Publications

Objectives This study sought to quantify contractile reserve of chronic dysfunctional myocardium, in particular in segments with intermediate transmural extent of infarction (TEI), using low-dose dobutamine cardiac magnetic resonance (CMR) in patients with a chronic total coronary occlusion (CTO). Background Recovery of dysfunctional segments with intermediate TEI after percutaneous coronary intervention is variable and difficult to predict, and may be related to contractility of the unenhanced rim. Methods Fifty-one patients (mean age 60 ± 9 years, 76% male) with a CTO underwent CMR at baseline and 35 patients underwent CMR at follow-up to quantify segmental wall thickening (SWT) at rest during 5 and 10 μg/kg/min dobutamine, and at follow-up. Delayed-enhancement CMR was performed to quantify TEI. Dysfunctional segments were stratified according to TEI, end-diastolic wall thickness (EDWT), or unenhanced rim thickness, and SWT was quantified. Segments with an intermediate TEI (25% to 75%) were further stratified according to baseline SWT of the unenhanced rim (SWTUR) (<45% and >45%), and SWT was quantified. For each parameter, odds ratio (OR) and diagnostic performance for the prediction of contractile reserve were calculated. Results Significant contractile reserve was present in dysfunctional segments with EDWT >6 mm, unenhanced rim thickness >3 mm, or TEI of <25%; only TEI had significant relation with contractile reserve (OR: 0.98; 95% confidence interval [CI]: 0.96 to 0.99; p = 0.02). In segments with intermediate TEI (n = 58), mean SWT did not improve significantly. However, segments with SWTUR <45% showed contractile reserve and improved at follow-up, whereas segments with SWTUR >45% were unchanged. SWTUR had a significant relation with contractile reserve (OR: 0.98; 95% CI: 0.97 to 0.99; p = 0.02). Conclusions CMR quantification of transmurality of infarcted myocardium allows the assessment of the potential of dysfunctional segments to improve in function during dobutamine of most segments. However, in segments with intermediate TEI, measurement of baseline contractility of the epicardial rim better identifies which segments maintain contractile reserve.

The first-in-man ABSORB Cohort A trial demonstrated the bioresorption of the ABSORB BVS (Abbott Vascular, Santa Clara, CA, USA) at two years. This report describes the 4-year clinical outcomes.The ABSORB Cohort A trial enrolled 30 patients with a single de novo native coronary artery lesion. Clinical follow-up was available in 29 patients since one patient withdrew consent after the six month follow-up. At four years, the hierarchical ID-MACE of 3.4% remained unchanged. Clopidogrel therapy had been discontinued in all patients.Four-year clinical results demonstrate a sustained low MACE rate (3.4%) without any late complications such as stent thrombosis.

Abstract Extended reality (XR) is an emerging technology currently finding its way into various medical fields. This systematic review aimed to compile a comprehensive overview of the current data on XR in cardiovascular medicine. To identify the currently available evidence of the applications of XR in cardiology, we searched PubMed and Web of Science until 31 July 2024 using predefined keywords. After screening, a total of 164 studies were included. Overall, the publications were characterized by very heterogeneous study designs. From the published data, it can already be deduced that XR can support every area of cardiology, from education (n = 31) and training (n = 36) to peri-procedural care (n = 78) and rehabilitation (n = 16). Extended reality offers a wide range of applications, and the aim of using these technologies is to optimize the clinical practice. However, these technologies are still in development, and randomized controlled trials are urgently needed to identify their benefits and limitations.

Compared with percutaneous interventions in native coronary arteries, revascularization of saphenous vein graft (SVG) lesions is associated with increased rates of immediate and long‐term major adverse cardiac events (MACE). The Symbiot II trial was a multicenter prospective study designed to evaluate the feasibility and safety of a novel self‐expanding polytetrafluoroethylene (ePTFE)‐covered stent in the treatment of de novo and restenotic SVG lesions. The primary endpoint was MACE through 30 days postprocedure. Successful Symbiot stent deployment was achieved in 75 of 77 patients (97.4%) with SVG lesions ≤ 35 mm in length (visual assessment). The procedural success rate (defined as < 30% residual stenosis at the target site and no clinical complications) was 83%, and all study device procedures provided grade 3 TIMI flow postprocedure. Within the first 30 days postprocedure, four patients (5.2%) experienced MACE (defined as death, Q‐wave or non‐Q‐wave myocardial infarction, and clinically driven target vessel revascularization), of whom three patients (3.9%) experienced periprocedural non‐Q‐wave myocardial infarction. No subacute stent thrombosis was observed over the 6‐month follow‐up period. No relevant luminal loss at the target site (mean, 0.3 ± 0.9 mm) was observed in the 58 patients (77.3% of enrolled patients) who underwent quantitative coronary angiography at 6 months. The incidences of binary in‐stent restenosis, in‐segment restenosis, and target vessel failure (defined as acute and late‐term MACE through 6 months postprocedure) were low (7.0%, 8.6%, and 14.3%, respectively). The Symbiot self‐expanding ePTFE membrane‐covered stent was associated with a high procedural success rate (97.4%), low incidences of MACE at 30 days (5.2%) and 6 months (14.3%), suggesting that it is safe and effective in the treatment of SVG disease. Catheter Cardiovasc Interv 2005;64:361–368. © 2005 Wiley‐Liss, Inc.

