The year in cardiovascular medicine 2025: the top 10 papers in interventional cardiology.

Objective To evaluate the safety,feasibility and efficacy of emergency percutaneous coronary intervention(PCI)on the spot in the patients with acute myocardial infarction(AMI)in country hospitals by interventional cardiologists from higher-level hospitals(converse transport).Methods A total of 81 AMI patients received emergency PCI on the spot by interventional cardiologists from other higher-level hospitals (transported doctors)from Mar 2004 to Sep 2008 in our hospital.The mean age of patients was 68.6 ± 3.6 years (36.0-83.0 years).Forty-six patients were male and 35 were female.There were 56 cases with anterior myocardial infarction and 25 with inferior myocardial infarction(including 11 cases combined with right ventricular infarction).The average time from symptom onset to admission was 6.2 ± 1.8 hours(2.0-12.0hours).Results Three cases were transported to higher-level hospitals for CABG because of severe conditions.The other 78 cases received emergency PCI on the spot,among whom 66 cases received primary PCI.Another 12 cases received rescue PCI.Eight one stents were implanted in total into the infarcted arteries.One operation was failed because the balloon could not go through the lesion.The success.rate was 98.7％.Four patients occurred peri-operative cardiac adverse events and 2 cases died.Four cases died during the 32-86 months follow-up,of whom I was cardiac death and 3 was non-cardiac deaths.No fatal cardiovascular events occurred in the remained cases.Conclusion Emergency PCI on the spot by interventional cardiologists from other cities(converse transport PCI)in AMI is safe,feasible and effective.But it needs to be confirmed in a large-scale study in the future. Key words: Acute myocardial infarction; Percutaneous coronary intervention; Interventional cardiologists; Converse transport

In individual cases, routine preoperative imaging might not be sufficient for optimal planning of cardiovascular procedures. Three-dimensional printing (3D), a widely used technique to build life-like replicas of anatomical structures that has proven value in different medical disciplines, might overcome these shortcomings. However, data on 3D printing in cardiovascular medicine are limited to single reports. This stimulated us to present our single-centre experience with 3D printing models in cardiac surgery and interventional cardiology. Between the years 2006 and 2013, we fabricated 3D printing models using preoperative computed tomography or magnetic resonance imaging data in paediatric and adult cardiac surgery, as well as interventional cardiology. We present the 8 most representative cases. The models were very helpful for perioperative planning and orientation, as well as simulation of procedures due to the exact and life-like illustration of the cardiovascular anatomy. The fabrication of 3D printing models is feasible for perioperative planning and simulation in a variety of complex cases in paediatric and adult cardiac surgery, as well as in interventional cardiology. Further studies including more patients and providing more data are expected to demonstrate that the use of 3D printing may decrease morbidity and mortality of complex, non-routine procedures in cardiovascular medicine.

In interventional cardiology (IC), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures are the most frequent ones. Since the 1990s, the number of IC procedures has increased rapidly. It is also known that these procedures are associated with high radiation doses due to long fluoroscopy time (FT) and large number of cine-frames (CF) acquired to document the procedure. Mapping skin doses in IC is useful to find the probability of skin injuries, to detect areas of overlapping field, and to get a permanent record of the most exposed areas of skin. The purpose of this study was to estimate the maximum skin dose (MSD) in patients undergoing CA and PTCA, and to compare these values with the reference levels proposed in the literature. Patients’ dose measurements were carried out on a sample of 38 patients at the hemodynamic department, in four local hospitals in Rio de Janeiro, Brazil, using Gafchromic© XR-RV2 films. In PTCA procedures, the median and third quartile values of MSD were estimated at 2.5 and 5.3 Gy, respectively. For the CA procedures, the median and third quartile values of MSD were estimated at 0.5 and 0.7 Gy, respectively. In this paper, we used the Pearson’s correlation coefficient (r), and we found a fairly strong correlation between FT and MSD (r=0.8334, p<0.0001), for CA procedures. The 1 Gy threshold for deterministic effects was exceeded in nine patients. The use of Gafchromic© XR-RV2 films was shown to be an effective method to measure MSD and the dose distribution map. The method is effective to identify the distribution of radiation fields, thus allowing the follow-up of the patient to investigate the appearance of skin injuries.

n more than 20 years since the first percutaneous coronary revascularization procedures, the field of interventional cardiology has proliferated beyond all expectations. Now more than 1 million procedures are performed worldwide each year. Stenting has revolutionized the field, which previously relied on balloon dilatation in the majority of patients. With 50% of patients now undergoing stent implantation, the groundwork is laid for further important advances. In this article, we discuss the 4 most important new advances in the field of interventional cardiology: platelet inhibition, prevention of restenosis, stent evolution, and angiogenesis.

