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Collet C, Munhoz D, Mizukami T, Sonck J, Matsuo H, Shinke T, Ando H, Ko B, Biscaglia S, Rivero F, Engstrøm T, Arslani K, Leone AM, van Nunen LX, Fearon WF, Christiansen EH, Fournier S, Desta L, Yong A, Adjej J, Escaned J, Nakayama M, Eftekhari A, Zimmermann FM, Sakai K, Storozhenko T, da Costa BR, Campo G, West NEJ, De Potter T, Heggermont W, Buytaert D, Bartunek J, Berry C, Collison D, Johnson T, Amano T, Perera D, Jeremias A, Ali Z, Pijls NHJ, De Bruyne B, Johnson NP. Influence of Pathophysiological Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes. Circulation 2024. [PMID: 38742491 DOI: 10.1161/circulationaha.124.069450] [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] [Received: 02/29/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Diffuse coronary artery disease (CAD) impacts the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiological CAD patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularisation and procedural outcomes. METHODS This prospective, investigator-initiated, single-arm, multicentre study enrolled patients with at least one epicardial lesion with an FFR ≤ 0.80 scheduled for PCI. Manual FFR pullbacks were employed to calculate PPG. The primary outcome of optimal revascularisation was defined as a post-PCI FFR ≥ 0.88. RESULTS 993 patients with 1044 vessels were included. The mean FFR was 0.68 ± 0.12, PPG 0.62 ± 0.17, and post-PCI FFR 0.87 ± 0.07. PPG was significantly correlated with the change in FFR after PCI (r=0.65, 95% CI 0.61-0.69, p<0.001) and demonstrated excellent predicted capacity for optimal revascularisation (AUC 0.82, 95% CI 0.79-0.84, p<0.001). Conversely, FFR alone did not predict revascularisation outcomes (AUC 0.54, 95% CI 0.50-0.57). PPG influenced treatment decisions in 14% of patients, redirecting them from PCI to alternative treatment modalities. Periprocedural myocardial infarction occurred more frequently in patients with low PPG (<0.62) compared to those with focal disease (OR 1.71, 95% CI: 1.00-2.97). CONCLUSIONS Pathophysiological CAD patterns distinctly affect the safety and effectiveness of PCI. The PPG showed an excellent predictive capacity for optimal revascularisation and demonstrated added value compared to a FFR measurement.
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Affiliation(s)
- Carlos Collet
- 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
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Toshiro Shinke
- Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | | | | | - Antonio Maria Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome Italy; IRCCS, Catholic University School of Medicine, Largo A. Gemelli, Rome, Italy; Center of Excellence in Cardiovascular Diagnostics and Therapeutic, Ospedale Fabenefratelli Isola Tiberina Gemelli Isola, Rome Italy
| | - Lokien X van Nunen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine and VA Palo Alto Health Care System, Palo Alto, CA
| | | | - Stephane Fournier
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Liyew Desta
- Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Andy Yong
- Concord Repatriation General Hospital, University of Sydney, New South Wales, Australia
| | - Julien Adjej
- Department of Cardiology, Arnault Tzanck Institute Saint Laurent du Var, France
| | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid, Spain
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Koshiro Sakai
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Tatyana Storozhenko
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine
| | - Bruno R da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford; Clinical Epidemiology & Health Care Research, Institute of Health Policy and Management Evaluation (IHPME), University of Toronto, Canada
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | | | - Tom De Potter
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | | | | | - Colin Berry
- School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; NHS Golden Jubilee Hospital, Clydebank, United Kingdom
| | - Damien Collison
- School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; NHS Golden Jubilee Hospital, Clydebank, United Kingdom
| | - Thomas Johnson
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, St Thomas' Hospital Campus, King's College London, London, United Kingdom
| | | | - Ziad Ali
- St Francis Hospital and Heart Center, Roslyn, NY
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX
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García-Guimarães M, Bastante T, Del Val D, Fernández-Rodríguez D, Guiberteau-Diaz T, Salamanca J, Rivero F, Alfonso F. Angiographic patterns in spontaneous coronary artery dissection: novel diagnostic insights. Expert Rev Cardiovasc Ther 2024; 22:167-175. [PMID: 38683109 DOI: 10.1080/14779072.2024.2349103] [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: 02/15/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Spontaneous coronary artery dissection (SCAD) is a rare but well-recognized cause of acute coronary syndrome, especially important in women. Invasive coronary angiography (ICA) is the fundamental diagnostic technique for the confirmation of SCAD. Knowing the angiographic patterns suggestive of SCAD is essential for the correct identification of patients with this entity. AREAS COVERED In this narrative review, the main angiographic characteristics of SCAD lesions as detected by ICA are presented and discussed. EXPERT OPINION In addition to the specific angiographic classification of SCAD, several authors have described complementary angiographic patterns suggestive of SCAD. Knowledge and correct identification of these angiographic patterns is essential for the correct diagnosis of patients with clinical suspicion of SCAD.
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Affiliation(s)
- Marcos García-Guimarães
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Cardiology Department, Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Teresa Bastante
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - David Del Val
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Diego Fernández-Rodríguez
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Cardiology Department, Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - Jorge Salamanca
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
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Hoff DEM, Kolos K, Misch GW, Ray D, Liu B, Valverde AA, Brodeur M, Burdette DP, Callahan N, Clark JA, Gallant AT, Kondev FG, Morgan GE, Mumpower MR, Orford R, Porter WS, Rivero F, Savard G, Scielzo ND, Sharma KS, Sieja K, Sprouse TM, Varriano L. Direct Mass Measurements to Inform the Behavior of ^{128m}Sb in Nucleosynthetic Environments. Phys Rev Lett 2023; 131:262701. [PMID: 38215364 DOI: 10.1103/physrevlett.131.262701] [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] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 07/25/2023] [Accepted: 11/13/2023] [Indexed: 01/14/2024]
Abstract
Nuclear isomer effects are pivotal in understanding nuclear astrophysics, particularly in the rapid neutron-capture process where the population of metastable isomers can alter the radioactive decay paths of nuclei produced during astrophysical events. The β-decaying isomer ^{128m}Sb was identified as potentially impactful since the β-decay pathway along the A=128 isobar funnels into this state bypassing the ground state. We report the first direct mass measurements of the ^{128}Sb isomer and ground state using the Canadian Penning Trap mass spectrometer at Argonne National Laboratory. We find mass excesses of -84564.8(25) keV and -84608.8(21) keV, respectively, resulting in an excitation energy for the isomer of 43.9(33) keV. These results provide the first key nuclear data input for understanding the role of ^{128m}Sb in nucleosynthesis, and we show that it will influence the flow of the rapid neutron-capture process.
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Affiliation(s)
- D E M Hoff
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Kolos
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G W Misch
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D Ray
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - B Liu
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - A A Valverde
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - M Brodeur
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - D P Burdette
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - N Callahan
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - J A Clark
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - A T Gallant
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - F G Kondev
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - G E Morgan
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - M R Mumpower
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- Center for Theoretical Astrophysics, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - R Orford
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - W S Porter
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - F Rivero
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - G Savard
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
- Department of Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - N D Scielzo
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K S Sharma
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
| | - K Sieja
- Université de Strasbourg, IPHC, 23 rue du Loess 67037 Strasbourg, France CNRS, UMR7178, 67037 Strasbourg, France
| | - T M Sprouse
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L Varriano
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
- Department of Physics, University of Chicago, Chicago, Illinois 60637, USA
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Marschall A, Rivero F, Del Val D, Bastante T, Cuesta J, Alfonso F. Calcified Nodule: A Rare Clinical Diagnosis in Patients Presenting With ST-Segment Elevation Myocardial Infarction. JACC Case Rep 2023; 28:102122. [PMID: 38204557 PMCID: PMC10774823 DOI: 10.1016/j.jaccas.2023.102122] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 01/12/2024]
Abstract
Calcified nodules (CNs) represent the least common cause of acute coronary syndrome. Furthermore, case reports describing CNs as the underlying cause for ST-segment elevation myocardial infarction are exceptional. We present a patient with ST-segment elevation myocardial infarction caused by a CN and outline the corresponding diagnostic angiographic and intracoronary imaging findings.
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Affiliation(s)
- Alexander Marschall
- Servicio de Cardiología, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Rivero
- Servicio de Cardiología, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - David Del Val
- Servicio de Cardiología, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Cuesta
- Servicio de Cardiología, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
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5
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Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, IIS-IP, CIBER-CV, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, C/ Diego de León 62, Madrid 28006, Spain
| | - Alexander Marschall
- Department of Cardiology, IIS-IP, CIBER-CV, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, C/ Diego de León 62, Madrid 28006, Spain
| | - Fernando Rivero
- Department of Cardiology, IIS-IP, CIBER-CV, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, C/ Diego de León 62, Madrid 28006, Spain
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Alfonso F, Rivero F. Artificial intelligence-assisted angiographically-derived fractional flow reserve. Coron Artery Dis 2023; 34:542-544. [PMID: 37865859 DOI: 10.1097/mca.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology. Hospital Universitario de La Princesa. Universidad Autónoma de Madrid. IIS-IP, CIBER-CV, Madrid, Spain
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7
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Munhoz D, Collet C, Mizukami T, Yong A, Leone AM, Eftekhari A, Ko B, da Costa BR, Berry C, Collison D, Perera D, Christiansen EH, Rivero F, Zimmermann FM, Ando H, Matsuo H, Nakayama M, Escaned J, Sonck J, Sakai K, Adjedj J, Desta L, van Nunen LX, West NEJ, Fournier S, Storozhenko T, Amano T, Engstrøm T, Johnson T, Shinke T, Biscaglia S, Fearon WF, Ali Z, De Bruyne B, Johnson NP. Rationale and design of the pullback pressure gradient (PPG) global registry. Am Heart J 2023; 265:170-179. [PMID: 37611857 DOI: 10.1016/j.ahj.2023.07.016] [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] [Received: 04/06/2023] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Diffuse disease has been identified as one of the main reasons leading to low post-PCI fractional flow reserve (FFR) and residual angina after PCI. Coronary pressure pullbacks allow for the evaluation of hemodynamic coronary artery disease (CAD) patterns. The pullback pressure gradient (PPG) is a novel metric that quantifies the distribution and magnitude of pressure losses along the coronary artery in a focal-to-diffuse continuum. AIM The primary objective is to determine the predictive capacity of the PPG for post-PCI FFR. METHODS This prospective, large-scale, controlled, investigator-initiated, multicenter study is enrolling patients with at least 1 lesion in a major epicardial vessel with a distal FFR ≤ 0.80 intended to be treated by PCI. The study will include 982 subjects. A standardized physiological assessment will be performed pre-PCI, including the online calculation of PPG from FFR pullbacks performed manually. PPG quantifies the CAD pattern by combining several parameters from the FFR pullback curve. Post-PCI physiology will be recorded using a standardized protocol with FFR pullbacks. We hypothesize that PPG will predict optimal PCI results (post-PCI FFR ≥ 0.88) with an area under the ROC curve (AUC) ≥ 0.80. Secondary objectives include patient-reported and clinical outcomes in patients with focal vs. diffuse CAD defined by the PPG. Clinical follow-up will be collected for up to 36 months, and an independent clinical event committee will adjudicate events. RESULTS Recruitment is ongoing and is expected to be completed in the second half of 2023. CONCLUSION This international, large-scale, prospective study with pre-specified powered hypotheses will determine the ability of the preprocedural PPG index to predict optimal revascularization assessed by post-PCI FFR. In addition, it will evaluate the impact of PPG on treatment decisions and the predictive performance of PPG for angina relief and clinical outcomes.