Ostial atherosclerotic lesions are distinct from other lesion sites in terms of outcomes following percutaneous interventions. Despite aggressive lesion modification strategies, long-term outcome is hampered by restenosis. Various stent designs have failed to show significant improvement in target lesion revascularization (TLR) rates. The present study evaluates the clinical outcomes following sirolimus-eluting stent implantation for ostial lesions.The sirolimus-eluting stent (SES) was the device of choice at our institute for all coronary interventions from April 2002 to March 2003. This study population is comprised of 50 patients who received drug-eluting stents for atherosclerotic ostial lesions during this period. Sixty-eight percent of the patients were male and 24 patients (48%) had a history of previous revascularization. Indication for intervention were as follows: acute myocardial infarction, 7 patients (14%), stable angina, 23 patients (46%), unstable angina, 20 patients (40%). Angioplasty and stent implantations were done according to the standard protocol. All patients were prospectively followed up for major adverse cardiac events. The event-free survival was 90% at one year. There were 5 (10%) target vessel revascularization, 3 (6%) myocardial infarctions and 1 (2%) death during a mean follow-up of 414.5 +/- 54.5 days. TLR was required in 4 (8%) patients.SES implantation is feasible in ostial locations and is associated with low subsequent revascularization.

Background Coronary microvascular dysfunction (CMD) is a common complication of ST‐segment–elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events. Whether CMD after STEMI is associated with functional left ventricular remodeling (FLVR) and diastolic dysfunction, has not been investigated. Methods and Results This is a nonrandomized, observational, prospective study of patients with STEMI with multivessel disease. Coronary flow reserve and index of microcirculatory resistance of the culprit vessel were measured at 3 months post‐STEMI. CMD was defined as index of microcirculatory resistance ≥25 or coronary flow reserve <2.0 with a normal fractional flow reserve. We examined the association between CMD, LV diastolic dysfunction, FLVR, and major adverse cardiac events at 12‐month follow‐up. A total of 210 patients were enrolled; 59.5% were men, with a median age of 65 (interquartile range, 58–76) years. At 3‐month follow‐up, 57 patients (27.14%) exhibited CMD. After 12 months, when compared with patients without CMD, patients with CMD had poorer LV systolic function recovery (−10.00% versus 8.00%; P <0.001), higher prevalence of grade 2 LV diastolic dysfunction (73.08% versus 1.32%; P <0.001), higher prevalence of group 3 or 4 FLVR (11.32% versus 7.28% and 22.64% versus 1.99%, respectively; P <0.001), and higher incidence of major adverse cardiac events (50.9% versus 9.8%; P <0.001). Index of microcirculatory resistance was independently associated with LV diastolic dysfunction and adverse FLVR. Conclusions CMD is present in ≈1 of 4 patients with STEMI during follow‐up. Patients with CMD have a higher prevalence of LV diastolic dysfunction, adverse FLVR, and major adverse cardiac events at 12 months compared with those without CMD. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT05406297.

As the global population ages, elderly patients will form an increasing proportion of those undergoing percutaneous coronary intervention (PCI). We investigated the safety and efficacy of bare metal stents (BMS) and DES in all patients undergoing PCI at our institution, stratified by age.We investigated three sequential groups of consecutive patients treated exclusively with BMS (n=2,194; January 2000 to April 2002), sirolimus-eluting stents (SES, n=834; April 2002 to February 2003) and paclitaxel-eluting stents (PES, n=2,841; February 2003 to December 2005). The primary endpoint was all-cause mortality. Secondary endpoints included target vessel revascularisation (TVR) and composite major adverse cardiac events (MACE, defined as all-cause death, any nonfatal myocardial infarction or TVR). Patients were followed up for a median of 1,366 days. Patients were stratified into equal quintiles based on age (<51.8, 51.8-58.4, 58.4-65.4, 65.4-73.0 and >73.0 years). All-cause mortality was significantly higher in the eldest two groups, while TVR rates were similar across all age groups. DES were associated with reductions in TVR and MACE and a trend towards reduced mortality in all age groups.DES are safe and effective when compared to BMS, irrespective of age.