The first aim of this study was the development of performance metrics in a virtual reality simulation for interventional procedure in a real case of multivessel coronary disease. A second aim was to assess the construct validity of these metrics by comparing the performance of interventional cardiologists with different levels of experience. Ninety-four practicing interventional cardiologists attending the EuroPCR 2005 in Paris, France participated in this study. Complete data was available on eighty-nine participants (95%). Participants were divided into three categories depending on experience. Group 1 (novices): N = 33, < 1 years experience; Group 2 (intermediate experience): N = 14, >50 cases per year for the last two years and Group 3 (master physicians): N = 42 participants completed > 100 cases per year during the last five years. Over a period of months during 2004-2005 we identified potential performance metrics for cases of coronary artery disease which were then applied to a case of a patient admitted because of stable angina (class 1) with multivessel coronary disease. Patient's coronary anatomy and lesions were then reconstructed and implemented for the VIST virtual reality simulator. All participants were required to perform this case. Overall, experienced interventional cardiologists performed significantly better than the novices for traditional metrics such as time (p = 0.03), contrast fluid (p = 0.0008) and Fluroscopy time (p = 0.005). Master physicians performed significantly better than the other two groups on metrics which assessed technical performance e.g., time to ascend the aorta (p = 0.0004) and stent placement accuracy (p = 0.02). Furthermore, master physicians made fewer handling errors than the intermediated group who in turn made fewer than the novice group (p = 0.0003). Performance consistency was also a linear function of experience. Novel performance metrics developed for the assessment of technical skills for a simulated intervention for multi-vessel coronary disease showed that more experienced interventional cardiologists performed the procedure better than less experienced interventionalists thus demonstrating construct validity of the metrics.

The cardiovascular market research reports by iData cover Interventional Cardiology, Cardiac Surgery, Cardiac Rhythm Management and the Electrophysiology market. The fastest growing segments within interventional cardiology are expected to be driven by new technologies, such as CTO crossers, FFR guidewires and OCT catheters. The vascular access market will grow due to a combination of increasing patient population and the shift towards technologically advanced devices that will continue to gain market share at the expense of older, less expensive devices. Factors like technological advancement, a growing aging population, and people affected by diabetes, high blood pressure are favouring the market. On the other hand, increasing health expenditure, cardiovascular diseases and increasing tobacco users are supplying the market. Throughout this research series, iData has covered several countries in great detail. Each country may be purchased as a stand-alone report, tailoring the data to your needs. iData Research has an ever-expanding medical market intelligence library consisting of focused, in-depth, accurate, and exclusive research you will not find anywhere else. Our highly qualified team of industry analysts follow a structured and independent research methodology designed to provide the most valuable return on actionable market data in the world. Similar to other medical device markets, the interventional cardiology market has been experiencing a period of consolidation in recent years. Large competitors are either entering the overall market or expanding their reach by entering new segments through strategic mergers and acquisitions. One trend that has risen as a result of consolidation is the bundling of devices at a discount. Bundling is driven by unfavorable reimbursement conditions and larger competitors who have a wide variety of devices to offer across the interventional cardiology market and are able to negotiate more cost-effective contracts with hospitals and labs. As a result competitive pressure is expected to contribute to declines in prices across the majority of segments in the market.

