Cardiac Lesions Research Articles

Interventional real-time molecular MRI for targeting early myocardial injury in a pig model

Myocardial ischemia induces tissue injury with subsequent inflammation and recruitment of immune cells. Besides myocardial tissue characterization, magnetic resonance imaging (MRI) allows for functional assessment using molecular imaging contrast agents. Here, we assessed ischemic cardiac lesions non-invasively directly after ischemia/reperfusion (I/R) in a porcine model by advanced MRI techniques and molecular imaging, targeting the cell adhesion molecule P-selectin functionalized with microparticles of iron oxide (MPIO). We used a closed-chest model of I/R by temporary coronary balloon-occlusion, real time 3T MRI-guided coronary injection of MPIO-based contrast agents, as well as injury, edema and iron-sensitive MRI. Within the first hours after I/R, we found T1 mapping to be most sensitive for tissue injury, with no changes in edema-sensitive MRI. Intriguingly, P-selectin MPIO contrast agent selectively enhanced the ischemic area in iron-sensitive MRI. In conclusion, this approach allows for sensitive detection of early myocardial inflammation beyond traditional edema-sensitive imaging.

Effect of Sequential, Colocalized Radiofrequency and Pulsed Field Ablation on Cardiac Lesion Size and Histology.

Sequential application of radiofrequency with pulsed field (PF) ablation may increase lesion depth while preserving the advantages of PF. The study's aim was to determine lesion dimensions of sequential, colocalized radiofrequency and PF ablation. A preclinical study using swine (n=4) performed lesions in the right/left ventricles. Ablations were performed with a force-sensing 3.5-mm irrigated-tip ablation catheter using a generator delivering both radiofrequency and PF. PF was delivered using unipolar, biphasic pulses at a standard dose (PF index, 300) with 4-mL/min irrigation. Radiofrequency was delivered at 50 W for 10 s (15 mL/min). Lesions were created by applying colocalized radiofrequency followed by sequential application of PF on the same location, PF followed by sequential application of radiofrequency on the same location, PF alone, or radiofrequency alone. Tissue was collected after 2 hours for lesion assessment. Results are mean±SD. Forty-five lesions were analyzed. The lesion depth of radiofrequency alone was 4.9±0.8 mm. The mean lesion depth and width for PF alone were 3.5±0.6 and 5.1±1.8 mm. Lesion depths for combined applications were significantly greater versus PF alone (6.2±1.8 mm radiofrequency followed by sequential application of PF on the same location; 5.7±1.3 mm PF followed by sequential application of radiofrequency on the same location; P<0.0001 for both). Lesion widths were also significantly greater with combined therapy versus PF alone (8.6±1.8 mm radiofrequency followed by sequential application of PF on the same location; 8.9±2.1 mm PF followed by sequential application of radiofrequency on the same location; P<0.0001 for both). Histology for both combined lesions showed central thermal necrosis surrounded by a hemorrhagic and transitional PF zone. Combined, colocalized radiofrequency and PF, irrespective of order, show significantly increased lesion size compared with the same dose of PF or radiofrequency alone.

Introducing the Concept of Hypertensive Heart Disease to Improve Hypertensive Left Ventricular Hypertrophy.

Among the organ damage mediated by hypertension, cardiac lesions hold significant importance. Numerous authors focus on hypertensive heart disease (HHD) rather than exclusively on left ventricular hypertrophy (LVH). This narrative review aims to assess the incorporation of the concept of 'hypertensive heart disease' (HHD) in hypertension (HTN) guidelines. Furthermore, if HHD is not addressed, the review will evaluate the potential benefits of including this concept in future studies. The following databases were searched: Scopus, Medline, Springer, Science Direct, Wiley, SAGE, Cambridge, Oxford Journals, and Google Scholar. Attention was given to the guidelines related to hypertension(HTN); the search items were "guidelines" and "hypertension." Within these guidelines, we specifically sought references to 'hypertensive heart disease.'. The concept of "HHD" is clearly advantageous compared to "HTN LVH," as it not only addresses LVH but also considers other structures of the heart that may be severely affected, which can significantly influence treatment. The concept of "hypertensive heart disease" is mentioned in only 8 out of 36 guidelines on HTN. The therapeutic implications and recommendations are absent in the guidelines. The concept of HHD is reasonable and evidence-based, and there is no reason to focus only on LVH when considering HTN-induced damage to the heart. It is time to update our recommendations for heart treatment by using the phrase "Treatment of hypertensive heart disease" instead of "Treatment of hypertensive LVH." This update can enhance our awareness of the need to improve not only HTN LVH but the other parts of the heart as well.

