sex, prior percutaneous coronary intervention, baseline hemoglobin, greater procedure acuity, and longer procedure duration.</div></div><div><h3>Conclusions</h3><div>Bleeding after M-TEER is associated with increased risk of subsequent death and hospital readmission. Although reductions in bleeding complications over time are encouraging, continued efforts are needed to further mitigate hemorrhagic complications of M-TEER.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 20","pages":"Pages 2337-2349"},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535111","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 Severity and Extent of Iliofemoral Atherosclerosis on Clinical Outcomes in Patients Undergoing TAVR","authors":"Masaaki Nakase MD ,&nbsp;Daijiro Tomii MD ,&nbsp;Daryoush Samim MD ,&nbsp;Christoph Gräni MD ,&nbsp;Fabien Praz MD ,&nbsp;Jonas Lanz MD, MSc ,&nbsp;Stefan Stortecky MD, MPH ,&nbsp;David Reineke MD ,&nbsp;Stephan Windecker MD ,&nbsp;Thomas Pilgrim MD, MSc","doi":"10.1016/j.jcin.2024.07.009","DOIUrl":"10.1016/j.jcin.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Vascular complications remain a major concern in transfemoral transcatheter aortic valve replacement (TAVR). The Hostile score has been proposed to stratify risk in TAVR patients with peripheral artery disease.</div></div><div><h3>Objectives</h3><div>The authors aimed to assess the validity of the Hostile score in predicting iliofemoral vascular complications after TAVR.</div></div><div><h3>Methods</h3><div>In a prospective TAVR registry, we validated the Hostile score for the prediction of puncture and non–puncture site vascular complications. This scoring system integrates the extent (number of lesions, lesion length, and minimum lumen diameter) and complexity (tortuosity, calcification, and the presence of obstruction) of iliofemoral atherosclerosis.</div></div><div><h3>Results</h3><div>Of 2,023 patients who underwent transfemoral TAVR with contemporary devices between March 2014 and June 2022, 106 (5.2%) patients experienced puncture site vascular complications and 28 (1.4%) patients experienced non–puncture site vascular complications. The Hostile score was higher in patients with vascular complications than those without complications (1.00 [Q1-Q3: 0-5.00] vs 1.00 [Q1-Q3: 0-4.00]; <em>P</em> &lt; .001). A higher body mass index (OR: 1.23; 95% CI: 1.04-1.50) and the use of Prostar (OR: 6.03; 95% CI: 2.23-16.30) or MANTA (OR: 6.18; 95% CI: 2.67-14.27) compared with ProGlide were independent predictors of puncture site vascular complications, whereas a higher Hostile score (OR: 1.91; 95% CI: 1.55-2.35) and female sex (OR: 2.69; 95% CI: 1.12-6.42) were independent predictors of non–puncture site vascular complications. The area under the receiver-operating characteristic curves for the prediction of puncture site and non–puncture site vascular complications were 0.554 and 0.829, respectively.</div></div><div><h3>Conclusions</h3><div>The Hostile score proved useful in predicting non–puncture site vascular complications after TAVR. (SwissTAVI Registry; <span><span>NCT01368250</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 20","pages":"Pages 2353-2363"},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465741","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":"Antithrombotic Therapy in High Bleeding Risk, Part II","authors":"Mattia Galli MD, PhD ,&nbsp;Felice Gragnano MD, PhD ,&nbsp;Martina Berteotti MD, PhD ,&nbsp;Rossella Marcucci MD ,&nbsp;Giuseppe Gargiulo MD, PhD ,&nbsp;Paolo Calabrò MD, PhD ,&nbsp;Fabrizia Terracciano MD ,&nbsp;Felicita Andreotti MD, PhD ,&nbsp;Giuseppe Patti MD ,&nbsp;Raffaele De Caterina MD, PhD ,&nbsp;Davide Capodanno MD, PhD ,&nbsp;Marco Valgimigli MD, PhD ,&nbsp;Roxana Mehran MD ,&nbsp;Pasquale Perrone Filardi MD, PhD ,&nbsp;Plinio Cirillo MD, PhD ,&nbsp;Dominick J. Angiolillo MD, PhD ,&nbsp;Working Group of Thrombosis of the Italian Society of Cardiology","doi":"10.1016/j.jcin.2024.09.011","DOIUrl":"10.1016/j.jcin.2024.09.011","url":null,"abstract":"<div><div>Over the past decades, there have been great advancements in the antithrombotic management of patients undergoing percutaneous interventions, but most of the available evidence derives from studies conducted in the setting of cardiac interventions. Antithrombotic treatment regimens used in patients undergoing percutaneous cardiac interventions, in particular coronary, are frequently extrapolated to patients undergoing noncardiac interventions. However, the differences in risk profile of the population treated and the types of interventions performed may translate into differences is the safety and efficacy associated with antithrombotic therapy. Noncardiac percutaneous interventions are commonly performed in patients at high bleeding risk, which may indeed impact outcomes, hence underscoring the importance of risk stratification to guide clinical decision-making processes. In this review, we appraise the available evidence on antithrombotic therapy in high-bleeding-risk patients undergoing noncardiac percutaneous interventions.