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Andreini D, Belmonte M, Penicka M, Van Hoe L, Mileva N, Paolisso P, Nagumo S, Nørgaard BL, Ko B, Otake H, Koo BK, Jensen JM, Mizukami T, Munhoz D, Updegrove A, Taylor C, Leipsic J, Sonck J, De Bruyne B, Collet C. Impact of coronary CT image quality on the accuracy of the FFR CT Planner. Eur Radiol 2024; 34:2677-2688. [PMID: 37798406 DOI: 10.1007/s00330-023-10228-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/03/2023] [Accepted: 07/30/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To assess the accuracy of a virtual stenting tool based on coronary CT angiography (CCTA) and fractional flow reserve (FFR) derived from CCTA (FFRCT Planner) across different levels of image quality. MATERIALS AND METHODS Prospective, multicenter, single-arm study of patients with chronic coronary syndromes and lesions with FFR ≤ 0.80. All patients underwent CCTA performed with recent-generation scanners. CCTA image quality was adjudicated using the four-point Likert scale at a per-vessel level by an independent committee blinded to the FFRCT Planner. Patient- and technical-related factors that could affect the FFRCT Planner accuracy were evaluated. The FFRCT Planner was applied mirroring percutaneous coronary intervention (PCI) to determine the agreement with invasively measured post-PCI FFR. RESULTS Overall, 120 patients (123 vessels) were included. Invasive post-PCI FFR was 0.88 ± 0.06 and Planner FFRCT was 0.86 ± 0.06 (mean difference 0.02 FFR units, the lower limit of agreement (LLA) - 0.12, upper limit of agreement (ULA) 0.15). CCTA image quality was assessed as excellent (Likert score 4) in 48.3%, good (Likert score 3) in 45%, and sufficient (Likert score 2) in 6.7% of patients. The FFRCT Planner was accurate across different levels of image quality with a mean difference between FFRCT Planner and invasive post-PCI FFR of 0.02 ± 0.07 in Likert score 4, 0.02 ± 0.07 in Likert score 3 and 0.03 ± 0.08 in Likert score 2, p = 0.695. Nitrate dose ≥ 0.8mg was the only independent factor associated with the accuracy of the FFRCT Planner (95%CI - 0.06 to - 0.001, p = 0.040). CONCLUSION The FFRCT Planner was accurate in predicting post-PCI FFR independent of CCTA image quality. CLINICAL RELEVANCE STATEMENT Being accurate in predicting post-PCI FFR across a wide spectrum of CT image quality, the FFRCT Planner could potentially enhance and guide the invasive treatment. Adequate vasodilation during CT acquisition is relevant to improve the accuracy of the FFRCT Planner. KEY POINTS • The fractional flow reserve derived from coronary CT angiography (FFRCT) Planner is a novel tool able to accurately predict fractional flow reserve after percutaneous coronary intervention. • The accuracy of the FFRCT Planner was confirmed across a wide spectrum of CT image quality. Nitrates dose at CT acquisition was the only independent predictor of its accuracy. • The FFRCT Planner could potentially enhance and guide the invasive treatment.
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Affiliation(s)
- Daniele Andreini
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant'Ambrogio Hospital, IRCCS, Via Cristina Belgioioso 173, 20157, Milan, Italy.
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Medical University of Sofia, Sofia, Bulgaria
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | | | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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2
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Mileva N, Ohashi H, Paolisso P, Leipsic J, Mizukami T, Sonck J, Norgaard BL, Otake H, Ko B, Maeng M, Munhoz D, Nagumo S, Belmonte M, Vassilev D, Andreini D, Barbato E, Koo BK, De Bruyne B, Collet C. Relationship between coronary volume, myocardial mass, and post-PCI fractional flow reserve. Catheter Cardiovasc Interv 2023; 101:1182-1192. [PMID: 37102381 DOI: 10.1002/ccd.30664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) measured after percutaneous coronary intervention (PCI) carries prognostic information. Yet, myocardial mass subtended by a stenosis influences FFR. We hypothesized that a smaller coronary lumen volume and a large myocardial mass might be associated with lower post-PCI FFR. AIM We sought to assess the relationship between vessel volume, myocardial mass, and post-PCI FFR. METHODS This was a subanalysis with an international prospective study of patients with significant lesions (FFR ≤ 0.80) undergoing PCI. Territory-specific myocardial mass was calculated from coronary computed tomography angiography (CCTA) using the Voronoi's algorithm. Vessel volume was extracted from quantitative CCTA analysis. Resting full-cycle ratio (RFR) and FFR were measured before and after PCI. We assessed the association between coronary lumen volume (V) and its related myocardial mass (M), and the percent of total myocardial mass (%M) with post-PCI FFR. RESULTS We studied 120 patients (123 vessels: 94 left anterior descending arteries, 13 left Circumflex arteries, 16 right coronary arteries). Mean vessel-specific mass was 61 ± 23.1 g (%M 39.6 ± 11.7%). The mean post-PCI FFR was 0.88 ± 0.06 FFR units. Post-PCI FFR values were lower in vessels subtending higher mass (0.87 ± 0.05 vs. 0.89 ± 0.07, p = 0.047), and with lower V/M ratio (0.87 ± 0.06 vs. 0.89 ± 0.07, p = 0.02). V/M ratio correlated significantly with post-PCI RFR and FFR (RFR r = 0.37, 95% CI: 0.21-0.52, p < 0.001 and FFR r = 0.41, 95% CI: 0.26-0.55, p < 0.001). CONCLUSION Post-PCI RFR and FFR are associated with the subtended myocardial mass and the coronary volume to mass ratio. Vessels with higher mass and lower V/M ratio have lower post-PCI RFR and FFR.
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Affiliation(s)
- Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Cardiology Clinic, Alexandrovska University Hospital, Sofia, Bulgaria
| | - Hirofumi Ohashi
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Jonathon Leipsic
- The Centre for Cardiovascular Innovation, UBC, Vancouver, Canada
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Clinical Pharmacology, Showa University, Tokyo, Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Bjarne L Norgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hiromasa Otake
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
- Department of Internal Medicine, Discipline of Cardiology, University of Campinas, Campinas, Brazil
| | - Sakura Nagumo
- Department of Internal Medicine, Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
- Department of Cardiology, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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3
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Fabbricatore D, Buytaert D, Valeriano C, Mileva N, Paolisso P, Nagumo S, Munhoz D, Collet C, De Potter T. Ambulatory pulmonary vein isolation workflow using the Perclose ProglideTM suture-mediated vascular closure device: the PRO-PVI study. Europace 2023; 25:1361-1368. [PMID: 36793243 PMCID: PMC10105833 DOI: 10.1093/europace/euad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/11/2023] [Indexed: 02/17/2023] Open
Abstract
AIMS The leading reason for delayed discharge after pulmonary vein isolation (PVI) is vascular complications. This study aimed to evaluate feasibility, safety, and efficacy of the Perclose Proglide™ suture-mediated vascular closure in ambulatory PVI, report complications, patient satisfaction, and cost of this approach. METHODS AND RESULTS Patients scheduled for PVI were enrolled prospectively in an observational design. Feasibility was assessed as % discharged the day of procedure. Efficacy was analysed as acute access site closure rate, time to reach haemostasis, time to ambulate, and time to discharge. Safety analysis consisted of vascular complications at 30 days. Cost analysis was reported using direct and indirect cost analysis. A 1:1 propensity matched control cohort was used for comparing time to discharge to usual workflow. Of 50 enrolled patients, 96% were discharged on the same day. 100% of devices were successfully deployed. Immediate (<1 min) haemostasis was reached in 30 patients (62.5%). Mean time to discharge was 5:48 ± 1:03 h (vs. 10:16 ± 1:21 h in the matched cohort, P < 0.0001). Patients reported high level of satisfaction with the post-operative time. No major vascular complication occurred. Cost analysis showed a neutral impact compared to the standard of care. CONCLUSION The use of the closure device for femoral venous access after PVI led to safe discharge of patients within 6 h from the intervention in 96% of the population. This approach could minimize the overcrowding of healthcare facilities. The gain in post-operative recovery time improved patients' satisfaction and balanced the economic cost of the device.
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Affiliation(s)
- Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, corso Umberto I, 40, 80138 Napoli NA, Italy
| | - Dimitri Buytaert
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Chiara Valeriano
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, corso Umberto I, 40, 80138 Napoli NA, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, corso Umberto I, 40, 80138 Napoli NA, Italy
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Cardiology, Showa University Fujigaoka Hospital, 1 Chome-30 Fujigaoka, Aoba Ward, Yokohama, Kanagawa 227-0043, Japan
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, corso Umberto I, 40, 80138 Napoli NA, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Tom De Potter
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
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Vandeloo B, Andreini D, Brouwers S, Mizukami T, Monizzi G, Lochy S, Mileva N, Argacha JF, De Boulle M, Muyldermans P, Belmonte M, Sonck J, Gallinoro E, Munhoz D, Roosens B, Trabattoni D, Galli S, Seki R, Penicka M, Wyffels E, Mushtaq S, Nagumo S, Pardaens S, Barbato E, Bartorelli AL, De Bruyne B, Cosyns B, Collet C. Diagnostic performance of exercise stress tests for detection of epicardial and microvascular coronary artery disease: the UZ Clear study. EUROINTERVENTION 2023; 18:e1090-e1098. [PMID: 36147027 PMCID: PMC9909457 DOI: 10.4244/eij-d-22-00270] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/02/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cardiac stress tests remain the cornerstone for evaluating patients suspected of having obstructive coronary artery disease (CAD). Coronary microvascular dysfunction (CMD) can lead to abnormal non-invasive tests. AIMS We sought to assess the diagnostic performance of exercise stress tests with indexes of epicardial and microvascular resistance as reference. METHODS This was a prospective, single-arm, multicentre study of patients with an intermediate pretest probability of CAD and positive exercise stress tests who were referred for invasive angiography. Patients underwent an invasive diagnostic procedure (IDP) with measurement of fractional flow reserve (FFR) and index of microvascular resistance (IMR) in at least one coronary vessel. Obstructive CAD was defined as diameter stenosis (DS) >50% by quantitative coronary angiography (QCA). The objective was to determine the false discovery rate (FDR) of cardiac exercise stress tests with both FFR and IMR as references. RESULTS One hundred and seven patients (137 vessels) were studied. The mean age was 62.1±8.7, and 27.1% were female. The mean diameter stenosis was 37.2±27.5%, FFR was 0.84±0.10, coronary flow reserve was 2.74±2.07, and IMR 20.3±11.9. Obstructive CAD was present in 39.3%, whereas CMD was detected in 20.6%. The FDR was 60.7% and 62.6% with QCA and FFR as references (p-value=0.803). The combination of FFR and IMR as clinical reference reduced the FDR by 25% compared to QCA (45.8% vs 60.7%; p-value=0.006). CONCLUSIONS In patients with evidence of ischaemia, an invasive functional assessment accounting for the epicardial and microvascular compartments led to an improvement in the diagnostic performance of exercise tests, driven by a significant FDR reduction.