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Affiliation(s)
- Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
| | - Andy Yong
- Concord Repatriation General Hospital, University of Sydney, New South Wales, Australia
| | - Antonio Maria Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University School of Medicine, Rome, Italy; Center of Excellence in Cardiovascular Diagnostics and Therapeutic, Ospedale Fabenefratelli Isola Tiberina Gemelli Isola, Rome, Italy
| | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Bruno R da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, England; Clinical Epidemiology and Health Care Research, Institute of Health Policy and Management Evaluation (IHPME), University of Toronto, Toronto, Ontorio, Canada
| | - Colin Berry
- School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Damien Collison
- School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, St Thomas' Hospital Campus, King's College London, London, UK
| | | | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | | | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid, Spain
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Koshiro Sakai
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzanck Institute Saint Laurent du Var, France
| | - Liyew Desta
- Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Lokien X van Nunen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Stephane Fournier
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Tatyana Storozhenko
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Thomas Engstrøm
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Johnson
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Toshiro Shinke
- Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine and VA Palo Alto Health Care System, Palo Alto, CA
| | - Ziad Ali
- St Francis Hospital and Heart Center, Roslyn, NY
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX.
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Cortés C, Fernández-Corredoira PM, Liu L, López-Palop R, Rivero F, Jiménez O, Freites A, Goncalves-Ramirez LR, Minguito C, Concepción R, Pérez A, Del Val D, Leithod G, Oberhuber-Kurth J, Amat-Santos IJ, Diarte JA, San Román JA, Ortas Nadal MR, Gutiérrez-Chico JL. Long-term prognostic value of quantitative-flow-ratio-concordant revascularization in stable coronary artery disease. Int J Cardiol 2023; 389:131176. [PMID: 37442350 DOI: 10.1016/j.ijcard.2023.131176] [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: 05/02/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Confirming the prognostic value of global QFR and evaluating the long-term prognosis of QFR-concordant therapy in stable coronary artery disease. BACKGROUND Wire-based functional evaluation of coronary disease is linked to patient's prognosis. Quantitative Flow Ratio (QFR) is a newer index of computational physiology, linked to clinical outcomes and prognosis at 1 year follow-up. Long-term prognosis of QFR-concordant revascularization in stable coronary artery disease is however unknown hitherto. METHODS Consecutive patients with stable coronary disease undergoing coronary angiography were included. Centralized and blinded QFR analysis of three coronary territories was performed. Three vessel QFR (3vQFR) was defined as the sum of the basal QFR of each coronary territory. QFR-concordant revascularization was met if all significant lesions (QFR ≤ 0.80) were revascularized and all non-significant lesions (QFR > 0.80) were not; otherwise, the case was defined as QFR-discordant revascularization. Patient-oriented composite end-point (POCE) of cardiac death, myocardial infarction and unscheduled revascularization was the primary endpoint. RESULTS A total of 803 patients from six high-volume centers were included. Canadian Cardiovascular Society (CCS) class II angina was the most frequent (48.9%) clinical presentation. Median of follow-up was 68.8 months. 3vQFR was an independent predictor of POCE (HR 1.79 CI95% 1.01-3.18), with 2.75 as optimal cut-off value, irrespective of the therapy received. QFR-discordant revascularization (QFR+/Revascularization- or QFR-/Revascularization+) was an independent predictor of POCE in multivariate analysis (HR 1.65, CI 95% 1.03-2.64). CONCLUSION Global burden of epicardial coronary atherosclerosis, as evaluated by 3vQFR, as well as QFR-discordant therapy are independent predictors of adverse clinical outcome at long-term follow-up in stable coronary artery disease.
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Affiliation(s)
- Carlos Cortés
- Hospital Clínico Universitario de Valladolid, Valladolid, CIBERCV, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | | | - Lili Liu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP. Madrid, Spain
| | | | - Alfonso Freites
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Ainhoa Pérez
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP. Madrid, Spain
| | - Gunnar Leithod
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - José A Diarte
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Juan Luis Gutiérrez-Chico
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Bundeswehrzentralkrankenhaus, Koblenz, Germany
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9
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Collet C, Johnson NP, Mizukami T, Fearon WF, Berry C, Sonck J, Collison D, Koo BK, Meneveau N, Agarwal SK, Uretsky B, Hakeem A, Doh JH, Da Costa BR, Oldroyd KG, Leipsic JA, Morbiducci U, Taylor C, Ko B, Tonino PAL, Perera D, Shinke T, Chiastra C, Sposito AC, Leone AM, Muller O, Fournier S, Matsuo H, Adjedj J, Amabile N, Piróth Z, Alfonso F, Rivero F, Ahn JM, Toth GG, Ihdayhid A, West NEJ, Amano T, Wyffels E, Munhoz D, Belmonte M, Ohashi H, Sakai K, Gallinoro E, Barbato E, Engstrøm T, Escaned J, Ali ZA, Kern MJ, Pijls NHJ, Jüni P, De Bruyne B. Impact of Post-PCI FFR Stratified by Coronary Artery. JACC Cardiovasc Interv 2023; 16:2396-2408. [PMID: 37821185 DOI: 10.1016/j.jcin.2023.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/12/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated. OBJECTIVES This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery. METHODS We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. RESULTS Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005). CONCLUSIONS The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.
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Affiliation(s)
- Carlos Collet
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium.
| | - Nils P Johnson
- Division of Cardiology, Department of Medicine, McGovern Medical School at University of Texas Health and Memorial Hermann Hospital, Houston, Texas, USA
| | - Takuya Mizukami
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Jeroen Sonck
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Damien Collison
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France; University of Burgundy Franche-Comté, Besançon, France
| | - Shiv Kumar Agarwal
- Division of Cardiology, Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Barry Uretsky
- Division of Cardiology, Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Abdul Hakeem
- Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Bruno R Da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Keith G Oldroyd
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Jonathon A Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Victoria, Australia
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Divaka Perera
- National Institute for Health Research Guy's and St Thomas' Biomedical Research Centre, King's College London and Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Claudio Chiastra
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Andrei C Sposito
- Department of Internal Medicine, Discipline of Cardiology, University of Campinas, Campinas, Brazil
| | - Antonio Maria Leone
- Center of Excellence in Cardiovascular Sciences, Ospedale Fatebenefratelli Isola Tiberina Gemelli Isola, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzanck Institute Saint Laurent du Var, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gabor G Toth
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Abdul Ihdayhid
- Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Curtin University, Perth, Australia
| | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Eric Wyffels
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium
| | - Daniel Munhoz
- Cardiovascular Center Aalst, onze lieve vrouw 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
| | - Marta Belmonte
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Hirofumi Ohashi
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Koshiro Sakai
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Javier Escaned
- Instituto de Investigacion Sanitaria Del Hospital Clinico San Carlos, Complutense University, Madrid, Spain
| | - Ziad A Ali
- St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Morton J Kern
- University of California Irvine and Veterans Affairs Long Beach Healthcare System, Irvine, California, USA
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Peter Jüni
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
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10
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Rivero F, Roquero P, Cuesta J, Bastante T, Del Val D, Aguilar R, Salamanca J, Díez-Villanueva P, Alfonso F. Improvement in the Infarct-Related Artery Coronary Flow by Impella Support. JACC Cardiovasc Interv 2023; 16:2191-2193. [PMID: 37565967 DOI: 10.1016/j.jcin.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 08/12/2023]
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Alfonso F, Rivero F. Hyperemic and non-hyperemic indexes in coronary physiology. Causes and implications of discordant results. Int J Cardiol Heart Vasc 2023; 47:101225. [PMID: 37576080 PMCID: PMC10422667 DOI: 10.1016/j.ijcha.2023.101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
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12
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Gomez-Lara J, Gracida M, Rivero F, Gutiérrez-Barrios A, Muntané-Carol G, Romaguera R, Fuentes L, Marcano A, Roura G, Ferreiro JL, Teruel L, Brugaletta S, Alfonso F, Comín-Colet J, Gomez-Hospital JA. Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia: The Randomized RAIN-FLOW Study. J Am Heart Assoc 2023:e030285. [PMID: 37345805 DOI: 10.1161/jaha.123.030285] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background ST-segment-elevation myocardial infarction complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have been shown to improve the Thrombolysis in Myocardial Infarction flow, optimal treatment of no reflow remains unsettled. Saline infusion at 20 mL/min via a dedicated microcatheter causes (flow-mediated) hyperemia. The objective is to compare the efficacy of pharmacologic versus flow-mediated hyperemia in patients with ST-segment-elevation myocardial infarction complicated with no reflow. Methods and Results In the RAIN-FLOW (Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia) study, 67 patients with ST-segment-elevation myocardial infarction and no reflow were randomized to receive either pharmacologic-mediated hyperemia with intracoronary adenosine or nitroprusside (n=30) versus flow-mediated hyperemia (n=37). The angiographic corrected Thrombolysis in Myocardial Infarction frame count and the minimal microcirculatory resistance, as assessed with intracoronary pressure-thermistor wire, dedicated microcatheter, and thermodilution techniques, were compared after study interventions. Both Thrombolysis in Myocardial Infarction frame count(40.2±23.1 versus 39.2±20.7; P=0.858) and minimal microcirculatory resistance (753.6±661.5 versus 993.3±740.8 Wood units; P=0.174) were similar between groups. Thrombolysis in Myocardial Infarction 3 flow was observed in 26.7% versus 27.0% (P=0.899). Flow-mediated hyperemia showed 2 different thermodilution patterns during saline infusion indicative of the severity of the no reflow phenomenon. In-hospital death and nonfatal heart failure were observed in 10.4% and 26.9%, respectively. Conclusions Both treatments showed similar (and limited) efficacy restoring coronary flow. Flow-mediated hyperemia with thermodilution pattern assessment allowed the simultaneous characterization of the no reflow degree and response to hyperemia. No reflow was associated with a high rate of adverse outcomes. Further research is warranted to prevent and to treat no reflow in patients with ST-segment-elevation myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04685941.
