EurointerventionPub Date : 2024-11-04DOI: 10.4244/EIJ-D-23-00868
Bruno Scheller, Norman Mangner, Raban V Jeger, Samuel Afan, Felix Mahfoud, Felix J Woitek, Gregor Fahrni, Carsten Schwenke, Beatrix Schnorr, Franz Kleber
{"title":"A randomised trial of sirolimus- versus paclitaxel-coated balloons for de novo coronary lesions.","authors":"Bruno Scheller, Norman Mangner, Raban V Jeger, Samuel Afan, Felix Mahfoud, Felix J Woitek, Gregor Fahrni, Carsten Schwenke, Beatrix Schnorr, Franz Kleber","doi":"10.4244/EIJ-D-23-00868","DOIUrl":"10.4244/EIJ-D-23-00868","url":null,"abstract":"<p><strong>Background: </strong>Paclitaxel-coated balloons (PCB) are a viable alternative to drug-eluting stents in the treatment of de novo coronary lesions. Whether sirolimus represents an alternative to paclitaxel for drug-coated balloons remains elusive.</p><p><strong>Aims: </strong>This randomised, controlled, multicentre, non-inferiority trial investigated a novel sirolimus-coated balloon (SCB) with a crystalline coating versus a PCB in de novo coronary lesions.</p><p><strong>Methods: </strong>To compare a novel SCB with a clinically proven PCB, 70 patients with de novo coronary lesions were enrolled at 4 centres in Germany and Switzerland. The primary endpoint was non-inferiority regarding angiographic late lumen loss (LLL) at 6 months, with a predefined margin of δ=0.35 mm. Secondary endpoints included procedural success, major adverse cardiac events, and individual clinical endpoints.</p><p><strong>Results: </strong>Quantitative coronary angiography revealed no differences in baseline parameters. At 6 months, in-segment LLL was 0.04±0.39 mm in the PCB group versus 0.11±0.37 mm in the SCB group (non-significant), respectively. The mean difference between SCB and PCB was 0.07 mm (95% confidence interval: -0.12 to 0.26). Non-inferiority at the predefined margin of 0.35 was shown. Clinical event rates up to 12 months were not different between the groups (3 target lesion revascularisations in the PCB group versus 2 in the SCB group, no myocardial infarctions, no deaths).</p><p><strong>Conclusions: </strong>The novel SCB showed similar angiographic outcomes in the treatment of de novo coronary disease as compared with a clinically proven PCB (ClinicalTrials.gov: NCT03908450).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 21","pages":"e1322-e1329"},"PeriodicalIF":7.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568639","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}
EurointerventionPub Date : 2024-11-04DOI: 10.4244/EIJ-D-24-00491
Ovidio De Filippo, Wojciech Wańha, Tiziana Sanavia, Rafal Januszek, Federico Giacobbe, Gianluca Campo, Tineke H Pinxterhuis, Davide Capodanno, Brunon Tomasiewicz, Mario Iannaccone, Attilio Leone, Rafał Wolny, Francesco Bruno, Giuseppe Patti, Giuseppe Musumeci, Gaetano Liccardo, Roberto Verardi, Sergio Raposeiras Roubin, Giuseppe Tarantini, Łukasz Kuźma, Leor Perl, Andrea Gagnor, Krzysztof Reczuch, Federico Conrotto, Domenico Tuttolomondo, Eline H Ploumen, Piotr Niezgoda, Serena Caglioni, Pierluigi Omedè, Antonio Greco, Jacek Kubica, Robert J Gil, Raffaele Piccolo, Ran Kornowski, Jacek Bil, Arianna Morena, Paolo Zocca, Mauro Pennone, Mariusz Gąsior, Miłosz Jaguszewski, Clemens von Birgelen, Piero Fariselli, Gaetano M De Ferrari, Wojciech Wojakowski, Fabrizio D'Ascenzo