Objective Fluoroscopy remains an unreplaceable imaging technique in the contemporary electrophysiology era.We evaluated the impact of a combined lead screens, which is composed of a suspended-typed lead glass screen and a moveable lead screen, on clinically significant parameters of radiation exposure. Methods One hundred and seventeen patients receiving electrophysiology studies performed by a single experienced interventional cardiologist from December 2014 to June 2015 in Fuwai Hospital were continuously enrolled.Radiation dose rates in different X ray projections were measured, including right anterior oblique(RAO)30°, anterior posterior(AP), left anterior oblique(LAO)30° and LAO 45°.Measurements of radiation dose rate were repeated in different X ray projections with the protection of combined lead screens.Dose area product(DAP)and cumulative air kerma(CAK)data were automatically computed by the system for each x-ray acquisition. Results Under the protection of the combined lead screens, radiation dose rates in RAO 30°, AP, LAO 30° and LAO 45° projection were significantly dropped from(14.8±4.8) mSv/h, (26.9±15.6) mSv/h, (72.7±13.4) mSv/h, (131.4±75.5) mSv/h to(0.8±0.7) mSv/h, (2.4±0.7) mSv/h, (2.0±1.3) mSv/h and(2.6±1.6) mSv/h, respectively(P<0.001). In the subgroup analysis, radiation dose rate measured of the patients with BMI≥25.0 were statistically higher than that of the patients whose BMI was lower than 25.0 in all the three projection angles(AP, LAO 30° and LAO 45°). However, this difference of the radiation dose rates in the two groups disappeared after the application of the combined lead screen. Conclusion As a practical and applicable personal protection technique, the combined lead screens can offer an extra protection against radiation exposure for interventional cardiologist during the electrophysiology procedures. Key words: Electrophysiology study; Radiation exposure; Combined lead screens; Radiation protection

Objective To discuss the effect of clinical nursing path in interventional cardiology, and its impact on relieve of working pressure in nurses. Methods The interventional cardiology patients who used clinical nursing path were selected as the experimental group from January to December in 2013, and patients who used traditional nursing were selected as the control group from January to December in 2012. The length of hospital stay, the satisfaction of nursing job, as well as the writing time of nursing care records and working pressure were compared between the two groups. Results The average length of hospital stay in the experimental group was (7.8±1.1) days, which was significantly shorter than that in the control group (t=4.828, P<0.01). The satisfaction score of nursing job in the experimental group was (24.6±2.8), which was significantly higher than that in the control group (t=4.739, P<0.01). The nursing care records writing time of each time point in the experimental group nurses was significantly shorter than those in the control group (t=5.869, 5.402, 6.537, 5.618, 4.498, 5.724, respectively; P<0.01). Emotional fatigue and apathy for work of nurses were significantly lower than before, and the personal accomplishment score was significantly higher than before, and the differences were statistically significant (t=4.006, 2.641, 2.333, 2.306, 5.623, respectively; P<0.05). Conclusions Patients with cardiac intervention who used the clinical nursing path cannot only shorten the hospital stay significantly and improve the satisfaction of nursing job, but also can effectively shorten the writing time of the nursing care records, and reduce nurses′ working pressure. Key words: Questionnaire survey; Pressure; Satisfaction; Cardiac intervention; Clinical care path

Recent innovations in interventional cardiology have dramatically expanded the therapeutic options for patients with cardiac conditions. Interventional cardiology is no longer limited to the treatment of coronary artery disease but allows also treatment of valvular disease, stroke prevention, hypertension, etc. One of the most important new treatment options is the percutaneous treatment for aortic valve stenosis (transcatheter aortic valve implantation), since aortic valve disease is a rather common problem in elderly patients, with many of them at high risk for surgery. Similarly, mitral regurgitation is often associated with comorbidities which make surgery high risk. The MitraClip is a promising percutaneous alternative to surgical valve repair or replacement. Other procedures discussed in this review are the percutaneous left atrial appendage closure as a non-pharmacologic therapy to prevent strokes, and renal denervation for resistant hypertension. This review explains the basic principles of these procedures, the most important clinical evidence, and also provides additional recent clinical data on each of them.