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Affiliation(s)
- Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Montserrat Gracida
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Fernando Rivero
- Hospital Universtiario La Princesa, Instituto de Investigación Sanitaria-IP (IIS-IP), CIBER-CV Madrid Spain
| | | | - Guillem Muntané-Carol
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Lara Fuentes
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Ana Marcano
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Gerard Roura
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - José Luis Ferreiro
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Luis Teruel
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Salvatore Brugaletta
- Hospital Clínic i Provincial de Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
| | - Fernando Alfonso
- Hospital Universtiario La Princesa, Instituto de Investigación Sanitaria-IP (IIS-IP), CIBER-CV Madrid Spain
| | - Josep Comín-Colet
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Joan-Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
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13
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Cortese B, Testa G, Rivero F, Erriquez A, Alfonso F. Long-Term Outcome of Drug-Coated Balloon vs Drug-Eluting Stent for Small Coronary Vessels: PICCOLETO-II 3-Year Follow-Up. JACC Cardiovasc Interv 2023; 16:1054-1061. [PMID: 37164603 DOI: 10.1016/j.jcin.2023.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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] [Received: 11/20/2022] [Revised: 01/30/2023] [Accepted: 02/12/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Native vessel coronary artery disease represents 1 of the most attractive fields of application for drug-coated balloons (DCBs). To date, several devices have been compared with drug-eluting stents (DESs) in this setting with different outcomes. OBJECTIVES The authors sought to compare the short- and long-term performance of the paclitaxel DCB with the everolimus-eluting stent in patients with de novo lesions in small coronary vessel disease. METHODS PICCOLETO II (Drug Eluting Balloon Efficacy for Small Coronary Vessel Disease Treatment) was an academic, international, investigator-driven, multicenter, open-label randomized clinical trial in which patients were allocated to a DCB (n = 118) or DES (n = 114). We previously reported the superiority of DCBs regarding in-lesion late lumen loss at 6 months. Herein we report the final 3-year clinical follow-up with the occurrence of major adverse cardiac events (MACEs), a composite of cardiac death, nonfatal myocardial infarction, target lesion revascularization, and its individual components. RESULTS The 3-year clinical follow-up (median 1,101 days; IQR: 1,055-1,146 days) was available for 102 patients allocated to DCB and 101 to DES treatment. The cumulative rate of all-cause death (4% vs 3.9%; P = 0.98), cardiac death (1% vs 1.9%; P = 0.56), myocardial infarction (6.9% vs 2%; P = 0.14), and target lesion revascularization (14.8% vs 8.8%; P = 0.18) did not significantly differ between DCBs and DESs. MACEs and acute vessel occlusion occurred more frequently in the DES group (20.8% vs 10.8% [P = 0.046] and 4% vs 0% [P = 0.042], respectively). CONCLUSIONS The long-term clinical follow-up of the PICCOLETO II randomized clinical trial shows a higher risk of MACEs in patients with de novo lesions in small vessel disease when they are treated with the current-generation DES compared with the new-generation paclitaxel DCB. (Drug Eluting Balloon Efficacy for Small Coronary Vessel Disease Treatment [PICCOLETO II]; NCT03899818).
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Affiliation(s)
- Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy; DCB Academy, Milano, Italy.
| | | | - Fernando Rivero
- Cardiology Department, Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Madrid, Spain
| | - Andrea Erriquez
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Madrid, Spain
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14
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Osinalde EP, Bastante T, Cecconi A, Muñiz ÁM, García-Guimaraes M, Rivero F, Rojas-González A, Olivera MJ, Salamanca J, de Isla LP, De Agustín JA, Caballero P, Torres RA, Jiménez-Borreguero LJ, Alfonso F. Intracoronary thrombus assessment with cardiac computed tomography angiography in a deferred stenting strategy: the MATURE prospective study (MSCT to Assess ThrombUs REsolution). Coron Artery Dis 2023; 34:167-176. [PMID: 36762665 DOI: 10.1097/mca.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 02/11/2023]
Abstract
BACKGROUND Cardiac computed tomography angiography (CCTA) is precise in noninvasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate CCTA for intracoronary thrombus and stenosis detection in patients with acute coronary syndromes with high thrombus burden selected for a deferred stenting strategy. METHODS We systematically performed a CCTA in consecutive patients following a deferred stenting strategy, 24 h before the scheduled repeated coronary angiography including optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both techniques. Agreement was determined per lesion using the weighted Kappa ( K ) coefficient and absolute intraclass correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed. RESULTS Thirty lesions in 28 consecutive patients were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good ( K = 0.554; P < 0.001), but both showed poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs. 33.3%; P = 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter measurement (ICC = 0.85; P < 0.001) and was able to identify all the patients with severe residual stenosis. CONCLUSIONS Although CCTA showed just a good concordance with angiography in intracoronary thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden selected for a deferred stenting strategy CCTA may substitute repeat angiography.
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Affiliation(s)
- Eduardo Pozo Osinalde
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid
| | - Teresa Bastante
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Álvaro Montes Muñiz
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Marcos García-Guimaraes
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
- Cardiology Department, Hospital del Mar - Parc de Salut Mar, Barcelona
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Antonio Rojas-González
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - María José Olivera
- Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | | | | | - Paloma Caballero
- Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rio Aguilar Torres
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | | | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
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15
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Del Val D, Bastante T, Rivero F, Cuesta J, Martinez-Avial M, Alfonso F. "Lotus root": a novel optical coherence tomography imaging pattern in spontaneous coronary artery dissection. EUROINTERVENTION 2023; 18:1458-1459. [PMID: 36660809 PMCID: PMC10111131 DOI: 10.4244/eij-d-22-00775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/10/2022] [Indexed: 01/21/2023]
Affiliation(s)
- David Del Val
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria, IIS-IP, Hospital Universitario de La Princesa, Madrid, Spain
| | - Teresa Bastante
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria, IIS-IP, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria, IIS-IP, Hospital Universitario de La Princesa, Madrid, Spain
| | - Javier Cuesta
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria, IIS-IP, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria, IIS-IP, Hospital Universitario de La Princesa, Madrid, Spain
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16
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Fabris E, Berta B, Hommels T, Roleder T, Hermanides RS, Rivero F, von Birgelen C, Escaned J, Camaro C, Kennedy MW, Pereira B, Magro M, Nef H, Reith S, Roleder-Dylewska M, Gasior P, Malinowski KP, De Luca G, Garcia-Garcia HM, Granada JF, Wojakowski W, Kedhi E. Long-term outcomes of patients with normal fractional flow reserve and thin-cap fibroatheroma. EUROINTERVENTION 2023; 18:e1099-e1107. [PMID: 36170036 PMCID: PMC9909454 DOI: 10.4244/eij-d-22-00306] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/04/2022] [Accepted: 08/09/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND The long-term prognostic implications of fractional flow reserve (FFR)-negative lesions hosting vulnerable plaques remain unsettled. AIMS The aim of this study was to evaluate the association of non-ischaemic lesions hosting optical coherence tomography (OCT)-detected thin-cap fibroatheromas (TCFA) with first and recurrent cardiovascular events during follow-up up to 5 years in a diabetes mellitus (DM) patient population. METHODS COMBINE OCT-FFR is a prospective, international, double-blind, natural history study. Patients with DM and with ≥1 FFR-negative lesion were classified into 2 groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint (PE) is a composite of cardiac mortality, target vessel-related myocardial infarction (TV-MI), clinically driven target lesion revascularisation (TLR), or unstable angina (UA) requiring hospitalisation during follow-up up to 5 years. RESULTS Among 390 DM patients (age 67.5±9 years; 37% female) with ≥1 FFR-negative lesion, 292 (74.9%) were TCFA-negative while 98 (25.1%) were TCFA-positive. The PE occurred more frequently in TCFA-positive than in TCFA-negative patients (21.4% vs 8.2%, hazard ratio [HR] 2.89, 95% confidence interval [CI]: 1.61-5.20; p<0.001; 6.42 vs 2.46 events per 100 patient-years, rate ratio [RR] 2.61, 95% CI: 1.38-4.90; p=0.002). Furthermore, when TV-MI, TLR, and UA were treated as recurrent components of the PE, TCFA-positive patients experienced a higher risk of recurrent events (HR 2.89, 95% CI; 1.74-4.80; p<0.001; 13.45 vs 2.87 events per 100 patient-years, RR 4.69, 95% CI: 2.86-7.83; p<0.001). A multivariable analysis identified the presence of TCFA as an independent predictor of the PE (HR 2.76, 95% CI: 1.53-4.97; p<0.001). CONCLUSIONS OCT-detected TCFA-positive lesions, although not ischaemia-generating, are associated with an increased risk of adverse events during long-term follow-up. CLINICALTRIALS gov: NCT02989740.
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Affiliation(s)
- Enrico Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Balázs Berta
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
- Isala Hartcentrum, Zwolle, the Netherlands
| | | | - Tomasz Roleder
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Clemens von Birgelen
- Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- Technical Medical Centre, Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos IdISSC, Complutense University, Madrid, Spain
| | - Cyril Camaro
- Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Michael Magro
- Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Holger Nef
- Universitätsklinikum Gießen und Marburg, Gießen/Marburg, Germany
| | | | - Magda Roleder-Dylewska
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Piotr Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | | | - Juan F Granada
- Cardiovascular Research Foundation, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Elvin Kedhi
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Erasmus Hospital, Université libre de Bruxelles, Brussels, Belgium
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17
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Rodriguez-Leor O, Toledano B, López-Palop R, Rivero F, Brugaletta S, Linares JA, Benito T, Carrillo P, Puigfel M, Cediel G, Sadaba M, Vaquerizo B, Rondán J, Gómez I, Alfonso F, Sáez R, Planas A, Lozano F, Hernández F, Sabaté M, Ruíz-Arroyo JR, Torres F, de la Torre Hernández JM, Gutiérrez E, Cid-Álvarez AB, Díez JL, Fernández L, Moreu J, Ojeda S, Cerrato P, Ruiz-Quevedo V, Sanchis J, Gómez-Menchero A, Ocaranza R, Mohandes M, Hernández JM, Alfageme MM, Aguiar P, López Mínguez JR, Pérez de Prado A. Changes in the treatment strategy following intracoronary pressure wire in a contemporaneous real-life cohort of patients with intermediate coronary stenosis. Results from a nationwide registry. Cardiovasc Revasc Med 2023; 51:55-64. [PMID: 36822975 DOI: 10.1016/j.carrev.2023.01.027] [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: 07/21/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease. AIMS To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis. METHODS Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed. RESULTS 1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0 %). The extent of coronary artery disease changed in 771 patients (54.5 %). There was a change in treatment strategy in 779 patients (55.1 %) (18.0 % if medical treatment; 68.8 % if PCI; 58.9 % if surgery (p < 0.001 for PCI vs medical treatment; p = 0.041 for PCI vs CABG; p < 0.001 for medical treatment vs CABG)). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6 % vs 8.2 %, p = 0.034). CONCLUSIONS The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.
