Publications

Percutaneous Versus Surgical Treatment for Patients With Hypertrophic Obstructive Cardiomyopathy and Enlarged Anterior Mitral Valve Leaflets

Background— The purpose of this study was to compare percutaneous transluminal septal myocardial ablation (PTSMA) and septal myectomy combined with mitral leaflet extension (MLE) in symptomatic hypertrophic obstructive cardiomyopathy patients with an enlarged anterior mitral valve leaflet (AMVL). Both PTSMA and myectomy reduce septal thickness and left ventricular outflow tract (LVOT) gradient; however, an uncorrected enlarged AMVL may predispose to residual systolic anterior motion (SAM) after successful standard myectomy or PTSMA. Myectomy with MLE previously demonstrated superior hemodynamic results compared with standard myectomy, but its value relative to PTSMA is unknown. Methods and Results— Twenty-nine patients (aged 44±12 years) underwent myectomy with MLE, and 43 patients (aged 52±17 years) underwent PTSMA. Mitral leaflet area was similar in both groups (16.7±3.4 versus 15.9±2.7 cm 2 , respectively). After PTSMA, 2 patients died, 4 needed a reintervention, and 4 required a permanent pacemaker for complete heart block. After surgery, only 1 patient needed a reintervention. At 1-year follow-up, LVOT gradients did not differ between surgical and PTSMA patients (17±14 versus 23±19 mm Hg, respectively). Preinterventional mitral regurgitation grade was more severe in the surgical group, but with myectomy combined with MLE, the residual grade was similar to that of PTSMA. Mean SAM grade decreased significantly more after surgery (from 2.9±0.3 to 0.5±0.7 mm Hg versus from 2.8±0.5 to 1.3±0.9 mm Hg, P <0.05). Conclusions— PTSMA in these selected patients with hypertrophic obstructive cardiomyopathy had more periprocedural complications and resulted in more reinterventions. Hemodynamic results (SAM grade and reduction in mitral regurgitation) were better in surgical patients.

Influence of Prior Treatment Upon the Efficacy of As-Needed Budesonide/Formoterol in Mild Asthma in the SYGMA 1 and 2 Studies

Budesonide facilitates weaning from mechanical ventilation in difficult-to-wean very severe COPD patients: Association with inflammatory mediators and cells

Reliability analysis of structural stainless steel design provisions

Preventative therapy in adults with asthma

Comparison of lung vascular and epithelial permeability indices in the adult respiratory distress syndrome.

Measurements of pulmonary clearance of inhaled 99mTc-DTPA and transvascular 113mIntransferrin flux were made in 12 patients with established ARDS and 14 volunteer control subjects (7 smokers and 7 nonsmokers). Smokers had significantly increased 99mTc-DTPA clearance (clearance rate constant, 3.6 +/- 0.8; mean +/- SEM) compared with nonsmokers (1.2 +/- 0.1). All patients with ARDS had increased clearance of 99mTc-DTPA (5.2 +/- 0.9), but the finding was nonspecific in that increased clearance overlapped with the findings in normal smokers. Protein flux in smokers (protein flux units, 0.0 +/- 0.2) was similar to that in nonsmokers (0.3 +/- 0.2). In 9 of the 12 patients with ARDS, protein flux was increased, and as a group (3.2 +/- 1.0) they differed significantly (p less than 0.01) from the combined smoking and nonsmoking control subjects (0.2 +/- 0.1, n = 14). The parameters of DTPA clearance and transvascular protein flux correlated well in the patients with ARDS (Spearman's rank correlation = 0.71, p less than 0.01). Although 99mTc-DTPA clearance is a sensitive technique in ARDS, a single study in this context does not allow a diagnostic conclusion because of its non-specificity. Abnormal protein flux appears to be more specific for ARDS but was not a universal finding in the patients studied.

Acute Pancreatitis

No abstract is provided for this article.

A Histological “Fly-Through” of a Diseased Coronary Artery

No abstract is provided for this article.

Effects of phosphoinositide-3-kinase inhibitors on steroid-insensitive airway inflammation in poly(I:C) and allergen challenged mice

Viral infections induce exacerbations in asthmatic patients with increased airway inflammation that is corticosteroid-insensitive. The aim of this study was to evaluate the effects of phosphoinositide-3-kinase (PI3K) inhibitors on airway inflammation in induced by the viral mimic poly(I:C) in combination with ovalbumin in sensitized mice. A/J male mice were sensitized and challenged by OVA. Then poly(I:C) was given intranasally for 3 days, and AS604850 (AS; PI3Kγ inhibitor), IC87114 (IC; PI3Kδ inhibitor) and/or fluticasone propionate (FP, a corticosteroid) were administered intranasally 2h before each poly(I:C) exposure. Bronchoalveolar lavage fluid (BALF) was collected at 24h after the last poly(I:C) exposure. Macrophages, neutrophils and eosinophils in BALF were quantified by FACS analysis. The levels of CXCL1 and TNF-α in BALF were determined using a ELISA kit. Poly(I:C) exposure caused a significant increase in BALF macrophages, neutrophils, eosinophils, CXCL1 and TNF-α, which was not inhibited by FP (0.05 mg/ml). Neither AS (4.0 mg/ml) nor IC (4.0 mg/ml) alone inhibited airway inflammation, while the combination of IC and FP demonstrated greater inhibition on the inflammation in poly(I:C) and OVA-exposed mice. In contrast, the combination of AS and FP did not show anti-inflammatory activity. These data suggest that PI3Kδ inhibitor combined with a corticosteroid offers potential treatment for corticosteroid insensitive airway inflammation during viral infections.