Drug-Coated Balloon-Based Treatment of Left Main True Bifurcation Lesion.

There is a paucity of data regarding drug-coated balloon (DCB) treatment in the context of left main (LM) true bifurcation lesions. The aim of this study was to evaluate the safety and efficacy of DCB-based treatment for unprotected LM true bifurcation lesions. A total of 39 patients with LM true bifurcation lesion (Medina: 1,1,1/0,1,1/1,0,1) who were successfully treated with DCB alone or in combination with drug-eluting stent (DES) were retrospectively enrolled into the DCB-based group. They were compared with 39 propensity-matched patients who were treated with second-generation DES from the COBIS III registry (n = 2648). Major adverse cardiovascular events (MACE) were defined as cardiac death, myocardial infarction, stent or target lesion thrombosis, and target lesion revascularization at the 2-year follow-up. Baseline clinical characteristics were similar between the groups, except for the prevalence of in-stent restenosis (ISR) lesions (41.0% in DCB-based group vs. 17.9% in DES-only group, p = 0.047). In the DCB-based group, 59.0% of the patients (n = 23) underwent DCB-only treatment. There were no cases of abrupt vessel closure requiring treatment following DCB application. The MACE were comparable between both groups (12.8% in DCB-based group vs. 17.9% in DES-only group, p = 0.861) after 2 years. In patients with unprotected LM true bifurcation lesions, DCB-based treatment demonstrated comparable clinical outcomes at the 2-year follow-up when compared to DES-only treatment. DCB-based treatment could be considered a safe and effective alternative to DES for carefully selected patients who have achieved satisfactory predilation results (Impact of DCB Treatment in De Novo Coronary Lesion; NCT04619277).

Surgical Repair of Double Outlet Right Ventricle Infants Guided by Three Dimensional-Computed Tomography Cardiac Modeling and Printing.

Double outlet right ventricle (DORV) is a challenging congenital cardiac lesion to surgically master. We utilize computed tomography-guided-three-dimensional (3D) modeling/printing and novel in-house software to delineate anatomical relationships providing operative insight into the surgical approach. Our intent is to highlight this and showcase our technology. We have created a repository of 3D heart reconstructions allowing for review of DORV patients. 3D intraoperative software anatomical manipulation and physical 3D prints were used to gain insight into DORV anatomy with the assistance of an on-site 3D Lab. The software used (Arc 3D Model Viewer) was designed in-house by our 3D Lab, tested and refined through ongoing use by our cardiothoracic surgery team. It allows for the subtraction and addition of anatomical structures and rotation in all axes. Clinicians can pan into the heart and determine specific anatomical boundaries and relationships. From 2010 to 2023, our program operated on 71 patients with DORV and our 3D lab has reconstructed 29 3D-hearts. Reconstructions were analyzed using Arc 3D Model Viewer. 3D reconstructions were viewed in our care conferences and intraoperatively allowing for discussion and determination of the optimal operative approach. Overall survival for DORV patients was 96% (68/71) with two mortalities in patients who did not receive 3D reconstructions. 3D reconstruction has allowed decision-making to be moved out of the operating room into the preoperative planning phase. 3D reconstruction is now standard for all DORV patients in our surgical service. We hope to demonstrate this technology with our newly developed Arc 3D Model Viewer and summarize our clinical results.

New biomarkers in scorpion stings.

