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Temporal changes in coronary plaque as assessed by an artificial intelligence-based optical coherence tomography: from the first-in-human trial on DREAMS 3G scaffold. Eur Heart J Cardiovasc Imaging 2024; 25:491-497. [PMID: 37936296 DOI: 10.1093/ehjci/jead299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 11/09/2023] Open
Abstract
AIMS The aim of the study is to assess the impact of the baseline plaque composition on the DREAMS 3G luminal late loss and to compare the serial plaque changes between baseline and 6 and 12 months (M) follow-up. METHODS AND RESULTS A total of 116 patients were enrolled in the BIOMAG-I trial. Patients were imaged with optical coherence tomography (OCT) pre- and post-DREAMS 3G implantation and at 6 and 12 M. OCTPlus software uses artificial intelligence to assess composition (i.e. lipid, calcium, and fibrous tissue) of the plaque. The differences between the OCT-derived minimum lumen area (MLA) post-percutaneous coronary intervention and 12 M were grouped into three terciles. Patients with larger MLA differences at 12 M (P = 0.0003) had significantly larger content of fibrous tissue at baseline. There was a reduction of 24.8% and 20.9% in lipid area, both P < 0.001, between the pre-DREAMS 3G OCT and the 6 and 12 M follow-up. Conversely, the fibrous tissue increased by 48.4% and 36.0% at 6 and 12 M follow-up, both P < 0.001. CONCLUSION The larger the fibrous tissue in the lesion at baseline, the larger the luminal loss seen at 6 and 12 M. Following the implantation of DREAMS 3G, favourable healing of the vessel coronary wall occurs as shown by a decrease in the lipid area and an increase in fibrous tissue.
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WATCH-BPM-Comparison of a WATCH-Type Blood Pressure Monitor with a Conventional Ambulatory Blood Pressure Monitor and Auscultatory Sphygmomanometry. SENSORS (BASEL, SWITZERLAND) 2023; 23:8877. [PMID: 37960576 PMCID: PMC10650650 DOI: 10.3390/s23218877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/18/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Smart devices that are able to measure blood pressure (BP) are valuable for hypertension or heart failure management using digital technology. Data regarding their diagnostic accuracy in comparison to standard noninvasive measurement in accordance to Riva-Rocci are sparse. This study compared a wearable watch-type oscillometric BP monitor (Omron HeartGuide), a wearable watch-type infrared BP monitor (Smart Wear), a conventional ambulatory BP monitor, and auscultatory sphygmomanometry. METHODS Therefore, 159 consecutive patients (84 male, 75 female, mean age 64.33 ± 16.14 years) performed observed single measurements with the smart device compared to auscultatory sphygmomanometry (n = 109) or multiple measurements during 24 h compared to a conventional ambulatory BP monitor on the upper arm (n = 50). The two BP monitoring devices were simultaneously worn on the same arm throughout the monitoring period. In a subgroup of 50 patients, single measurements were also performed with an additional infrared smart device. RESULTS The intraclass correlation coefficient (ICC) between the difference and the mean of the oscillometric Omron HeartGuide and the conventional method for the single measurement was calculated for both systole (0.765) and diastole (0.732). This is exactly how the ICC was calculated for the individual mean values calculated over the 24 h long-term measurement of the individual patients for both systole (0.880) and diastole (0.829). The ICC between the infrared device and the conventional method was "bad" for SBP (0.329) and DBP (0.025). Therefore, no further long-term measurements were performed with the infrared device. CONCLUSION The Omron HeartGuide device provided comparable BP values to the standard devices for single and long-term measurements. The infrared smart device failed to acquire valid measurement data.
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Functional Status and Quality of Life 6 Months After Extracorporeal Membrane Oxygenation Therapy for COVID-19-Related Pulmonary Failure. ASAIO J 2023; 69:942-949. [PMID: 37256794 DOI: 10.1097/mat.0000000000001993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly used in COVID-19-related pulmonary failure and the number of patients recovering from COVID-19 is growing. Here, we assess survival and recovery 6 months after ECMO for COVID-19. From April 2020 to September 2021, n = 60 (60.5 [51.0-65.0] years, 23.3% female) were treated with venovenous/venoarterial ECMO for COVID-19. 41.7% were weaned off ECMO, survival-to-discharge was 40.0% (n = 24). Age (63.0 [60.0-66.8] vs. 55.0 [43.8-60.0] years, p < 0.001), vasoactive support (97.2% vs . 75.0%, p = 0.013), and pre-ECMO SOFA scores (13.0 [12.0-14.8] vs. 12.0 [10.0-13.8] p = 0.036) correlated with nonsurvival. All patients aged >65 years, with histories of neoplasia, immunocompromise, chronic renal failure, or frailty died. After 6 months, 20 were alive (6-month survival 33.3%, survival conditioned on survival-to-discharge 83.3%), with follow-up in 19. 57.9% showed no relevant, 26.3% moderate, 15.8% severe deficits. Cardiopulmonary status was satisfactory (mMRC level: 84.2% ≤2). 73.7% were independent in daily life. Cognitive impairments were frequent (52.6%). 26.3% showed moderate depression, 15.8% posttraumatic stress disorder. Social and work life were considerably affected. Extracorporeal membrane oxygenation thus can serve as salvage therapy in COVID-19, but advanced age, immunocompromise, histories of neoplasia, and frailty must be considered as relative contraindications. Age, vasoactive support, and SOFA scores assist discriminating in daily practice. Deficits after 6 months are substantial, and efforts need to focus on long-term recovery.
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Coronary stent imaging in photon counting computed Tomography: Optimization of reconstruction kernels in a phantom. Eur J Radiol 2023; 166:110983. [PMID: 37480648 DOI: 10.1016/j.ejrad.2023.110983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Imaging stents and in-stent stenosis remains a challenge in coronary computed tomography angiography (CCTA). In comparison to conventional Computed Tomography, Photon Counting CT (PCCT) provides decisive clinical advantages, among other things by providing low dose ultra-high resolution imaging of coronary arteries. This work investigates the image quality in CCTA using clinically established kernels and those optimized for the imaging of cardiac stents in PCCT, both for in-vitro stent imaging in 400 μm standard resolution mode (SRM) and 200 μm Ultra High Resolution Mode (UHR). METHODS Based on experimental scans, vascular reconstruction kernels (Bv56, Bv64, Bv72) were optimized. In an established phantom, 10 different coronary stents with 3 mm diameter were scanned in the first clinically available PCCT. Scans were reconstructed with clinically established and optimized kernels. Four readers measured visible stent lumen, performed ROI-based density measurements and rated image quality. RESULTS Regarding the visible stent lumen, UHR is significantly superior to SRM (p < 0.001). In all levels, the optimized kernels are superior to the clinically established kernels (p < 0.001). One optimized kernel showed a significant reduction of noise compared to the clinically established kernels. Overall image quality is improved with optimized kernels. CONCLUSIONS In a phantom study PCCT UHR with optimized kernels for stent imaging significantly improves the ability to assess the in-stent lumen of small cardiac stents. We recommend using UHR with an optimized sharp vascular reconstruction kernel (Bv72uo) for imaging of cardiac stent.