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Affiliation(s)
- Oriol Rodriguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER de Enfermedades CardioVasculares (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
| | - Beatriz Toledano
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Fernando Rivero
- Servicio de Cardiología, Hospital de la Princesa, Madrid, Spain
| | - Salvatore Brugaletta
- Servicio de Cardiología, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | - Tomás Benito
- Servicio de Cardiología, Hospital de León, León, Spain
| | - Pilar Carrillo
- Servicio de Cardiología, Hospital de Sant Joan, Alacant, Spain
| | - Martí Puigfel
- Servicio de Cardiología, Hospital Josep Trueta de Girona, Girona, Spain
| | - German Cediel
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mario Sadaba
- Servicio de Cardiología, Hospital de Galdakao, Galdakao, Spain
| | | | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Spain
| | - Iván Gómez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Roberto Sáez
- Servicio de Cardiología, Hospital de Basurto, Basurto, Spain
| | - Ana Planas
- Servicio de Cardiología, Hospital de Castellón, Castellón de la Plana, Spain
| | - Fernando Lozano
- Servicio de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Felipe Hernández
- Servicio de Cardiología, Clínica Universitaria de Navarra, Madrid, Spain
| | - Manel Sabaté
- Servicio de Cardiología, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | | | | | - Enrique Gutiérrez
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Belén Cid-Álvarez
- Servicio de Cardiología, Hospital Clínico de Santiago, Santiago de Compostela, Spain
| | - José Luís Díez
- Servicio de Cardiología, Hospital Universitari de la Fe, Valencia, Spain
| | - Luis Fernández
- Servicio de Cardiología, Hospital de Cruces, Barakaldo, Spain
| | - José Moreu
- Servicio de Cardiología, Hospital de Toledo, Toledo, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Pablo Cerrato
- Servicio de Cardiología, Hospital de Mérida, Mérida, Spain
| | | | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Mohsen Mohandes
- Servicio de Cardiología, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - Pablo Aguiar
- Servicio de Cardiología, Hospital San Pedro de Logroño, Logroño, Spain
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Cid Alvarez B, Rodriguez Leor O, Gonzalo N, Diarte Miguel JA, Muñoz Camacho JF, Jurado Román A, Diego Nieto A, Oteo JF, Rivero F, Avanzas P, Lozano I, Calviño R, Moreu J, Sanchez DM, Jimenez Mazuecos J, Ocaranza-Sanchez R, de la Torre JM, Mohandes M, Lozano F, Telleria M, Palazuelos J, Gonzalez R, Jimenez V, Gomez Lara J, Prado APD. CRT-100.39 Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Artery Disease in a Real-Life Setting: Results From the REPLICA-EPIC18 Study. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.025] [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: 02/22/2023]
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19
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Cuesta J, Bastante T, Del Val D, Rivero F, Alfonso F. Plaque Progression Secondary to Intraplaque Hemorrhage Associated With Coronary Vasospasm. JACC Cardiovasc Interv 2023; 16:116-117. [PMID: 36599579 DOI: 10.1016/j.jcin.2022.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.
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20
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Lorenzo N, Hernandez V, Montes A, Rivero F, Reyes* G, Aguilar R. Left Ventricular Thrombosis and Pulmonary Thromboembolism in an Asymptomatic Covid-19 Patient. Arq Bras Cardiol 2022; 119:996-998. [PMID: 36541997 PMCID: PMC9814811 DOI: 10.36660/abc.20210590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 06/01/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Natalia Lorenzo
- Hospital Universitario Infanta CristinaCardiologiaParlaEspanhaHospital Universitario Infanta Cristina - Cardiologia, Parla – Espanha
| | - Veronica Hernandez
- Hospital Universitario Infanta CristinaCardiologiaParlaEspanhaHospital Universitario Infanta Cristina - Cardiologia, Parla – Espanha
| | - Alvaro Montes
- Hospital Universitario de la PrincesaCardiologia e Cirurgia CardíacaMadridEspanhaHospital Universitario de la Princesa - Cardiologia e Cirurgia Cardíaca, Madrid – Espanha
| | - Fernando Rivero
- Hospital Universitario de la PrincesaCardiologia e Cirurgia CardíacaMadridEspanhaHospital Universitario de la Princesa - Cardiologia e Cirurgia Cardíaca, Madrid – Espanha
| | - Guillermo Reyes*
- Hospital Universitario de la PrincesaCardiologia e Cirurgia CardíacaMadridEspanhaHospital Universitario de la Princesa - Cardiologia e Cirurgia Cardíaca, Madrid – Espanha
| | - Rio Aguilar
- Hospital Universitario de la PrincesaCardiologia e Cirurgia CardíacaMadridEspanhaHospital Universitario de la Princesa - Cardiologia e Cirurgia Cardíaca, Madrid – Espanha,Correspondência: Rio Aguilar • Hospital Universitario de la Princesa. C/Diego de León, 62. Madrid 28006. Espanha E-mail:
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21
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Aparisi A, Garcia Guimaraes M, Gutierrez-Barrios A, Gomez-Lara J, Rivero F, Salvatella N, Tizon H, Cubero-Gallego H, Negrete A, Vaquerizo B. Microvascular dysfunction and absolute coronary blood flow after percutaneous coronary intervention of a chronic total occlusion. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1129] [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
The development of a coronary chronic total occlusion (CTO) causes changes in the distal epicardial vascular bed and in the microvasculature tributary of the occluded vessel. Studies with positron emission tomography showed an increase in myocardial blood flow and coronary flow reserve (CFR) after percutaneous coronary intervention (PCI) of a CTO (1). These changes are not immediate after PCI, since they usually involve a process of weeks-months (2).
The FLOW-CTO study aims to evaluate the evolution of microvascular resistance and absolute coronary blood flow (ABF) after PCI of a CTO.
The study consecutively included patients in 4 national centers in Spain. In these patients, a coronary physiology study was performed, immediately after PCI and at 6 months follow-up. Fractional flow reserve (FRR), CFR and index of microcirculatory resistance (IMR) were determined. ABF and microvascular resistances were determined by continuous thermodilution during maximal hyperemia induced by serum infusion (3). Coronary microvascular dysfunction (MVD) was defined as an IMR ≥25 and/or an CFR <2.0, in the presence of an FFR >0.80. We present data from the baseline study immediately after PCI of a CTO in the first 49 patients.
Most patients were male (90%), with a median age of 62 years-old [IQR 56–69]. The prevalence of hypertension, dyslipidemia and diabetes were 71, 67 and 41%, respectively. The median left ventricular ejection fraction was 55% [IQR 45–60]. Eighty-six percent of the patients had exertional angina and 14% had history of congestive heart failure.
The most frequently involved vessel was the right coronary artery (55%). The most used technique was antegrade guidewire escalation (74%). The median length of the devices implanted was 59±25 mm. The mean percentage of residual stenosis was 8±4%.
Despite the good angiographic result, 20% of the lesions had an FFR value ≤0.80. Of those patients with a non-significant FFR value (>0.80), 54% had signs of MVD. Those patients with an elevated IMR (≥25) showed a non-significant trend towards a lower ABF (143±79 vs. 192±59 mL/min; p=0.1043), with significantly higher microvascular resistance (694±206 vs. 471±166 mmHg/(l/min); p=0.0328). Those patients with a reduced CFR (<2.0) had lower ABF (166±57 vs. 207±64 ml/min; p=0.0460) and a non-significant trend towards a higher microvascular resistance (535±240 vs. 466±195 mmHg/(l/min); p=0.3419). Diabetes mellitus was identified as a predictor of an elevated IMR (OR 6.3, 95% CI 1.1–13; p=0.046) or reduced CFR (OR 5.7, 95% CI 1.4–22, p=0.013).
In our study, more than half of the patients presented signs of MVD immediately after PCI of a CTO. Despite an optimal angiographic result, in a fifth of the cases we found a significant alteration of the parameters that evaluate the epicardial circulation. Diabetes mellitus was found as a predictor of MVD after PCI of a CTO.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Aparisi
- Hospital del Mar , Barcelona , Spain
| | | | | | - J Gomez-Lara
- University Hospital Bellvitge , Barcelona , Spain
| | - F Rivero
- University Hospital of La Princesa , Madrid , Spain
| | | | - H Tizon
- Hospital del Mar , Barcelona , Spain
| | | | - A Negrete
- Hospital del Mar , Barcelona , Spain
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22
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Blanco-Domínguez R, de la Fuente H, Rodríguez C, Martín-Aguado L, Sánchez-Díaz R, Jiménez-Alejandre R, Rodriguez-Arabaolaza I, Curtabbi A, Garcia-Guimaraes MM, Vera A, Rivero F, Cuesta J, Jimenez-Borreguero LJ, Cecconi A, Duran-Cambra A, Taurón M, Alonso J, Bueno H, Villalba-Orero M, Enriquez JA, Robson SC, Alfonso F, Sánchez-Madrid F, Martínez-González J, Martín P. CD69 expression on regulatory T cells protects from immune damage after myocardial infarction. J Clin Invest 2022; 132:152418. [PMID: 36066993 PMCID: PMC9621142 DOI: 10.1172/jci152418] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Increasing evidence has pointed to the important function of T cells in controlling immune homeostasis and pathogenesis after myocardial infarction (MI), although the underlying molecular mechanisms remain elusive. In this study, a broad analysis of immune markers in 283 patients revealed significant CD69 overexpression on Tregs after MI. Our results in mice showed that CD69 expression on Tregs increased survival after left anterior descending (LAD) coronary artery ligation. Cd69–/– mice developed strong IL-17+ γδT cell responses after ischemia that increased myocardial inflammation and, consequently, worsened cardiac function. CD69+ Tregs, by induction of AhR-dependent CD39 ectonucleotidase activity, induced apoptosis and decreased IL-17A production in γδT cells. Adoptive transfer of CD69+ Tregs into Cd69–/– mice after LAD ligation reduced IL-17+ γδT cell recruitment, thus increasing survival. Consistently, clinical data from 2 independent cohorts of patients indicated that increased CD69 expression in peripheral blood cells after acute MI was associated with a lower risk of rehospitalization for heart failure (HF) after 2.5 years of follow-up. This result remained significant after adjustment for age, sex, and traditional cardiac damage biomarkers. Our data highlight CD69 expression on Tregs as a potential prognostic factor and a therapeutic option to prevent HF after MI.
