Publications

Background Long-term outcomes of ST-segment-elevation myocardial infarction in patients with diabetes have been barely investigated. The objective of this analysis from the EXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION trial) trial was to compare 10-year outcomes of patients with ST-segment-elevation myocardial infarction with and without diabetes. Methods and Results Of the study population, 258 patients had diabetes and 1240 did not. The primary end point was patient-oriented composite end point of all-cause death, any myocardial infarction, or any revascularization. Secondary end points were the individual components of the primary combined end point, cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis. All end points were adjusted for potential confounders. At 10 years, patients with diabetes showed a higher incidence of patient-oriented composite end point compared with those without (46.5% versus 33.0%; adjusted hazard ratio [HR], 1.31 [95% CI, 1.05-1.61]; P=0.016) mainly driven by a higher incidence of any revascularization (24.4% versus 16.6%; adjusted HR, 1.61 [95% CI, 1.19-2.17]; P=0.002). Specifically, patients with diabetes had a higher incidence of any revascularization during the first 5 years of follow-up (20.2% versus 12.8%; adjusted HR, 1.57 [95% CI, 1.13-2.19]; P=0.007) compared with those without diabetes. No statistically significant differences were found with respect to the other end points. Conclusions Patients with ST-segment-elevation myocardial infarction who had diabetes had worse clinical outcome at 10 years compared with those without diabetes, mainly driven by a higher incidence of any revascularizations in the first 5 years. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04462315.

No abstract is provided for this article.

Background: By measuring eNO at multiple flows and applying mathematical models of eNO exchange dynamics, the signal can be partitioned into its proximal airway [Jno (nl/sec)] and distal airway/alveolar contributions [CA(NO) (ppb)]. This method is time consuming, requires at least 3 exhalations and is affected by a number of limitations such as axial diffusion and turbulent flow. We eveloped a more practical method based on the production of NO (Vno) at two exhalation flow rates. Methods: In a group of 27 normal subjects (38±2 yr; 20 male), 13 steroid naive asthmatic patients (34±3 yr; 6 male, FEV1 70±4% predicted), 14 patients with chronic obstructive pulmonary disease (COPD) (65±2 yr; 10 male, FEV1 58±3%), and 12 patients with cystic fibrosis (21±4 yr; 8 male, FEV1 60±3%) we compared CA(NO) and Jno with the variation of total NO production at 50 and 200 ml/s [Vno50-200 (nl/s)]. Vno was measured by calculating the average area under the curve (NO concentration/time) of two successive exhalations at each flow rate. Results: Vno50-200 was strongly correlated with Jnoin normal subjects (r=0.94, p Conclusions: The flow dependent component of exhaled NO, which is affected by its bronchial production, can be estimated by measuring Vno50-200. This method is simple, does not require sophisticated equipment or equations and is in agreement with Jno calculated mathematically.

No abstract is provided for this article.

Recently, the plaque characterization field was explored with the use of the substrate (frequency domain analysis) rather than the envelope (amplitude or gray-scale imaging) of the intravascular ultrasound (IVUS) radiofrequency data. However, there is no data about the agreement of quantitative outcome between the two methods. The aim of this study was to assess the correlation and agreement between quantitative coronary ultrasound and the geometrical measurements provided by the spectral analysis of ultrasound radiofrequency data [IVUS-Virtual Histology (IVUS-VH), Volcano Therapeutics). Twenty-five patients were included in this study. The IVUS catheter used was a commercially available mechanical sector scanner (Ultracross 2.9 Fr 30 MHz catheter, Boston Scientific) covered with an outer sheath. IVUS-VH significantly underestimated lumen [relative difference (RD) = 14.8 ± 5.6; P < 0.001], vessel (RD = 14.1 ± 4.8; P < 0.001), and plaque (RD = 11.5 ± 10.8; P < 0.001) cross-sectional areas (CSAs). Nevertheless, when adjusted for the ultrasound propagation delay caused by the sheath, relative differences of measurements were remarkably low (0.49% ± 6.3%, P = 0.64 for lumen; 2.33% ± 4.6%, P = 0.007 for vessel; and 4.2% ± 10.4%, P = 0.005 for plaque CSA). These data suggest that the volumetric output of the IVUS-VH software underestimates measurements when acquired with a 30 MHz catheter. However, after applying a mathematical adjustment method for the ultrasound propagation delay caused by the outer sheath of the 30 MHz catheter, relative differences of direct measurements were negligible. These results suggest that ultrasound radiofrequency data analysis could provide, aside from precise compositional data, an accurate geometrical output. © 2005 Wiley-Liss, Inc.