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A new resorbable magnesium scaffold for de novo coronary lesions (DREAMS 3): one-year results of the BIOMAG-I first-in-human study. EUROINTERVENTION 2023; 19:e414-e422. [PMID: 37334655 PMCID: PMC10397670 DOI: 10.4244/eij-d-23-00326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The third-generation coronary sirolimus-eluting magnesium scaffold, DREAMS 3G, is a further development of the DREAMS 2G (commercial name Magmaris), aiming to provide performance outcomes similar to drug-eluting stents (DES). AIMS The BIOMAG-I study aims to assess the safety and performance of this new-generation scaffold. METHODS This is a prospective, multicentre, first-in-human study with clinical and imaging follow-up scheduled at 6 and 12 months. The clinical follow-up will continue for 5 years. RESULTS A total of 116 patients with 117 lesions were enrolled. At 12 months, after completion of resorption, in-scaffold late lumen loss was 0.24±0.36 mm (median 0.19, interquartile range 0.06-0.36). The minimum lumen area was 4.95±2.24 mm² by intravascular ultrasound and 4.68±2.32 mm² by optical coherence tomography. Three target lesion failures were reported (2.6%, 95% confidence interval: 0.9-7.9), all clinically driven target lesion revascularisations. Cardiac death, target vessel myocardial infarction and definite or probable scaffold thrombosis were absent. CONCLUSIONS Data at the end of the resorption period of DREAMS 3G showed that the third-generation bioresorbable magnesium scaffold is clinically safe and effective, making it a possible alternative to DES. CLINICALTRIALS gov: NCT04157153.
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Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter. Cardiovasc Ultrasound 2023; 21:13. [PMID: 37537565 PMCID: PMC10398930 DOI: 10.1186/s12947-023-00312-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION One of the most helpful aspects of intracardiac echocardiography (ICE) implementation in electrophysiological studies (EPS) is the real-time visualisation of catheters and cardiac structures. In this prospective study, we investigated ICE-guided zero-fluoroscopy catheter navigation during radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) in patients with typical atrial flutter (AFL). METHODS AND RESULTS Thirty consecutive patients (mean age 72.9 ± 11.4 years, 23 male) with ongoing (n = 23) or recent CTI-dependent AFL underwent an EPS, solely utilizing ICE for catheter navigation. Zero-fluoroscopy EPS could be successfully accomplished in all patients. Mean EPS duration was 41.4 ± 19.9 min, and mean ablation procedure duration was 20.8 ± 17.1 min. RF ablation was applied for 6.0 ± 3.1 min (50W, irrigated RF ablation). Echocardiographic parameters, such as CTI length, prominence of the Eustachian ridge (ER), and depth of the CTI pouch on the ablation plane, were assessed to analyse their correlation with EPS- or ablation procedure duration. The CTI pouch was shallower in patients with an ablation procedure duration above the median (4.8 ± 1.1 mm vs. 6.4 ± 0.9 mm, p = 0.04), suggesting a more lateral ablation plane in these patients, where the CTI musculature is stronger. CTI length or ER prominence above the respective median did not correlate with longer EPS duration. CONCLUSIONS Zero-fluoroscopy CTI ablation guided solely by intracardiac echocardiography in patients with CTI-dependent AFL is feasible and safe. ICE visualisation may help to localise the optimal ablation plane, detect and correct poor tissue contact of the catheter tip, and recognise early potential complications during the ablation procedure.
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Confusion in connection with pulmonary hypertension due to premature ventricular complexes requires diagnostic work-up. Eur Heart J Case Rep 2023; 7:ytad321. [PMID: 37501708 PMCID: PMC10369202 DOI: 10.1093/ehjcr/ytad321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
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One- and two-year clinical outcomes of treatment with resorbable magnesium scaffolds for coronary artery disease: the prospective, international, multicentre BIOSOLVE-IV registry. EUROINTERVENTION 2023:EIJ-D-22-01069. [PMID: 37226676 DOI: 10.4244/eij-d-22-01069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Bioresorbable scaffolds have been developed to overcome the limitations of drug-eluting stents and to reduce long-term adverse events. AIMS We aimed to assess the long-term safety and efficacy of a sirolimus-eluting resorbable magnesium scaffold to ensure its safe rollout into clinical routine. METHODS BIOSOLVE-IV is a prospective, international, multicentre registry including more than 100 centres in Europe, Asia, and Asia-Pacific. Enrolment started directly after the commercialisation of the device. Follow-up assessments are scheduled at 6 and 12 months, and annually for up to 5 years; we herein report the 24-month outcomes. RESULTS Overall, 2,066 patients with 2,154 lesions were enrolled. Patients were 61.9±10.5 years old, 21.6% had diabetes, and 18.5% had non-ST-elevation myocardial infarction (NSTEMI). Lesions were 14.8±4.0 mm long with a reference vessel diameter of 3.2±0.3 mm. Device and procedure success were 97.5%, and 99.1%, respectively. The 24-month target lesion failure (TLF) rate was 6.8%, mainly consisting of clinically driven target lesion revascularisations (6.0%). Patients with NSTEMI had significantly higher TLF rates than those without (9.3% vs 6.2%; p=0.025), whereas there were no significant differences observed for patients with diabetes or with type B2/C lesions (a 24-month TLF rate of 7.0% and 7.9%, respectively). The 24-month rate of definite or probable scaffold thrombosis was 0.8%. Half of the scaffold thromboses occurred after premature discontinuation of antiplatelet/anticoagulation therapy, and only one scaffold thrombosis occurred beyond the 6-month follow-up, on day 391. CONCLUSIONS The BIOSOLVE-IV registry showed good safety and efficacy outcomes, confirming a safe rollout of the Magmaris into clinical practice.