Scorpion stings have a fatality rate of 0.16%, with the majority of deaths occurring in children. The resources currently available for diagnosing cardiac dysfunction caused by scorpion stings, the most common cause of death, are echocardiograms and laboratory tests, such as troponin, creatine phosphokinase-MB (CKMB), and Brain natriuretic peptide (BNP). The present study aims to evaluate the accuracy of the biomarkers soluble Supression tumorigenicity 2 (sST2) and Heart-type fatty-acid-binding protein (FABP3) in detecting cardiac dysfunction in patients stung by scorpions. This work is a prospective cross-sectional study, carried out between December 2020 and May 2022, with patients, aged 0-19 years, stung by a scorpion. Serum or plasma samples from all patients with signs of severity upon hospital admission were collected and tested with standardized cardiac damage biomarker kits. The results were compared with cardiac dysfunction detected by cardiac ultrasound. This study included 49 patients, the majority female (51%), with a median age of 3.6 years. Left ventricular dysfunction was identified in 13 patients (26.5%), with 7 cases classified as severe. The biomarkers of sST2 and FABP-3 showed an association with left ventricular dysfunction, presenting AUCs of 0.77 and 0.81, respectively. The cut-off values determined for both biomarkers showed a sensitivity of 92.3%. Ultrasensitive troponin presented an AUC of 0.89, with a sensitivity of 84.6%. The study showed an association between sST2 and FABP-3, as well as the presence of acute cardiac dysfunction, identified by cardiac ultrasound. Both biomarkers demonstrated sensitivity in identifying patients with signs of cardiac damage, similar to troponin. The results related to cardiac dysfunction may be linked to the early detection of cardiac lesions and subclinical dysfunctions, enabling faster and more effective interventions. Limitations of this study include the small sample size, data collection in a single center, and the lack of serial measurements of biomarkers.

Diagnostic Algorithm Using Multimodal Imaging for the Differential Diagnosis of Intra-Cardiac Masses.

Cardiac masses are complex clinical conditions that frequently pose diagnostic challenges in cardiology practice. These masses can form within heart chambers or near the pericardium and are generally categorized as either non-neoplastic or neoplastic. These latter are further classified into benign and malignant (primary and secondary or metastatic). Diagnosing these conditions often requires a multiparametric approach that includes both clinical features, such as the patient's and associated clinical conditions, and multimodality imaging. However, histological examination of the resected specimen is often necessary to ascertain the nature of the mass. Given their heterogeneity and the rarity of many cardiac masses, there are no guidelines or consensus on the best diagnostic approach. Modern imaging protocols must be tailored to the specific clinical issues and patient characteristics, given the rapid advancements in technology. Thus, it is imperative to use a multimodality approach, combining different imaging techniques and multidisciplinary teamwork. Hereby, we propose a practical algorithm for evaluating cardiac lesions using a step-by-step implementation of multimodal imaging. Ultimately, the goal is to tailor the most suitable imaging technique to the patient's needs.

Echocardiographic predictors of surgical outcomes in pulmonary atresia with intact ventricular septum and development of a discriminatory calculator: an Australian tertiary institution experience.

Pulmonary atresia with intact ventricular septum is a rare congenital cardiac lesion with significant anatomical heterogeneity. Surgical planning of borderline cases remains challenging and is primarily based on echocardiography. The aim was to identify echocardiographic parameters that correlate with surgical outcome and to develop a discriminatory calculator. Retrospective review of all pulmonary atresia with intact ventricular septum cases at a statewide tertiary paediatric cardiac centre was performed between 2004 and 2020. Demographic, clinical, and echocardiographic data were collected. Logistic regression was used to develop a discriminatory tool for prediction of biventricular repair. Forty patients were included. Overall mortality was 27.5% (n = 11) and confined to patients managed as univentricular (11 vs 0, p = 0.027). Patients who underwent univentricular palliation were more likely to have an associated coronary artery abnormality (17 vs 3, p = 0.001). Fifteen surviving patients (51.7%) achieved biventricular circulation while 14 (48.3%) required one-and-a-half or univentricular palliation. Nineteen patients (47.5%) underwent percutaneous pulmonary valve perforation. No patients without tricuspid regurgitation achieved biventricular repair. The combination of tricuspid valve/mitral valve annulus dimension ratio and right ventricle/left ventricle length ratio identified biventricular management with a sensitivity of 93% and specificity of 96%. An online calculator has been made available. Pulmonary atresia with intact ventricular septum is a challenging condition with significant early and interstage morbidity and mortality risk. Patient outcomes were comparable to internationally reported data. Right ventricle/left ventricle length and tricuspid valve/mitral valve annulus dimension ratios identified a biventricular pathway with a high level of sensitivity and specificity. Absent tricuspid regurgitation was associated with a univentricular outcome.