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Affiliation(s)
- Rafael Blanco-Domínguez
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Hortensia de la Fuente
- Department of Immunology, Hospital Universitario de la Princesa, CIBER Cardiovascular, Madrid, Spain
| | - Cristina Rodríguez
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Martín-Aguado
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Raquel Sánchez-Díaz
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Rosa Jiménez-Alejandre
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Andrea Curtabbi
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Alberto Vera
- Department of Cardiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Alberto Cecconi
- Department of Cardiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Albert Duran-Cambra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manel Taurón
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Judith Alonso
- Research, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain
| | - Héctor Bueno
- Cardiology Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - María Villalba-Orero
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - José Antonio Enriquez
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Simon C Robson
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, United States of America
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Francisco Sánchez-Madrid
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Pilar Martín
- Vascular Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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23
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Cortes C, Corredoira PF, Rivero F, Esteves AF, Melo OJ, Goncalves-Ramírez L, Liu L, Perez guerrero A. TCT-235 5-Year Prognostic Value of QFR-Guided Revascularization in Patients With Stable Coronary Artery Disease: A Multicenter Registry. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.276] [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: 11/30/2022]
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24
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García-Guimarães M, Gutiérrez-Barrios A, Gómez-Lara J, Aparisi Á, Salvatella N, Rivero F. Microvascular dysfunction and invasive absolute coronary flow after percutaneous coronary intervention for a chronic total occlusion. The FLOW-CTO study. Rev Esp Cardiol (Engl Ed) 2022; 75:769-771. [PMID: 35662521 DOI: 10.1016/j.rec.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Marcos García-Guimarães
- Servicio de Cardiología, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | | | - Josep Gómez-Lara
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Álvaro Aparisi
- Servicio de Cardiología, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Neus Salvatella
- Servicio de Cardiología, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Fernando Rivero
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
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25
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Diego-Nieto A, Núñez JC, Miñana G, Amat-Santos IJ, Salinas-Sanguino P, Mohandes M, Regueiro A, Pan M, Lacunza J, Caballero-Borrego J, Fernández-Díaz JA, Fernández Cisnal A, Santos-Martínez S, Gonzalo N, Vaquerizo B, Rivero F, Jurado-Román A, Abellán-Huerta J, Rumiz González E, Rondán-Murillo J, López Benito M, Astorga Burgo JC, Jiménez Mazuecos J, Bosa Ojeda F, Moreno-Ambroj C, Sabaté M, Ojeda S, Valdesuso Aguilar R, López Pérez M, Sanchis J, Campo-Prieto A, Escaned J, Goicolea J, Martín-Moreiras J. Seguridad y viabilidad del acceso radial para intervenciones coronarias percutáneas de oclusiones totales crónicas. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.05.021] [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: 10/15/2022]
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26
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Muñoz-Ortiz T, Hu J, Sanz-Rodríguez F, Ortgies DH, Jaque D, Méndez-González D, Aguilar R, Alfonso F, Rivero F, Martín Rodríguez E, García Solé J. Optical detection of atherosclerosis at molecular level by optical coherence tomography: An in vitro study. Nanomedicine 2022; 43:102556. [PMID: 35390527 DOI: 10.1016/j.nano.2022.102556] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/22/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
There is an urgent need for contrast agents to detect the first inflammation stage of atherosclerosis by cardiovascular optical coherence tomography (CV-OCT), the imaging technique with the highest spatial resolution and sensitivity of those used during coronary interventions. Gold nanoshells (GNSs) provide the strongest signal by CV-OCT. GNSs are functionalized with the cLABL peptide that binds specifically to the ICAM-1 molecule upregulated in the first stage of atherosclerosis. Dark field microscopy and CV-OCT are used to evaluate the specific adhesion of these functionalized GNSs to activated endothelial cells. This adhesion is investigated under static and dynamic conditions, for shear stresses comparable to those of physiological conditions. An increase in the scattering signal given by the functionalized GNSs attached to activated cells is observed compared to non-activated cells. Thus, cLABL-functionalized GNSs behave as excellent contrast agents for CV-OCT and promise a novel strategy for clinical molecular imaging of atherosclerosis.
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Affiliation(s)
- Tamara Muñoz-Ortiz
- Nanomaterials for Bioimaging Group (nanoBIG), Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain; Instituto Nicolás Cabrera, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jie Hu
- Xiamen Institute of Rare-earth Materials, Haixi Institutes Chinese Academy of Sciences, Xiamen, Fujian, China
| | - Francisco Sanz-Rodríguez
- Nanomaterials for Bioimaging Group (nanoBIG), Departamento de Biología, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain
| | - Dirk H Ortgies
- Nanomaterials for Bioimaging Group (nanoBIG), Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain; Nanomaterials for Bioimaging Group (nanoBIG), Instituto Ramón y Cajal de Investigación, Sanitaria Hospital Ramón y Cajal, Madrid, Spain
| | - Daniel Jaque
- Nanomaterials for Bioimaging Group (nanoBIG), Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain; Instituto Nicolás Cabrera, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain; Nanomaterials for Bioimaging Group (nanoBIG), Instituto Ramón y Cajal de Investigación, Sanitaria Hospital Ramón y Cajal, Madrid, Spain
| | - Diego Méndez-González
- Nanomaterials for Bioimaging Group (nanoBIG), Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain; Nanomaterials for Bioimaging Group (nanoBIG), Instituto Ramón y Cajal de Investigación, Sanitaria Hospital Ramón y Cajal, Madrid, Spain
| | - Río Aguilar
- Cardiology Department, Hospital Universitario de la Princesa, Instituto Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de la Princesa, Instituto Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de la Princesa, Instituto Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Emma Martín Rodríguez
- Instituto Nicolás Cabrera, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain; Nanomaterials for Bioimaging Group (nanoBIG), Instituto Ramón y Cajal de Investigación, Sanitaria Hospital Ramón y Cajal, Madrid, Spain; Nanomaterials for Bioimaging Group (nanoBIG), Departamento de Física Aplicada, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain.
| | - José García Solé
- Nanomaterials for Bioimaging Group (nanoBIG), Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain; Instituto Nicolás Cabrera, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain
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Bastante T, Cuesta J, Rivero F, del Val D, Martínez-Avial y M, Alfonso F. Implante de marcapasos sin cables Micra y pr�tesis a�rtica transcat�ter en un mismo procedimiento. RECIC 2022. [DOI: 10.24875/recic.m22000298] [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: 11/17/2022] Open
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28
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García-García HM, Finizio M, del Val D, Rivero F, Waksman R, Alfonso F. High-definition intravascular ultrasound: current clinical uses. Int J Cardiovasc Imaging 2022. [DOI: 10.1007/s10554-022-02526-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: 11/30/2022]
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29
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Jurado-Román A, Miñana G, Salinas P, Regueiro A, Caballero-Borrego J, Martín-Moreiras J, Rivero F, Lacunza J, Rondán J, Amat-Santos IJ, Sanchís J, Gonzalo N, Sabaté M, Astorga JC, Mohandes M, Gómez-Menchero A, Fernández Díaz JA, Ojeda S, Paredes E, Vaquerizo B, Vinhas H, López M, Rodríguez S, Rúmiz E, Jiménez-Mazuecos J, Lee DH, Robles J, Gutiérrez A, Morales FJ, Consuegra L, Maristany J, Bosa Ojeda F, Goicolea J, Escaned J, Galeote G. Overlapping versus single long stents in long chronic total occlusions: insights of the Iberian CTO Registry. Minerva Cardiol Angiol 2022; 71:284-293. [PMID: 35420282 DOI: 10.23736/s2724-5683.22.06046-x] [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: 11/08/2022]
Abstract
BACKGROUND It is unknown whether the availability of long drug-eluting stents modify the PCI strategy of long CTO. To describe the contemporary PCI strategy of long chronic total occlusions (CTO) using overlapping (OS) or single long stents (SS) and to analyze its results. METHODS 2842 consecutive CTO PCIs were included. T hose with an occlusion length ≥20 mm in which ≥ 1 DES was implanted were analyzed. We compared procedural characteristics and clinical outcomes of CTO treated with OS or SS. RESULTS 1088 CTO PCIs were analyzed (79.9% males; 64.7±10.6 years). Mean J-score was 2.8 ± 0.9. A SS was used in 38.5% of cases and OS in 61.5%. Total stent length was 64.1±29.9 mm; it was higher in the OS group (OS:79.9±25.5 mm vs SS:38.3±14.7 mm; p<0.0001). Mean number of stents in the OS group was 2.3±1. Very long stents (≥40 mm) were used in 27.4% of cases, more frequently in the OS group (OS:32.4% vs SS:19.3%; p<0.0001). After a mean follow-up of 19±15.9 months, the rate of adverse events (MACE) was 2% (cardiac death:1.6%, myocardial infarction:1.6%, target lesion revascularization:1.9% and stent thrombosis: 0.18%) with no significant differences between both groups. Overlapping was not an independent predictor of MACE. CONCLUSIONS In long CTO PCIs, OS is more frequently used than single stenting, especially in more complex procedures. Clinical outcomes at a mid-term follow-up are favorable. Using newer generation DES, overlapping was not an independent predictor of MACE, however a trend toward a higher event rate was observed in the OS group.