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Safety and performance of the third-generation drug-eluting resorbable coronary magnesium scaffold system in the treatment of subjects with de novo coronary artery lesions: 6-month results of the prospective, multicenter BIOMAG-I first-in-human study. EClinicalMedicine 2023; 59:101940. [PMID: 37113674 PMCID: PMC10126775 DOI: 10.1016/j.eclinm.2023.101940] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Background A third-generation coronary drug-eluting resorbable magnesium scaffold (DREAMS 3G) was developed to enhance the performance of previous scaffold generations and achieve angiographic outcomes comparable to those of contemporary drug-eluting stents. Methods This prospective, multicenter, non-randomized, first-in-human study was conducted at 14 centers in Europe. Eligible patients had stable or unstable angina, documented silent ischemia, or non-ST-elevation myocardial infarction, and a maximum of two single de novo lesions in two separate coronary arteries with a reference vessel diameter between 2.5 mm and 4.2 mm. Clinical follow-up was scheduled at one, six and 12 months and annually thereafter until five years. Invasive imaging assessments were scheduled six and 12 months postoperatively. The primary endpoint was angiographic in-scaffold late lumen loss at six months. This trial was registered at ClinicalTrials.gov (NCT04157153). Findings Between April 2020 and February 2022, 116 patients with 117 coronary artery lesions were enrolled. At six months, in-scaffold late lumen loss was 0.21 mm (SD 0.31). Intravascular ultrasound assessment showed preservation of the scaffold area (mean 7.59 mm2 [SD 2.21] post-procedure vs 6.96 mm2 [SD 2.48]) at six months) with a low mean neointimal area (0.02 mm2 [SD 0.10]). Optical coherence tomography revealed that struts were embedded in the vessel wall and were already hardly discernible at six months. Target lesion failure occurred in one (0.9%) patient; a clinically driven target lesion revascularization was performed on post-procedure day 166. No definite or probable scaffold thrombosis or myocardial infarction was observed. Interpretation These findings show that the implantation of DREAMS 3G in de novo coronary lesions is associated with favorable safety and performance outcomes, comparable to contemporary drug-eluting stents. Funding This study was funded by BIOTRONIK AG.
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Confusion in a Patient with Premature Ventricular Complexes Originating in the Left Ventricular Summit – Case Report. EUROPEAN HEART JOURNAL - CASE REPORTS 2023; 7:ytad142. [PMID: 37063379 PMCID: PMC10098649 DOI: 10.1093/ehjcr/ytad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/09/2022] [Accepted: 03/24/2023] [Indexed: 03/30/2023]
Abstract
Abstract
Background
Premature ventricular complexes (PVC) originating in the ventricular outflow tracts are mostly of benign character.
Case summary
We describe a rare case of pulmonary hypertension with severe hypoxemia and confusion caused by a significant mitral regurgitation during PVC originating in the LV summit. After successful PVC ablation all above-mentioned clinical parameters had normalised.
Conclusion
PVC originating in the outflow tracts should be considered as a potential though rare cause of severe mitral regurgitation and pulmonary hypertension.
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Zero-fluoroscopy ablation of the cavotricuspid isthmus guided by intracardiac echocardiography in patients with typical atrial flutter. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In previous studies we have demonstrated the advantages of electrophysiology catheter navigation by intracardiac echocardiography (ICE). In this prospective study we investigated ICE-guided zero-fluoroscopy ablation of the cavotricuspid isthmus (CTI) involving a decapolar diagnostic and an irrigated radiofrequency (RF) ablation catheter in patients with typical atrial flutter (AFL).
Methods and results
Twenty-seven consecutive patients (mean age 73.4±11.6 years, 18 male) with ECG-recordings suggesting ongoing (n=19) or recent CTI-dependent AFL underwent an electrophysiological study (EPS) utilizing solely ICE for catheter navigation. All EPS could be successfully accomplished without the need for fluoroscopy. CTI-dependent AFL was confirmed by entrainment manoeuvre in all patients with ongoing AFL. Mean EPS duration was 44.0±20.3 minutes and mean ablation procedure duration was 22.3±16.4 minutes. RF ablation was applied for 6.3±3.1 minutes (50 Watts, irrigated RF-ablation in all patients). After the last RF application, bidirectional CTI-Block was confirmed by differential pacing in all patients. Echocardiographic parameters such as CTI-length, prominence of the eustachian ridge (ER), and depth of the CTI-pouch on the ablation plane (Figure 1) were assessed to analyse their correlation with EPS- or ablation procedure duration. CTI-pouch was shallower in patients with ablation procedure duration above median (4,9±1.09mm vs. 6.3±0.9mm, p=0.048), suggesting a more laterally ablation plane in these patients, where the CTI musculature is stronger. CTI-length or ER-prominence above the respective median did not correlated with longer EPS duration. However, in some cases with prominent ER inversion of the ablation catheter was needed to achieve contact of catheter-tip to the tissue. An asymptomatic intramural hematoma was diagnosed by ICE after successful ablation in one patient, no other major or minor complications were documented in this study.
Conclusions
Zero-fluoroscopy CTI ablation guided solely by intracardiac echocardiography in patients with CTI-dependent AFL is feasible and safe. ICE visualisation may help to localize the optimal ablation plane, to detect and correct poor tissue contact of the catheter tip and recognise early potential complications during the ablation procedure.
Funding Acknowledgement
Type of funding sources: None.
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TCT-591 Predictors of Cross-Over for Distal Radial Access: Insights From the DISCO RADIAL Study. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comparison of a pulsatile and a continuous flow left ventricular assist device in high-risk PCI. Int J Cardiol 2022; 360:7-12. [PMID: 35597491 DOI: 10.1016/j.ijcard.2022.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mechanical circulatory support devices are able to generate additional cardiac output or maintain sufficient circulation during high-risk PCI. We prospectively compared the hemodynamic and clinical performance of the new iVAC2L® device with the Impella 2.5® device during high-risk PCI. MATERIALS AND METHODS In 40 patients [10 female, age 75 ± 8 years, left ventricular ejection fraction (LVEF) 44 ± 11%] high-risk PCIs were performed under iVAC (n = 20) or Impella (n = 20) support. Hemodynamic parameters were collected before and after device placement as well as immediately after PCI. Blood parameters of hemolysis were analyzed before and after support. RESULTS Correct device placement was achieved in 17 patients (85%) under iVAC use and in 19 patients (95%) under Impella use. PCI success was 98%. Under iVAC2L® support, systolic, diastolic and mean aortic blood pressure increased significantly with increasing support time. In contrast, aortic pressure increased directly under Impella support, but the increase was comparable between both devices. Impella support generated a significantly higher additional blood flow, as compared to iVAC support (2.07 ± 0.09 l/min vs. 1.25 ± 0.05 l/min, p < 0.001). Five patients (iVAC n = 3) suffered from critical events during high-risk PCI, but both devices were able to maintain stable hemodynamic conditions. After PCI, one severe bleeding occurred in each group. After Impella support, haptoglobin was significantly decreased, indicating potential hemolysis. CONCLUSIONS High-risk PCIs under support by both devices are feasible and safe and ensure stable hemodynamic conditions also if complications occur. Aortic pressure increases significantly with both devices, but later under iVAC use. Potential hemolysis occurs more frequent under Impella support.
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Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv 2022; 15:1191-1201. [PMID: 35595673 DOI: 10.1016/j.jcin.2022.04.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. OBJECTIVES The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. METHODS DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications. RESULTS Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. CONCLUSIONS With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time.