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Affiliation(s)
- Bert Vandeloo
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
| | | | - Stijn Lochy
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Medical Faculty, Medical University Sofia, Sofia, Bulgaria
| | - Jean-François Argacha
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Matthias De Boulle
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Philip Muyldermans
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Marta Belmonte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences University Federico II, Naples, Italy
- Department of Internal Medicine, Discipline of Cardiology, University of Campinas (Unicamp), Campinas, Brazil
| | - Bram Roosens
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | | | | | - Ruiko Seki
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences University Federico II, Naples, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Cosyns
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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5
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Deguchi T, Sato M, Kohyama N, Fujita K, Nagumo S, Suzuki H, Ebato M, Kogo M. Development of a model predicting cardiac events in heart failure patients with decreased renal function: a retrospective study. Int J Clin Pharm 2023; 45:210-219. [PMID: 36414822 DOI: 10.1007/s11096-022-01502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inappropriate and multiple medications affect the prognosis of patients with acute decompensated heart failure (ADHF). However, in ADHF patients with decreased renal function, there have been no reports on prognostic factors, including medication data, or models for predicting cardiac events. AIM To develop a model including medication data to predict cardiac events in ADHF patients with decreased renal function. METHOD This retrospective cohort study included 443 first-time admitted ADHF patients with decreased renal function (estimated glomerular filtration rate < 60 mL/min/1.73 m2 at discharge) in the Showa University Fujigaoka Hospital. The primary outcome was cardiac events within one year after discharge, defined as the composite of HF readmission, HF mortality, and cardiovascular mortality. The model for predicting cardiac events was developed using predictive factors extracted by multivariable analysis. The cardiac events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test. RESULTS The incidence of cardiac events within one year after discharge was 20.1%. By multivariable analysis, we observed that atrial fibrillation, weight loss < 5%, brain natriuretic peptide ≥ 200 pg/mL, polypharmacy, and beta-blockers use below target dosage were significantly associated with an increased risk of cardiac events. The developed model, the cardiac events rate in the high-risk group was significantly higher than in the low-risk group (41.0 vs. 9.2%, p < 0.001). CONCLUSION The developed model for predicting cardiac events will be useful in decision-making to support appropriate early management of ADHF patients with decreased renal function.
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Affiliation(s)
- Tomokazu Deguchi
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan. .,Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Miki Sato
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Noriko Kohyama
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Kanako Fujita
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan.,Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mari Kogo
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
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Iso Y, Kitai H, Ichimori K, Kubota M, Tsujiuchi M, Nagumo S, Toshida T, Yonechi T, Ebato M, Suzuki H. Cardiac Structure and Cardiorespiratory Fitness in Young Male Japanese Rugby Athletes. J Cardiovasc Dev Dis 2023; 10:jcdd10010012. [PMID: 36661907 PMCID: PMC9861008 DOI: 10.3390/jcdd10010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Limited data are available on athlete's heart for rugby athletes. This study aimed to investigate cardiac structure and its relationship with cardiorespiratory fitness in young Japanese rugby athletes. A prospective cross-sectional study using echocardiography and cardiopulmonary exercise testing (CPET) was conducted on 114 male collegiate rugby players. There was a higher prevalence of increased left ventricular (LV), atrial, and aortic dimensions in the young athletes than that in previously published reports, whereas the wall thickness was within the normal range. Anthropometry and CPET analyses indicated that the forwards and backs presented muscular and endurance phenotypes, respectively. Indexed LV and aortic dimensions were significantly larger in the backs than in the forwards, and the dimensions significantly correlated with oxygen uptake measured by CPET. On the four-tiered classification for LV hypertrophy, abnormal LV geometry was found in 16% of the athletes. Notably, the resting systolic blood pressure was significantly higher in athletes with concentric abnormal geometry than in the other geometry groups, regardless of their field positions. Japanese young athletes may exhibit unique phenotypes of cardiac remodeling in association with their fitness characteristics. The four-tiered LV geometry classification potentially offers information regarding the subclinical cardiovascular risks of young athletes.
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Affiliation(s)
- Yoshitaka Iso
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama 227-8518, Japan
- Correspondence: ; Tel.: +81-45-971-1151
| | - Hitomi Kitai
- Department of Clinical Pathology and Laboratory, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Department of Physical Therapy, Showa University School of Nursing and Rehabilitation Sciences, Yokohama 226-8555, Japan
| | - Keiko Ichimori
- Department of Clinical Pathology and Laboratory, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
| | - Megumi Kubota
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama 227-8518, Japan
| | - Miki Tsujiuchi
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama 227-8518, Japan
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama 227-8518, Japan
| | - Tsutomu Toshida
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
| | - Toru Yonechi
- Faculty of Sport Science, Nippon Sport Science University, Yokohama 227-0033, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
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7
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Mizukami T, Sonck J, Sakai K, Ko B, Maeng M, Otake H, Koo B, Nagumo S, Nørgaard BL, Leipsic J, Shinke T, Munhoz D, Mileva N, Belmonte M, Ohashi H, Barbato E, Johnson NP, De Bruyne B, Collet C. Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease. J Am Heart Assoc 2022; 11:e026960. [PMID: 36444858 PMCID: PMC9851458 DOI: 10.1161/jaha.122.026960] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Coronary artery disease (CAD) patterns play an essential role in the decision-making process about revascularization. The pullback pressure gradient (PPG) quantifies CAD patterns as either focal or diffuse based on fractional flow reserve (FFR) pullbacks. The objective of this study was to evaluate the impact of CAD patterns on acute percutaneous coronary intervention (PCI) results considered surrogates of clinical outcomes. Methods and Results This was a prospective, multicenter study of patients with hemodynamically significant CAD undergoing PCI. Motorized FFR pullbacks and optical coherence tomography (OCT) were performed before and after PCI. Post-PCI FFR >0.90 was considered an optimal result. Focal disease was defined as PPG >0.73 (highest PPG tertile). Overall, 113 patients (116 vessels) were included. Patients with focal disease were younger than those with diffuse CAD (61.4±9.9 versus 65.1±8.7 years, P=0.042). PCI in vessels with high PPG (focal CAD) resulted in higher post-PCI FFR (0.91±0.07 in the focal group versus 0.86±0.05 in the diffuse group, P<0.001) and larger minimal stent area (6.3±2.3 mm2 in focal versus 5.3±1.8 mm2 in diffuse CAD, P=0.015) compared withvessels with low PPG (diffuse CAD). The PPG was associated with the change in FFR after PCI (R2=0.51, P<0.001). The PPG significantly improved the capacity to predict optimal PCI results compared with an angiographic assessment of CAD patterns (area under the curvePPG 0.81 [95% CI, 0.73-0.88] versus area under the curveangio 0.51 [95% CI, 0.42-0.60]; P<0.001). Conclusions PCI in vessels with focal disease defined by the PPG resulted in greater improvement in epicardial conductance and larger minimal stent area compared with diffuse disease. PPG, but not angiographically defined CAD patterns, distinguished patients attaining superior procedural outcomes. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03782688.
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Affiliation(s)
- Takuya Mizukami
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Department of Clinical PharmacologyShowa UniversityTokyoJapan
| | - Jeroen Sonck
- Cardiovascular Center AalstOLV ClinicAalstBelgium
| | - Koshiro Sakai
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Division of Cardiology, Department of MedicineShowa University School of MedicineTokyoJapan
| | - Brian Ko
- Monash Cardiovascular Research CentreMonash University and Monash Heart, Monash HealthClaytonVictoriaAustralia
| | - Michael Maeng
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular CenterSeoul National University HospitalSeoulKorea
| | - Sakura Nagumo
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Division of Cardiology, Department of Internal MedicineShowa University Fujigaoka HospitalYokohamaJapan
| | | | - Jonathon Leipsic
- Department of Medicine and RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Toshiro Shinke
- Division of Cardiology, Department of MedicineShowa University School of MedicineTokyoJapan
| | - Daniel Munhoz
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Department of Internal Medicine, Discipline of CardiologyUniversity of Campinas (Unicamp)CampinasBrazil,Department of Advanced Biomedical SciencesUniversity of Naples, Federico IINaplesItaly
| | - Niya Mileva
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Cardiology Clinic Alexandrovska University HospitalSofiaBulgaria
| | - Marta Belmonte
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Department of CardiologyUniversity of MilanMilanItaly
| | - Hirofumi Ohashi
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Department of CardiologyAichi Medical UniversityNagakuteJapan
| | - Emanuele Barbato
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Department of Advanced Biomedical SciencesUniversity of Naples, Federico IINaplesItaly
| | - Nils P. Johnson
- Division of Cardiology, Department of Medicine, Weatherhead PET CenterMcGovern Medical School at UTHealth and Memorial Hermann HospitalHoustonTX
| | - Bernard De Bruyne
- Cardiovascular Center AalstOLV ClinicAalstBelgium,Department of CardiologyLausanne University Center HospitalLausanneSwitzerland
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8
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Ohashi H, Mileva N, Paolisso P, Leipsic J, Mizukami T, Sonck J, Norgaard B, Otake H, Ko B, Maeng M, Sakai K, Munhoz D, Nagumo S, Belmonte M, Vassilev D, Barbato E, Koo BK, De Bruyne B, Collet C. TCT-273 Relationship Between Coronary Volume, Myocardial Mass and Post-PCI Fractional Flow Reserve. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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9
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Mileva N, Nagumo S, Mizukami T, Sonck J, Berry C, Gallinoro E, Monizzi G, Candreva A, Munhoz D, Vassilev D, Penicka M, Barbato E, De Bruyne B, Collet C. Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e023207. [PMID: 35301851 PMCID: PMC9075440 DOI: 10.1161/jaha.121.023207] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background A relevant proportion of patients with suspected coronary artery disease undergo invasive coronary angiography showing normal or nonobstructive coronary arteries. However, the prevalence of coronary microvascular disease (CMD) and coronary spasm in patients with nonobstructive coronary artery disease remains to be determined. The objective of this study was to determine the prevalence of coronary CMD and coronary vasospastic angina in patients with no obstructive coronary artery disease. Methods and Results A systematic review and meta‐analysis of studies assessing the prevalence of CMD and vasospastic angina in patients with no obstructive coronary artery disease was performed. Random‐effects models were used to determine the prevalence of these 2 disease entities. Fifty‐six studies comprising 14 427 patients were included. The pooled prevalence of CMD was 0.41 (95% CI, 0.36–0.47), epicardial vasospasm 0.40 (95% CI, 0.34–0.46) and microvascular spasm 24% (95% CI, 0.21–0.28). The prevalence of combined CMD and vasospastic angina was 0.23 (95% CI, 0.17–0.31). Female patients had a higher risk of presenting with CMD compared with male patients (risk ratio, 1.45 [95% CI, 1.11–1.90]). CMD prevalence was similar when assessed using noninvasive or invasive diagnostic methods. Conclusions In patients with no obstructive coronary artery disease, approximately half of the cases were reported to have CMD and/or coronary spasm. CMD was more prevalent among female patients. Greater awareness among physicians of ischemia with no obstructive coronary arteries is urgently needed for accurate diagnosis and patient‐tailored management.