Comparison of carbon dioxide control during pressure controlled versus pressure-regulated volume controlled ventilation in children (CoCO2): protocol for a pilot digital randomised controlled trial in a quaternary paediatric intensive care unit

IntroductionDigital trials are a promising strategy to increase the evidence base for common interventions and may convey considerable efficiency benefits in trial conduct. Although paediatric intensive care units (PICUs) are...

Sex Differences in Procedural Characteristics and Clinical Outcomes Among Patients Undergoing Bifurcation PCI.

The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents. We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Calcified Amorphous Tumor and Granulomatosis with Polyangiitis—Case Report and Systematic Review of the Literature

Background: Calcified amorphous tumor (CAT) is a rare, mostly incidental tumor-like cardiac lesion of unknown histogenesis. Current imaging modalities do not differentiate between CAT and other masses. As it can be a source for embolization, surgical excision of CAT is mandatory. CAT in patients with Granulomatosis with polyangiitis (GPA) is exceedingly rare. Methods: This systematic literature review was prompted by the case of a CAT in a patient with GPA. The search of all types of studies in two databases (PubMed and Scopus) was conducted through November 2024 to identify the relevant studies. Results: Nine studies were included describing cases of patients being diagnosed with GPA and a cardiac mass. All included patients had a histopathological examination of the either biopsied or surgically resected mass. Only one case reported a CAT. In our case, the patient was diagnosed with GPA through a kidney biopsy, whereas a cardiac mass in the right atrium was diagnosed by echocardiography during evaluation for possible kidney transplantation. One year later a progression was observed, and the mass was resected. The histopathological examination revealed a CAT. The patient could be successfully discharged in a good clinical condition. Conclusions: This systematic literature search and case report highlight the importance of regular echocardiographic examination in patients with GPA. Moreover, surgical excision is crucial for the diagnosis and for further therapy planning, regardless of whether the mass is neoplastic or not.

Profile of congenital heart disease and its mode of presentation in children admitted in a tertiary care hospital: a cross-sectional study

Background: Congenital heart disease (CHD) is contributing more to the infant mortality rate these days. Therefore, we must investigate the profiles of CHD, it's presenting clinical features, and its consequences to assist pediatricians and cardiologists in taking the necessary actions as soon as possible to reduce infant mortality further. Methods: This cross-sectional study was carried out on 111 infants with CHD who were admitted to the Bankura Sammilani Medical College and Hospital's pediatric medicine department in Bankura, India. The children ranged in age from one month to five years. Following approval by the Institutional Ethics Committee and parental/guardian consent, we used a case record proforma to gather data on enrolled children over ten months. To analyze the data, EpiInfo (version 3.5.1) software was used. This study received approval from the Institutional Ethics Committee. Result: Male children contributed 53.15%, while female children contributed 46.85%. Children between the ages of one and six months made up 55.86% of the total. Among cardiac lesions, acyanotic CHD was more prevalent than cyanotic CHD (81.08% vs. 18.92%). In all cases of CHD, the most prevalent lesion type was ventricular septal defect (VSD) (43.24%). The most prevalent form of cyanotic CHD, however, was the tetralogy of Fallot's (9.9%). Most of the children with atrial septal defects presented in late infancy. Inadequate weight gain (85.59%) and malnutrition (84.68%) were the most prevalent clinical characteristics and complications of CHD. Conclusion: The most common complication of CHD in children under five is malnutrition, a risk factor for infant death. Hence, a community-based case-control study is essential to determine the precise extent of these burdens.

Multimodality Imaging Supports Cardiac Lesion Diagnosis in Patient With Liver Carcinoma: A Case Report