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Distal versus conventional radial access for coronary angiography and intervention: Design and rationale of DISCO RADIAL study. Am Heart J 2022; 244:19-30. [PMID: 34666014 DOI: 10.1016/j.ahj.2021.10.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transradial access (TRA) has become the default access method for coronary diagnostic and interventional procedures. As compared to transfemoral access, TRA has been shown to be safer, cost-effective and more patient-friendly. Radial artery occlusion (RAO) represents the most frequent complication of TRA, and precludes future coronary procedures through the radial artery, the use of the radial artery as a conduit for coronary artery bypass grafting or as arteriovenous fistula for patients on hemodialysis. Recently, distal radial access (DRA) has emerged as a promising alternative to TRA, yielding potential for minimizing the risk of RAO. However, an international multicenter randomized comparison between DRA, and conventional TRA with respect to the rate of RAO is still lacking. TRIAL DESIGN DISCO RADIAL is a prospective, multicenter, open-label, randomized, controlled, superiority trial. A total of 1300 eligible patients will be randomly allocated to undergo coronary angiography and/or percutaneous coronary intervention (PCI) through DRA or TRA using the 6 Fr Glidesheath Slender sheath introducer. Extended experience with both TRA and DRA is required for operators' eligibility and optimal evidence-based best practice to reduce RAO systematically implemented by protocol. The primary endpoint is the incidence of forearm RAO assessed by vascular ultrasound at discharge. Several important secondary endpoints will also be assessed, including access-site cross-over, hemostasis time, and access-site related complications. SUMMARY The DISCO RADIAL trial will provide the first large-scale multicenter randomized evidence comparing DRA to TRA in patients scheduled for coronary angiography or PCI with respect to the incidence of RAO at discharge.
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New Generation Miniaturized Insertable Cardiac Monitor with a Long Sensing Vector: Insertion Procedure, Sensing Performance, and Home Monitoring Transmission Success in a Real-World Population. Heart Rhythm O2 2022; 3:152-159. [PMID: 35496450 PMCID: PMC9043386 DOI: 10.1016/j.hroo.2022.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Objective Methods Results Conclusion
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BIOSOLVE-IV-registry: Safety and performance of the Magmaris scaffold: 12-month outcomes of the first cohort of 1,075 patients. Catheter Cardiovasc Interv 2021; 98:E1-E8. [PMID: 32881396 PMCID: PMC8359313 DOI: 10.1002/ccd.29260] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/07/2020] [Accepted: 08/22/2020] [Indexed: 12/03/2022]
Abstract
OBJECTIVES We aimed to assess the safety and performance of the Magmaris sirolimus-eluting bioresorbable magnesium scaffold in a large patient population. BACKGROUND Magmaris has shown good outcomes in small-sized controlled trials, but further data are needed to confirm its usability, safety, and performance. METHODS BIOSOLVE-IV is an international, single arm, multicenter registry including patients with a maximum of two single de novo lesions. Follow-up is scheduled up to 5 years; the primary outcome is target lesion failure (TLF) at 12 months. RESULTS A total of 1,075 patients with 1,121 lesions were enrolled. Mean patient age was 61.3 ± 10.5 years and 19.2% (n = 206) presented with non-ST-elevation myocardial infarction (NSTEMI). Lesions were 3.2 ± 0.3 mm in diameter and 14.9 ± 4.2 mm long; 5.1% (n = 57) were bifurcation lesions. Device success was 97.3% (n = 1,129) and procedure success 98.9% (n = 1,063). The Kaplan-Meier estimate of TLF at 12 months was 4.3% [95% confidence interval, CI: 3.2, 5.7] consisting of 3.9% target lesion revascularizations, 0.2% cardiac death, and 1.1% target-vessel myocardial infarction. Definite/probable scaffold thrombosis occurred in five patients (0.5% [95% CI: 0.2, 1.1]), thereof four after early discontinuation of antiplatelet/anticoagulation therapy. CONCLUSION BIOSOLVE-IV confirms the safety and performance of the Magmaris scaffold in a large population with excellent device and procedure success and a very good safety profile up to 12 months in a low-risk population.
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[Not Available]. Herzschrittmacherther Elektrophysiol 2020; 31:231. [PMID: 27240925 DOI: 10.1007/s00399-016-0438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Patient Directed Recording of a Bipolar Three-Lead Electrocardiogram using a Smartwatch with ECG Function. J Vis Exp 2019. [PMID: 31885372 DOI: 10.3791/60715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Cardiac arrhythmias and cardiovascular diseases are a major public health problem in developed countries. A major goal in preventive medicine is the reduction of cardiovascular death by early detection of atrial fibrillation (AF), which may cause stroke, or early detection of life-threatening myocardial ischemia in acute coronary syndrome. Detection of arrhythmia is often challenging if symptoms occur when patients have no chance for immediate electrocardiogram (ECG) diagnostic testing, or if the observation time period is short or an immediate visit to their doctor is not possible. Smartwatches and other wearable devices are able to record a single lead ECG recording, but a single lead ECG is often not sufficient for diagnosis of cardiovascular disorders. Even diagnosis of AF can be difficult with only information from a single lead bipolar ECG. Some smart devices use photoplethysmography for detection of cardiac rhythm, but this technique can only give indirect hints of the underlying cardiac rhythm, is prone to interferences, and cannot be used for detection of myocardial ischemia. A three-lead bipolar ECG like the Einthoven leads used in regular ECGs can add useful information concerning arrhythmia detection or even diagnosis of other cardiovascular diseases like ischemia. Therefore, we describe a protocol for the patient-directed recording of an Einthoven three-lead ECG using a smartwatch.
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High-risk PCI under support of a pulsatile left ventricular assist device - First German experience with the iVAC2L system. Int J Cardiol 2019; 297:30-35. [PMID: 31630819 DOI: 10.1016/j.ijcard.2019.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/07/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND During high-risk percutaneous coronary intervention (PCI) complications may occur, leading to unstable hemodynamic conditions. Circulatory support devices might help to intercept these conditions by supporting cardiac output. We investigated in a prospective trial the performance of the pulsatile iVAC2L system in the setting of high-risk PCI. METHODS Circulatory support by the iVAC2L device was attempted in 20 consecutive patients (three females, mean age 72 ± 9 years, LVEF 44 ± 12%) undergoing high-risk PCI. Aortic pressure data were collected after device placement and immediately after PCI. RESULTS Successful device placement was achieved in 17 (85%) patients; kinking of iliac artery and device length limited correct device placement in the remaining three patients. PCI success was 100%. With ongoing support (overall support time 122 ± 32min) systolic, diastolic and mean blood pressure increased significantly and kept the higher level until device removal. Critical events occurred in three patients (massive vasospasm, coronary perforation, no-flow in LCA after wire placement), but the iVAC2L device helped to maintain stable hemodynamic conditions with no need for cardiopulmonary resuscitation. Serial controls of hemolysis related parameters in a subgroup of ten patients revealed no significant device related hemolysis after the performance of the iVAC2l system. CONCLUSIONS High-risk PCI under hemodynamic support by the iVAC2L device is feasible and safe. Aortic pressure increases with ongoing support. The device helps to stabilize hemodynamic situations if complications occur.