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Affiliation(s)
- Alfonso Jurado-Román
- La Paz University Hospital, Madrid, Spain - .,University General Hospital of Ciudad Real, Ciudad Real, Spain -
| | - Gema Miñana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), INCLIVA, Hospital Clínic Universitari, University of Valencia, Valencia, Spain
| | - Pablo Salinas
- Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | - Javier Lacunza
- University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Juan Rondán
- University Hospital of Cabueñes, Gijón, Spain
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain
| | - Juan Sanchís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), INCLIVA, Hospital Clínic Universitari, University of Valencia, Valencia, Spain
| | - Nieves Gonzalo
- Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Hugo Vinhas
- University Hospital of Algarve, Algarve, Portugal
| | | | | | - Eva Rúmiz
- University General Hospital of Valencia, Valencia, Spain
| | | | - Dae-Hyun Lee
- University Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | - Javier Escaned
- Hospital Clinico Universitario San Carlos, Madrid, Spain
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Rivero F, Cuesta J, Jiménez-Valero S, Bastante T, Del Val D, Alfonso F. Balloon-assisted tracking deployment of a coronary sinus reducer through a Vieussens valve. Cardiol J 2022; 29:360-361. [PMID: 35411932 PMCID: PMC9007494 DOI: 10.5603/cj.2022.0017] [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: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria, IIS-IP, CIBER-CV, Spain.
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria, IIS-IP, CIBER-CV, Spain
| | | | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria, IIS-IP, CIBER-CV, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria, IIS-IP, CIBER-CV, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria, IIS-IP, CIBER-CV, Spain
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Wiebe J, Byrne RA, Alfonso F, Maeng M, Bradaric C, Kretov E, Cuesta J, Kuna C, Ibrahim T, Rivero F, Heugl M, Christiansen EH, Joner M, Schunkert H, Laugwitz KL, Kastrati A, Cassese S. Clinical outcomes of everolimus-eluting bioresorbable scaffolds or everolimus-eluting stents in patients with acute myocardial infarction: two-year results of the randomised ISAR-Absorb MI trial. EUROINTERVENTION 2022; 17:1348-1351. [PMID: 34702694 PMCID: PMC9743231 DOI: 10.4244/eij-d-21-00653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jens Wiebe
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Cardiovascular Research Institute, Mater Private Hospital, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fernando Alfonso
- Cardiac Department, Hospital Universitario de La Princesa Madrid, Madrid, Spain
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Bradaric
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Evgeny Kretov
- E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Javier Cuesta
- Cardiac Department, Hospital Universitario de La Princesa Madrid, Madrid, Spain
| | - Constantin Kuna
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa Madrid, Madrid, Spain
| | - Mira Heugl
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
| | | | - Michael Joner
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.,Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Department of Cardiology, Technische Universität München, Munich, Germany
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32
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Rivero F, Marco V, Biccirè FG, Budassi S, Cuesta J, Del Val D, Bastante T, de la Fuente H, Prati F, Alfonso F. The double injection technique to improve visualization of severe coronary lesions with optical coherence tomography. Catheter Cardiovasc Interv 2022; 99:1511-1517. [PMID: 35238444 DOI: 10.1002/ccd.30138] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a high-resolution imaging modality that provides a precise evaluation of coronary anatomy. However, the presence of severe coronary lesions can prevent the required adequate distal contrast flushing resultting in inadequate blood clearance and poor image quality or complete blood shadowing of the underlying vessel wall. OBJECTIVES The aim of this prospective study was to evaluate the feasibility and safety of a novel "double injection technique" (DIT) to overcome the limitations of the conventional technique (CT) in patients with severely stenotic lesions. METHODS Twenty-three patients with severe angiographic lesions were sequentially imaged before intervention with OCT with the CT and then with DIT. A total of 5125 OCT frames were carefully matched and analyzed by an independent central core lab. A semiquantitative image quality score was used to grade the number of quadrants (0-4) with vessel wall visualization. RESULTS Optimal OCT visualization (Grades 3-4) significantly improved by the DIT (68% vs. 38% of frames, p < 0.001). The DIT also improved the mean score (3.1 ± 0.6 vs. 2.0 ± 0.8; p < 0.05; mean improvement of 1.1 ± 0.5 per patient). There were no complications associated with the DIT. CONCLUSION The DIT significantly improved preintervention image quality of OCT in severe coronary lesions.
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Affiliation(s)
- Fernando Rivero
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Valeria Marco
- Centro per la Lotta Contro L' Infarto-CLI Foundation, Rome, Italy
| | | | - Simone Budassi
- Centro per la Lotta Contro L' Infarto-CLI Foundation, Rome, Italy
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Hortensia de la Fuente
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Francesco Prati
- Centro per la Lotta Contro L' Infarto-CLI Foundation, Rome, Italy.,UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
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Delgado-Arana JR, Rumoroso JR, Regueiro A, Martín-Moreiras J, Miñana G, Mohandes M, Pan M, Salinas P, Caballero-Borrego J, Fernández-Díaz JA, Jurado-Román A, Lacunza J, Vaquerizo B, Rivero F, Abellán-Huerta J, Rondán J, Gómez Menchero A, Santos-Martínez S, Subinas A, Arévalos V, Diego Nieto A, Sanchis J, Rojas S, Ojeda S, Gonzalo N, López-Pérez M, Goicolea J, Sádaba M, Gómez-Salvador I, Sabaté M, Núñez García JC, Amat-Santos IJ. Plaque modification in calcified chronic total occlusions: the PLACCTON study. Rev Esp Cardiol (Engl Ed) 2022; 75:213-222. [PMID: 34301507 DOI: 10.1016/j.rec.2021.06.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. METHODS Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. RESULTS Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). CONCLUSIONS Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits.
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Affiliation(s)
- José R Delgado-Arana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José R Rumoroso
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier Martín-Moreiras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Gema Miñana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Mohsen Mohandes
- Departamento de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofia, Instituto Maimónides de investigación biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Pablo Salinas
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Alfonso Jurado-Román
- Departamento de Cardiología, Hospital La Paz, Madrid, Spain; Departamento de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Javier Lacunza
- Departamento de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Fernando Rivero
- Departamento de Cardiología, Hospital de La Princesa, Madrid, Spain
| | | | - Juan Rondán
- Departamento de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | | | - Sandra Santos-Martínez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Asier Subinas
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Víctor Arévalos
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alejandro Diego Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Sergio Rojas
- Departamento de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Soledad Ojeda
- Departamento de Cardiología, Hospital Reina Sofia, Instituto Maimónides de investigación biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Javier Goicolea
- Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Mario Sádaba
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Itziar Gómez-Salvador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Manel Sabaté
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jean Carlos Núñez García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
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Delgado-Arana JR, Rumoroso JR, Regueiro A, Martín-Moreiras J, Miñana G, Mohandes M, Pan M, Salinas P, Caballero-Borrego J, Fernández-Díaz JA, Jurado-Román A, Lacunza J, Vaquerizo B, Rivero F, Abellán-Huerta J, Rondán J, Gómez Menchero A, Santos-Martínez S, Subinas A, Arévalos V, Diego Nieto A, Sanchis J, Rojas S, Ojeda S, Gonzalo N, López-Pérez M, Goicolea J, Sádaba M, Gómez-Salvador I, Sabaté M, Núñez García JC, Amat-Santos IJ. Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Alfonso F, García-Guimaraes M, Alvarado T, Sanz-Ruiz R, Roura G, Amat-Santos IJ, Abdul-Jawad Altisent O, Tizón-Marcos H, Flores-Ríos X, Masotti M, Pérez-de Prado A, Ferre GF, Ruiz-Poveda FL, Valero E, Portero-Portaz JJ, Diez-Villanueva P, Salamanca J, Bastante T, Rivero F. Clinical implications of arterial hypertension in patients with spontaneous coronary artery dissection. Coron Artery Dis 2022; 33:75-80. [PMID: 33878074 DOI: 10.1097/mca.0000000000001043] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome. Many patients with SCAD have associated coronary risk factors. However, the implications of arterial hypertension in SCAD patients remain unknown. OBJECTIVE This study sought to assess the clinical implications of arterial hypertension in a nationwide cohort of patients with SCAD. METHODS The Spanish SCAD registry (NCT03607981) prospectively enrolled 318 consecutive patients. All coronary angiograms were centrally analyzed to confirm the diagnosis of SCAD. Patients were classified according to the presence of arterial hypertension. RESULTS One-hundred eighteen patients (37%) had a diagnosis of arterial hypertension. Hypertensive SCAD patients were older (60 ± 12 vs. 51 ± 9 years old) and had more frequently dyslipidemia (56 vs. 23%) and diabetes (9 vs. 3%) but were less frequently smokers (15 vs. 35%) than normotensive SCAD patients (all P < 0.05). Most patients in both groups were female (90 vs. 87%, NS) and female patients with hypertension were more frequently postmenopausal (70 vs. 47%, P < 0.05). Hypertensive SCAD patients had more severe lesions and more frequently multivessel involvement (15 vs. 7%, P < 0.05) and coronary ectasia (19 vs. 7%, P < 0.05) but showed a similar prevalence of coronary tortuosity (34 vs. 26%, NS). Revascularization requirement was similar in both groups (17 vs. 26%, NS) but procedural success was significantly lower (65 vs. 88%, P < 0.05) and procedural-related complications more frequent (65 vs. 41%, P < 0.05) in SCAD patients with hypertension. CONCLUSION Patients with SCAD and hypertension are older, more frequently postmenopausal and have more coronary risk factors than normotensive SCAD patients. During revascularization SCAD patients with hypertension obtain poorer results and have a higher risk of procedural-related complications (NCT03607981).