ABSTRACTIntroductionNonbacterial thrombotic endocarditis (NBTE) is a rare cardiac manifestation in patients with advanced malignancies of the lungs, pancreas, gynecological system, and gastrointestinal tract. It is often confirmed postmortem by histopathological evidence of sterile platelet‐fibrin deposits attached to the endocardium, most often on heart valves. To the best of our knowledge, our case is the first to report multiple heart lesions caused by the systemic effect of cholangiocarcinoma.Case PresentationWe report the case of a 53‐year‐old male who presented with a stroke; extensive imaging studies, including transthoracic echocardiography (TTE), 2D/3D transesophageal echocardiography (TEE), cardiac multi‐slice computed tomography, and cardiac magnetic resonance, found masses on the mitral valve, the aortic valve, and in the right ventricle, with the largest diameter 43 × 11 mm, which led to a diagnosis of NBTE secondary to presumed cholangiocarcinoma. Combining different echocardiography techniques, including TTE and TEE in specific clinical contexts, and training echocardiographers to improve TEE interpretation skills could be the most cost‐effective option for early diagnosis, particularly in limited‐resource settings, where advanced imaging modalities are not widely applicable.ConclusionsNBTE can manifest in patients with advanced cancer. A high index of clinical suspicion is of central importance for the diagnosis of NBTE, especially through an identification of the underlying predisposing conditions. A multi‐disciplinary approach is crucial for NBTE optimal diagnosis and treatment. As in our patient, multimodality imaging plays a complementary role in clearly defining the nature of cardiac lesions.

Beyond Prostaglandin E1: Management of Infants With Critical Congenital Heart Defects

Critical congenital heart defects (CHDs) are life-threatening cardiac lesions requiring cardiac surgery or transcatheter intervention or result in death within 28 days after birth. In infants with critical CHDs, delayed diagnosis and inappropriate management are associated with higher mortality and comorbidities. Antenatal anomaly screening and fetal echocardiography has improved the detection of fetal CHDs, which helps in perinatal management planning with multidisciplinary teams. Even with precision delivery planning, postnatal transition may affect each infant with CHDs differently depending on the variants and severity of the defect. Therefore, it is important to have a thorough understanding of the hemodynamic physiology in infants with a critical CHD during the transition from intrauterine to extrauterine life and alter management accordingly. This review summarizes the care of infants with critical CHDs in the immediate transition period with a focus on cases with distinctive physiology.

Abstract 4135333: Peripheral Perfusion Index: Normative Values From Electronically Reported Critical Congenital Heart Disease Screenin

Background: Critical Congenital Heart Disease (CCHD) screening is performed in an effort to reduce morbidity and mortality associated with CCHD by facilitating early detection. This screening consists of pulse oximetry and is most effective at identification of cyanotic cardiac lesions, with less sensitivity for left sided obstructive lesions. Research: Question Peripheral perfusion index (PPI) is obtained from the plethysmographic signal of a pulse oximeter and represents the ratio of pulsatile to non-pulsatile blood flow. As such, it is a surrogate for peripheral perfusion at the site of measurement. PPI has been postulated to be an adjunctive screening method for low perfusion states in neonates, including left sided obstructive lesions. To date, reference ranges of PPI values in neonates have not been published in the United States. This project utilized electronically reported CCHD screening results to establish normative PPI data in healthy neonates. Methods: In Minnesota, CCHD screening results are electronically sent to the Minnesota Department of Health (MDH) and are cross referenced against the Minnesota Birth Information System, which tracks infants who are identified to have a congenital birth defect within the first year of life. These data were provided by the MDH for infants born in Minnesota from Jan 2017 through Dec 2022. Infants were included in the analysis if they did not have a known critical congenital heart defect, were born between 35 and 42 weeks gestation, and were 24-48 hours of life at time of screening. Results: PPI data from 11,179 cases were included in the analysis. Overall, there is a trend towards increasing PPI with gestational age. Pre-ductal PPI trended higher than post-ductal PPI. There was no difference between PPI in males and females. Conclusions: These data reflect trends identified in international data. This is the largest dataset to date of PPI in healthy neonates and the first in the United States. Future studies will compare neonates with left sided obstructive lesions against these normative data. If PPI is found to predict left sided obstructive lesions in neonates, there may be utility in use of PPI in CCHD screening to facilitate earlier detection of these lesions.

Assessment of Cutting-Balloon Angioplasty with Novel Bioabsorbable Polymer-Coated Everolimus-Eluting Stent in Treating Calcified Coronary Lesions Guided by Intravascular Ultrasound (CUPID Trial): study design and protocol