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TCT-45 Safety and Performance of the Resorbable Magnesium Scaffold, Magmaris, in a Real-World Setting: First Cohort Subjects at 12-Month Follow-Up of the BIOSOLVE-IV Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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TCT-321 Head-to-Head Comparison of a Pulsatile and a Continuous Flow Left Ventricular Assist Device in High-Risk PCI Setting: iVAC2L Versus Impella 2.5. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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P6514Head to head comparison of a pulsatile versus continuous flow left ventricular assist device in high-risk PCI setting: iVAC2L vs. Impella 2.5. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
To compare the hemodynamic and clinical performance between iVAC2L and Impella 2.5 in high-risk PCI.
Patients and methods
In 35 patients [8 female, age 75±8 years, left ventricular ejection fraction 45±12%] high-risk PCI was performed under Impella 2.5 (n=15) or IVAC2L (n=20) use. Aortic pressure and flow was collected before and after device placement and after PCI. Blood parameters of hemolysis were collected before and after PCI.
Results
Correct placement was achieved in 17 iVAC2L-patients and in 14 Impella-patients. PCI success was 97%. Support time was comparable between both groups. No early increase in aortic pressure occurred under full iVAC2L-support, but with prolonged support it increased significantly and kept higher level (Table 1). In contrast, aortic pressure increased significantly immediately under Impella, but the increase was comparable between the devices after PCI. Flow under Impella was significantly higher compared to iVAC2L (2.07±0.09l/min vs. 1.25±0.05l/min, p<0.001). In five patients (iVAC2L n=3) critical events during PCI occurred, but both devices helped to stabilise hemodynamics. After PCI, one severe bleeding in each group and one stroke after iVAC2L occurred. Haptoglobin level after Impella showed signs of hemolysis (Table 1).
Table 1 prePCI (no support) prePCI (full support) postPCI (full support) postPCI (no support) iVAC2L RRsyst Ao (mmHg, mean±SD) 123±29 125±21 142±28*§ 142±31# Impella 2.5 RRsyst Ao (mmHg, mean±SD) 137±23 148±29&% 151±22 153±22% iVAC2L RRdiast Ao (mmHg, mean±SD) 57±16 59±14 68±18* 69±18# Impella 2.5 RRdiast Ao (mmHg, mean±SD) 60±12 76±15&% 84±16* 76±17# iVAC2L RRmean Ao (mmHg, mean±SD) 81±17 83±16 97±21*§% 94±27# Impella 2.5 RRmean Ao (mmHg, mean±SD) 91±15 102±17&% 109±16* 106±17# iVAC2L Haptoglobin (mg/l, mean±SD) 1485±689 1261±648 Impella 2.5 Haptoglobin (mg/l, mean±SD) 1456±570 894±371$ iVAC2L LDH (U/l, mean±SD) 240±90 241±68 Impella 2.5 LDH (U/l, mean±SD) 220±82 252±101 Ao = Aorta. *p<0.05 prePCI (no support) vs. postPCI (full support); #p<0.05 prePCI (no support) vs. postPCI (no support); §p<0.05 prePCI (full support) vs. postPCI (full support); &p<0.05 prePCI (no support) vs. prePCI (full support); %p<0.05 iVAC vs. Impella.
Conclusion
High-risk PCI under support of both devices is feasible and safe. Aortic pressure increases with both devices but earlier under Impella. Differences in outcome and hemodynamics between the 2 devices need to be evaluated in large multi-center studies.
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Recording of Bipolar Multichannel ECGs by a Smartwatch: Modern ECG Diagnostic 100 Years after Einthoven. SENSORS (BASEL, SWITZERLAND) 2019; 19:E2894. [PMID: 31261981 PMCID: PMC6651039 DOI: 10.3390/s19132894] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 11/16/2022]
Abstract
Aims: Feasibility study of accurate three lead ECG recording (Einthoven I, II and III) using an Apple Watch Series 4. Methods: In 50 healthy subjects (18 male; age: 40 ± 12 years) without known cardiac disorders, a 12-lead ECG and three bipolar ECGs, corresponding to Einthoven leads I, II and III were recorded using an Apple Watch Series 4. Einthoven I was recorded with the watch on the left wrist and the right index finger on the crown, Einthoven II with the watch on the left lower abdomen and the right index finger on the crown, Einthoven III with the watch on the left lower abdomen and the left index finger on the crown. Four experienced cardiologists were independently asked to assign the watch ECGs to Einthoven leads from 12-lead ECG for each subject. Results: All watch ECGs showed an adequate signal quality with 134 ECGs of good (89%) and 16 of moderate signal quality (11%). Ninety-one percent of all watch ECGs were assigned correctly to corresponding leads from 12-lead ECG. Thirty-nine subjects (78%) were assigned correctly by all cardiologists. All assignment errors occurred in patients with similar morphologies and amplitudes in at least two of the three recorded leads. Erroneous assignment of all watch ECGs to leads from standard ECG occurred in no patient. Conclusion: Recording of Einthoven leads I-III by a smartwatch is accurate and highly comparable to standard ECG. This might contribute to an earlier detection of cardiac disorders, which are associated with repolarization abnormalities or arrhythmias.
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Intracardiac echocardiography versus fluoroscopy for endovascular and endocardial catheter navigation during cryo-ablation of the slow pathway in AVNRT patients. Cardiovasc Ultrasound 2019; 17:12. [PMID: 31186001 PMCID: PMC6560740 DOI: 10.1186/s12947-019-0162-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background A new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients. Methods Clinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution. Results Slow pathway ablation or modulation was successful in all patients. Fluoroscopy time and radiation dose in the fluoroscopy group were 11.2 ± 9.0 min and 20.3 ± 16.2Gycm2, whereas no fluoroscopy was used in the opposite group (p < 0.001, respectively). EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.). Conclusions Zero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques. Trial registration (German Clinical Trials Register ID: DRKS00011360; Registration Date 14.12.2016) Electronic supplementary material The online version of this article (10.1186/s12947-019-0162-2) contains supplementary material, which is available to authorized users.