From April 16, 2002 to October 16, 2002, 10 consecutive patients with coronary disease on chronic dialysis were treated with sirolimus-eluting stents. Diabetes was present in 30% and half of the patients had multivessel coronary disease. On average, patients had been on dialysis for 5 years prior to the procedure (range: 2-15 years). Five patients were on hemodialysis and 5 patients were on peritoneal dialysis. Overall, 18 lesions were treated with 1.9 +/- 1.1 sirolimus-eluting stents per patient. At a mean follow-up of 403 days, there were no cases of death, myocardial infarction, or target lesion revascularization.

No abstract is provided for this article.

Objectives In this retrospective study, we examined the incidence of post-procedural conduction abnormalities and the need for pacing in patients undergoing percutaneous implantation of the aortic valve. Background Safety and feasibility studies have suggested anecdotally the occurrence of conduction abnormalities and requirements for pacing after percutaneous implantation of the aortic valve. Methods We examined the standard 12-lead electrocardiograms (ECGs) of 40 consecutive patients in whom a CoreValve Revalving System (CoreValve, Paris, France) was implanted between November 2005 and March 2008. We examined the 12-lead ECG before treatment, after treatment, and at 1-month follow-up. We documented the requirements for temporary or permanent pacemaking. Results The mean age of patients was 82 ± 7 years. Post-procedural mortality at 72 h was 0%. There was a significant increase in the frequency of left bundle branch block (LBBB) after percutaneous aortic valve replacement (15% before treatment vs. 55% after treatment, p = 0.001). Although the incidence of LBBB had decreased after follow-up of 1 month, it did not reach statistical significance, with the proportion decreasing from 55% to 48% (p = 0.63). The only 2 patients with pre-treatment right bundle branch block became dependent on temporary pacing immediately after valve implantation and subsequently needed permanent pacing. A temporary and permanent pacemaker was required in 20% and 18% of patients, respectively. Conclusions In this study, there was a significant increase in the frequency of LBBB after percutaneous insertion of the aortic valvar prosthesis. Patients with pre-existing right bundle branch block may be at risk for the development of complete heart block and subsequent need for pacing.

Near-infrared spectroscopy (NIRS) is able to quantify cholesterol within coronary arteries by the lipid core burden index (LCBI). We studied the prognostic value of NIRS-derived LCBI in patients with coronary artery disease (CAD) for adverse cardiac outcome during long-term follow-up. During 2009–2013, NIRS was performed in a non-culprit artery of 275 patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina. LCBI was quantified by an independent corelab for the region of interest (LCBIROI) and the 4 and 10 mm long segment with the maximum LCBI (MaxLCBI4mm and MaxLCBI10mm). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, non-fatal ACS, or unplanned revascularization. Hazard ratios (HR) were adjusted for age, gender, clinical risk factors, and segment plaque burden based on intravascular ultrasound. During a median follow-up of 4.1 years, 79 patients (28.7%) had MACE. There was a statistically significant and independent continuous relationship between higher MaxLCBI4mm values and a higher risk of MACE. Each 100 units increase of MaxLCBI4mm was associated with a 19% increase in MACE [hazard ratios (HR) 1.19, 95% confidence intervals (95% CI): 1.07–1.32, P = 0.001]. Continuous MaxLCBI4mm remained independently associated with MACE after exclusion of target lesion-related events (HR 1.21, 95% CI: 1.08–1.35), as well as after exclusion of adverse events related to the NIRS-imaged coronary segment (HR 1.19, 95% CI: 1.06–1.34). Results for MaxLCBI10mm were comparable. NIRS-derived LCBI is associated with adverse cardiac outcome in CAD patients during long-term follow-up independent of clinical risk factors and plaque burden.