BackgroundVarious devices and techniques have been used for plaque modification in the treatment of severe coronary artery calcification. This prospective, multicenter, randomized, open-label study aims to evaluate the safety and efficacy of cutting balloon angioplasty using a novel bioabsorbable polymer-coated everolimus-eluting coronary stent for treating various degrees of calcified coronary lesions.MethodsWe outline the trial design aimed at assessing whether the cutting balloon (Wolverine™) is non-inferior to the non-compliant balloon in treating patients with calcified lesions, encompassing both de novo and in-stent restenosis (ISR) lesions. We aim to enroll 250 patients who have undergone bioabsorbable polymer-coated everolimus-eluting coronary stent (Synergy™) implantation. The primary endpoint is the minimal stent cross-sectional area at the calcium site as determined by intravascular ultrasonography. The secondary endpoints include major adverse cardiac events and target lesion revascularization at 12 months, alongside procedural convenience and operator-centric parameters, such as the number of balloons used, procedure time, and total contrast medium volume used.DiscussionIn this study, we will evaluate the efficacy and safety of Wolverine™ and non-compliant balloon in patients with calcified coronary lesions and provide a rationale for which type of balloons will optimally modify calcium lesions. In addition, we will attempt to expand the indications of the cutting balloon for treating mild-to-severe calcified coronary lesions. As the scope of insurance coverage for cutting balloons remains limited in some countries, this study may provide evidence for extending insurance coverage to the treatment of de novo calcified and ISR lesions.Trial registrationClinicalTrials.gov NCT06177808. Registered on January 1, 2024.

OSDOKINA crush technique for the management of side branch ostial lesion ISTANBOL study

Abstract Background Isolated ostial bifurcation lesions (Medina type 0.0.1) represent &amp;lt;20% of coronary bifurcation lesions. Percutaneous coronary intervention (PCI) of this subset of lesions is challenging for the interventional cardiologist because of the technical difficulty and potential risk of serious complications. Purposes Recently, we devised a new technique, called the OSDOKINA crush technique, for the treatment of Medina type 0.0.1 coronary bifurcation lesions. The aim of this study was to evaluate the technical feasibility, safety and short-term and midterm procedural and clinical results achieved with OSDOKINA crush technique for Medina type 0.0.1 coronary bifurcation lesions. Materials and Methods Between September 2020 and January 2024, we included 49 patients who had Medina type 0,0,1 coronary bifurcation lesions. The vessel size had to be ≥2.5 mm by visual estimation on coronary angiography. Demographic, clinical and lesion characteristics of the cases were recorded. Quantitative coronary angiography analyses were performed using dedicated bifurcation angiographic software. Procedural success was defined as successful implantation of the stent into the target lesion, causing a final residual stenosis ≤30%. Major adverse cardiac events(MACE) were defined as cardiac death, myocard infarction and target lesion revascularisation. All patients were followed up to twelve months after the intervention. Results The lesion localisations were the ostium of diagonal branch in 19 (38.7%), ostium of the obtuse marginalis branch in 17 (34.6%), ostium of right posterior descending or right posterolateral branch in 13 (26.7%). SB RVD, SB lesion length and SB diameter stenosis by QCA were 2.65±0.35 mm, 9.4±3.9 mm, and 79.8±12.6, respectively. SB predilatation was applied in all cases. In 1 patient (2.1%), a stent had to be placed in the main branch using the double-kissing mini crush technique due to flow-limiting dissection that developed after the second kissing balloon inflation. Considering all cases, the angiographic success rate was 97.9% (n: 48). All patients had 12-month follow-up results. Acute myocardial infarction occurred in 1 patient (2.1%) due to side branch stent thrombosis. No patient had main branch revascularization. Cardiac or non-cardiac death was not observed. Cumulative MACE was 2.1%(n:1). Conclusion The OSDOKINA crush technique has excellent acute results and midterm clinical outcomes in the management of Medina type 0.0.1 coronary bifurcation lesions. Multicenter studies with large patient groups are needed.

Drug-coated balloon versus drug-eluting stent revascularization in the treatment of de novo acute myocardial infarction