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Affiliation(s)
- Fernando Alfonso
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Marcos García-Guimaraes
- Cardiac Department, Hospital del Mar - Parc de Salut Mar
- Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona
| | - Teresa Alvarado
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Ricardo Sanz-Ruiz
- Cardiac Department, Hospital General Universitario Gregorio Marañón, IIS-GM, CIBERCV, Madrid
| | - Gerard Roura
- Cardiac Department, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona
| | | | | | - Helena Tizón-Marcos
- Cardiac Department, Hospital del Mar - Parc de Salut Mar
- Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona
| | - Xacobe Flores-Ríos
- Cardiac Department, Complexo Hospitalario Universitario de A Coruña, A Coruña
| | - Mónica Masotti
- Cardiac Department, Hospital Clinic de Barcelona, Barcelona
| | | | | | | | | | | | - Pablo Diez-Villanueva
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Jorge Salamanca
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Teresa Bastante
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
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Del Val D, López-Melgar B, Rivero F, Valdivia-Mazeyra MF, Bastante T, Cuesta J, Roquero P, Alfonso F. Anterior Mitral Leaflet Dissection and Pseudoaneurysm Late After Transcatheter Aortic Valve Replacement: Look Beyond the Obvious. Circ Cardiovasc Imaging 2022; 15:e013724. [PMID: 35184573 DOI: 10.1161/circimaging.121.013724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David Del Val
- Cardiology Department (D.d.V., B.L.-M., F.R., T.B., J.C., P.R., F.A.), Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria (D.d.V., F.R., T.B., J.C., F.A.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Beatriz López-Melgar
- Cardiology Department (D.d.V., B.L.-M., F.R., T.B., J.C., P.R., F.A.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department (D.d.V., B.L.-M., F.R., T.B., J.C., P.R., F.A.), Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria (D.d.V., F.R., T.B., J.C., F.A.), Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Teresa Bastante
- Cardiology Department (D.d.V., B.L.-M., F.R., T.B., J.C., P.R., F.A.), Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria (D.d.V., F.R., T.B., J.C., F.A.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Javier Cuesta
- Cardiology Department (D.d.V., B.L.-M., F.R., T.B., J.C., P.R., F.A.), Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria (D.d.V., F.R., T.B., J.C., F.A.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Pilar Roquero
- Cardiology Department (D.d.V., B.L.-M., F.R., T.B., J.C., P.R., F.A.), Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department (D.d.V., B.L.-M., F.R., T.B., J.C., P.R., F.A.), Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria (D.d.V., F.R., T.B., J.C., F.A.), Hospital Universitario de La Princesa, Madrid, Spain
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Montes A, Pozo Osinalde E, Bastante T, Cecconi A, Garcia-Guimaraes M, Rivero F, De Rueda C, Rojas Gonzalez A, Olivera MJ, Salamanca J, De Agustin JA, Caballero P, Aguilar Torres R, Jimenez Borreguero LJ, Alfonso Manterola F. Intracoronary thrombus assessment with cardiac computed tomography angiography in a deferred stenting strategy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.416] [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: None.
Background.
Cardiac computed tomography angiography (CCTA) is precise in non-invasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate the diagnostic accuracy of CCTA for intracoronary thrombus and stenosis detection in acute coronary syndromes (ACS) with high thrombus burden selected for a deferred stenting (DS) strategy.
Methods.
We systematically performed a CCTA in consecutive DS patients 24 hours before the scheduled repeated coronary angiography that also included optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both non-invasive and invasive diagnostic tests. Agreement was determined per lesion using weighted Kappa (K) coefficient and absolute intra-class correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed.
Results.
Thirty lesions in 28 consecutive patients with a large thrombus burden were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good (K= 0.554; p< 0.001), but both showed a poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs 33.3%; p= 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter stenosis (ICC= 0.85; p< 0.001), and was able to identify all the patients with severe residual stenosis.
Conclusion.
CCTA is able to assess intracoronary thrombus. Although CCTA showed just a good concordance with angiography in thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden CCTA may substitute repeat angiography in patients considered for DS. Abstract Figure.
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Affiliation(s)
- A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - E Pozo Osinalde
- Hospital Clinico San Carlos, Cardiology Department, Madrid, Spain
| | - T Bastante
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | | | - F Rivero
- University Hospital De La Princesa, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Madrid, Spain
| | | | - MJ Olivera
- University Hospital De La Princesa, Madrid, Spain
| | - J Salamanca
- University Hospital De La Princesa, Madrid, Spain
| | - JA De Agustin
- Hospital Clinico San Carlos, Cardiology Department, Madrid, Spain
| | - P Caballero
- University Hospital De La Princesa, Madrid, Spain
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Bastante T, Rivero F, Cuesta J, Del Val D, Roquero P, Alfonso F. Treatment of spontaneous coronary artery dissection with fenestration: clinical and angiographic follow-up. Rev Esp Cardiol (Engl Ed) 2022; 75:177-179. [PMID: 34635468 DOI: 10.1016/j.rec.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Rivero
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Javier Cuesta
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - David Del Val
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Pilar Roquero
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain.
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Alfonso F, Cuesta J, Ojeda S, Camacho-Freire S, García del Blanco B, Vaquerizo B, Zueco J, Trillo R, Mauri J, Velázquez M, Córdoba-Soriano JG, Serra A, Navarro F, Pan M, Díaz J, Otaegui I, Salvatella N, De la TorreHernandez JM, Val DD, Bastante T, Rivero F. Procedural Results and One-Year Clinical Outcomes of Treatment of Bioresorbable Vascular Scaffolds Restenosis (from the RIBS VII Prospective Study). Am J Cardiol 2022; 162:31-40. [PMID: 34903344 DOI: 10.1016/j.amjcard.2021.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
Currently, both drug-eluting stents (DES) and drug-eluting balloons are recommended in patients with in-stent restenosis (ISR) of metallic stents. However, the clinical results of repeated interventions in patients with restenosis of bioresorbable vascular scaffolds (BVS) remain unsettled. We sought to assess the results of interventions in patients with BVS-ISR as compared with those obtained in patients with ISR of DES and bare-metal stents (BMS). Restenosis Intrastent: Treatment of Bioresorbable Vascular Scaffolds Restenosis (RIBS VII) is a prospective multicenter study (23 Spanish sites) that included 117 consecutive patients treated for BVS-ISR. Inclusion/exclusion criteria were similar to those of previous RIBS studies. Patients in the RIBS IV (DES-ISR, n = 309) and RIBS V (BMS - ISR, n = 189) randomized trials, were used as controls. Most patients with BVS-ISR were treated with DES (76%). Patients with BVS-ISR were younger, had larger vessels, and after interventions had higher in-segment residual diameter stenosis (19 ± 13%, 15 ± 11%, 15 ± 12%, p <0.001) than those treated for DES-ISR and BMS-ISR, respectively. At 1-year clinical follow-up (obtained in 100% of patients) target lesion revascularization (6%) was similar to that seen in patients with DES-ISR and BMS-ISR (8.7% and 3.7%, p = 0.32). Freedom from death, myocardial infarction, and target vessel revascularization (primary clinical end point) was 8.5%, also similar to that found in patients with DES-ISR and BMS-ISR (14.2% and 7.4%, p = 0.09). Results were also similar when only patients treated with DES in each group were compared and remained unchanged after adjusting for potential confounders in baseline characteristics. Time to BVS-ISR did not influence angiographic or clinical results. This study demonstrates the safety and efficacy of coronary interventions for patients presenting with BVS-ISR. One-year clinical results in these patients are comparable to those seen in patients with ISR of metallic stents (ClinicalTrials.gov ID:NCT03167424).
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Alfonso F, Rivero F, Segovia-Cubero J. Early diagnosis of cardiac allograft vasculopathy: biopsy, liquid biopsy, non-invasive imaging, coronary imaging, or coronary physiology? Eur Heart J 2021; 42:4930-4933. [PMID: 34665226 DOI: 10.1093/eurheartj/ehab722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBERCV, Madrid, Spain
| | - Javier Segovia-Cubero
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Universidad Autónoma de Madrid, CIVERCV, Madrid, Spain
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Gomez-Lara J, Oyarzabal L, Ortega-Paz L, Brugaletta S, Romaguera R, Salvatella N, Roura G, Rivero F, Fuentes L, Alfonso F, Otaegui I, Vandeloo B, Vaquerizo B, Sabate M, Comin-Colet J, Gomez-Hospital JA. Coronary Endothelium-Dependent Vasomotor Function After Drug-Eluting Stent and Bioresorbable Scaffold Implantation. J Am Heart Assoc 2021; 10:e022123. [PMID: 34729992 PMCID: PMC8751934 DOI: 10.1161/jaha.121.022123] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early generation drug-eluting stents (DESs) showed a high grade of coronary endothelial dysfunction that was attributed to lack of stent reendothelialization. Endothelium-dependent vasomotor response of current DESs and bioresorbable scaffolds (BRSs) remains unknown. This study sought to assess the device-related endothelial function of current devices and to correlate neointima healing with endothelial function. Methods and Results A total of 206 patients from 4 randomized trials treated with the durable-polymer everolimus-eluting Xience (n=44), bioresorbable-polymer sirolimus-eluting Orsiro (n=35), polymer-free biolimus-eluting Biofreedom (n=24), bioactive endothelial-progenitor cell-capturing sirolimus-eluting Combo DES (n=25), polymer-based everolimus-eluting Absorb (n=44), and Mg-based sirolimus-eluting Magmaris BRS (n=34) underwent endothelium-dependent vasomotor tests and optical coherence tomography imaging, as per protocol, at follow-up. Crude vasomotor responses of distal segments to low-dose acetylcholine (10-6 mol/L) were different between groups: bioresorbablepolymer DEShad the worst (-8.4%±12.6%) and durable-polymer DES had the most physiologic (-0.4%±11.8%; P=0.014). High-dose acetylcholine (10-4 mol/L) showed similar responses between groups (ranging from -10.8%±11.6% to -18.1%±15.4%; P=0.229). Device healing was different between devices. Uncovered struts ranged from 6.3%±7.1% (bioresorbable-polymer DES) to 2.5%±4.5% (bioactive DES; P=0.056). In multivariate models, endothelium-dependent vasomotor response was associated with age, bioresorbable-polymer DES, and angiographic lumen loss, but not with strut coverage nor plaque type. Endothelial dysfunction (defined as ≥4% vasoconstriction) was observed in 46.6% of patients with low-dose and 68.9% with high-dose acetylcholine, without differences between groups. Conclusions At follow-up, endothelial dysfunction was frequently observed in distal segments treated with current stents without remarkable differences between devices. Although neointima healing was different between devices, poor healing was not associated with endothelial dysfunction.