The common wisdom at the end of the 20th century was that the United States was training too many specialists, including cardiologists.1 By 2001, however, there was increasing evidence that the supply of cardiologists was not meeting the growing demand. That year, as president-elect of the American College of Cardiology (ACC), I appointed a task force to evaluate cardiology workforce. The task force undertook a 2-year process of literature review, hypothesis generation, research design, data acquisition, and analysis. This intense effort included a Bethesda Conference at which consensus was achieved on a report that will be published in the Journal of the American College of Cardiology . Based on various types of information and data, the ACC task force concluded that the United States is facing a shortage of cardiologists. This will reduce access to specialty care of proven benefit and will undermine our nation’s vital cardiovascular research effort. The Bethesda Conference report includes 8 working group documents that recommend several short- and intermediate-term strategies to help narrow the growing demand-supply gap for cardiologists (see Table 1). Some recommendations can be implemented at a local practice or institution level. Others will require a series of complex and coordinated actions at a national level. Hopefully, the report will catalyze actions by academic medical centers, regulatory organizations, federal policymakers, professional societies, and others that influence the output of cardiovascular specialists. View this table: TABLE 1. Working Groups of the ACC Task Force on Workforce Several things continue to drive demand for cardiologists. Elsewhere, I have argued that various scientific, social, and demographic “demand catalysts” outweigh factors that might decrease demand for cardiologists during the next decade2 (see Table 2). Although the relative influence of each demand factor will change over time, one thing is certain: the cardiovascular disease burden in the United States …

Who Is Best Trained to Treat Peripheral Arterial Disease?–Reply–I

Background: Fluoroscopic radiation has been implicated in reducing the sex ratio (M:F) by potentially damaging the Y chromosome. We examined the effects of exposure to fluoroscopic radiation on gender of offspring of cardiologists across the world. Methods: An internet based survey was e-mailed worldwide to 8000 physicians who practice invasive electrophysiology and/or interventional cardiology. Survey questions included age, race, sub-specialty, hours of exposure to radiation, number of children, gender of off-spring, miscarriages and mutations and exposure to radiation prior to conception of each child. Logistic regression analyses were performed on years of exposure and gender of offspring born post radiation exposure. Results: Responses of 377 cardiologists (84% male and 16% female) were reviewed. With a total of 398 males and 402 females born to 377 cardiologists, although reduced, the overall sex ratio (0.99) was not significantly different from that observed in the general population (1.05). Univariate logistic regression analysis identified higher male births with increasing hours of radiation exposure (OR 1.034, CI 1.003-1.067 p=0.03) and increasing paternal age (OR 1.05, CI 1.01-1.08, p=0.002). Subgroup analysis of children of male cardiologists revealed higher incidence of male births with increasing age and radiation exposure and multivariate analysis only identified paternal age as predictor of higher incidence of male births (OR 1.05, CI 1.01-1.089, p=0.0027). Conclusion: Exposure to ionizing radiation leads to a decrease in the sex ratio (M/F) in younger male cardiologists, while this effect is reversed with greater number of male births in older male cardiologists.