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Affiliation(s)
- Niya Mileva
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Cardiology Clinic Alexandrovska University Hospital Sofia Bulgaria
| | - Sakura Nagumo
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Division of Cardiology Department of Internal Medicine Showa UniversityFujigaoka Hospital Kanagawa Japan
| | - Takuya Mizukami
- Division of Cardiology Department of Internal Medicine Showa UniversityFujigaoka Hospital Kanagawa Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples, Federico II Naples Italy
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Translational Medical Sciences University of Campania "Luigi Vanvitelli" Naples Italy
| | | | | | - Daniel Munhoz
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Clinical Medicine Discipline of Cardiology University of Campinas UNICAMP Campinas Brazil.,Department of Advanced Biomedical Sciences University of Naples, Federico II Naples Italy
| | - Dobrin Vassilev
- Cardiology Clinic Alexandrovska University Hospital Sofia Bulgaria
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples, Federico II Naples Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Cardiology Lausanne University Hospital Lausanne Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium
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10
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Sonck J, Mizukami T, Johnson NP, Nagumo S, Gallinoro E, Candreva A, Mileva N, Munhoz D, Shinke T, Svanerud J, Barbato E, De Bruyne B, Collet C. Development, validation, and reproducibility of the pullback pressure gradient (PPG) derived from manual fractional flow reserve pullbacks. Catheter Cardiovasc Interv 2022; 99:1518-1525. [PMID: 35233906 DOI: 10.1002/ccd.30064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022]
Abstract
Fractional flow reserve (FFR) pullbacks assess the location and magnitude of pressure drops along the coronary artery. The pullback pressure gradient (PPG) quantifies the FFR pullback curve and provides a numeric expression of focal versus diffuse coronary artery disease. This study aims (1) to validate the PPG using manual FFR pullbacks compared with motorized FFR pullbacks as a reference; and (2) to determine the intra- and interoperator reproducibility of the PPG derived from manual FFR pullbacks. Patients with stable coronary artery disease and an FFR ≤ 0.80 were included. All patients underwent FFR pullback evaluation either with a motorized device or manually, depending on the study cohort. The agreement of the PPG between repeated pullbacks was assessed using the Bland-Altman method. Overall, 116 FFR pullback maneuvers (96 manual and 20 motorized) were analyzed. There was excellent agreement between the PPG derived from manual and motorized pullbacks (mean difference -0.01 ± 0.07, 95% limits of agreement [LOA] -0.14 to 0.12). The intra- and interoperator reproducibility of PPG derived from manual pullbacks were excellent (mean difference <0.01, 95% LOA -0.11 to 0.12, and mean difference <0.01, 95% LOA -0.12 to 0.11, respectively). The duration of the pullback maneuver did not impact the reproducibility of the PPG (r = 0.12, 95% CI: -0.29 to 0.49, p = 0.567). Manual pullbacks allow for an accurate PPG calculation. The inter- and intraoperator reproducibility of PPG derived from manual pullbacks were excellent.
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Affiliation(s)
- Jeroen Sonck
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Takuya Mizukami
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, Showa University Hospital, Tokyo, Japan
| | - Nils P Johnson
- Department of Medicine, Division of Cardiology, Weatherhead PET Center, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Sakura Nagumo
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Internal Medicine, Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Emanuele Gallinoro
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Candreva
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Niya Mileva
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, Cardiology Clinic Alexandrovska University Hospital, Sofia, Bulgaria
| | - Daniel Munhoz
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.,Department of internal medicine, Discipline of Cardiology, University of Campinas (Unicamp), Campinas, Brazil
| | - Toshiro Shinke
- Department of Cardiology, Showa University Hospital, Tokyo, Japan
| | | | - Emanuele Barbato
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Bernard De Bruyne
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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11
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Gallinoro E, Monizzi G, Sonck J, Candreva A, Mileva N, Nagumo S, Munhoz D, Buytaert D, Mastrangelo A, Andreini D, Galli S, Bartorelli AL, Barbato E, De Bruyne B, Collet C. Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy. Int J Cardiol 2022; 352:27-32. [PMID: 35120947 DOI: 10.1016/j.ijcard.2022.01.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Percutaneous coronary interventions (PCI) in calcified coronary artery lesions are associated with impaired stent expansion, higher rate of periprocedural complications and cardiac mortality. Lesion preparation using calcium modifying techniques such as Rotational Atherectomy (RA) or Intravascular Lithotripsy (IVL) has been advocated. Studies comparing these technologies are lacking. We aimed to compare the in-stent pressure gradient, evaluated by virtual fractional flow-reserve, in calcific lesions treated using either RA or IVL. METHODS Patients undergoing either RA- or IVL-assisted PCI from two European centers were included. Propensity score matching (1:2) was performed to control for potential bias. Primary outcome was post- PCI in-stent pressure gradient calculated by virtual fractional flow reserve (vFFRgrad). Secondary outcomes included the proportion of patients with complete functional revascularization defined as of distal vFFR post PCI (vFFRpost) ≥ 0.90. RESULTS From a cohort of 210 patients, 105 matched patients (70 RA and 35 IVL) were included. Pre-PCI vFFR did not differ between groups (0,65 ± 0,13 RA and 0,67 ± 0,11 IVL). After PCI, in-stent pressure gradients were significantly lower in the IVL group (0.032 ± 0.026 vs 0.043 ± 0.026 in the RA group, p = 0.024). The proportions of vessels with functional complete revascularization was similar between the two groups (32.9% vs. 37.1% in the RA and IVL group, respectively; p = 0.669). CONCLUSIONS Calcific lesions preparation with IVL is effective and resulted in improved in-stent pressure gradient compared to RA. Approximately one third of the patients undergoing PCI for a severely calcified lesion achieved functional revascularization with no difference between rotational RA and IVL.
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Affiliation(s)
- E Gallinoro
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Monizzi
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - J Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - A Candreva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - N Mileva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Cardiology Clinic, Alexandrovska University Hospital, Sofia, Bulgaria
| | - S Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - D Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy; Department of Internal Medicine, Discipline of Cardiology, University of Campinas (Unicamp), Campinas, Brazil
| | - D Buytaert
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - D Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - S Galli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - A L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - E Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - B De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - C Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
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12
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Bertolone DT, Gallinoro E, Monizzi G, Sonck J, Candreva A, Mileva N, Nagumo S, Munhoz D, Buytaert D, Mastrangelo A, Andreini D, Galli S, Bartonelli A, Barbato E, Bruyne BD, Collet C. 662 Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Percutaneous coronary interventions (PCI) in calcified coronary artery lesions are associated with impaired stent expansion, higher rate of periprocedural complications and cardiac mortality. Lesion preparation using calcium modifying techniques such as Rotational Atherectomy (RA) or Intravascular Lithotripsy (IVL) has been advocated. Studies comparing these technologies are lacking. We aimed to compare the in-stent pressure gradient, evaluated by virtual fractional flow-reserve, in calcific lesions treated using either RA or IVL.
Methods and results
Patients undergoing either RA- or IVL-assisted PCI from two European centres were included. Propensity score matching (1:2) was performed to control for potential bias. Primary outcome was post-PCI in-stent pressure gradient calculated by virtual fractional flow reserve (vFFRgrad). Secondary outcomes included the proportion of patients with complete functional revascularization defined as of distal vFFR post PCI (vFFRpost) ≥0.90. From a cohort of 210 patients, 105 matched patients (70 RA and 35 IVL) were included. Pre-PCI vFFR did not differ between groups (0.65 ± 0.13 RA and 0.67 ± 0.11 IVL). After PCI, in-stent pressure gradients was significantly lower in the IVL group (0.032 ± 0.026 vs. 0.043 ± 0.026 in the RA group, P = 0.024). The proportion of vessels with functional complete revascularization was similar between the two groups (32.9% vs. 37.1% in the RA and IVL group, respectively; P = 0.669).
Conclusions
Calcific lesions preparation with IVL is effective and resulted in improved in-stent pressure gradient compared to RA. Approximately one third of the patients undergoing PCI for a severely calcified lesion achieved functional revascularization with no difference between rotational RA and IVL. 662 FigureIn stent gradients after RA and IVL. (A) Box plot depicting the distribution of the in-stent pressure gradient vFFRgrad between the two groups. (B) Cumulative frequency distribution curves demonstrating lower vFFRgrad after intravascular lithotripsy compared to rotational atherectomy. RA, rotational atherectomy; IVL, intravascular lithotripsy; vFFRgrad, in-stent pressure gradient.
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Affiliation(s)
- Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giovanni Monizzi
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | | | - Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Cardiology Clinic, Alexandrovska University Hospital, Sofia, Bulgaria
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Discipline of Cardiology, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, University of Milan, Milan, Italy
| | | | - Antonio Bartonelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, University of Milan, Milan, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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13
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Candreva A, Pagnoni M, Rizzini ML, Mizukami T, Gallinoro E, Mazzi V, Gallo D, Meier D, Shinke T, Aben JP, Nagumo S, Sonck J, Munhoz D, Fournier S, Barbato E, Heggermont W, Cook S, Chiastra C, Morbiducci U, De Bruyne B, Muller O, Collet C. Risk of myocardial infarction based on endothelial shear stress analysis using coronary angiography. Atherosclerosis 2021; 342:28-35. [PMID: 34815069 DOI: 10.1016/j.atherosclerosis.2021.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Wall shear stress (WSS) has been associated with atherogenesis and plaque progression. The present study assessed the value of WSS analysis derived from conventional coronary angiography to detect lesions culprit for future myocardial infarction (MI). METHODS AND RESULTS Three-dimensional quantitative coronary angiography (3DQCA), was used to calculate WSS and pressure drop in 80 patients. WSS descriptors were compared between 80 lesions culprit of future MI and 108 non-culprit lesions (controls). Endothelium-blood flow interaction was assessed by computational fluid dynamics (10.8 ± 1.41 min per vessel). Median time between baseline angiography and MI was 25.9 (21.9-29.8) months. Mean patient age was 70.3 ± 12.7. Clinical presentation was STEMI in 35% and NSTEMI in 65%. Culprit lesions showed higher percent area stenosis (%AS), translesional vFFR difference (ΔvFFR), time-averaged WSS (TAWSS) and topological shear variation index (TSVI) compared to non-culprit lesions (p < 0.05 for all). TSVI was superior to TAWSS in predicting MI (AUC-TSVI = 0.77, 95%CI 0.71-0.84 vs. AUC-TAWSS = 0.61, 95%CI 0.53-0.69, p < 0.001). The addition of TSVI increased predictive and reclassification abilities compared to a model based on %AS and ΔvFFR (NRI = 1.04, p < 0.001, IDI = 0.22, p < 0.001). CONCLUSIONS A 3DQCA-based WSS analysis was feasible and can identify lesions culprit for future MI. The combination of area stenoses, pressure gradients and WSS predicted the occurrence of MI. TSVI, a novel WSS descriptor, showed strong predictive capacity to detect lesions prone to cause MI.
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Affiliation(s)
- Alessandro Candreva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Cardiology, Zurich University Hospital, Zurich, Switzerland; Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Mattia Pagnoni
- Dept. of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Maurizio Lodi Rizzini
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Valentina Mazzi
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - David Meier
- Dept. of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Toshiro Shinke
- Dept. of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | | | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Department of Internal Medicine, University of Campinas (Unicamp), Campinas, Brazil
| | - Stephane Fournier
- Dept. of Cardiology, Lausanne University Hospital, Lausanne, Switzerland; Dept. of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Stephane Cook
- Department of Cardiology, HFR Fribourg, Fribourg, Switzerland
| | - Claudio Chiastra
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Oliver Muller
- Dept. of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
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Sonck J, Mizukami T, Ko B, Maeng M, Otake H, Jensen JM, Koo BK, Norgaard B, Nagumo S, Munhoz D, Mileva N, Andreini D, Collinsworth A, Updegrove A, Leipsic J, De Bruyne B, Collet C. TCT-358 Accuracy of the FFRCT Planner in Coronary Calcific Lesions: A Substudy of the Precise PCI Plan (P3) Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Andreini D, Penicka M, Mileva N, Mizukami T, Sonck J, Norgaard B, Ko B, Otake H, Koo BK, Jensen JM, Maeng M, Nagumo S, Munhoz D, Collinsworth A, Updegrove A, Leipsic J, de Bruyne B, Collet C. TCT-229 Impact of Coronary CT Image Quality on the Accuracy of the FFRCT Planner to Predict Fractional Flow Reserve After PCI. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Mileva N, Mizukami T, Paolisso P, Sonck J, Andreini D, Otake H, Nagumo S, Norgaard B, Leipsic J, Maeng M, Koo BK, Ko B, Munhoz D, Collinsworth A, Updegrove A, Jensen JM, Andreini D, Taylor C, De Bruyne B, Collet C. TCT-258 Relationship Between Myocardial Mass and Post-PCI Fractional Flow Reserve. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Gallinoro E, Monizzi G, Candreva A, Sonck J, Mileva N, Mastrangelo A, Andreini D, Bartorelli AL, Galli S, Nagumo S, Munhoz D, Barbato E, De Bruyne B, Collet C. Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Percutaneous coronary interventions (PCI) in calcified coronary artery lesions is associated with impaired stent expansion, higher rate of periprocedural complications and cardiac mortality. Lesion preparation using dedicated calcium modifying techniques such as RA or IVL has been advocated. Studies comparing these technologies are lacking.