{"title":"Treatment of in-stent restenosis with ultrathin-strut versus thin-strut drug-eluting stents or drug-eluting balloons: a multicentre registry.","authors":"Ovidio De Filippo, Wojciech Wańha, Tiziana Sanavia, Rafal Januszek, Federico Giacobbe, Gianluca Campo, Tineke H Pinxterhuis, Davide Capodanno, Brunon Tomasiewicz, Mario Iannaccone, Attilio Leone, Rafał Wolny, Francesco Bruno, Giuseppe Patti, Giuseppe Musumeci, Gaetano Liccardo, Roberto Verardi, Sergio Raposeiras Roubin, Giuseppe Tarantini, Łukasz Kuźma, Leor Perl, Andrea Gagnor, Krzysztof Reczuch, Federico Conrotto, Domenico Tuttolomondo, Eline H Ploumen, Piotr Niezgoda, Serena Caglioni, Pierluigi Omedè, Antonio Greco, Jacek Kubica, Robert J Gil, Raffaele Piccolo, Ran Kornowski, Jacek Bil, Arianna Morena, Paolo Zocca, Mauro Pennone, Mariusz Gąsior, Miłosz Jaguszewski, Clemens von Birgelen, Piero Fariselli, Gaetano M De Ferrari, Wojciech Wojakowski, Fabrizio D'Ascenzo","doi":"10.4244/EIJ-D-24-00491","DOIUrl":"10.4244/EIJ-D-24-00491","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on ultrathin-strut drug-eluting stent (ultrathin DES) performance in DES in-stent restenosis (ISR).</p><p><strong>Aims: </strong>We aimed to assess the efficacy and safety of ultrathin DES compared to thin-strut DES and drug-eluting balloons (DEB) for DES-ISR.</p><p><strong>Methods: </strong>Patients from the DEB Dragon (ClinicalTrials.gov: NCT04415216) and ULTRA registries (ClinicalTrials.gov: NCT05205148) were divided into ultrathin DES, thin-strut DES, or DEB groups for DES-ISR treatment. Both propensity score matching (PSM) and inverse probability weighting (IPW) were considered to adjust the distribution of patients in each class. Cox regression was applied to the following main endpoints: device-oriented composite endpoints (DOCE; including cardiac death, target lesion revascularisation [TLR] and target vessel myocardial infarction), TLR and target vessel revascularisation (TVR).</p><p><strong>Results: </strong>A total of 269, 541, and 557 patients received an ultrathin DES, thin-strut DES, and DEB, respectively. After 3 years of follow-up, in the IPW-adjusted overall cohort, ultrathin DES were associated with a significantly reduced risk of DOCE compared to DEBs (hazard ratio [HR] 0.353, 95% confidence interval [CI]: 0.194-0.642; p<0.001), as well as thin-strut DES (HR 0.645, 95% CI: 0.457-0.911; p=0.013). Compared to DEBs, ultrathin DES also reduced the risks of both TLR (HR 0.184, 95% CI: 0.081-0.417; p<0.001) and TVR (HR 0.188, 95% CI: 0.093-0.379; p<0.001), while thin-strut DES did not (TLR: HR 0.686, 95% CI: 0.407-1.157; p=0.157; TVR: HR 0.706, 95% CI: 0.453-1.101; p=0.124). For diffuse ISR patients, ultrathin DES reduced the risk of DOCE (HR 0.364, 95% CI: 0.188-0.705; p=0.003), as did thin-strut DES (HR 0.602, 95% CI: 0.367-0.987; p=0.044), while a reduction of TLR (HR 0.220, 95% CI: 0.091-0.531; p<0.001) and TVR (HR 0.241, 95% CI: 0.113-0.513; p<0.001) was achieved only by ultrathin DES.</p><p><strong>Conclusions: </strong>Ultrathin DES were associated with reduced DOCE, TLR and TVR risks in diffuse ISR compared to DEBs.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 21","pages":"e1340-e1354"},"PeriodicalIF":7.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569878","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}
EurointerventionPub Date : 2024-10-21DOI: 10.4244/EIJ-D-24-00203
Zuzana Motovska, Ota Hlinomaz, Jan Mrozek, Petr Kala, Tobias Geisler, Milan Hromadka, Ibrahim Akin, Jan Precek, Jiri Kettner, Pavel Cervinka, Gilles Montalescot, Jiri Jarkovsky, Jan Belohlavek, Josef Bis, Jan Matejka, Alexandra Vodzinska, Tamilla Muzafarova, Pavol Tomasov, Alexander Schee, Stanislav Bartus, Andrea Andrasova, Christoph B Olivier, Ales Kovarik, Petr Ostadal, Regina Demlova, Lenka Souckova, Ivan Vulev, Zdeněk Coufal, Janusz Kochman, Iuri Marinov, Jacek Kubica, Gregory Ducrocq, Michal Karpisek, Zdenek Klimsa, Martin Hudec, Petr Widimsky, Deepak L Bhatt, Dapt-Shockami Study Group