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Cerebrovascular events, bleeding complications and device related thrombi in atrial fibrillation patients with chronic kidney disease and left atrial appendage closure with the WATCHMAN™ device. BMC Cardiovasc Disord 2019; 19:112. [PMID: 31092201 PMCID: PMC6518765 DOI: 10.1186/s12872-019-1097-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/03/2019] [Indexed: 01/26/2023] Open
Abstract
Background Impaired renal function increases the bleeding risk, leading to a conservative prescription and frequent discontinuation of oral anticoagulation in atrial fibrillation patients with chronic kidney disease (CKD). Interventional left atrial appendage closure (LAAC) might be an alternative therapeutic strategy for these patients. Methods We aimed to prospectively assess cerebrovascular (CE) and bleeding events, as well as peri-procedural and long-term complications in a cohort of consecutive patients undergoing interventional LAAC using the WATCHMAN™ device, with focus on CKD patients. Results One hundred and eighty-nine consecutive patients undergoing interventional LAAC were included in this analysis; 171 (90.5%) patients had a reduced estimated glomerular filtration rate (eGFR; patients for each CKD stage: II = 66; IIIa = 32; IIIb = 43; IV = 18; V = 12). During a follow-up of 310 patient years three (1.0%) patients suffered a CE (two strokes, one transitory ischemic attack) and five (1.6%) other ones a bleeding complication. The observed stroke rate was more than two-thirds and the bleeding risk more than half lower than expected. Device related thrombi (DRT) were detected in twelve (6.5%) patients; women had significantly more DRT than men (12.5% vs. 2.6%; p = 0.009). Patients with an eGFR< 30 ml/min/1.73m2 showed a trend to a higher DRT rate as compared to the opposite group (13.3% vs. 5.1%; p = 0.10). Thrombus resolved with temporary oral anticoagulation therapy in ten patients without sequelae; thrombus consolidation was confirmed by serial TEE controls in the remaining two patients. Conclusions Atrial fibrillation patients with CKD have low CE and bleeding rates after LAAC with the WATCHMAN™ device. DRT risk is higher in female and patients with severe CKD. More frequent post-interventional TEE controls might be justified for early DRT detection and safe management of patients at high DRT risk. Trial registration (German Clinical Trials Register ID: DRKS00 010768; Registration Date 07.07.2016).
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Angiographic and clinical performance of a paclitaxel-coated balloon compared to a second-generation sirolimus-eluting stent in patients with in-stent restenosis: the BIOLUX randomised controlled trial. EUROINTERVENTION 2018; 14:1096-1103. [DOI: 10.4244/eij-d-17-01079] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Impact of procedure-related conduction disturbances after transcatheter aortic valve implantation on myocardial performance and survival evaluated by conventional and speckle tracking echocardiography. Echocardiography 2018; 35:621-631. [PMID: 29437242 DOI: 10.1111/echo.13823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Although procedure-related new cardiac conduction disturbances (CCDs) remain an important issue in transcatheter aortic valve implantation (TAVI), their effect on myocardial function and overall patient outcome remains unclear. The goal of this study was to analyze the influence of procedure-related CCDs on systolic and diastolic LV performance and on patient survival after TAVI. METHODS AND RESULTS Ninety-five patients who underwent TAVI for severe symptomatic aortic stenosis (AS) and had a complete follow-up were evaluated with respect to procedure-related CCDs. Left ventricular (LV) performance was measured using standard echocardiographic parameters and speckle tracking analysis. Survival was assessed during longer-term follow-up (mean: 29.1 ± 16.9 months). After TAVI, the improvement of global LV function expressed as ejection fraction (LVEF; from 45.5 ± 10.0 to 47.8 ± 13.9%, P = .13) was not significant. New CCDs were found in 35.7% of TAVI recipients. A comparison between patients with and without new CCDs showed that LV systolic function improved in those without CCDs, while it tended to deteriorate in patients with CCDs (change in LVEF: 5.5 ± 12.3% vs -4.9% ± 11.5%, P = .001; change in global longitudinal strain (GLS): -1.1 ± 4.6% vs 1.2 ± 4.5%, P = .01). Changes in diastolic function did not differ significantly between the groups (changes in transmitral E/A-ratio: -0.3 ± 0.6 vs -0.5 ± 0.5, P = .1). Kaplan-Meier survival analysis revealed no significant differences between the two cohorts (P = .795). CONCLUSION Procedure-related conduction abnormalities after TAVI lead to an LBBB-related dyssynchrony with impairment of LV performance but not of overall survival.
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First successful prevention of cardiopulmonary resuscitation during high-risk percutaneous coronary intervention by use of a pulsatile left ventricular assist device: baptism of fire of the iVAC2L device: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty005. [PMID: 31020087 PMCID: PMC6426094 DOI: 10.1093/ehjcr/yty005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022]
Abstract
Introduction Efforts in percutaneous coronary intervention (PCI) lead to interventional treatment of complex stenoses as an alternative to coronary bypass surgery. Nevertheless, complications during PCI can occur with sudden need for circulatory support. Circulatory support devices are helpful tools during high-risk PCI to generate additional output or maintain sufficient circulation in critical situations. Case description We report the case of the first successful prevention of cardiopulmonary resuscitation by use of transfemoral pulsatile ventricular assist device with up to 2l additional cardiac output during a high-risk PCI in an 80-year old man with complex stenosis and a history of ventricular fibrillation during prior coronary angiography. Discussion The device managed to maintain an adequate circulation during massive vasospasm and bradycardia. The iVAC2L seems to be a useful tool in high-risk PCI. Its general effect on haemodynamics and patients' outcome has to be evaluated in larger multi-centre studies.
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Efficacy of a one-catheter concept for transradial coronary angiography. PLoS One 2018; 13:e0189899. [PMID: 29293533 PMCID: PMC5749733 DOI: 10.1371/journal.pone.0189899] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Transradial coronary angiography (TRC) can be performed with a one-catheter approach for the right and left coronary ostium (R/LCO). We investigated the performance of a special diagnostic catheter widely used for the one-catheter-approach, the Tiger (Tiger II, TerumoTM). Methods In a dual center registry we analyzed 1412 TRC-procedures exclusively performed by experienced TRC-operators. We compared the performance of the Tiger with Judkins catheters by retrospectively judging ostial catheter stability during contrast injection, and by measuring contrast use, fluoroscopy time (FT) and complication rate. Results Poor or failed ostial engagement was found in 40.5% in the Tiger group, compared to 46.6% with the use of Judkins catheters (p<0.183). Ostial instability of the Tiger was found more often during engagement of the LCO than the RCO (34.4% vs. 10.8%, p<0.001), whereas it was similar in the LCO and RCO for Judkins catheters (27.4% vs. 26.7%, p = 0.840). TRC-procedures performed with Tiger catheters were associated with less contrast volume (63.48 ± 29.83mL vs. 82.51 ± 56.58mL, p<0.004) and shorter FT than with Judkins catheters. (198.27 ± 194.8sec vs. 326.85 ± 329.70sec). Forearm hematomas occurred less often with the Tiger (1.2% vs. 6.6%, p< 0.02). Conclusion The Tiger employed as a single catheter in TRC is an effective tool to achieve lower contrast volume and fluoroscopy time at a low complication rate. Unstable engagement affects predominantly the left coronary artery, but its overall frequency is similar for both, the Tiger and Judkins catheters.