Objectives
To compare the in-stent pressure gradient, evaluated by virtual fractional flow-reserve, in calcific lesions treated using either rotational atherectomy (RA) or intravascular lithotripsy (IVL).
Methods
Patients undergoing either RA- or IVL-assisted PCI from two European centers were included. Propensity score matching (1:2) was performed to control for potential bias. Primary outcome was post- PCI in-stent pressure gradient calculated by virtual fractional flow reserve (vFFRgrad, calculated as the difference between the vFFR at the proximal minus distal edge of the stent). Secondary outcomes included the proportion of patients with complete functional revascularization defined as of distal vFFR post PCI (vFFRpost) ≥0.90.
Results
From a cohort of 210 patients, 105 matched patients (70 RA and 35 IVL) were included. Pre-PCI vFFR did not differ between groups (0,65±0,13 RA and 0,67±0,11 IVL). After PCI, in-stent pressure gradient was significantly lower in the IVL group (0.032±0.026 vs 0.043±0.026 in the RA group, p=0.024). The proportion of vessels with functional complete revascularization was similar between the two groups (32.9% vs. 37.1% in the RA and IVL group, respectively; p=0.669)
Conclusions
Calcific lesions preparation with IVL is effective and resulted in improved in-stent pressure gradient compared to RA. Approximately one third of the patients undergoing PCI for a severely calcified lesion achieved functional revascularization with no difference between rotational RA and IVL.
Funding Acknowledgement
Type of funding sources: None. In stent gradients after RA and IVL
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Affiliation(s)
- E Gallinoro
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - G Monizzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - A Candreva
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - J Sonck
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - N Mileva
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | | | - D Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - S Galli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - S Nagumo
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - D Munhoz
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - B De Bruyne
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - C Collet
- Cardiovascular Research Center Aalst, Aalst, Belgium
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18
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Mileva N, Nagumo S, Gallinoro E, Sonck J, Verstreken S, Dierkcx R, Heggermont W, Bartunek J, Goethals M, Heyse A, Barbato E, De Bruyne B, Collet C, Vanderheyden M. Validation of Coronary Angiography-Derived Vessel Fractional Flow Reserve in Heart Transplant Patients with Suspected Graft Vasculopathy. Diagnostics (Basel) 2021; 11:diagnostics11101750. [PMID: 34679451 PMCID: PMC8534544 DOI: 10.3390/diagnostics11101750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/06/2023] Open
Abstract
Cardiac transplant-related vasculopathy remains a leading cause of morbidity and mortality in heart transplant (HTx) recipients. Recently, coronary angiography-derived vessel fractional flow reserve (vFFR) has emerged as a new diagnostic computational tool to functionally evaluate the severity of coronary artery disease. Although vFFR estimates have been shown to perform well against invasive FFR in atherosclerotic coronary artery disease, data on the use of vFFR in heart transplant recipients suffering from cardiac transplant-related arteriopathy are lacking. The aim of the presented study was to validate coronary angiography-derived vessel fractional flow reserve to calculate fractional flow reserve in HTx patients with and without cardiac transplant-related vasculopathy. A prospective, single center study of HTx patients referred for annual check-up, undergoing surveillance coronarography was conducted. Invasive FFR was measured using a motorized device at the speed of 1.0 mm/s in all three major coronary arteries. Angiography-derived pullback FFR was derived from the angiogram and compared with invasive FFR pullback curve. Overall, 18,059 FFR values were extracted from the FFR pullback curves from 23 HTx patients. The mean age was 59.3 ± 9.7 years, the mean time after transplantation was 5.24 years [IQR 1.20, 11.25]. A total of 39 vessels from 23 patients (24 LAD, 11 LCX, 4 RCA) were analyzed. Mean distal vFFR was 0.87 ± 0.14 whereas invasive distal FFR was 0.88 ± 0.17. An excellent correlation was found between invasive distal FFR and vFFR (r = 0.92; p < 0.001). The correlation of the pullback tracing was high, with a correlation coefficient between vFFR and invasive FFR pullback values of 0.72 (95% CI 0.71 to 0.73, p < 0.001). The mean difference between vFFR and invasive FFR pullback values was -0.01 with 0.06 of SD (limits of agreements -0.12 to 0.13). In HTx patients, coronary angiography-derived FFR correlates excellently with invasively measured wire-derived FFR. Therefore, angiography derived FFR could be used as a novel diagnostic tool to quantify the functional severity of graft vasculopathy.
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Affiliation(s)
- Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Cardiology Clinic, Alexandrovska University Hospital, 1430 Sofia, Bulgaria
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Cardiology, Showa University Fujigaoka Hospital, Tokyo 8501, Japan
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Advanced Biomedical Sciences, University Federico II, 80131 Naples, Italy
| | - Sofie Verstreken
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Riet Dierkcx
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Ward Heggermont
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Marc Goethals
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Alex Heyse
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Cardiology, Lausanne University Hospital, 1100 Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Correspondence: ; Tel.: +32-53-72-44-39
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19
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Fournier S, Keulards DC, van 't Veer M, Colaiori I, Di Gioia G, Zimmermann F, Mizukami T, Nagumo S, Kodeboina M, El Farissi M, Zelis J, Sonck J, Collet C, Pijls NH, De Bruyne B. Normal values of thermodilution-derived absolute coronary blood flow and microvascular resistance in humans. EUROINTERVENTION 2021; 17:e309-e316. [PMID: 33016881 PMCID: PMC9724861 DOI: 10.4244/eij-d-20-00684] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Absolute hyperaemic coronary blood flow (Q, in mL/min) and resistance (R, in Wood units [WU]) can be measured invasively by continuous thermodilution. AIMS The aim of this study was to assess normal reference values of Q and R. METHODS In 177 arteries (69 patients: 25 controls, i.e., without identifiable coronary atherosclerosis; 44 patients with mild, non-obstructive atherosclerosis), thermodilution-derived hyperaemic Q and total, epicardial, and microvascular absolute resistances (Rtot, Repi, and Rmicro) were measured. In 20 controls and 29 patients, measurements were obtained in all three major coronary arteries, thus allowing calculations of Q and R for the whole heart. In 15 controls (41 vessels) and 25 patients (71 vessels), vessel-specific myocardial mass was derived from coronary computed tomography angiography. RESULTS Whole heart hyperaemic Q tended to be higher in controls compared to patients (668±185 vs 582±138 mL/min, p=0.068). In the left anterior descending coronary artery (LAD), hyperaemic Q was significantly higher (293±102 mL/min versus 228±71 mL/min, p=0.004) in controls than in patients. This was driven mainly by a difference in Repi (43±23 vs 83±41 WU, p=0.048), without significant differences in Rmicro. After adjustment for vessel-specific myocardial mass, hyperaemic Q was similar in the three vascular territories (5.9±1.9, 4.9±1.7, and 5.3±2.1 mL/min/g, p=0.44, in the LAD, left circumflex and right coronary artery, respectively). CONCLUSIONS The present report provides reference values of absolute coronary hyperaemic Q and R. Q was homogeneously distributed in the three major myocardial territories but the large ranges of observed hyperaemic values of flow and of microvascular resistance preclude their clinical use for inter-patient comparison.
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Affiliation(s)
- Stephane Fournier
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium,Lausanne University Centre Hospital, Lausanne, Switzerland,Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | - Giuseppe Di Gioia
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium,Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Sakura Nagumo
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium
| | | | | | - Jo Zelis
- Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands
| | - Jeroen Sonck
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium,Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium
| | - Nico H.J. Pijls
- Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands,Department of Biomedical Engineering Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Bernard De Bruyne
- Cardiovascular Centre Aalst, OLV-Clinic Aalst, Moorselbaan 164, B-9300 Aalst, Belgium
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20
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Candreva A, Mizukami T, Sonck J, Munhoz D, Nagumo S, Di Gioia G, Gallinoro E, Mileva N, Bartunek J, Wyffels E, Barbato E, De Bruyne B, Perera D, Collet C. Hyperemic hemodynamic characteristics of serial coronary lesions assessed by pullback pressure gradients. Catheter Cardiovasc Interv 2021; 98:E647-E654. [PMID: 34264014 DOI: 10.1002/ccd.29868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 07/01/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To characterize hemodynamics of serial coronary stenoses using fractional flow reserve (FFR) pullbacks and the pullback pressure gradients (PPG) index. BACKGROUND The cross-talk between stenoses within the same coronary artery makes the prediction of the functional contribution of each lesion challenging. METHODS AND RESULTS One-hundred seventeen patients undergoing coronary angiography for stable angina were prospectively recruited. Serial lesions were defined as two or more narrowings with visual diameter stenosis >50% on conventional angiography. Motorized FFR pullback tracings were obtained at 1 mm/s. Pullbacks were visually adjudicated as presenting two, one, and no focal pressure drops. The pattern of disease (i.e., focal or diffuse) was quantified using the PPG index. Twenty-five vessels presented serial lesions (mean PPG 0.48 ± 0.17). Two, one or no focal pressure drops were observed in 40% (n = 10; PPG 0.59 ± 0.17), 52% (n = 13; PPG 0.44 ± 0.12) and 8% of cases (n = 2; PPG 0.27 ± 0.01; p-value = 0.01). Distal FFR was similar between vessels with two, one and no focal pressure drops in the pullback curve (p-value = 0.27). The PPG index independently predicted the presence of two focal pressure drops in the pullback curve (p = 0.04). CONCLUSIONS FFR pullbacks in serial coronary lesions exhibit three distinct functional patterns. High PPG was associated with pullback curves presenting two pressure drops. The PPG provides a quantitative assessment of the pattern of coronary artery disease in cases with serial lesions and might be useful to assess the appropriateness of percutaneous revascularization.
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Affiliation(s)
- Alessandro Candreva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Division of Clinical Pharmacology, Show University School of Medicine, Tokyo, Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Division of Clinical Pharmacology, Show University School of Medicine, Tokyo, Japan
| | - Giuseppe Di Gioia
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Divaka Perera
- Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, UK
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
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21
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G Toth G, Collet C, Langhoff Thuesen A, Mizukami T, Casselman F, Riber LP, Van Praet F, Junker A, Nagumo S, De Bruyne B, Okkels Jensen L, Barbato E. Influence of fractional flow reserve on grafts patency: Systematic review and patient-level meta-analysis. Catheter Cardiovasc Interv 2021; 99:730-735. [PMID: 34233071 PMCID: PMC9546321 DOI: 10.1002/ccd.29864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the impact of invasive functional guidance for coronary artery bypass graft surgery (CABG) on graft failure. BACKGROUND Data on the impact of fractional flow reserve (FFR) in guiding CABG are still limited. METHODS Systematic review and individual patient data meta-analysis were performed. Primary objective was the risk of graft failure, stratified by FFR. Risk estimates are reported as odds ratios (ORs) derived from the aggregated data using random-effects models. Individual patient data were analyzed using mixed effect model to assess relationship between FFR and graft failure. This meta-analysis is registered in PROSPERO (CRD42020180444). RESULTS Four prospective studies comprising 503 patients referred for CABG, with 1471 coronaries, assessed by FFR were included. Graft status was available for 1039 conduits at median of 12.0 [IQR 6.6; 12.0] months. Risk of graft failure was higher in vessels with preserved FFR (OR 5.74, 95% CI 1.71-19.29). Every 0.10 FFR units decrease in the coronaries was associated with 56% risk reduction of graft failure (OR 0.44, 95% CI 0.34 to 0.59). FFR cut-off to predict graft failure was 0.79. CONCLUSION Surgical grafting of coronaries with functionally nonsignificant stenoses was associated with higher risk of graft failure.