Introduction: The feared possibility of involvement in a medical malpractice lawsuit ultimately becomes reality for many physicians in high-risk specialties including cardiology. In a survey of cardiologists and fellows, 15.9% of those from the United States and 13.5% from China stated they were influenced by the fear of malpractice litigation in at least half of all cases they managed daily. A study of 40,916 physicians covered by a large nationwide professional liability insurer from 1991 to 2005 found that the percentage of cardiologists facing a malpractice claim each year is between 7.5%-10%, above the average across all physicians. This study analyzes interventional cardiology malpractice claims by specific procedure and allegation types. Methods: Seventy-nine cardiology malpractice claims involving procedures were identified in a major nationwide legal database (over 200,000 cases) called VerdictSearch. An exemption was obtained from the Yale University Institutional Review Board. Baseline patient characteristics, reasons for lawsuit, and case outcomes were recorded. Statistical analysis included percentage distributions and Fisher’s exact test. Results: A defendant verdict was reached in 64.6% of cases; plaintiƒ verdict, 21.5% (with average payout $5,212,719.79); and settlement, 13.9%. Death was the injury in 48.1% of cases and did not influence the likelihood of a plaintiƒ verdict. Of the 53.2% of cases involving cardiac catheterization, angioplasty, or stenting, periprocedural injury was alleged in 83.3%, lack of informed consent in 7.1%, failure to perform the correct procedure in a timely manner or at all in 14.3%, and performance of an unnecessary procedure in 7.1% (Figure 1). The most common injury type was arterial (non-coronary), including injury to the catheterization site, followed by coronary artery dissection or tamponade (Figure 2). Electrophysiology procedures were the next most common category, and receiving a defendant verdict was significantly less likely for these cases than any other type. A cardiothoracic or vascular surgeon was named as a co-defendant in 25.3% of cases. In 12.6% of cases, cardiologist failure to obtain timely surgical consultation or ensure backup surgeon availability during procedure performance was alleged. Discussion: Comprehensively reviewing interventional cardiology malpractice claims can elucidate common contributory factors to adverse outcomes and practice improvement opportunities. This study ’ s results suggest, for instance, that securing appropriate cardiothoracic surgical backup prior to a catheterization, angioplasty, or stent procedure would significantly decrease the number of lawsuits. Diligence in the informed consent process should also be prioritized, as this area generated allegations in 7.1% of cases. Though VerdictSearch is a large, nationwide legal database, its content is limited to those attorneys, courts, and states who choose to report cases. However, any selection biases may be bidirectional and ultimately cancel each other out, since the attorney on the prevailing side of every case theoretically has equal incentive to report it to a public database so the verdict can be used as a marketing tool for that attorney. By uniquely stratifying cardiology malpractice claims within a large nationwide database by specific procedure types and allegations, this study points to factors that commonly contribute to adverse patient outcomes and enables cardiologists to reflect upon opportunities for clinical practice improvement.

Mind and body interventions aim to harness the "relaxation response", reduce stress, and improve quality of life, which is important in the search for more holistic treatment approaches in cardiovascular medicine. This article describes the pertinent pathophysiological correlates building the mechanistic backbone for these interventions. They can be found in the complex connections of brain and heart (central and autonomic nervous system, hypothalamic-pituitary-adrenal axis), which play an important role in the development of various cardiovascular disease conditions and hold potential as therapeutic targets. The evidence regarding the effect of mind and body interventions in cardiology with a focus on arrhythmia and psychocardiology is reviewed systematically. To date, mostly small pilot studies prone to substantial bias and without adequate power have dominated the field and longer-term outcome data are lacking. Ultimately, integration of mind and body interventions could empower patients by strengthening their individual responsibility and mental power in addition to the benefits of stress reduction and improvement of quality of life. Whether this will translate into relevant longer-term clinical outcomes remains uncertain. Therefore, this field offers multifaceted opportunities for further research and practical applications.

Objective: To describe bibliometric study of scholarly literature published inPakistan Heart Journal covering period from 2005 to 2018 and to explorepublication trends. Methodology: This quantitative study applied bibliometric methods to analyzeoriginal articles, authorship pattern, citations, contributions from differentregions and other relevant parameters of Pakistan Heart Journal covering periodfrom January 2005 to December 2018. The data was collected fromPostgraduate Medical Institute (PGMI) Library Hayatabad Peshawar and officialwebsite of PHJ. Results: The study reveals that number of articles published in issues of thejournal per year ranged from 09 to 57. Cardiology is main subject area covered inthe articles with stable Ischemic heart disease as leading topic (15.46%)followed by Preventive cardiology (14.40%), Interventional cardiology, Heartfailure and Acute Coronary Syndrome. Articles with three authors were more innumbers (23.30%). Journal (95.53%) proved to be the more cited source ofinformation. Variation was found in the number of references cited in each article(40.05%) (153) articles had 11-20 references. Article's length was analyzed andit was revealed that a majority (30.22%) of articles comprised of five pages. Inregards to productivity, more authors belonged to Khyber Pakhtunkhwaregion(40.96%). Number of articles submitted by foreign authors has shown asteady increase reflecting international acceptance and recognition. Conclusion: Pakistan Heart Journal is more than fifty years old journal withgradual increase in number of articles in the last seven years. This is specialtyorientatedjournal about heart diseases, larger number of articles were onischemic heart disease followed by preventive cardiology, interventionalcardiology and heart failure. Key Words: Scientometrics, Bibliometrics, Original articles, Pakistan HeartJournal-Bibliometrics