{"title":"Cangrelor versus crushed ticagrelor in patients with acute myocardial infarction and cardiogenic shock: rationale and design of the randomised, double-blind DAPT-SHOCK-AMI trial.","authors":"Zuzana Motovska, Ota Hlinomaz, Jan Mrozek, Petr Kala, Tobias Geisler, Milan Hromadka, Ibrahim Akin, Jan Precek, Jiri Kettner, Pavel Cervinka, Gilles Montalescot, Jiri Jarkovsky, Jan Belohlavek, Josef Bis, Jan Matejka, Alexandra Vodzinska, Tamilla Muzafarova, Pavol Tomasov, Alexander Schee, Stanislav Bartus, Andrea Andrasova, Christoph B Olivier, Ales Kovarik, Petr Ostadal, Regina Demlova, Lenka Souckova, Ivan Vulev, Zdeněk Coufal, Janusz Kochman, Iuri Marinov, Jacek Kubica, Gregory Ducrocq, Michal Karpisek, Zdenek Klimsa, Martin Hudec, Petr Widimsky, Deepak L Bhatt, Dapt-Shockami Study Group","doi":"10.4244/EIJ-D-24-00203","DOIUrl":"10.4244/EIJ-D-24-00203","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is a devastating and fatal complication of acute myocardial infarction (AMI). CS can affect the pharmacokinetics and pharmacodynamics of medications. The unique properties of cangrelor make it the optimal P2Y12 inhibitor for CS-AMI, in terms of both efficacy and safety. The DAPT-SHOCK-AMI trial (ClinicalTrials.gov: NCT03551964; EudraCT: 2018-002161-19) will assess the benefits of cangrelor in patients with an initial CS-AMI undergoing primary angioplasty. This randomised, multicentre, placebo-controlled trial of approximately 550 patients (with an allowed 10% increase) in 5 countries using a double-blind design will compare initial P2Y12 inhibitor treatment strategies in patients with CS-AMI of (A) intravenous cangrelor and (B) ticagrelor administered as crushed tablets at a loading dose of 180 mg. The primary clinical endpoint is a composite of all-cause death, myocardial infarction (MI), or stroke within 30 days. The main secondary endpoints are (1) the net clinical endpoint, defined as death, MI, urgent revascularisation of the infarct-related artery, stroke, or major bleeding as defined by the Bleeding Academic Research Consortium criteria; (2) cardiovascular-related death, MI, urgent revascularisation, or heart failure; (3) heart failure; and (4) cardiovascular-related death, all (1-4) within 1 year after study enrolment. A platelet reactivity study that tests the laboratory antiplatelet benefits of cangrelor, when given in addition to standard antiplatelet therapy, will be conducted using vasodilator-stimulated phosphoprotein phosphorylation. The primary laboratory endpoints are the periprocedural rate of onset and the proportion of patients who achieve effective P2Y12 inhibition. The DAPT-SHOCK-AMI study is the first randomised trial to evaluate the benefits of cangrelor in patients with CS-AMI.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1309-e1318"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480991","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}
EurointerventionPub Date : 2024-10-21DOI: 10.4244/EIJ-E-24-00046
John A Bittl
{"title":"Phoenix rising: a credible signal for CABG from ISCHEMIA?","authors":"John A Bittl","doi":"10.4244/EIJ-E-24-00046","DOIUrl":"10.4244/EIJ-E-24-00046","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1260-e1261"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480995","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}
EurointerventionPub Date : 2024-10-21DOI: 10.4244/EIJ-D-24-00245
Laura Besola, Alessandro Fiocco, Nicola Nencioni, Martina Dini, Giacomo Ravenni, Danilo Ruggiero, Michele Celiento, Andrea Colli