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Affiliation(s)
- Gabor G Toth
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Anne Langhoff Thuesen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Filip Casselman
- Departement of Cardiovascular and Thoracic Surgery, OLV Hospital Aalst, Aalst, Belgium
| | - Lars Peter Riber
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Frank Van Praet
- Departement of Cardiovascular and Thoracic Surgery, OLV Hospital Aalst, Aalst, Belgium
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Division of Cardiology, Department of Internal medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, Universtiy Hospital Center Lausanne, Lausanne, Switzerland
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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22
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Suzuki Y, Matsumoto N, Nagumo S, Matsuo R, Kuronuma K, Ashida T, Tani S, Yoda S, Amano Y, Okumura Y. Incremental Predictive Value of Coronary Calcium Score in Risk Stratification of Coronary Revascularization in Patients With Normal or Mild Ischemia Using Nuclear Myocardial Perfusion Single Photon Emission Computed Tomography. Circ J 2021; 85:877-882. [PMID: 33504711 DOI: 10.1253/circj.cj-20-0805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The incremental predictive value of the coronary artery calcium score (CACS) for risk stratification of coronary revascularization in patients with normal or mildly abnormal nuclear myocardial perfusion single photon emission computed tomography (MPS) scores is unknown.Methods and Results:We analyzed 528 patients in whom CACS was calculated and who underwent stress MPS within 3 months. Patients with known coronary artery disease, prior coronary revascularization, and those undergoing hemodialysis were excluded. Patients were followed-up with coronary revascularization based on the evidence of physiological ischemia defined by fractional flow reserve or severe coronary stenosis (≥90%). CACS was significantly associated with the summed stress score (SSS) from MPS assessment. Multivariate logistic regression analysis showed that high CACS (≥300; odds ratio [OR] 5.44, 95% confidence interval [CI] 2.28-13.0) and SSS (OR 1.29, 95% CI 1.18-1.40) were significant (P<0.001) predictors of future coronary revascularization. The log-rank test showed that high CACS stratified coronary revascularization in normal SSS (0-3; P<0.001) or mildly abnormal SSS (4-8; P=0.028) groups, whereas high CACS did not significantly stratify coronary revascularization in moderate to severe SSS (≥9; P=0.757). CONCLUSIONS Risk stratification using CACS with a cut-off value 300 may have incremental predictive value for revascularization in patients with normal or mildly abnormal MPS.
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Affiliation(s)
| | | | - Sakura Nagumo
- Department of Cardiology, Showa University Fujigaoka Hospital
| | - Rei Matsuo
- Department of Cardiology, Nihon University Hospital
| | | | | | | | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University
| | - Yasuo Amano
- Department of Radiology, Nihon University Hospital
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University
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23
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Lodi Rizzini M, Nagumo S, Gallo D, Sonck J, Mizukami T, D'Ascenzo F, Buytaert D, Morbiducci U, De Bruyne B, Chiastra C, Collet C. Mismatch between morphological and functional assessment of the length of coronary artery disease. Int J Cardiol 2021; 334:1-9. [PMID: 33933514 DOI: 10.1016/j.ijcard.2021.04.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Morphological evaluation of coronary lesion length is a paramount step during invasive assessment of coronary artery disease. Likewise, the extent of epicardial pressure losses can be measured using longitudinal vessel interrogation with fractional flow reserve (FFR) pullbacks. We aimed to quantify the mismatch in lesion length between morphological (based on quantitative coronary angiography, QCA, and optical coherence tomography, OCT) and functional evaluations. METHODS This is a prospective and multicenter study of patients evaluated by QCA, OCT and motorized fractional flow reserve pullbacks (mFFR). The difference in lesion length between the functional and anatomical evaluations was referred to as FAM. RESULTS 117 patients (131 vessels) were included. Median lesion length derived from angiography was 16.05 mm [11.40-22.05], from OCT was 28.00 mm [16.63-38.00] and from mFFR 67.12 mm [25.38-91.37]. There was no correlation between QCA and mFFR lesion length (r = 0.124, 95% CI -0.168-0.396, p = 0.390). OCT lesion length did correlate with mFFR (r = 0.469, 95% CI 0.156-0.696, p = 0.004). FAM was strongly associated with the improvement in vessel conductance with percutaneous coronary intervention (PCI), higher mismatch was associated with lower post-PCI FFR. CONCLUSIONS Lesion length assessment differs between morphological and functional evaluations. The morphological-functional mismatch in lesion length is frequent, and influences the results of PCI in terms of post-PCI FFR. Integration of the extent of pressure losses provides clinically relevant information that may be useful for clinical decision-making concerning revascularization strategy.
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Affiliation(s)
- Maurizio Lodi Rizzini
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Sakura Nagumo
- Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium; Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences University Federico II, Naples, Italy
| | - Takuya Mizukami
- Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium; Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Fabrizio D'Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Dimitri Buytaert
- Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium
| | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | - Claudio Chiastra
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium.
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24
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Nagumo S, Gallinoro E, Candreva A, Dierckx S, Dierckx R, Heggermont W, Bartunek J, Goethals M, Buytaert D, Mileva N, De Bruyne B, Sonck J, Collet C, Vanderheyden M. Validation of Coronary Angiography-Derived Vessel Fractional Flow in Heart Transplant Patients with Suspected Graft Vasculopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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25
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Nagumo S, Collet C, Norgaard BL, Otake H, Ko B, Koo BK, Leipsic J, Andreini D, Heggermont W, Jensen JM, Takahashi Y, Ihdayhid A, Zhang Z, Barbato E, Maeng M, Mizukami T, Bartunek J, Updegrove A, Penicka M, Rogers C, Taylor C, De Bruyne B, Sonck J. Rationale and design of the precise percutaneous coronary intervention plan (P3) study: Prospective evaluation of a virtual computed tomography-based percutaneous intervention planner. Clin Cardiol 2021; 44:446-454. [PMID: 33656754 PMCID: PMC8027584 DOI: 10.1002/clc.23551] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Fractional flow reserve (FFR) measured after percutaneous coronary intervention (PCI) has been identified as a surrogate marker for vessel related adverse events. FFR can be derived from standard coronary computed tomography angiography (CTA). Moreover, the FFR derived from coronary CTA (FFRCT) Planner is a tool that simulates PCI providing modeled FFRCT values after stenosis opening. Aim To validate the accuracy of the FFRCT Planner in predicting FFR after PCI with invasive FFR as a reference standard. Methods Prospective, international and multicenter study of patients with chronic coronary syndromes undergoing PCI. Patients will undergo coronary CTA with FFRCT prior to PCI. Combined morphological and functional evaluations with motorized FFR hyperemic pullbacks, and optical coherence tomography (OCT) will be performed before and after PCI. The FFRCT Planner will be applied by an independent core laboratory blinded to invasive data, replicating the invasive procedure. The primary objective is to assess the agreement between the predicted FFRCT post‐PCI derived from the Planner and invasive FFR. A total of 127 patients will be included in the study. Results Patient enrollment started in February 2019. Until December 2020, 100 patients have been included. Mean age was 64.1 ± 9.03, 76% were males and 24% diabetics. The target vessels for PCI were LAD 83%, LCX 6%, and RCA 11%. The final results are expected in 2021. Conclusion This study will determine the accuracy and precision of the FFRCT Planner to predict post‐PCI FFR in patients with chronic coronary syndromes undergoing percutaneous revascularization.
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Affiliation(s)
- Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bjarne L Norgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milano - Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milan, Italy
| | | | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yu Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Abdul Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Zinlong Zhang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | | | | | | | | | | | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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Katbeh A, De Potter T, Geelen P, Nagumo S, Balogh Z, Albano M, Van Camp G, Penicka M. Acute change in left atrial performance in patients with atrial fibrillation undergoing catheter ablation using AutoStrain. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): International PhD Program in Cardiovascular Pathophysiology and Therapeutics CardioPaTh
Background
Radio-frequency catheter ablation (CA) is associated with changes of left atrial (LA) structure and function. However, the data on the accuracy of automated analysis of LA strain (LAS) are unavailable. Therefore, the aim of the present study was to compare automated with manual LAS analysis in patients with atrial fibrillation (AF) undergoing CA during sinus rhythm.
Methods
We prospectively enrolled 36 consecutive patients (age: 62 ± 22 years, 33% female) with symptomatic AF and preserved left ventricular (LV) ejection fraction (≥50%) undergoing the CA during sinus rhythm. All patients underwent comprehensive echocardiography at 1-day pre-CA and at 1-day post-CA. Reservoir and contractile LAS were assessed using both the automated and the manual technique as average of segmental values in apical four-chamber (4CH) view using the onset of QRS as a reference point.
Results
Radio-frequency CA was associated with significant decrease in magnitude of reservoir and contractile LAS in all patients, and increase in LA end-systolic (max) and end-diastolic (min) volume index (all p < 0.001) (figure 1). The correlation between (semi-) automated and manual LAS assessment was excellent in all measurements (figure 2). The manual correction was needed in 7 out of 36 patients (19%). Despite this, the time needed to perform AutoStrain-derived analysis was significantly lower than the time needed for the manual LAS analysis (12 ± 3 ms vs. 40 ± 5 ms, p < 0.01). Moreover, in 10 randomly selected patients, the AutoStrain showed significantly lower interobserver variability than the manual LAS analysis (3.1% vs. 6.7%, p < 0.01).
Conclusion
The AutoStrain-derived LAS analysis showed a high correlation with manual LAS analysis. Moreover, the AutoStrain technique was associated with significantly shorter analysis time and lower interobserver variability compared with the manual technique.
Abstract Figure.
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Affiliation(s)
- A Katbeh
- Olv Hospital Aalst, Aalst, Belgium
| | | | - P Geelen
- Olv Hospital Aalst, Aalst, Belgium
| | - S Nagumo
- Olv Hospital Aalst, Aalst, Belgium
| | - Z Balogh
- Olv Hospital Aalst, Aalst, Belgium
| | - M Albano
- Olv Hospital Aalst, Aalst, Belgium
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27
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Katbeh A, De Potter T, Geelen P, Nagumo S, Balogh Z, Albano M, Van Camp G, Penicka M. Atrial strain performance in patients with paroxysmal atrial fibrillation undergoing successful radio-frequency catheter ablation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): International PhD Program in Cardiovascular Pathophysiology and Therapeutics CardioPaTh
Background
Radio-frequency catheter ablation (CA) is associated with changes of left atrial (LA) structure and function. However, there is limited knowledge regarding the long-term impact of successful CA on atrial morphology and mechanics.
Purpose
To compare the time course of LA and right atrial (RA) performance in patients with paroxysmal atrial fibrillation (AF) undergoing the first CA.
Methods
This prospective study included 89 consecutive patients (age:62 ± 21 years; 66% male) with a history of symptomatic AF who underwent successful CA. All patients maintained SR during follow-up. A comprehensive echocardiographic examination was performed 1- day before and 1-day, 3-month and 12-month after CA. The reservoir and contractile strain for both LA and RA (LAS, RAS), and left intra-atrial mechanical dispersion (LAMD) were assessed using 2D speckle tracking echocardiography in all three apical views (only 4CH view for RAS and LAMD).