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Impact of sheath diameter of different sheath types on vascular complications and mortality in transfemoral TAVI approaches using the Proglide closure device. PLoS One 2017; 12:e0183658. [PMID: 28837613 PMCID: PMC5570351 DOI: 10.1371/journal.pone.0183658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 07/10/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Evaluation of the impact of the sheath diameter on vascular complications and mortality in transfemoral aortic valve implantation. METHOD Between 2012 and 2014, 183 patients underwent the procedure using a sheath diameter of 18-24 F. This collective was divided into two groups: group 1, with a sheath diameter of 18F (G1, n = 94), consisted of patients with 18F Medtronic Sentrant and 18 F Direct Flow sheaths, and group 2 with a sheath diameter of 19-24 F (G2, n = 89) consisted of patients with Edwards expandable e-sheath and Solopath sheaths. Perclose-Proglide® was used as a closure device in all patients. RESULTS G1 had significantly more female patients (64.9% vs. 46.1% in G2, p = 0.01) and the average BMI was lower (26 ± 4.5% vs. 27.4 ± 4.7%, p = 0.03). There was no significant difference in the incidence of major and minor vascular complications (G1: 12.8% vs. G2: 12.4%, p = 0.9). 30-day mortality was similar in both groups (G1: 6.4 ± 2.5% [95% CI: 0.88-0.98], G2: 3.7 ± 1.9% [95% CI: 0.92-0.99]. The Kaplan Meier analysis of survival revealed no significant differences either. CONCLUSION The difference in sheath diameter had no effect on either incidence or severity of vascular complications. There was no impact on mortality either.
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Impact of closure devices on vascular complication and mortality rates in TAVI procedures. Int J Cardiol 2017; 241:133-137. [DOI: 10.1016/j.ijcard.2017.01.088] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/15/2016] [Accepted: 01/13/2017] [Indexed: 12/17/2022]
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Erratum to: Third generation drug eluting stent (DES) with biodegradable polymer in diabetic patients: 5 years follow-up. Cardiovasc Diabetol 2017; 16:59. [PMID: 28472961 PMCID: PMC5418688 DOI: 10.1186/s12933-017-0541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Third generation drug eluting stent (DES) with biodegradable polymer in diabetic patients: 5 years follow-up. Cardiovasc Diabetol 2017; 16:23. [PMID: 28183306 PMCID: PMC5301341 DOI: 10.1186/s12933-017-0500-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/27/2017] [Indexed: 01/07/2023] Open
Abstract
Objective To report the long-term safety and efficacy data of a third generation drug eluting stent (DES) with biodegradable polymer in the complex patient population of diabetes mellitus after a follow-up period of 5 years. Background After percutaneous coronary intervention patients with diabetes mellitus are under higher risk of death, restenosis and stent thrombosis (ST) compared to non-diabetic patients. Methods In 126 centers worldwide 3067 patients were enrolled in the NOBORI 2 registry, 888 patients suffered from diabetes mellitus (DM), 213 of them (14%) being insulin dependent (IDDM). Five years follow-up has been completed in this study. Results At 5 years, 89.3% of the patients were available for follow-up. The reported target lesion failure (TLF) rates at 5 years were 12.39% in DM group and 7.34% in non-DM group; (p < 0.0001). In the DM group, the TLF rate in patients with IDDM was significantly higher than in the non-IDDM subgroup (17.84 vs. 10.67%; p < 0.01). The rate of ST at 5 years was not different among diabetic versus non-diabetic patients or IDDM versus NIDDM. Only 10 (<0.4%) very late stent thrombotic events beyond 12 months occurred. Conclusions The Nobori DES performed well in patients with DM. As expected patients with DM, particularly those with IDDM, had worse outcomes. However, the very low rate of very late stent thrombosis in IDDM patients might have significant clinical value in the treatment of these patients. Clinical trial registration ISRCTN81649913; http://www.controlled-trials.com/isrctn/search.html?srch=81649913&sort=3&dir=desc&max=10
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Left ventricular adaptation after TAVI evaluated by conventional and speckle-tracking echocardiography. Int J Cardiol 2017; 228:633-637. [DOI: 10.1016/j.ijcard.2016.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/16/2016] [Accepted: 11/05/2016] [Indexed: 11/28/2022]
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The Changing Landscape for Stroke Prevention in AF. J Am Coll Cardiol 2017; 69:777-785. [DOI: 10.1016/j.jacc.2016.11.061] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 12/13/2022]
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First high-risk percutaneous coronary intervention under use of the iVAC2l system in Germany. Future Cardiol 2017; 13:117-123. [PMID: 28111968 DOI: 10.2217/fca-2016-0064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Percutaneous coronary intervention of complex stenoses is becoming more and more of an alternative to coronary bypass surgery. Nevertheless, complications can occur and lead to the need for circulatory support and/or emergency surgery. Circulatory support devices like the intra-aortic balloon pump showed only low benefit in patients' outcome. Devices with higher cardiac output necessitate more complex implantation procedures. We report the case of the first successful use of a transfemoral pulsatile ventricular assist device with up to 2 l additional cardiac output during high-risk percutaneous coronary intervention in a 74-year-old man with complex stenosis. The device was safe and feasible during coronary intervention in its use. Its beneficial effect on hemodynamics and patients' outcome has to be evaluated in larger multicenter studies.
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[Ventricular fibrillation vs dying heart pattern]. Herzschrittmacherther Elektrophysiol 2016; 27:417. [PMID: 27844193 DOI: 10.1007/s00399-016-0463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Charge transport mechanism in lead oxide revealed by CELIV technique. Sci Rep 2016; 6:33359. [PMID: 27628537 PMCID: PMC5024125 DOI: 10.1038/srep33359] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023] Open
Abstract
Although polycrystalline lead oxide (PbO) belongs to the most promising photoconductors for optoelectronic and large area detectors applications, the charge transport mechanism in this material still remains unclear. Combining the conventional time-of-flight and the photo-generated charge extraction by linear increasing voltage (photo-CELIV) techniques, we investigate the transport of holes which are shown to be the faster carriers in poly-PbO. Experimentally measured temperature and electric field dependences of the hole mobility suggest a highly dispersive transport. In order to analyze the transport features quantitatively, the theory of the photo-CELIV is extended to account for the dispersive nature of charge transport. While in other materials with dispersive transport the amount of dispersion usually depends on temperature, this is not the case in poly-PbO, which evidences that dispersive transport is caused by the spatial inhomogeneity of the material and not by the energy disorder.
