Eurointervention最新文献

{"title":"Coronary flow and resistance patterns indexed by subtended myocardial mass in coronary microvascular dysfunction.","authors":"Thabo Mahendiran, Nikolaos Stalikas, Emanuele Gallinoro, Danielle Keulards, Koshiro Sakai, Frederic Bouisset, Michele Mattia Viscusi, Sara Corradetti, Jeroen Sonck, Marcel van 't Veer, Adriaan Wilgenhof, Nico H J Pijls, Carlos Collet, Bernard De Bruyne","doi":"10.4244/EIJ-D-25-00229","DOIUrl":"10.4244/EIJ-D-25-00229","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronary microvascular dysfunction (CMD) exhibit impaired vasodilatation of the microcirculation. This manifests as reduced microvascular resistance reserve (MRR) due to either increased resting flow (Q_rest; functional CMD) or decreased hyperaemic flow (Q_hyper; structural CMD). However, coronary flow is intimately linked to myocardial mass, potentially confounding the interpretation of flow and resistance measurements.</p><p><strong>Aims: </strong>We investigated the relationship between subtended myocardial mass, microvascular resistance, and coronary flow to determine whether the disturbed resistance and flow patterns seen in CMD persisted after indexing by subtended myocardial mass.</p><p><strong>Methods: </strong>We recruited 100 patients with angina with non-obstructive coronary arteries who underwent coronary computed tomography angiography to quantify vessel-specific subtended myocardial mass. Continuous intracoronary thermodilution was used to quantify absolute coronary flow and microvascular resistance, both at rest and during hyperaemia. Among patients with an MRR <3.0, hyperaemic microvascular resistance (R_μ,hyper) ≥475 Wood units (WU) defined structural CMD (versus functional CMD). Flow and resistance measurements were analysed both in absolute terms and after indexing by subtended mass.</p><p><strong>Results: </strong>Mass and flow were analysed in 100 patients in the left anterior descending artery. The mean subtended myocardial mass in the structural CMD group (47.00±13.83 grams) was significantly lower than in the control group (59.64±21.69 grams; p=0.027), with no significant difference between the control group and the functional CMD group (53.75±13.99 grams; p=0.339). After indexing by the subtended mass, patients with structural CMD still had higher R_μ,hyper (control: 20.68±7.99 WUâ¢kg vs structural CMD: 30.58±11.63 WUâ¢kg; p<0.001) and lower Q_hyper (control: 4.56±2.20 ml/min/g vs structural CMD: 3.20±0.90 ml/min/g; p=0.013). Conversely, patients with functional CMD exhibited similar indexed values of R_μ,hyperand Q_hyper to controls.</p><p><strong>Conclusions: </strong>Despite significantly lower subtended mass, patients with structural CMD exhibit abnormal indexed R_μ,hyper and Q_hyper, supporting the notion of hyperaemic flow restriction at the tissue level that is independent of subtended mass. However, patients with functional CMD have similar subtended myocardial mass to controls and exhibit no flow restriction during hyperaemia.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 16","pages":"921-932"},"PeriodicalIF":9.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876860","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":"Does a positive bubble study after PFO closure matter: is it much ado about nothing or an indication for reintervention?","authors":"Eric Horlick, Lusine Abrahamyan","doi":"10.4244/EIJ-E-25-00025","DOIUrl":"10.4244/EIJ-E-25-00025","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 16","pages":"892-893"},"PeriodicalIF":9.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876861","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":"Letter: Complex PCI in severe aortic stenosis: high risk, low reward?","authors":"Nikolaos Ktenopoulos, Anastasios Apostolos, Konstantinos Toutouzas","doi":"10.4244/EIJ-D-25-00472","DOIUrl":"10.4244/EIJ-D-25-00472","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 16","pages":"985-986"},"PeriodicalIF":9.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876864","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":"Prevalence, classification, and treatment of residual shunt after patent foramen ovale closure.","authors":"Kristian Ujka, Alessandra Pizzuto, Mario Giordano, Francesca Maria Di Muro, Gianpiero Gaio, Maria Giovanna Russo, Berardo Sarubbi, Francesco Meucci, Giuseppe Santoro","doi":"10.4244/EIJ-D-24-00856","DOIUrl":"10.4244/EIJ-D-24-00856","url":null,"abstract":"<p><strong>Background: </strong>Residual shunt (RS) after transcatheter patent foramen ovale (PFO) closure has been associated with an increased risk of recurrent stroke over long-term follow-up. However, RS prevalence, anatomical characteristics, and treatment strategies are poorly understood.</p><p><strong>Aims: </strong>This study aimed to assess the prevalence and causes of RS, as well as to evaluate the safety and feasibility of its percutaneous treatment.</p><p><strong>Methods: </strong>Patients with RS at transcranial Doppler after transcatheter PFO closure in three Italian high-volume centres between 2000 and 2022 were included. The prevalence and anatomical characteristics of RS, its relationship with the original occluding device, and the procedural details of percutaneous treatment were assessed.