Results
At baseline, all patients with paroxysmal AF showed a significant reduction of reservoir and contractile LAS and RAS compared with controls (all p < 0.01). CA was associated with a significant decrease in reservoir and contractile LAS while no significant difference was observed for RAS. At 3-month follow-up, the LAS showed full recovery, whereas the RAS did not show any significant change from 1-day post CA values. At 12-month follow-up, both reservoir and contractile LAS showed further improvement compared to baseline and 3-month values. LAMD derived from the LA strain curve followed a similar trend. Although the RA motion was not affected in the early phase, both reservoir and contractile RAS showed a significant increase between 3-month and 12-month follow-up.
Conclusion
Although the radio-frequency CA affected negatively LA performance in the acute phase, it has a long-term positive impact on both left and right atrial function.
Figure
Time course of reservoir and contractile LAS and RAS at Baseline, 1-day, 3-month and 12-month follow-up.
Abstract Figure.
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Affiliation(s)
- A Katbeh
- Olv Hospital Aalst, Aalst, Belgium
| | | | - P Geelen
- Olv Hospital Aalst, Aalst, Belgium
| | - S Nagumo
- Olv Hospital Aalst, Aalst, Belgium
| | - Z Balogh
- Olv Hospital Aalst, Aalst, Belgium
| | - M Albano
- Olv Hospital Aalst, Aalst, Belgium
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28
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Mizukami T, Sonck J, Gallinoro E, Kodeboina M, Canvedra A, Nagumo S, Bartunek J, Wyffels E, Vanderheyden M, Shinke T, De Bruyne B, Collet C. Duration of Hyperemia With Intracoronary Administration of Papaverine. J Am Heart Assoc 2021; 10:e018562. [PMID: 33459027 PMCID: PMC7955433 DOI: 10.1161/jaha.120.018562] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takuya Mizukami
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium.,Clinical Research Institute for Clinical Pharmacology and Therapeutics Showa University Tokyo Japan.,Department of Cardiology Gifu Heart Center Gifu Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples, Federico II Naples Italy
| | | | - Monika Kodeboina
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium
| | | | - Sakura Nagumo
- Department of Cardiology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Jozef Bartunek
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium
| | | | - Toshiro Shinke
- Division of Cardiology Department of Medicine Showa University School of Medicine Tokyo Japan
| | - Bernard De Bruyne
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium.,Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium
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29
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Monizzi G, Sonck J, Nagumo S, Buytaert D, Van Hoe L, Grancini L, Bartorelli AL, Vanhoenacker P, Simons P, Bladt O, Wyffels E, De Bruyne B, Andreini D, Collet C. Quantification of calcium burden by coronary CT angiography compared to optical coherence tomography. Int J Cardiovasc Imaging 2020; 36:2393-2402. [DOI: 10.1007/s10554-020-01839-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/03/2020] [Indexed: 12/26/2022]
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30
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Tsujiuchi M, Ebato M, Maezawa H, Ikeda N, Mizukami T, Nagumo S, Iso Y, Yamauchi T, Suzuki H. The Prognostic Value of Left Atrial Reservoir Functional Indices Measured by Three-Dimensional Speckle-Tracking Echocardiography for Major Cardiovascular Events. Circ J 2020; 85:631-639. [PMID: 33191318 DOI: 10.1253/circj.cj-20-0617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Left atrial (LA) volume and left ventricular longitudinal strain (LVLS) have significant prognostic values for major cardiovascular events (MACEs). Prognostic values of LA reservoir functional indices measured by 3-dimensional (3D) speckle-tracking echocardiography (STE) were evaluated.Methods and Results:A total of 264 patients, who underwent 2-dimensional (2D) echocardiography and 3DSTE for various underlying heart diseases, were followed up to record MACE. After a mean follow up of 547±435 days, 30 patients developed MACE: 7 cardiac deaths, 6 strokes, 1 non-fatal myocardial infarction, and 22 admissions for heart failure (5 of these had cardiac death after discharge, whereas 1 sustained stroke after discharge). Receiver operating characteristic curve analysis was performed to determine the optimal cut-off levels of 4 LA functional indices: LA emptying fraction (LAEmpF), LA longitudinal strain (LALS), LA circumferential strain (LACS), and LA area change ratio (LAAC), using 3DSTE. Among these factors, 2DLVLS, 3DLAEmpF, and 3DLALS demonstrated a higher hazard ratio (>5.0) than other variables. The 3DLAEmpF and 3DLALS had a higher average treatment effect (ATE) and ATE on the treated (ATT), respectively, than the other indices after propensity score matching. Addition of 3DLAEmpF to the base model using clinical variables and LV ejection fraction or 2DLVLS demonstrated higher prognostic power. CONCLUSIONS LAEmpF calculated using 3DSTE possessed additive prognostic values for the prediction of MACE.
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Affiliation(s)
- Miki Tsujiuchi
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Hideyuki Maezawa
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Naoko Ikeda
- Cardiovascular Center, Showa University Koto Toyosu Hospital
| | - Takuya Mizukami
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Yoshitaka Iso
- Showa University Research Institute for Sports and Exercise
| | - Takenori Yamauchi
- Department of Hygiene, Public Health, and Preventive Medicine, Showa University School of Medicine
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
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31
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Candreva A, Sonck J, Nagumo S, Gallinoro E, Di Gioia G, Kodeboina M, Mizukami T, Bartunek J, De Bruyne B, Collet C. Hyperemic hemodynamic characteristics of serial coronary lesions assessed by pressure pullbacks gradients (PPG) index. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The evaluation of functional significance in serial coronary lesions is crucial for achieving optimal clinical outcomes. In this setting, fractional flow reserve (FFR) measurements with pullback pressure recording can be helpful in assessing lesion functional significance.
Purpose
To describe the functional characteristics of angiography-defined serial coronary lesions using FFR-derived motorised pullback tracings, and to describe the Pullback Pressure Gradients (PPG) index - in these lesions.
Methods
Prospective, multicentre study with independent core laboratory analysis. Patients undergoing coronary angiography due to stable angina were enrolled. Serial lesions were defined angiographically as the presence of 2 or more narrowings with visual diameter stenosis >50% separated at least by 3 times the reference vessel diameter in the same coronary vessel. Continuous IV adenosine-FFR measurements were obtained using a motorised device at a speed of 1 mm/s. Pullback curves were assessed to determine the presence of focal step-ups (FFR >0.05 units over 20 mm). In addition, the PPGindex was computed for all vessels. PPGindex values close to 0 define functional diffuse disease whereas values close to 1 define focal disease.
Results
From a total of 159 vessels (117 patients), 25 vessels were adjudicated as presenting serial lesions (mean PPGindex 0.48±0.17, range 0.26–0.87). Two focal pressure step-ups were observed in 40% of the cases (n=10; mean PPGindex 0.59±0.17), whereas 8% of the vessels presented a progressive pressure losses (n=2; mean PPGindex 0.27±0.01). In the remaining 52% of the cases, a single pressure step-up was recorded (n=13; mean PPGindex 0.44±0.12; ANOVA p-value = 0.01). The PPGindex independently predicted the presence of two focal pressure step ups.
Conclusion
Hyperemic FFR curves in tandem stenoses revealed high prevalence of functional diffuse CAD. Two pressure step-ups occurred in less than half of the vessels. High PPG-Index identified vessels with two focal pressure drops. FFR tracings and the PPGindex provide a more objective CAD evaluation, which can lead to changes in the therapeutic approach.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Candreva
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - J Sonck
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - S Nagumo
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - E Gallinoro
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - G Di Gioia
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - M Kodeboina
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - T Mizukami
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - J Bartunek
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - B De Bruyne
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - C Collet
- Cardiovascular Research Center Aalst, Aalst, Belgium
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32
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Albano M, Nagumo S, Vanderheyden M, Bartunek J, Collet C, Balogh Z, Katbeh A, Kodeboina M, Van Camp G, Penicka M. Long-term outcome of minimally invasive mitral valve annuloplasty in disproportionate mitral regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Hypothetical concept of disproportionate secondary mitral regurgitation (SMR) has been recently introduced to facilitate patient's selection for mitral valve intervention. However, real world data validating this concept are unavailable.
Purpose
To investigate long-term effects of minimally invasive mitral valve annuloplasty (MVA) in patients with disproportionate (dSMR) versus proportionate SMR.
Methods
The study population consisted of 44 consecutive patients (age 67±9,5 years; 64% males) on guidelines-directed therapy with advanced heart failure (HF), reduced LV ejection fraction (EF) (32±9,7%) and SMR undergoing isolated mini-invasive MVA. Patients with organic mitral regurgitation or concomitant myocardial revascularization were excluded. To assess SMR disproportionality, the PISA-derived effective regurgitant orifice area (EROA) and regurgitant volume (RV) were compared to the estimated EROA and RV by using Gorlin formula and pooled real world data.
Results
According to EROA, a total of 20 (46%) and 24 (54%) patients, respectively, had dSMR and proportionate SMR (pSMR). According to RV, a total of 17 (39%) had dSMR and 27 (61%) had pSMR. Patients with dSMR showed significantly lower prevalence of male gender and higher prevalence of diabetes mellitus than patients with pSMR (p<0,001). Moreover, we observed smaller LV end-diastolic volume, larger EROA and RV (both p<0,01) and higher LV EF (p=0,02) in the dSMR versus the pSMR group. Other baseline characteristics were similar. During median follow up of 4.39 y (IQR 2,2–9,96y), a total of 25 (56%) patients died from any cause while 21 (47%) individuals were readmitted for worsening HF. Patients with dSMR versus pSMR according to both EROA and RV showed significantly lower rate of HF readmissions (both p<0.05) (Figure 1, 2). In Cox regression analysis combining clinical and imaging parameters, dSMR was the only independent predictor of HF readmissions (HR 0.20, 95% CI 0.07–0.60, p=0.004). In contrast, mortality was similar between dSMR and pSMR (NS) with age as the only independent predictor (HR 1,10; 95% CI 1,03–1,18, p=0,003).
Conclusions
Minimally invasive MVA is associated with significant reduction of HF readmissions in patients with dSMR versus pSMR while the mortality is similar. This suggests the importance of other parameters, i.e. age and degree of LV remodeling, to guide clinical management in SMR.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Albano
- Olv Hospital Aalst, Aalst, Belgium
| | - S Nagumo
- Olv Hospital Aalst, Aalst, Belgium
| | | | | | - C Collet
- Olv Hospital Aalst, Aalst, Belgium
| | - Z Balogh
- Olv Hospital Aalst, Aalst, Belgium
| | - A Katbeh
- Olv Hospital Aalst, Aalst, Belgium
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33
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Monizzi G, Sonck J, Nagumo S, Buytaert D, Van Hoe L, Grancini L, Bartorelli A, De Bruyne B, Andreini D, Collet C. Quantification of calcium volume by coronary CT compared to OCT. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary artery calcifications are frequently observed in patients referred for cardiac catheterization. Using OCT, the calcified volume can be determined. CT is a sensitive non-invasive tool to detect coronary artery calcifications and may be useful to guide percutaneous coronary intervention.
Purpose
The aim of the study was to investigate the accuracy of CT-derived calcium volume with OCT as a reference in patients undergoing PCI.
Methods
66 calcified plaques (32 vessels) from 31 patients undergoing OCT-guided PCI with coronary CT angiography acquired as a standard of care were included. Coronary CT angiography and OCT images were matched using fiduciary points. Calcified plaques were reconstructed in three dimensions to calculate calcium volume. A Passing-Bablok regression analysis and the Bland-Altman method were used to assess agreement between imaging modalities.