{"title":"Transcatheter vacuum-assisted aspiration of large intracardiac and intravascular masses.","authors":"Laura Besola, Alessandro Fiocco, Nicola Nencioni, Martina Dini, Giacomo Ravenni, Danilo Ruggiero, Michele Celiento, Andrea Colli","doi":"10.4244/EIJ-D-24-00245","DOIUrl":"10.4244/EIJ-D-24-00245","url":null,"abstract":"<p><p>Intravascular and intracardiac masses are usually represented by thrombi, tumours, and vegetations. They can affect both the right and left chambers of the heart and the venous and arterial circulation. Traditionally, their treatment is surgical or, in some circumstances, based on systemic anticoagulation/fibrinolysis. However, the complexity and frailty of patients who sometimes present with these conditions have pushed surgeons to find alternative minimally invasive effective treatments. While small masses can be removed with multiple devices, large masses are a more challenging problem. Vacuum-assisted aspiration systems such as the AngioVac System were developed to treat intravenous and right-sided heart thrombi. The application of the AngioVac System was widened to right-sided endocarditis and, later, to left-sided thrombi and vegetations. This review summarises the clinical results of different uses of the vacuum-assisted aspiration system to treat intravenous and intracardiac masses.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1267-e1275"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480997","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}
EurointerventionPub Date : 2024-10-21DOI: 10.4244/EIJ-D-24-00240
Sripal Bangalore, Grace Rhodes, David J Maron, Rebecca Anthopolos, Sean M O'Brien, Philip G Jones, Daniel B Mark, Harmony R Reynolds, John A Spertus, Gregg W Stone, Harvey D White, Yifan Xu, Stephen E Fremes, Judith S Hochman, On Behalf Of The Ischemia Research Group
{"title":"Outcomes with revascularisation versus conservative management of participants with 3-vessel coronary artery disease in the ISCHEMIA trial.","authors":"Sripal Bangalore, Grace Rhodes, David J Maron, Rebecca Anthopolos, Sean M O'Brien, Philip G Jones, Daniel B Mark, Harmony R Reynolds, John A Spertus, Gregg W Stone, Harvey D White, Yifan Xu, Stephen E Fremes, Judith S Hochman, On Behalf Of The Ischemia Research Group","doi":"10.4244/EIJ-D-24-00240","DOIUrl":"10.4244/EIJ-D-24-00240","url":null,"abstract":"<p><strong>Background: </strong>Whether revascularisation (REV) improves outcomes in patients with three-vessel coronary artery disease (3V-CAD) is uncertain.</p><p><strong>Aims: </strong>Our objective was to evaluate outcomes with REV (percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]) versus medical therapy in patients with 3V-CAD.</p><p><strong>Methods: </strong>ISCHEMIA participants with 3V-CAD on coronary computed tomography angiography without prior CABG were included. Outcomes following initial invasive management (INV) with REV (PCI or CABG) versus initial conservative management (CON) with medical therapy alone were evaluated. Regression modelling was used to estimate the outcomes if all participants were to undergo prompt REV versus those assigned to CON. Outcomes were cardiovascular (CV) death/myocardial infarction (MI), death, CV death, and quality of life. Bayesian posterior probability for benefit (Pr [benefit]) for 1 percentage point lower 4-year rates with REV versus CON were evaluated.</p><p><strong>Results: </strong>Among 1,236 participants with 3V-CAD (612 INV/624 CON), REV was associated with lower 4-year CV death/MI (adjusted 4-year difference: -4.4, 95% credible interval [CrI] -8.7 to -0.3 percentage points, Pr [benefit]=94.8%) when compared with CON, with similar results for PCI versus CON (-5.8, 95% CrI: -10.8 to -0.5 percentage points, Pr [benefit]=96.4%) and CABG versus CON (-3.7, 95% CrI: -8.8 to 1.5 percentage points, Pr [benefit]=84.7%). Adjusted 4-year REV versus CON differences were as follows: death -1.2 (95% CrI: -4.7 to 2.2) percentage points, CV death -2.3 (95% CrI: -5.5 to 0.8) percentage points, with similar results for PCI and for CABG. The Pr (benefit) for death with REV (PCI or CABG) versus CON was 49-63%. The adjusted 12-month Seattle Angina Questionnaire-7 summary score differences favoured REV: REV versus CON 4.6 (95% CrI: 2.7-6.4) percentage points; PCI versus CON 3.6 (95% CrI: 1.2-5.8) percentage points and CABG versus CON 4.3 (95% CrI: 1.5-6.9) percentage points with high Pr (benefit).