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 20","pages":"Pages 2325-2336"},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535110","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":"Improving Balloon Pulmonary Angioplasty Through Target Endpoint Optimization With Pressure Catheter and Angiographic Lung Perfusion","authors":"Taijyu Satoh MD, PhD ,&nbsp;Nobuhiro Yaoita MD, PhD ,&nbsp;Satoshi Higuchi MD, PhD ,&nbsp;Kotaro Nochioka MD, PhD ,&nbsp;Saori Yamamoto MD, PhD ,&nbsp;Haruka Sato MD, PhD ,&nbsp;Kaito Yamada MD ,&nbsp;Yusuke Yamada MD ,&nbsp;Kohei Komaru MD ,&nbsp;Naoki Chiba MD ,&nbsp;Mitsuru Nakada MHSc ,&nbsp;Satoshi Miyata MD, PhD ,&nbsp;Hideki Ota MD, PhD ,&nbsp;Kei Takase MD, PhD ,&nbsp;Satoshi Yasuda MD, PhD","doi":"10.1016/j.jcin.2024.08.045","DOIUrl":"10.1016/j.jcin.2024.08.045","url":null,"abstract":"<div><h3>Background</h3><div>Balloon pulmonary angioplasty (BPA) has exhibited substantial progress in the management of chronic thromboembolic pulmonary hypertension (CTEPH). However, nearly one-half of the patients with CTEPH experience persistent pulmonary hypertension after undergoing BPA, emphasizing the need for enhanced therapies.</div></div><div><h3>Objectives</h3><div>The authors sought to investigate the clinical significance of functional assessment-guided dilation of the pulmonary artery (PA) in patients with CTEPH undergoing BPA treatment.</div></div><div><h3>Methods</h3><div>The prospective single-center cohort study enrolled 95 patients who underwent 278 consecutive BPA sessions. Lung parenchymal perfusion was assessed via 2-dimensional perfusion angiography, and pressure catheter measurements were taken to determine the PA pressure ratios. The correlation between lung perfusion and the pressure ratio was analyzed to establish an optimal target pressure ratio. Patients were stratified into 2 groups, a pressure-guided group (n = 28) and an angiographic group (n = 63), to evaluate whether optimizing the pressure ratio led to improvements in residual PH and complications.</div></div><div><h3>Results</h3><div>The pressure ratio and lung perfusion measurements of 141 PA lesions were analyzed. A piecewise linear regression model identified a target pressure ratio of 0.7, associated with significant enhancement in lung perfusion. The pressure-guided strategy achieved a higher rate of mean pulmonary artery pressure &lt;25 mm Hg (92.8% [26/28 patients] vs 60.3% [38/63 patients]; <em>P</em> = 0.001) and a concurrent reduction in BPA relevant complications (3.9% [4/101 sessions] vs 12.9% [23/177 sessions]; <em>P</em> = 0.019).</div></div><div><h3>Conclusions</h3><div>Functional assessment-guided PA dilation with a target pressure ratio of 0.7 proved beneficial in BPA treatment for patients with CTEPH. This approach improved the residual PH and reduced complications, highlighting its potential to enhance CTEPH management outcomes.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 20","pages":"Pages 2394-2407"},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535632","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":"Knuckle Guidewires to Create Dissections in Chronic Total Occlusion Percutaneous Coronary Intervention","authors":"Stéphane Rinfret MD, SM ,&nbsp;Glen A. Henry MD ,&nbsp;Jaikirshan J. Khatri MD ,&nbsp;Kambis Mashayekhi MD, PhD ,&nbsp;Khaldoon Alaswad MD ,&nbsp;Lorenzo Azzalini MD, PhD, MSc ,&nbsp;Luiz F. Ybarra MD, PhD, MBA ,&nbsp;Ram Vijayaraghavan MD ,&nbsp;Jarrod D. Frizzell MD ,&nbsp;Alexandre Avran MD ,&nbsp;Margaret B. McEntegart MD ,&nbsp;William L. Lombardi MD ,&nbsp;J. Aaron Grantham MD ,&nbsp;Emmanouil Brilakis MD","doi":"10.1016/j.jcin.2024.09.066","DOIUrl":"10.1016/j.jcin.2024.09.066","url":null,"abstract":"<div><div>Dissection and re-entry techniques are essential to achieve safe and effective chronic total occlusion recanalization. Several studies have demonstrated similar outcomes following extraplaque stenting compared with intraplaque stenting. Dissection techniques most often involve the use of knuckled wires to progress within and beyond the chronic total occlusion segment. In this expert consensus document, the authors compare the properties of different polymer-jacketed wires for their use in dissection techniques. The authors also describe 2 principal knuckle wire behaviors, the rolling and the traveling knuckles. Finally, several adjunctive techniques for safer dissection are described.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 20","pages":"Pages 2411-2424"},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535634","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":"Transcatheter Heart Valves Devices for Native Aortic Valve Regurgitation: Time for a Change?","authors":"Tanja K Rudolph","doi":"10.1016/j.jcin.2024.09.038","DOIUrl":"https://doi.org/10.1016/j.jcin.2024.09.038","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":" ","pages":""},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682011","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":"The Hostile Score","authors":"Tullio Palmerini MD","doi":"10.1016/j.jcin.2024.07.025","DOIUrl":"10.1016/j.jcin.2024.07.025","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 20","pages":"Pages 2364-2366"},"PeriodicalIF":11.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465744","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}