</p><p><strong>Results: </strong>Among the 2,362 patients who underwent PFO closure, any grade and significant RS were diagnosed in 8.8% and 3.6% of patients, respectively. It was more frequently found after use of the NobleStitch system than after double-disc device implantation (20.0% vs 8.5%; p<0.00001). Among double-disc device implantations, a higher rate of shunt was found with stiffer devices (9.8% vs 7.1%; p<0.05) and with devices larger than 25 mm (13.9% vs 6.6%; p<0.00001). Intradiscal RS (type 1) was most common (43.6%), followed by extradiscal RS (type 2; 35.1%) and RS due to unusual causes (type 3; 14.9%). Percutaneous treatment was successful in 89.4% of patients using different, anatomically tailored devices.</p><p><strong>Conclusions: </strong>RS is commonly found after transcatheter PFO closure and is significantly associated with the type and size of the occluding device implanted. It results from different mechanisms and can be safely and effectively treated by a percutaneous, patient-tailored approach in a high percentage of cases.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 16","pages":"933-941"},"PeriodicalIF":9.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876865","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":"Transcatheter aortic valve implantation in pure aortic regurgitation: one-year outcomes of the AURORA trial.","authors":"Fei-Cheng Yu, Xiao-Ping Peng, Jing Yao, Yun-Feng Yan, Silvia Corona, Bo Fu, Sheng Wang, Hai-Ping Wang, Xi-Jin Zhuang, Zheng-Ming Jiang, Yue-Wu Zhao, Yi-Da Tang, Ji-Zhe Xu, Chuan-Bao Li, Hui Chen, Ke Han, Hui Huang, Liang Guo, Walid Ben Ali, Thomas Modine, Hasan Jilaihawi, Nicolo Piazza, Guang-Yuan Song","doi":"10.4244/EIJ-D-25-00224","DOIUrl":"10.4244/EIJ-D-25-00224","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve implantation (TAVI) in pure aortic regurgitation (AR) remains challenging because of inadequate anchoring forces. Traditional approaches, which rely solely on virtual annulus oversizing, have demonstrated limited success. We propose a novel anatomical classification system and dual-anchoring theory to optimise the TAVI strategy in patients with pure AR.</p><p><strong>Aims: </strong>We aimed to evaluate the efficacy and safety of TAVI in pure AR using a novel anatomical classification system and dual-anchoring theory.</p><p><strong>Methods: </strong>The AURORA trial is a prospective, multicentre, single-arm study conducted across 16 centres in China. Patients with severe pure AR underwent comprehensive anatomical assessment using multidetector computed tomography (CT). Based on the ability to provide adequate anchoring forces (≥10% of oversizing) in three zones (left ventricular outflow tract, anatomical annulus, and ascending aorta), patients were classified into 4 types. Those with anatomical types 1-3 were enrolled and underwent TAVI using the VitaFlow valve system. The primary efficacy endpoint was device success, and the primary safety endpoints included 30-day mortality and major complications.</p><p><strong>Results: </strong>Among 187 screened patients, 100 patients with suitable anatomy (types 1-3) were enrolled. The mean age was 72.7±7.2 years, and the mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 9.10±5.81%. Device success was achieved in 91% of cases, with no procedural mortality. The new permanent pacemaker implantation rate was 9%. Postprocedural CT analysis in 43 patients revealed that the maximum contact forces were primarily localised between the virtual annulus and the sinotubular junction (83.7% of cases). No device failure occurred in later cases.</p><p><strong>Conclusions: </strong>The AURORA classification system shows that comprehensive anatomical assessment can lead to favourable outcomes in pure AR using conventional TAVI devices. The low pacemaker implantation rate and the absence of device failure in later cases suggest that optimal anatomical matching may be superior to aggressive oversizing strategies.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 16","pages":"952-960"},"PeriodicalIF":9.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876869","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":"Long-term predictors of target vessel failure after intracoronary lithotripsy: 12-month results from the France LILI registry.","authors":"Benjamin Honton, Hakim Benamer, Benoit Lattuca, Thibault Lhermusier, Nicolas Amabile, Frederic Marco, Janusz Lipiecki, Ashok Tirouvanziam, Julien Jeanneteau, Eric Van Belle, Alexandre Canville, Grégoire Rangé, Matthieu Périer, Jacques Monsegu, Thomas Cuisset, Géraud Souteyrand, Gonzalo Quaino, Marine Quillot, Gael Bouchou, Fabrice Leroy, Christophe Saint Etienne, Sebastien Levesque, Antoine Gommeaux, Antoine Gerbay, Benjamin Seguy, Benjamin Fialon, Julien Adjedj, Louis-Marie Desroche, Luc Maillard, Nicolas Lhoest, Olivier Darremont, Martine Gilard, Edouardo Aptecar, Pascal Motreff, Vincent Bataille, Philippe Commeau, Guillaume Cayla","doi":"10.4244/EIJ-D-24-00902","DOIUrl":"10.4244/EIJ-D-24-00902","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 15","pages":"e882-e885"},"PeriodicalIF":9.