</p><p><strong>Conclusions: </strong>In participants with 3V-CAD, REV (either PCI or CABG) was associated with a lower 4-year CV death/MI rate and improved quality of life, with similar results for PCI versus CON and CABG versus CON. The differences in all-cause mortality between REV and CON were small with wide confidence intervals. (ClinicalTrials.gov: NCT01471522).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1276-e1287"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480994","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}
EurointerventionPub Date : 2024-10-21DOI: 10.4244/EIJ-D-24-00336
Tingwen Weng, Daixin Ding, Guanyu Li, Shaofeng Guan, Wenzheng Han, Qian Gan, Ming Li, Lin Qi, Cheng Li, Yang Chen, Liang Zhang, Tianqi Li, Xifeng Chang, Yankai Chen, William Wijns, Xinkai Qu, Shengxian Tu
{"title":"Accuracy of coronary computed tomography angiography-derived quantitative flow ratio for onsite assessment of coronary lesions.","authors":"Tingwen Weng, Daixin Ding, Guanyu Li, Shaofeng Guan, Wenzheng Han, Qian Gan, Ming Li, Lin Qi, Cheng Li, Yang Chen, Liang Zhang, Tianqi Li, Xifeng Chang, Yankai Chen, William Wijns, Xinkai Qu, Shengxian Tu","doi":"10.4244/EIJ-D-24-00336","DOIUrl":"10.4244/EIJ-D-24-00336","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA)-derived Murray law-based quantitative flow ratio (CT-μFR) is a novel non-invasive method for fast computation of fractional flow reserve (FFR) from CCTA images, yet its diagnostic performance remains to be prospectively validated.</p><p><strong>Aims: </strong>We aimed to evaluate the diagnostic performance of onsite CT-μFR in patients with coronary artery disease.</p><p><strong>Methods: </strong>This prospective, single-centre trial enrolled patients with ≥1 lesion with 30-90% diameter stenosis on CCTA and planned invasive coronary angiography (ICA) within 30 days. CT-μFR, ICA-derived μFR and FFR were evaluated separately in a blinded fashion. The primary endpoint was the diagnostic accuracy of CT-μFR in identifying patients with haemodynamically significant coronary stenosis defined by the invasive standard: FFR ≤0.80, or μFR ≤0.80 when FFR was not available.</p><p><strong>Results: </strong>Between December 2020 and August 2023, 260 patients were consecutively enrolled. Paired comparison between CT-μFR and the invasive standard was obtained in 706 vessels from 260 patients. The patient-level accuracy of CT-μFR was 89.6% (95% confidence interval [CI]: 85.9-93.4%), which was significantly higher than the prespecified target of 72.0% (p<0.001). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for CT-μFR were 93.1%, 86.1%, 87.1%, 92.5%, 6.7, and 0.1, respectively. Out of the 231 vessels investigated by FFR, the accuracy of CT-μFR in vessels without extensive calcification was non-inferior to that of μFR (90.6% vs 88.9%; difference=1.8% [95% CI: -2.8 to 5.5%]; p for non-inferiority<0.001).</p><p><strong>Conclusions: </strong>The study met its prespecified primary endpoint of the diagnostic accuracy of CT-μFR in identifying patients with haemodynamically significant coronary stenosis. CT-μFR was non-inferior to ICA-derived μFR in vessels without extensive calcification. (ClinicalTrials.gov: NCT04665817).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1288-e1297"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480990","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}
EurointerventionPub Date : 2024-10-21DOI: 10.4244/EIJ-D-24-00413