Results
27 left anterior descending arteries and 5 right coronary arteries were analyzed. Median calcium volume by CT angiography and OCT were 18.23 mm 3 [IQR 8.09, 36.48] and 10.03 mm 3 [IQR 3.6, 22.88]. The Passing-Bablok analysis showed a proportional difference without a systematic difference (Coefficient A 0.08, 95% CI: −1.37 to 1.21, Coefficient B 1.61, 95% CI: 1.45 to 1.84); with a mean difference of 9.69 mm3 (LOA −10.2 mm 3 to 29.6 mm 3). No significant differences were observed for MLA: median value for CT 2.84 mm2 [IQR 2.03, 3.74] and for OCT 2.55 mm2 [IQR 1.91, 4.43].
Conclusions
Coronary CT angiography volumetric calcium evaluation overestimates calcium volume by 60% compared to OCT. Accounting for CT overestimation may allow for appropriate interpretation of calcific burden in the non-invasive setting. Coronary CT angiography may emerge as a tool to quantify calcium burden for invasive procedural planning.
Calcium burden comparison CT vs OCT
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - J Sonck
- Olv Hospital Aalst, Aalst, Belgium
| | - S Nagumo
- Olv Hospital Aalst, Aalst, Belgium
| | | | | | - L Grancini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - D Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - C Collet
- Olv Hospital Aalst, Aalst, Belgium
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Tanaka H, Nabeshima Y, Kitano T, Nagumo S, Tsujiuchi M, Ebato M, Mataki H, Takada M, Hayashi T, Sato D, Miyasaka Y, Araki K, Iwahashi N, Takeuchi M, Nakatani S. Optimal timing of echocardiography for heart failure inpatients in Japanese institutions: OPTIMAL Study. ESC Heart Fail 2020; 7:4213-4221. [PMID: 33006275 PMCID: PMC7754717 DOI: 10.1002/ehf2.13050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 11/11/2022] Open
Abstract
AIMS Guidelines for the diagnosis and treatment of acute and chronic heart failure (HF) provided by the European Society of Cardiology state that echocardiography is recommended for the assessment of the myocardial structure and function of subjects with suspected HF including HF with reduced (HFrEF), mid-range (HFmrEF), and preserved ejection fraction (HFpEF) as class I of recommendation and level C of evidence. However, the impact of timing of echocardiography on survival for hospitalized HF patients or the prevalence of echocardiography during their stay has not yet been fully investigated. Therefore, we designed and conducted a prospective multicentre study, Optimal Timing of Echocardiography for Heart Failure Inpatients in Japanese Institutions (OPTIMAL) study, to investigate and evaluate the prevalence of echocardiography during the in-hospital stay of HF patients, and the impact of timing of echocardiography on their survival. METHODS AND RESULTS OPTIMAL was based on a nationwide, prospective, multicentre registry at 10 institutions in Japan endorsed by the Japanese Society of Echocardiography. A total of 601 patients hospitalized with HF were enrolled between August 2016 and July 2018 at the participating centres. Their mean age was 73.9 ± 13.0 years, left ventricular ejection fraction was 37.0% (26.0-50.0), and 256 patients (42.6%) were female. Admission echocardiography (admission echo) was categorized as either standard or point-of-care echocardiography performed within 3 days of admission, as was pre-discharge echocardiography (pre-discharge echo) within 3 days of discharge. The primary endpoint was defined as cardiovascular death over a median follow-up period of 18.9 months (9.3-26.5 months). Admission echo was performed for 476 patients (79.2%) and pre-discharge echo for 216 patients (35.9%). The primary endpoint of cardiovascular death occurred in 65 patients (10.8%). Kaplan-Meier curve findings indicated that survival of patients with pre-discharge echo was significantly better than that of patients without it (log-rank P < 0.001), and the same findings were obtained for patients with HFrEF, HFmrEF, and HFpEF. However, survival of patients with and without admission echo was similar (log-rank P = 0.33). CONCLUSIONS This OPTIMAL study prospectively showed the importance of pre-discharge echo for hospitalized HF patients. Careful attention is needed regarding the haemodynamic status of HF patients by administering pre-discharge echo to avoid HF re-hospitalization after discharge, and pre-discharge echo may provide additional information for deciding the appropriate discharge time. Our findings may thus offer a new insight into the management of hospitalized HF patients.
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Affiliation(s)
- Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyusyu, Japan
| | - Tetsuji Kitano
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyusyu, Japan
| | - Sakura Nagumo
- Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Miki Tsujiuchi
- Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mio Ebato
- Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroyuki Mataki
- Division of Cardiology, Kobe Century Memorial Hospital, Kobe, Japan
| | - Masanori Takada
- Division of Cardiology, Medical Corporation Kawasaki Hospital, Kobe, Japan
| | - Taichi Hayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Sato
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoko Miyasaka
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Keiko Araki
- Department of Cardiology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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35
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Gigante C, Mizukami T, Sonck J, Nagumo S, Tanzilli A, Bartunek J, Vanderheyden M, Wyffels E, Barbato E, Pompilio G, Mushtaq S, Bartorelli A, De Bruyne B, Andreini D, Collet C. Graft patency and progression of coronary artery disease after CABG assessed by angiography-derived fractional flow reserve. Int J Cardiol 2020; 316:19-25. [DOI: 10.1016/j.ijcard.2020.04.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
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36
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Sunaga T, Yokoyama A, Nakamura S, Miyamoto N, Watanabe S, Tsujiuchi M, Nagumo S, Nogi A, Maezawa H, Mizukami T, Ebato M, Suzuki H, Nakamura A, Watanabe T, Sasaki T. Association of Potentially Inappropriate Medications With All-Cause Mortality in the Elderly Acute Decompensated Heart Failure Patients: Importance of Nonsteroidal Anti-Inflammatory Drug Prescription. Cardiol Res 2020; 11:239-246. [PMID: 32595809 PMCID: PMC7295559 DOI: 10.14740/cr1078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Acute decompensated heart failure (ADHF) is the most common cause of readmissions in the hospital. ADHF patients are associated with polypharmacy. It is a common problem among elderly patients due to frequently occurring multiple morbidities and is associated with the use of potentially inappropriate medications (PIMs). The aim of this study was to examine the association between PIMs and all-cause mortality in elderly ADHF patients. Methods This retrospective study included ADHF patients who were admitted to the Showa University Fujigaoka Hospital between January 2015 and August 2016. We investigated the proportion of patients taking at least one PIM at admission and the characteristics of patients at admission. PIMs were defined based on the Screening Tool of Older People's potentially inappropriate Prescriptions (STOPP). Multiple Cox regression analysis was performed to examine the association between PIM use and all-cause mortality. Results A total of 193 elderly patients (median age 81 years, interquartile range (IQR) 65 - 99 years) were included in the study. All-cause death occurred in 30 patients. The median number of medications at admission was 7 (IQR 0 - 18). The number of medications (greater than or equal to six) at admission was associated with mortality. Multivariate Cox regression analysis revealed that systolic blood pressure (SBP) < 100 mm Hg at admission, chronic obstructive pulmonary disease (COPD), and use of non-steroidal anti-inflammatory drugs (NSAIDs) at admission were independent predictors for all-cause mortality. Conclusions The medical staff should attempt to stop unnecessary medications that are prone to be inappropriate prescribing. In particular, prescription of NSAIDs should be carefully assessed and monitored.
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Affiliation(s)
- Tomiko Sunaga
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan.,Department of Pharmacy, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Azusa Yokoyama
- Department of Pharmacy, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Shoko Nakamura
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Nagisa Miyamoto
- Department of Pharmacy, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Saki Watanabe
- Division of Pharmaceutics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Miki Tsujiuchi
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Ayaka Nogi
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hideyuki Maezawa
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Takuya Mizukami
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Akihiro Nakamura
- Division of Pharmaceutics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Toru Watanabe
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan.,Department of Pharmacy, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Tadanori Sasaki
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
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37
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Di Gioia G, Sonck J, Ferenc M, Chen SL, Colaiori I, Gallinoro E, Mizukami T, Kodeboina M, Nagumo S, Franco D, Bartunek J, Vanderheyden M, Wyffels E, De Bruyne B, Lassen JF, Bennett J, Vassilev D, Serruys PW, Stankovic G, Louvard Y, Barbato E, Collet C. Clinical Outcomes Following Coronary Bifurcation PCI Techniques. JACC Cardiovasc Interv 2020; 13:1432-1444. [DOI: 10.1016/j.jcin.2020.03.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 01/01/2023]
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38
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Nagumo S, Gallinoro E, Candreva A, Mizukami T, Verstreken S, Dierckx R, Heggermont W, Bartunek J, de Bruyne B, Sonck J, Collet C, Vanderheyden M. Virtual Fractional Flow Reserve in Heart Transplant Recipients with and without Graft Vasculopathy. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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39
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Nagumo S, Collet C, Gallinoro E, Candreva A, Monizzi G, Mizukami T, Verstreken S, Dierckx R, Heggermont W, Bartunek J, Sonck J, De Bruyne B, Vanderheyden M. THE USEFULNESS OF VESSEL FRACTIONAL FLOW RESERVE FOR ASSESSING CARDIAC GRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Nagumo S, Gigante C, Mizukami T, Sonck J, Tanzilli A, Bartunek J, Vanderheyden M, Wyffels E, Barbato E, De Bruyne B, Andreini D, Collet C. GRAFT PATENCY AND PROGRESSION OF CORONARY ARTERY DISEASE AFTER CABG ASSESSED BY ANGIOGRAPHY-DERIVED FRACTIONAL FLOW RESERVE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Tsujiuchi M, Ebato M, Wada D, Nagumo S, Maezawa H, Yamauchi T, Suzuki H. P2445Prognostic values of left ventricular reservoir functional indices measured by three dimensional speckle tracking analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial functional indices measured by two dimensional echocardiography (2DE) have prognostic significance for major cardiovascular events (MACE). Retrospective analysis using propensity score matching to assess the prognostic values of left atrial reservoir function measured by three dimensional speckle tracking analysis (3DSTA) was performed.
Methods
Two hundred sixty-four patients (Male 60%, 65±15yo) who underwent both clinically indicated 2DE and 3DSTA for various underlying heart diseases from January 4, 2013 to February 28, 2016 were followed to record MACE. Patients with significant mitral valve disease, history of pulmonary vein isolation and persistent atrial fibrillation were excluded. Maximum and minimum left atrial volume (LAVImax and LAVImin), left atrial emptying fraction (LAEmpF), peak global LA area ratio (LAAC), circumferential strain (LACS) and longitudinal strain (LALS) were measured using 3DSTA. Standard indices including peak global LVLS (2DLVLS) and left ventricular ejection fraction (LVEF) and LA volume index were also assessed by 2DE. Cutoff line for LA reservoir functional indices and 2DLVLS was determined using ROC analysis. Average treatment effect for the treated (ATT), Average treatment effect (ATE) for each index were calculated after propensity score matching for clinical indices (age, sex, coronary artery disease, hypertension, diabetes, eGFR <45 ml/min/1.73m2, LVEF <40%)
Results
During a mean follow-up of 547±435 days, MACE developed in 30 patients (7 cardiac death 6 stroke, 1 nonfatal MI, 22 admission for heart failure). Age, coronary artery disease (CAD), diabetes mellitus (DM), chronic kidney disease (CKD: eGFR< 45ml/min/1.73m2), LVEF, 2DLVLS, LAVImax and LAVImin by 2DE and all LA indices by 3DSTA had significant prognostic value by univariate analysis. LAEmpF and LALS by 3DSTA had higher ATT, ATE and Log rank χ2 than other LA indices and 2DLVLS. The model added LALS or LAEmpF by 3DSTA had higher prognostic value (LALS <10.6%: AUC; 0.82, HR; 5.57 CI: 2.32–14.06, LAEmpF <33.0%: AUC; 0.82, HR; 6.59 CI; 2.60–20.18) than LA volume indices by 2DE and also tended to be better than 2DLVLS (LVLS <6.04%: AUC; 0.77, HR; 5.37 CI; 2.06–13.73).
propensity score matching
Conclusion
LALS and LAEmpF by 3DSTA showed additive prognostic value for MACE.