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Affiliation(s)
- Josep Gomez-Lara
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Loreto Oyarzabal
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Luis Ortega-Paz
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Salvatore Brugaletta
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Rafael Romaguera
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Neus Salvatella
- Heart Disease Research Group Mar Hospital, Biomedical Research Institute of Mar Hospital (IMIM) Barcelona Spain
| | - Gerard Roura
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Fernando Rivero
- University Hospital of La Princesa Health Resaerch Institute of La Princesa; CIBER-CV Madrid Spain
| | - Lara Fuentes
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Fernando Alfonso
- University Hospital of La Princesa Health Resaerch Institute of La Princesa; CIBER-CV Madrid Spain
| | - Imanol Otaegui
- Interventional Cardiology Department University Hospital of Vall Hebron Barcelona Spain
| | - Bert Vandeloo
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain.,Department of Cardiology Heart and Vascular Disease Center, Universty Hospital of Brussels Brussels Belgium
| | - Beatriz Vaquerizo
- Heart Disease Research Group Mar Hospital, Biomedical Research Institute of Mar Hospital (IMIM) Barcelona Spain
| | - Manel Sabate
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Josep Comin-Colet
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Joan-Antoni Gomez-Hospital
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
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Cortes C, Corredoira PF, Esteves AF, Jímenez O, Rivero F, Guerrero AP, Cerdán L, Sánchez-Rubio J, Ferre GF, Ferrer Gracia MC, Galache G, Lozano F, Perez de Prado A, Alfonso F, Ortas-Nadal MR, Diarte de Miguel JA. TCT-495 Prognostic Value of Global Quantitative Flow Ratio in Chronic Ischemic Heart Disease: A Multicenter Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1348] [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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Cañadas D, Torralba E, Alarcón de la Lastra Cubiles I, Rivero F, Gutierrez-Barrios A. TCT-199 FFR Saline: A Useful Adenosine-Free Index. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1052] [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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Salamanca J, Díez-Villanueva P, Rivero F, Sarraj A, Suarez-Sipmann F, Alfonso F. [Dispositivo de asistencia circulatoria Impella RP ® en shock poscardiotomía por fallo ventricular derecho]. Arch Cardiol Mex 2021; 91:525-527. [PMID: 33270621 PMCID: PMC8641453 DOI: 10.24875/acm.20000408] [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] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
| | | | - Fernando Rivero
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
| | - Anas Sarraj
- Servicio de Cirugía Cardiaca, Hospital Universitario de La Princesa, Madrid, España
| | | | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
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Cecconi A, De La Fuente H, Blanco Dominguez R, Navarrete G, Garcia-Guimaraes M, Vera A, Lopez Melgar B, Rivero F, Sanz Garcia A, Lozano Prieto M, Martin P, Sanchez-Madrid F, Alfonso F, Jimenez-Borreguero LJ. Effect of PM2.5 on circulating inflammatory cells and microRNA expression in acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1083] [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
Background
Air pollutants increase the risk of myocardial infarction. Air pollution-induced atherosclerotic plaque destabilization may be related to inflammation, but the specific inflammatory alterations remain unclear.
Purpose
The aim of this prospective study was to assess the inflammatory changes in circulating immune cells and microRNAs in patients with acute coronary syndrome related to short-term exposure to PM2.5.
Methods
We prospectively included all consecutive patients admitted between March 2017 and July 2018 with the diagnosis of acute coronary syndrome (STEMI, NSTEMI, unstable angina) and coronary angiography in the acute phase of the disease. We also included a control group of patients with stable angina. For each patient we collected air concentrations of PM2.5 from the closest meteorological station to the patient residence obtaining the previous 24-hour average before hospital admission. All patients underwent systematic circulating inflammatory cell analysis. A selection of patients underwent miRNAs analysis.
Results
A total of 261 patients were included. According to PM2.5 exposure, 31 patients were selected for miRNA analyses. STEMI patients exposed to PM2.5 showed a reduction of CD4+ regulatory T (Treg) cells (Figure 1A). In the microRNA assessment, PM2.5 exposure was associated with higher circulating levels of let-7f-5p, miR-223-3p, miR-423-3p, miR-197-3p, miR-335–5, miR-376c-3p and miR-501-3p. Regarding clinical presentation, PM2.5 exposure in STEMI and NSTEMI patients was associated with an increase of miR-let-7f-5p, whereas miR-423-3p and miR-146a-5p were increased only in STEMI patients (Figure 1B).
Conclusions
STEMI related to PM2.5 short-term exposure is associated to specific changes involving CD4+CD25+Foxp3+ Treg cells and miR-146a-5p.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Ministerio de Ciencia e Innovaciόn; Fundaciόn BBVA Equipos de Investigaciόn Científica 2018 and from Caixa Banking Foundation; Sociedad Espanola de Cardiologia; Ministerio de Ciencia, Innovaciόn y Universidades, Carlos III Institute of Health-Fondo de Investigaciόn Sanitaria; Comunidad de Madrid; Fondo Europeo de Desarrollo Regional
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Affiliation(s)
- A Cecconi
- Hospital Universitario La Princesa, Madrid, Spain
| | | | | | - G Navarrete
- Hospital Universitario La Princesa, Madrid, Spain
| | | | - A Vera
- Hospital Universitario La Princesa, Madrid, Spain
| | | | - F Rivero
- Hospital Universitario La Princesa, Madrid, Spain
| | | | | | - P Martin
- Spanish National Centre for Cardiovascular Research, Madrid, Spain
| | | | - F Alfonso
- Hospital Universitario La Princesa, Madrid, Spain
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del Val D, Rivero F, Cuesta J, Diego G, Antuña P, Alfonso F. Fatal acute mesenteric ischaemia following transcatheter aortic valve replacement. EUROINTERVENTION 2021; 17:588-589. [PMID: 33106224 PMCID: PMC9724836 DOI: 10.4244/eij-d-20-01015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- David del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/ Diego de León 62, 28006 Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo Diego
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Paula Antuña
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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Bastante T, García-Guimaraes M, Muñiz M, Cuesta J, Rivero F, Antuña P, De Rueda C, Hernández-Muñiz S, Aguilar R, Salamanca J, Pozo-Osinalde E, Jiménez-Borreguero J, Batlle M, Friera A, Alfonso F. <i class="fa fa-video-camera" aria-hidden="true"></i> Manejo contempor�neo de la disecci�n coronaria espont�nea. RECIC 2021. [DOI: 10.24875/recic.m20000095] [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: 11/17/2022] Open
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Affiliation(s)
- Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, C/ Diego de León 62, 28006 Madrid, Spain
| | | | | | - Soledad Ojeda
- Cardiac Department, Hospital Reina Sofía, IMIBIC, Córdoba, Spain
| | - Teresa Bastante
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
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49
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Alvarado T, Rivero F, Diego G, García-Guimaraes M, Salamanca J, Díez-Villanueva P, Cuesta J, Antuña P, Jiménez-Borreguero J, Alfonso F. Transcatheter aortic valve replacement using the new Evolut-Pro system: a prospective comparison with the Evolut-R device. J Thorac Dis 2021; 13:4023-4032. [PMID: 34422332 PMCID: PMC8339791 DOI: 10.21037/jtd-20-2409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/01/2020] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Abstract
Background Evolut Pro (EVP) is a novel self-expandable aortic valve. This prosthesis consists of an external porcine pericardial wrap designed to reduce paravalvular leak (PVL), maintaining the benefits of its predecessor, the Evolut R (EVR). The aim was to compare the functional and clinical results in the short and medium term of the new EVP with the EVR system. Methods Consecutive patients receiving either the EVR (n=50) or the EVP (n=33) from June 2015 to October 2018 were compared. Baseline characteristics, cardiovascular imaging, procedural outcomes, short and mid-term follow-up outcomes were prospectively collected and assessed. Results Residual mild PVL was common and comparable in the two groups (EVR 79% vs. EVP 70%; P=0.4). In the EVR group, the presence of PVL was directly related to prosthesis size, but this correlation was not observed in the EVP group. Conduction abnormalities were more prevalent with the EVP, but these did not translate into a higher need of permanent pacemaker implantation. Vascular and bleeding complications were infrequent in both groups. At mid-term clinical follow-up (median survival time: EVR 11±0.3 months, EVP 12±0.2 months), the 1-year rate of adverse events was similar (EVR: 24%, EVP: 33%; P=0.3). Conclusions Both protheses are effective for the treatment of severe aortic stenosis with excellent results at mid-term clinical follow up. The EVP remains associated with a significant rate of residual mild PVL that appears to be similar to that observed with EVR.
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Affiliation(s)
- Teresa Alvarado
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo Diego
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Paula Antuña
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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50
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Xhepa E, Bresha J, Joner M, Hapfelmeier A, Rivero F, Ndrepepa G, Nano N, Cuesta J, Kufner S, Cassese S, Bastante T, Aytekin A, Rroku A, García-Guimaraes M, Lahmann A, Pinieck S, Rai H, Fusaro M, Schunkert H, Pérez-Vizcayno M, Gonzalo N, Alfonso F, Kastrati A. Clinical outcomes by optical characteristics of neointima and treatment modality in patients with coronary in-stent restenosis. EUROINTERVENTION 2021; 17:e388-e395. [PMID: 32894230 PMCID: PMC9724978 DOI: 10.4244/eij-d-20-00662] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Drug-coated balloons (DCB) and drug-eluting stents (DES) represent the currently recommended treatments for in-stent restenosis (ISR). Optical coherence tomography (OCT) allows detailed neointimal characterisation which can guide treatment strategies. AIMS The aims of this study were first, to assess the relation between neointimal pattern and clinical outcomes following in-stent restenosis (ISR) treatment, and second, to explore a potential interaction between neointimal pattern and treatment modality relative to clinical outcomes. METHODS Patients undergoing OCT-guided treatment (DCB or DES) of ISR in three European centres were included. Based on the median of distribution of non-homogeneous neointima quadrants, patients were categorised into low and high inhomogeneity groups. RESULTS A total of 197 patients (low inhomogeneity=100 and high inhomogeneity=97) were included. There were no significant differences in terms of major adverse cardiac events (MACE) (p=0.939) or target lesion revascularisation (TLR) (p=0.732) between the two groups. The exploratory analysis showed a significant interaction between neointimal pattern and treatment modality regarding MACE (pint=0.006) and TLR (pint=0.022). DES showed a significant advantage over DCB in the high (MACE: HR 0.26 [0.10-0.65], p=0.004; TLR: HR 0.28 [0.11-0.69], p=0.006), but not in the low inhomogeneity group (MACE: p=0.917; TLR: p=0.797). CONCLUSIONS In patients with ISR treated with DCB or DES, there were no significant differences in terms of MACE or TLR between the low and high inhomogeneity groups. A significant interaction was observed between treatment modality and neointimal pattern with an advantage of DES over DCB in the high and no difference in the low inhomogeneity group. This warrants confirmation from prospective dedicated studies.
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Affiliation(s)
- Erion Xhepa
- Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Jola Bresha
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany,Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Fernando Rivero
- Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gjin Ndrepepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Nejva Nano
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Javier Cuesta
- Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sebastian Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Teresa Bastante
- Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alp Aytekin
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Andi Rroku
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Marcos García-Guimaraes
- Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Anna Lahmann
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Susanne Pinieck
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Himanshu Rai
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Massimiliano Fusaro
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Maria Pérez-Vizcayno
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense Madrid, Madrid, Spain
| | - Fernando Alfonso
- Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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