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Five-year clinical performance of a biodegradable polymer-coated biolimus-eluting stent in unselected patients. Heart 2016; 103:111-116. [DOI: 10.1136/heartjnl-2016-309283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/27/2016] [Accepted: 07/10/2016] [Indexed: 11/04/2022] Open
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IMPACT OF CLOSURE DEVICES IN TAVI PROCEDURES ON VASCULAR COMPLICATIONS AND MORTALITY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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[Mismanagement in the arrhythmia recognition algorithm of the LifeVest® with consecutive fatal outcome]. Herzschrittmacherther Elektrophysiol 2016; 27:57-62. [PMID: 26830775 DOI: 10.1007/s00399-016-0420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
We describe for the first time the misinterpretation of a wearable cardioverter defibrillator in the arrhythmia recognition algorithm with subsequent fatal outcome of a multi-morbid patient with an ischemic cardiomyopathy and a highly reduced left ventricular pump function (30 %). The patient's death was preceded by a life-threatening shockable rhythm which was repeatedly documented, but ultimately not correctly recognized by the system and therefore not treated.
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Abstract
Transradial coronary angiography (TRC) can be performed applying only one catheter fitting into the right and left coronary ostia (R/LCO). In this bicentric study (n = 2953), we analyzed the ostial performance of the Tiger_II_catheter widely used in TRC. Compared to Judkins catheters, the Tiger_II is frequently associated with ostial instability within the LCO but fits better into the RCO-irrespective of tube size. Judkins catheters generally need more peri-procedural contrast and radiation exposure. TRC may be started using a 5F_Tiger_II on the right side in order to be switched to 5F Judkins in case of propable LCO instability.
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TCT-671 Left Ventricular Adaptation After TAVI Evaluated By Echocardiography Including Speckle Tracking. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[Knowledge of guidelines for anticoagulation management of patients with atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2015; 26:141-7. [PMID: 25808237 DOI: 10.1007/s00399-015-0363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In Germany, about 1 million people are affected by atrial fibrillation (AF). Morbidity and mortality are high especially due to the risk of thromboembolic events. A valid risk stratification by the CHADS2 criteria is critical regarding the indication for anticoagulation and thus to improve prognosis. To what extent these criteria and guidelines are known and have been implemented among cardiologists and general practitioners in Germany has not been evaluated so far. METHODS A total of 558 cardiologists (46.8 %) and general practitioners (52.5 %) were surveyed during the annual meeting of the German Society of Cardiology or in writing in a representative sample of German general practitioners. RESULTS Compared to 51.8 % of general practitioners, 87.6 % of cardiologists (p < 0.001) claimed to know the CHADS2 criteria. In the total cohort, CHADS2 criteria were correctly identified as risk factors by 55.6-86.9 %. Cardiologists had significantly better knowledge of these criteria (63.6-91.2 % vs. 55.6-86.9 %, p < 0.001). A previous history of cerebral stroke was known to be a risk factor in almost all physicians in contrast to heart failure (47.3 % of cardiologists vs. 36.0 % of general practitioners, p < 0.001). Physicians who had attended a training course on anticoagulation and atrial fibrillation (n = 380) in the 2 years prior to the survey performed significantly better (p = 0.007) than those without training (n = 173). CONCLUSION While the majority of cardiologists knew the CHADS2 criteria and the related guidelines, these criteria were less known in the primary care sector. Nevertheless, even cardiologists do not always apply the guidelines for anticoagulation in AF correctly. Participants of training courses had a significantly better knowledge of these guidelines.
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Drug-eluting stents with biodegradable polymer for the treatment of patients with diabetes mellitus: clinical outcome at 2 years in a large population of patients. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:153-60. [PMID: 25737640 PMCID: PMC4342370 DOI: 10.2147/mder.s67399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study investigates the safety and efficacy of a third-generation drug-eluting stent (DES) with biodegradable polymer in the complex patient population of diabetes mellitus (DM). Clinical trial registration ISRCTN81649913. Background Percutaneous coronary interventions in patients with DM are associated with a higher incidence of death, restenosis, and stent thrombosis as compared to non-diabetic patients. The use of a DES has been shown to improve outcomes in diabetic patients. Methods Out of 3,067 patients, enrolled in 126 centers worldwide in the NOBORI 2 registry, 888 patients suffered from DM, 213 of them (14%) being insulin-dependent DM (IDDM). Two years’ follow-up has been completed in this study. Results At 1- and 2-year follow-up, 97% and 95% of the patients, respectively, were available. The reported target lesion failure (TLF) rates at 1- and 2-year follow-up were 6.0% and 7.2% in the DM group, respectively, and 3.0% and 4.2% in the non-DM group, respectively (P<0.001 for both years). Inside the DM group, the TLF rates of 9.9% and 11.7% at the 1- and 2-year follow-ups, respectively, in patients with IDDM were significantly higher than the TLF rates of 4.7% and 5.8%, respectively, in the non-IDDM subgroup (P<0.01 for both years). The rate of stent thrombosis at the 2-year follow-up was 1.0% in the DM group and 0.7% in non-DM patients. There were no cases of late, or very late stent thrombosis in IDDM patients. Conclusion The Nobori DES performed well in patients with DM. As expected, patients with DM, particularly those with IDDM, had worse outcomes. However, the absence of late, and very late stent thrombosis in IDDM patients merits further investigation, as this finding might have significant clinical value.
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Oral Abstract session: Pericardial diseases, masses and sources of embolism: Thursday 4 December 2014, 11:00-12:30 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Poster session 3: Thursday 4 December 2014, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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[Ten years of early defibrillation: "Bochum against sudden cardiac death". Acceptance and critical analysis of using automated external defibrillators]. Med Klin Intensivmed Notfmed 2014; 110:150-4. [PMID: 25348052 DOI: 10.1007/s00063-014-0436-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a comprehensive early defibrillation program in Bochum (Germany); since 2003 a total of 175 automated external defibrillators (AEDs) have been installed in urban areas by the city of Bochum and private companies. These were preferably installed in places with high foot traffic, e.g., public buildings, companies, and event/shopping centers. Approximately 15,000 laypeople who work in the vicinity of the AED locations were trained in the use of defibrillators and in basic resuscitation. In addition, rescue workers on fire trucks and medically trained personnel in physicians' medical practices were equipped as "first responders" with AEDs. RESULTS After an initiation phase, all available information after each AED use since August 2004 has been collected by the project coordinator. During the period of data collection (August 2004 to August 2013), an AED was used in a total of 17 patients who had suffered sudden cardiac death (SCD) under the project in Bochum. Eleven patients had primary ventricular fibrillation (VF). Six of these survived without neurological deficit. In another 6 patients, a nondefibrillatable rhythm disorder was diagnosed. The AEDs are reliable and showed impeccable rhythm analysis before the instructions to provide any necessary shock. DISCUSSION Compared to the number of existing units and an estimated number of 37-100 SCD/100,000, the use of the AEDs only 17 times appears relatively small. To improve the effectiveness of the AED program in Bochum, an analysis of the emergency service responses, which were necessary because of sudden circulatory collapse, is currently being performed. This will allow areas with an increased incidence of SCD to be identified and a plan for the strategic placement of AED and emergency services can be made.
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