João Silva-Marques, Catarina Oliveira
{"title":"The invisible gorilla in the cath lab: can we fly away from it?","authors":"João Silva-Marques, Catarina Oliveira","doi":"10.4244/EIJ-D-24-00413","DOIUrl":"10.4244/EIJ-D-24-00413","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1264-e1266"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480996","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}
EurointerventionPub Date : 2024-10-21DOI: 10.4244/EIJ-D-24-00297
Joanna Bartkowiak, Mohammad Kassar, Salomon J Brülisauer, Laura Bubulyte, Daryoush Samim, Andrea Ruberti, Raouf Madhkour, Lutz Büllesfeld, Stephan Windecker, Thomas Pilgrim, Nicolas Brugger, Fabien Praz
{"title":"Findings from transoesophageal echocardiographic follow-up after mitral transcatheter edge-to-edge repair.","authors":"Joanna Bartkowiak, Mohammad Kassar, Salomon J Brülisauer, Laura Bubulyte, Daryoush Samim, Andrea Ruberti, Raouf Madhkour, Lutz Büllesfeld, Stephan Windecker, Thomas Pilgrim, Nicolas Brugger, Fabien Praz","doi":"10.4244/EIJ-D-24-00297","DOIUrl":"10.4244/EIJ-D-24-00297","url":null,"abstract":"<p><strong>Background: </strong>Transoesophageal echocardiography (TOE) provides accurate evaluation of mitral valve (MV) function following mitral transcatheter edge-to-edge repair (M-TEER) and may better detect complications in case of suboptimal result.</p><p><strong>Aims: </strong>We aimed to evaluate midterm anatomical changes and structural complications after M-TEER using TOE and investigate their association with clinical outcomes at 2 years.</p><p><strong>Methods: </strong>A follow-up TOE at 6 months was systematically recommended to all patients included in our institutional prospective M-TEER registry until December 2021. We assessed changes in the incidence of mitral regurgitation (MR), MV stenosis (≥5 mmHg), and partial or complete single leaflet device attachment (SLDA) between the index procedure and follow-up and evaluated MV area and annular dimensions in a subset of patients with available three-dimensional (3D) datasets. The clinical endpoint was a composite of mortality and heart failure (HF) rehospitalisation at 2 years.</p><p><strong>Results: </strong>Among the 373 patients included in the registry between February 2012 and December 2021, 128 patients (34%) underwent elective TOE at 6 months. Using TOE, severe MR was observed in 13.3% (n=17) of the patients. The number of patients with an elevated MV gradient increased from 17 (13.3%) after the procedure to 23 (18%) at 6 months, and a new partial or complete SLDA was detected in 7.8% (n=10). Based on 3D TOE measurements, significant increases in MV area, annular area, annular perimeter, and intercommissural (but not anteroposterior) diameter were observed compared to intraprocedural images. A mean MV gradient ≥5 mmHg (hazard ratio [HR] 2.30, 95% confidence interval [CI]: 1.10-4.81; p=0.023) and the presence of severe MR at 6 months (HR 3.26, 95% CI: 1.18-8.99; p=0.023) were associated with the primary endpoint, which was met in 34 (26.6%) patients at 2 years.</p><p><strong>Conclusions: </strong>TOE follow-up allowed the detection of complications that would not be diagnosed using transthoracic echocardiography only and should therefore be used liberally in the patients presenting with a suboptimal result. A mean MV gradient ≥5 mmHg and severe MR, diagnosed at the 6-month TOE follow-up, were associated with adverse clinical outcomes.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1298-e1308"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480992","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}
EurointerventionPub Date : 2024-10-21DOI: 10.4244/EIJ-E-24-00047
Jörg Hausleiter, Lukas Stolz
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