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800941","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":"Management of device embolisation during left atrial appendage closure.","authors":"Joelle Kefer, Ole De Backer, Adel Aminian, Xavier Freixa, Sergio Berti, Ignacio Cruz-Gonzalez, Lorenz Räber, Nina Wunderlich, Philippe Garot, Jens Erik Nielsen-Kudsk, On Behalf Of The European Left Atrial Appendage Closure Club Elaacc","doi":"10.4244/EIJ-D-24-00812","DOIUrl":"10.4244/EIJ-D-24-00812","url":null,"abstract":"<p><p>Percutaneous left atrial appendage closure (LAAC) is increasingly used as a valuable intervention to prevent cardioembolic stroke among patients with atrial fibrillation who are poor candidates for long-term anticoagulation. The safety of the procedure has significantly improved over time; nevertheless, device embolisation remains a severe complication that still occurs in around 0.1% of cases. Its management must be rapid and effective in order to reduce mortality. The anatomical location of the embolised device dictates the technical approach for retrieval and has a major impact on the clinical outcome of patients. Percutaneous recapture is the main approach in case of an aortic or left atrial embolisation, while emergent surgery should be performed if the device becomes entangled in the mitral apparatus with poor haemodynamics unsolved by transcatheter device mobilisation into the left ventricular (LV) cavity. In cases of LV embolisation and stable haemodynamics, a transfemoral or transseptal retrieval may be attempted. The equipment for retrieval is key to success: all cath labs performing LAAC procedures should be equipped with minimum 16 Fr sheaths, steerable sheaths, single-loop snares and grasping tool devices. This paper includes a summary of the European Left Atrial Appendage Closure Club consensus recommendations for LAAC device embolisation management.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 15","pages":"e838-e846"},"PeriodicalIF":9.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800942","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":"Prognostic significance of mitral annular calcification assessed by computed tomography for transcatheter edge-to-edge repair outcomes.","authors":"Takashi Nagasaka, Vivek Patel, Kazuki Suruga, Yuchao Guo, Ofir Koren, Alon Shechter, Dhairya Patel, Tracy Salseth, Tarun Chakravarty, Aakriti Gupta, Hideki Ishii, Hasan Jilaihawi, Moody Makar, Mamoo Nakamura, Raj R Makkar","doi":"10.4244/EIJ-D-24-01115","DOIUrl":"10.4244/EIJ-D-24-01115","url":null,"abstract":"<p><strong>Background: </strong>Mitral annular calcification (MAC) presents challenges for transcatheter edge-to-edge repair (TEER). Limited data exist on how the anatomical features of MAC, assessed by computed tomography (CT), may be associated with TEER outcomes.</p><p><strong>Aims: </strong>We sought to examine the association between CT features of MAC and clinical outcomes after TEER at 3 years.</p><p><strong>Methods: </strong>This retrospective observational study included patients who underwent TEER and preprocedural CT. Patients were classified into no/mild MAC and moderate/severe MAC groups. Classification was determined by scoring calcium thickness, distribution, trigone involvement, and leaflet calcification. The primary outcome was all-cause mortality 3 years after TEER.</p><p><strong>Results: </strong>Among 391 patients who underwent pre-TEER cardiac CT, 318 (81.3%) had no/mild MAC, and 73 (18.7%) had moderate/severe MAC. At 3 years, all-cause mortality was comparable between the groups (17.6% vs 24.7 %; p=0.17), whereas patients with no/mild MAC had a significantly better New York Heart Association Class than those with moderate/severe MAC (p=0.029). Calcium thickness >5 mm and leaflet involvement were significant predictors of all-cause mortality at 3 years (odds ratio [OR] 2.38, 95% confidence interval [CI]: 1.08-5.25; p=0.032; OR 6.71, 95% CI: 3.28-13.7; p<0.001); patients exhibiting both of these indicators had a significantly higher incidence of all-cause mortality compared to those with calcium thickness ≤5 mm and no leaflet calcification.</p><p><strong>Conclusions: </strong>Overall, all-cause mortality did not significantly differ between patients with varied MAC severity. However, greater calcium thickness and leaflet involvement were associated with worse clinical outcomes in patients undergoing TEER. Detailed preoperative CT evaluation can facilitate the prediction and management of TEER outcomes.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 15","pages":"e847-e857"},"PeriodicalIF":9.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800943","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":"Expanding the boundaries of M-TEER: is it time to treat moderate secondary mitral regurgitation?","authors":"Marianna Adamo, Mauro Riccardi","doi":"10.4244/EIJ-E-25-00030","DOIUrl":"10.4244/EIJ-E-25-00030","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 15","pages":"e830-e831"},"PeriodicalIF":9.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800940","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":"Balloon-assisted translocation of the anterior mitral leaflet to facilitate native mitral replacement.","authors":"Vlasis Ninios, Georgios E Papadopoulos, Ilias Ninios","doi":"10.4244/EIJ-D-24-01083","DOIUrl":"10.4244/EIJ-D-24-01083","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 15","pages":"e886-e887"},"PeriodicalIF":9.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800937","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}