Abstract Objective To assess the efficacy and safety of a drug-coated balloon (DCB) revascularization on percutaneous coronary intervention (PCI) in patients with de novo acute myocardial infarction (AMI). Background Data on DCB-only treatment in the context of AMI are limited. Methods A total of 96 patients with de novo AMI successfully treated with DCB alone were retrospectively enrolled. Visual residual stenosis ≤ 30% without flow-limiting dissection was considered a satisfactory pre-balloon angioplasty and followed by DCB treatment. We compared it with 96 propensity-matched patients treated with second-generation drug-eluting stent (DES) from the PTRG-DES registry (n = 13,160 patients). Major adverse cardiovascular events (MACE) comprised cardiac death, myocardial infarction, stroke, stent or target lesion thrombosis, target vessel revascularization, and major bleeding (Bleeding Academic Research Consortium bleeding type 3 or greater) at 1 year. Results Baseline clinical characteristics were comparable between the groups. The mean device diameter was larger in DES group (2.7 ± 0.3 mm vs. 3.1 ± 0.4 mm, P &amp;lt; 0.001). No abrupt vessel closure requiring treatment occurred after treatment with DCB. The MACE was comparable in both groups (6.2% in DCB group vs. 7.3% in DES group, P = 0.790) at 1-year follow-up. Conclusions In de novo AMI patients, DCB-only treatment approach had comparable clinical outcomes at 1-year follow-up. DCB-only treatment may be a safe and effective alternative to DES in carefully selected patients who had satisfactory pre-dilation results.

Comparison of Outcome After Percutaneous Coronary Intervention for De Novo and In-Stent Restenosis Indications

In-stent restenosis (ISR) still occur after percutaneous coronary intervention (PCI). Few studies have compared outcomes after PCI for de novo stenosis and ISR and the results are conflicting. The aim of the present study is to compare outcomes after PCI for ISR and de novo coronary stenosis. Using patient level data from the randomized all-comer SORT OUT studies III-X, we included all patients with previous PCI and either an ISR or a de novo lesion as the study target lesion. Outcomes of interest were major adverse cardiac events (MACE) and target lesion revascularization (TLR) after 5 years. Of the 2928 patients with a previous PCI included in the SORT OUT studies, 491 (17%) were treated for ISR and 2437 (83%) for a de novo stenosis. Baseline characteristics did not differ significantly. At 5 years, MACE occurred in 148 patients (32%) in the ISR group and in 654 patients (28%) in the de novo stenosis group (Crude and adjusted HR 1.16 (0.97-1.38) and 1.16 (0.97-1.38)). The risk of TLR was higher in the ISR group when compared to the de novo stenosis group (Crude and adjusted HR 1.64 (95% CI, 1.24-2.17) and 1.71 (95% CI, 1.27-2.30)). In conclusion, the risk of MACE was similar after PCI of ISR and de novo lesions after 5 years. However, the risk of TLR was higher in the ISR group compared to the de novo stenosis group.

In vivo assessment of catheter-tissue contact using tissue proximity indication and its impact on cardiac lesion formation in pulsed field ablation

BackgroundNo evidence exists regarding whether tissue proximity indication (TPI), an impedance-based contact indicator, can improve in vivo lesion formation and durability during pulsed field ablation (PFA). ObjectiveThis in vivo study investigated the relationship between catheter-tissue contact and lesion formation. MethodsIn 5 porcine subjects, PFA applications were delivered at 35 atrial target sites using the VARIPULSE variable-loop circular catheter with the CARTO 3 mapping system. We compared acute ablative low-voltage zones (LVZs; <0.5 mV), chronic LVZs, and pathologic lesions between no/minimum contact (TPI-negative/flickering TPI-positive status) and consistent tissue contact (consistent TPI-positive status) for typical clinical scenarios and tissue tenting (TPI-positive status with electrodes extensively away from the 3-dimensional mapping surface) for safety margin. Ultrasound imaging also confirmed contact category assessments. ResultsAcute and chronic LVZs were significantly larger with consistent contact compared with no/minimum contact, including pathologic lesion length (36.0 ± 12.5 mm vs 17.4 ± 15.2 mm; P = .002) and maximum width (10.3 ± 2.7 mm vs 5.7 ± 5.1 mm; P = .035); results with tenting (length: 34.6 ± 11.7 mm; width: 11.3 ± 1.9 mm) were comparable to consistent contact. Lesion transmurality was achieved in all lesions with consistent contact or tissue tenting but only in 54.5% with no/minimum contact (P = .001 for each). The TPI-based electrode contact distance, measured as the cumulative length of the multielectrode catheter tip positive for TPI, significantly correlated with lesion length, maximum width, and transmurality. ConclusionConsistent TPI-based contact during PFA was strongly associated with distinct chronic transmural lesions, emphasizing the importance of tissue contact in optimizing circumferential lesion formation with circular PFA catheters.