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Affiliation(s)
- M Tsujiuchi
- Fujigaoka Hospital, Division of Cardiology, Department of Internal Medicine, Showa University, Yokohama, Japan
| | - M Ebato
- Fujigaoka Hospital, Division of Cardiology, Department of Internal Medicine, Showa University, Yokohama, Japan
| | - D Wada
- Fujigaoka Hospital, Division of Cardiology, Department of Internal Medicine, Showa University, Yokohama, Japan
| | - S Nagumo
- Fujigaoka Hospital, Division of Cardiology, Department of Internal Medicine, Showa University, Yokohama, Japan
| | - H Maezawa
- Fujigaoka Hospital, Division of Cardiology, Department of Internal Medicine, Showa University, Yokohama, Japan
| | - T Yamauchi
- Showa University, Department of Hygiene and Preventive Medicine, Tokyo, Japan
| | - H Suzuki
- Fujigaoka Hospital, Division of Cardiology, Department of Internal Medicine, Showa University, Yokohama, Japan
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Nagumo S, Mori H, Maeda A, Akashi YJ, Ako J, Ikari Y, Ebina T, Sato N, Tamura K, Namiki A, Fukui K, Michishita I, Kimura K, Suzuki H. Sex-Related Differences in In-Hospital Mortality in Japanese ST-Elevation Acute Myocardial Infarction Patients Presenting to Hospital in the 24 Hours After Symptom Onset - Results From K-ACTIVE. Circ Rep 2019; 1:313-319. [PMID: 33693156 PMCID: PMC7892487 DOI: 10.1253/circrep.cr-19-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background:
Despite the drastic advances in clinical care for patients with acute ST-elevation myocardial infarction (STEMI), female STEMI patients have higher in-hospital mortality rates than male patients. This study assessed the influence of sex on in-hospital mortality in STEMI patients in Kanagawa Prefecture, Japan. Methods and Results:
From October 2015 to June 2018, 2,491 consecutive STEMI patients (23.9% female) who presented to hospital in the 24 h after symptom onset were analyzed. The female patients were 9 years older and less frequently had diabetes, smoking and prior MI than male patients. Pre-hospital managements, including prehospital 12-lead electrocardiography, and symptom-to-door time were similar between the sexes. A door-to-device time ≤90 min was achieved in 61.3% of female cases and in 65.0% of male cases (P=0.13). Reperfusion therapy was provided to 94.6% of female and 97.6% of male patients (P<0.001). In-hospital mortality rate was not significantly different between female and male patients (6.6% vs. 7.8%, P=0.37). On multivariate logistic regression analysis, female sex itself was not associated with in-hospital mortality (OR, 1.52; 95% CI: 0.67–3.47, P=0.32). Conclusions:
There was no sex discrepancy in the in-hospital mortality of STEMI patients in this study. Guideline-based treatment, such as advanced pre-hospital management and a high use of reperfusion therapy might have attenuated the sex-related differences in the in-hospital mortality.
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Affiliation(s)
- Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
| | - Atsuo Maeda
- Department of Emergency and Disaster Medicine, Showa University Hospital Tokyo Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine Isehara Japan
| | - Toshiaki Ebina
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center Yokohama Japan
| | - Naoki Sato
- Division of Cardiology, Nippon Medical University Musashi Kosugi Hospital Kawasaki Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital Kawasaki Japan
| | - Kazuki Fukui
- Department of Cardiovascular Medicine, Kanagawa Cardiovascular and Respiratory Center Yokohama Japan
| | - Ichiro Michishita
- Division of Cardiology, Yokohama Sakae Kyosai Hospital Yokohama Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center Yokohama Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
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Kurata M, Asano T, Mori H, Mase H, Nagumo S, Wakatsuki D, Shimojima H, Ebato M, Miyazaki A, Suzuki H. Can an increase in the pulmonary vein volume measured by three dimensional computed tomography predict the presence of atrial fibrillation? J Arrhythm 2019; 35:230-237. [PMID: 31007787 PMCID: PMC6457391 DOI: 10.1002/joa3.12158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/29/2018] [Accepted: 12/26/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Left atrial (LA) dilation is associated with morbidity of atrial fibrillation (AF). However, little is known about pulmonary vein (PV) dilation. PURPOSE We investigated the PV volume in the patients with AF. METHODS AND RESULTS We performed 3dimensional computed tomography (3DCT) in 155 patients and divided them into three groups: 19 patients without AF (non-AF group, mean age 66 ± 12 years), 50 with paroxysmal AF (PAF group, mean age 67 ± 8 years) and 24 with persistent AF (PeAF group, mean age 64 ± 10 years). The absence of AF was diagnosed in patients with a cardiac implantable electronic device for at least 1 year (mean: 59 ± 37 months). We determined the PV volume as the total volume from the orifice to the first branch of each PV. According to the echocardiographic data, the LA dimension (LAD) and LA volume index (LAVI) were largest in the PeAF group followed by the PAF and non-AF group. According to the morphometric data obtained on 3D-CT, the PV volume was similar in PeAF and PAF groups but significantly smaller in the non-AF group (median value: 24 vs 21 vs 14 mL, respectively). According to the receiver operating characteristic curve analysis, the area under the curve for the PV volume in the presence of AF was 0.80, and the optimum cut-off value was 17 mL (sensitivity 74%, specificity 80%). CONCLUSION The PV volume might be useful for predicting the presence of AF before increases in the LAD and LAVI on echocardiography.
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Affiliation(s)
- Masaaki Kurata
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
- Department of BiochemistryShowa University Graduate School of MedicineYokohamaKanagawaJapan
| | - Taku Asano
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
| | - Hiroyoshi Mori
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
| | - Hiroshi Mase
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
| | - Sakura Nagumo
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
| | - Daisuke Wakatsuki
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
| | - Hisa Shimojima
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
| | - Mio Ebato
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
| | - Akira Miyazaki
- Department of BiochemistryShowa University Graduate School of MedicineYokohamaKanagawaJapan
| | - Hiroshi Suzuki
- Division of CardiologyDepartment of Internal medicineShowa University Fujigaoka HospitalYokohamaKanagawaJapan
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Tsujiuchi M, Yamauchi T, Ebato M, Maezawa H, Nogi A, Ikeda N, Mizukami T, Nagumo S, Iso Y, Nakadate T, Kokaze A, Suzuki H. Prognostic Value of Left Atrial Size and Functional Indices Measured by 3-Dimensional Speckle-Tracking Analysis. Circ J 2019; 83:801-808. [PMID: 30760654 DOI: 10.1253/circj.cj-18-0554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognostic value of indices for left atrial volumes (LAV) and reservoir function measured by 3D speckle-tracking analysis (3DSTA) has not been determined. Methods and Results: LA maximal and minimal volume indices (LAVImax, LAVImin), and LA emptying fraction (LAEmpF) were measured via 2D echocardiography (2DE) and 3DSTA in 514 patients (62% male, mean age: 66±15 years) with various cardiovascular diseases. Two cutoff values using normal±2SD (cutoff criterion 1) and receiver-operating characteristic analysis (cutoff criterion 2) were evaluated. During a mean follow-up of 720±383 days, MACE (cardiac death, nonfatal myocardial infarction, stroke and admission for heart failure) occurred in 98 patients. Kaplan-Meier survival analysis showed both cutoff criteria measured by 2DE and 3DSTA had significant predictive power for MACE (P<0.001). For cutoff criterion 1, 3DSTA measurements yielded higher hazard ratios than 2DE by Cox proportional hazard model. Cutoff criterion 2 using 3DSTA had higher average treatment effect values than 2DE by matching propensity scores on the outcome. Further, a regression model that included clinical variables, left ventricular ejection fraction and cutoff criterion 2 using 3DSTA-derived LAEmpF had significantly higher prognostic power than 2DE. CONCLUSIONS LA indices measured by 3DSTA had greater prognostic power for future MACE than 2DE. In particular, 3DSTA-derived LAEmpF has the potential to be a valuable prognostic tool in clinical settings.
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Affiliation(s)
- Miki Tsujiuchi
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital.,Department of Hygiene and Preventive Medicine, Showa University School of Medicine
| | - Takenori Yamauchi
- Department of Hygiene and Preventive Medicine, Showa University School of Medicine
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Hideyuki Maezawa
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Ayaka Nogi
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Naoko Ikeda
- Cardiovascular Center, Showa University Koto Toyosu Hospital
| | - Takuya Mizukami
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | - Yoshitaka Iso
- Showa University Research Institute for Sports and Exercise
| | - Toshio Nakadate
- Department of Hygiene and Preventive Medicine, Showa University School of Medicine
| | - Akatsuki Kokaze
- Department of Hygiene and Preventive Medicine, Showa University School of Medicine
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital
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45
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Suzuki Y, Nagumo S, Kuronuma K, Matsuo R, Ashida T, Makita A, Yoda S, Matsumoto N, Okumura Y. INCREMENTAL PREDICTIVE VALUE OF ULTRASOUND EVALUATION OF CAROTID ARTERY IN RISK STRATIFICATION USING MYOCARDIAL PERFUSION IMAGING WITH SEMICONDUCTOR SCANNER. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Nagumo S, Suzuki Y, Matsumoto N, Okumura Y. PHASE ANALYSIS USING LOW DOSE 99M TC GATED-SPECT DETECTS SIGNIFICANT LATE GADOLINIUM ENHANCEMENT IN PATIENTS WITH NON-ISCHEMIC DILATED CARDIOMYOPATHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Suzuki Y, Nagumo S, Kuronuma K, Ashida T, Matsuo R, Makita A, Yoda S, Matsumoto N, Okumura Y. INCREMENTAL PREDICTIVE VALUE OF CORONARY CALCIUM SCORE IN RISK STRATIFICATION USING MYOCARDIAL PERFUSION IMAGING WITH SEMICONDUCTOR SCANNER. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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48
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Nagumo S, Ebato M, Maeda A, Suzuki H. A case with purulent pericarditis diagnosed by the unintended pericardiography. Eur Heart J Case Rep 2018; 2:yty093. [PMID: 31020170 PMCID: PMC6177016 DOI: 10.1093/ehjcr/yty093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, Japan
| | - Atsuo Maeda
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, Japan
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Shimojima H, Ebato M, Asano T, Wakatsuki D, Mizukami T, Nagumo S, Sone H, Tanaka H, Takeuchi S, Hori Y, Suzuki H. A Case With Pulmonary Vein Stenosis and Obstruction After Pulmonary Vein Isolation: A Multimodality Approach. JACC Clin Electrophysiol 2018; 4:970-972. [PMID: 30025700 DOI: 10.1016/j.jacep.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Hisa Shimojima
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Mio Ebato
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan.
| | - Taku Asano
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Daisuke Wakatsuki
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Takuya Mizukami
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Sakura Nagumo
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiromoto Sone
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Susumu Takeuchi
- Department of Cardiovascular Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Yoshiro Hori
- Department of Radiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiroshi Suzuki
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
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Nagumo S, Tsujiuchi M, Mizukami T, Nogi A, Maezawa H, Ebato M, Suzuki H. Emphysema on CT Scan Predicts Clinical Outcomes in Patients Hospitalized for Heart Failure with Preserved Ejection Fraction. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.08.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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