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We sought to determine the level of agreement and the reproducibility of trans-thoracic echocardiography (TTE), contrast aortography (CA) and multislice computed tomography (MSCT) for the assessment of the aortic annulus, in patients referred for Transcatheter Aortic Valve Implantation (TAVI).Correct measurement of the aortic annulus is important for TAVI.The dimensions of the aortic annulus were measured using TTE, CA and MSCT in 70 patients with severe aortic stenosis, referred for TAVI. Agreement between imaging techniques and interobserver variability was assessed using the Bland - Altman method and a linear regression model.The MSCT Coronal view provided the largest mean annulus diameter (26.3 mm) followed by CA (24.4 mm), MSCT Mean (23.7 mm), TTE (22.6 mm), and MSCT Sagittal (21.8 mm) view. Differences in the annulus measurements were significant: MSCT Coronal view versus CA (mean, 95% confidence interval, Pearson's correlation) 2.0 mm, -1.9 to 6.0 mm, r = 0.72, CA versus MSCT Mean 0.2 mm, -3.3 to 3.7 mm, r = 0.76, MSCT Mean versus TTE 1.3 mm, -2.9 to 5.5 mm, r = 0.61, TTE versus MSCT Sagittal view 0.9 mm, -3.6 to 5.4 mm, r = 0.59, CA versus TTE 1.5 mm, -3.0 to 5.9 mm, r = 0.57. Interobserver variability was: TTE (mean, 95% confidence interval, Pearson's correlation) 0.29 mm, -4.2 to 4.8 mm, r = 0.57, CA 0.14 mm, -3.5 to 3.8 mm, r = 0.77, MSCT Mean 0.20 mm, -1.4 to 1.8 mm, r = 0.95.We found significant differences in the dimensions of the aortic annulus measured by MSCT, CA, and TTE. Interobserver variability for TTE and CA was substantially higher compared with MSCT.

To study recovery of segmental wall thickening (SWT), ejection fraction (EF), and end-systolic volume (ESV) after acute myocardial infarction (AMI) in patients who underwent primary stenting with drug-eluting stents. Additionally, to evaluate the predictive value of magnetic resonance imaging (MRI)-based myocardial perfusion and delayed enhancement (DE) imaging.Twenty-two patients underwent cine-MRI, first-pass perfusion, and DE imaging 5 days after successful placement of a drug-eluting stent in the infarct-related coronary artery. Regional myocardial perfusion and the transmural extent of DE were evaluated. A per patient perfusion score was calculated and consisted of a summation of all segmental scores. Myocardial infarct size was quantified by measuring the volume of DE. At 5 months after AMI, cine-MRI was performed and SWT, EF, and ESV were quantified. EF increased from 48+/-11 to 55+/-9% (P<0.01). SWT at 5 months was inversely related to baseline segmental DE scores (P<0.001) and segmental perfusion scores (P<0.001). EF and ESV at 5 months were related to acute infarct size (R(2)=0.65; P<0.001 and R(2)=0.78; P<0.001, respectively) and the calculated perfusion score (R(2)=0.23; P=0.02 and R(2)=0.14; P=0.09, respectively) at baseline.Marked recovery of left ventricular function was observed in patients receiving a drug-eluting stent for AMI. DE imaging appears to be a better prognosticator than perfusion imaging.

Coronary artery disease is often diffuse and patients with non-ST-segment acute coronary syndromes (NSTE-ACS) demonstrate multivessel coronary disease. The purpose of this study was to clarify whether interventions on stable chronic non-culprit lesions in patients with NSTE-ACS can prevent future adverse events.We performed a retrospective cohort study of 990 consecutive patients who underwent either single-vessel PCI (SVPCI: n=379) or multivessel PCI (MVPCI: n=611) in a setting of NSTE-ACS. Cox proportional hazards regression analysis was performed to compensate for differences in baseline characteristics between the groups. To minimise the impact of confounding factors, we performed propensity matching (SVPCI: n=230, MVPCI: n=230). Patients who had MVPCI had a lower rate of prior interventional treatment or myocardial infarction, and more complex lesions than patients with SVPCI. At three years, all-cause mortality was significantly lower in the MVPCI group than the SVPCI group (13.0% vs. 18.3%, p=0.02, adjusted HR 0.55, 95% CI: 0.38-0.80), while the rates of target vessel revascularisation and a composite of all-cause death or myocardial infarction were not different between the groups. In the propensity-matched cohort, all-cause death remained significantly lower in the MVPCI group (adjusted HR 0.41, 95% CI: 0.22-0.75) compared to the SVPCI group.In this retrospective study, multivessel PCI reduced all-cause mortality in a setting of NSTE-ACS compared to single-vessel PCI. Further investigations to confirm these results are warranted.

AimsWe evaluated the distribution and composition of atherosclerotic plaques at bifurcations with intravascular ultrasound-virtual histology (IVUS-VH) and multidetector computed tomography (MDCT) in relation to the bifurcation angle (BA).

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Introduction: Theoretical advantages of fully bioresorbable scaffold (BRS) stem from transient vessel support without rigid caging. Therefore, it could reduce long-term adverse events associated with the presence of foreign materials.Areas covered: This article will provide an overview of: drug-eluting BRS for various applications in the treatment of vascular disease; The mechanisms of active agent release from such scaffolds; currently available drug-eluting BRS and their future applications are also discussed.Expert opinion: The current BRS have been developed in order to achieve optimal vascular patency while providing long-term safety. The clinical efficacy and safety of BRS in coronary treatment have been reported as equal to that of the current metallic drug eluting stents in simple lesions. The application of BRS can potentially be expanded to other vascular beds. The research in bioengineering for the appropriate materials should not only focus on biocompatibility but also should be tailored according to the sites of implantation, which may require different strength and supporting period. The ultimate goal in this field is to develop a biocompatible device that provides equivalent and complementary therapy to other devices, and is able to disappear when the mechanical support and drug delivery are no longer required.