Abstract To clarify how low BMI and weight loss were associated with risk of chronic obstructive pulmonary disease (COPD) mortality, in a large prospective cohort of the general population across Japan, the Japan Collaborative Cohort Study, conducted between 1988 and 2009. A total of 45,837 male residents were observed for a median period of 19.1 years. Self-administered questionnaires, collecting information on BMI, weight loss since the age of 20, lifestyles, history of diseases, as well as records of COPD mortality, were analysed at 2019. During follow-up, 268 participants died from COPD. The multivariate-adjusted hazard ratio (95% confidence interval) of COPD mortality associated with a 1-SD increment of body mass index (BMI) was 0.48 (0.41–0.57), while for weight change from age of 20 (+ 2.0 kg) it was 0.63 (0.59–0.68). These associations were persistently observed after stratifications with smoking status, excluding those having airway symptoms in the baseline survey, and excluding early COPD deaths within 5, 10 and 15 years. Our study suggests that BMI and weight change since the age of 20 could be markers for COPD prognosis, indicated by risk of COPD mortality.

No abstract is provided for this article.

In this study the influence of plaque composition on mechanism of immediate lumen enlargement after PTCA were assessed by serial ultrasound imaging in 77 patients. According to the preprocedural ultrasonic plaque characteristics, the lesions were classified as soft (54.5%), diffusely calcified (14.3%), and mixed (31.2%). The total arc of calcium and plaque eccentricity were also calculated. The mean balloon/artery ratio was equal for all types of lesions (1.07 ± 0.19), but diffusely calcified lesions required a higher maximal balloon inflation pressure (11.3 ± 3.75 atm vs 9.0 ± 3.15 atm for calcified and soft lesions, respectively, p < 0.05). The increase in lumen area after PTCA was similar in soft and mixed lesions (3.49 ± 1.61 mm2 vs 3.56 ± 1.58 mm2, NS) and was slightly lower in diffusely calcified lesions (2.97 ± 1.33 mm2, NS). Reduction in plaque area was the main operative mechanism in lesions with soft plaque, explaining 77.9% of the acute lumen gain. Expansion of the total vessel area was the predominant mechanism of lumen area increase in lesions with calcified and mixed plaques (99.1% vs 74.2%, respectively, NS). In particular, lesions with a total arc of calcium >90 degrees showed a high prevalence of vessel expansion as a mechanism of lumen enlargement compared with lesions with a calcium arc <90° (79.3% vs 23.8%, respectively, p < 0.05). In the studied group, presence of calcification was highly associated with wall fracture and dissection after balloon dilatation (93.4% vs 6.6% in lesions with and without calcifications, respectively, p < 0.05). A trend toward a greater degree of plaque reduction in concentric lesions in comparison to eccentric lesions was observed (58.3% vs 48.5%, respectively, NS). In conclusion, immediate lumen enlargement after PTCA does not differ for soft and mixed plaques. Diffusely calcific plaques show a smaller lumen enlargement despite a higher balloon inflation pressure. Plaque compression or axial redistribution is the main operative mechanism of PTCA in soft plaques, whereas an increase in total vessel area determines the lumen enlargement in mixed/calcific plaques. Plaque fracture or wall dissection is almost invariably associated with presence of plaque calcification.

This month's highlights from the subspecialty journals cover a range of topics in cardiology.Sex differences in atrial fibrillation ablation are analyzed in Circulation: Arrhythmia and Electrophysiology.The usefulness of evaluating transaortic flow rate on dobutamine stress tests for low-flow, low-gradient aortic stenosis is presented in Circulation: Cardiovascular Imaging.Pretreatment with P2Y12 inhibitors before percutaneous coronary intervention for stable chronic coronary syndrome is evaluated in Circulation: Cardiovascular Interventions.Methods of adjudication for revascularization events are compared in Circulation: Cardiovascular Quality and Outcomes.Temporal trends in heart transplant waitlist characteristics and posttransplant outcomes over a nearly 30-year period are reported in Circulation: Heart Failure.