Early development of bioresorbable scaffold

In September 1986, I had the privilege to implant the first endoluminal prosthesis (wall stent), as we called the stent at that time, in our first patient in Rotterdam just a few months after the pioneering cases of Jacques Puel in Toulouse and Ulrich Sigwart in Lausanne. In 1986, there was not yet an official Ethics Committee established at the Thoraxcenter, and it was only with the blessing of the chairman of cardiology and the permission of Paul Hugenholtz and with the support of the chief of surgery Egbert Bos that I was allowed to implant the first stent. Following the implantation, I performed an angioscopy, as it was available in Europe at that time. I was shocked by the vision of the shiny metal embedded in this delicate structure that is a human coronary artery. I felt guilty to have introduced in that very delicate biological structure such a rough device as a self-expanding stent. Honestly, I left the cath-lab with a tremendous feeling of guiltiness, having the impression that I had carried out something irreversible that would leave this human coronary artery caged forever. As ominously predicted by our chief surgeon… by the third case, I experienced my first stent thrombosis despite extensive platelet antiaggregation and anticoagulation with aspirin, heparin, warfarin, persantine and reomacrodex. On the same, day I started to reflect on the fact whether it could be possible to scaffold a vessel without using a permanent metallic implant to keep the vessel largely patent.

Syntax II and Syntax III trials: what is the take home message for surgeons? Lessons learned from the 2 year results of Syntax II

No abstract is provided for this article.

Muscarinic receptor subtypes in human and guinea pig lung

Far from the turmoil, a summer with EuroIntervention

No abstract is provided for this article.

Bioresorption and Vessel Wall Integration of a Fully Bioresorbable Polymeric Everolimus-Eluting Scaffold

Objectives The aim of the present study was to investigate the relationship between the integration process and luminal enlargement with the support of light intensity (LI) analysis on optical coherence tomography (OCT), echogenicity analysis on intravascular ultrasound, and histology up to 4 years in a porcine model. Background In pre-clinical and clinical studies, late luminal enlargement has been demonstrated at long-term follow-up after everolimus-eluting poly-l-lactic acid coronary scaffold implantation. However, the time relationship and the mechanistic association with the integration process are still unclear. Methods Seventy-three nonatherosclerotic swine that received 112 Absorb scaffolds were evaluated in vivo by OCT, intravascular ultrasound, and post-mortem histomorphometry at 3, 6, 12, 18, 24, 30, 36, 42, and 48 months. Results The normalized LI, which is the signal densitometry on OCT of a polymeric strut core normalized by the vicinal neointima, was able to differentiate the degree of connective tissue infiltration inside the strut cores. Luminal enlargement was a biphasic process at 6 to 18 months and at 30 to 42 months. The latter phase occurred with vessel wall thinning and coincided with the advance integration process demonstrated by the steep change in normalized LI (0.26 [interquartile range (IQR): 0.20 to 0.32] at 30 months versus 0.68 [IQR: 0.58 to 0.83] at 42 months, p < 0.001). Conclusions In this pre-clinical model, late luminal enlargement relates to strut integration into the arterial wall. Quantitative LI analysis on OCT could be used as a surrogate method for monitoring the integration process of poly-l-lactic acid scaffolds, which could provide insight and understanding on the imaging-related characteristics of the bioresorption process of polylactide scaffolds in human.

Plates

Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug‐Eluting Stents in Older Adults

Objectives Little data are available to compare coronary artery bypass graft surgery ( CABG ) vs percutaneous coronary intervention ( PCI ) with drug‐eluting stents ( DES ) in older adults. We evaluate the long‐term outcomes of CABG vs PCI with DES in older adults with left main or multivessel coronary artery disease ( CAD ). Design Individual patient‐level meta‐analysis. Settings Databases from the BEST , PRECOMBAT , and SYNTAX trials were combined. Participants A total 1,079 adults aged 70 to 89 years were pooled. Measurements The primary outcome was a composite of death from any causes, myocardial infarction, stroke, or repeat revascularization. Results During a total of 6.3 (median, 4.9) years of follow‐up, the primary composite outcome of all‐cause mortality, myocardial infarction, stroke, or repeat revascularization occurred in 26% (141/550) and 34% (179/529) of patients in the CABG and PCI groups, respectively (hazard ratio ( HR ), 0.75; 95% confidence interval ( CI ), 0.60–0.94; P = .012). CABG was associated with fewer myocardial infarction (4% vs 8% for PCI ; HR , 0.48; 95% CI , 0.29–0.80; P = .037); and repeat revascularizations (8% vs 17% for PCI ; HR , 044; 95% CI , 0.31–0.64; P &lt; .001), but had little association with all‐cause mortality or stroke. Conclusion Older adults age 70 to 89 years with left main or multivessel CAD who participated in the BEST , PRECOMBAT , and SYNTAX trials; compared to PCI , CABG was associated with lower risk of primary outcome which was mostly driven by lower risk of myocardial infarction.

Adding formoterol to budesonide in moderate asthma—health economic results from the FACET study

Treatment Recommendation Based on SYNTAX score 2020 Derived from Coronary Computed Tomography Angiography and Invasive Coronary Angiography

Purpose The diagnostic performance of the SYNTAX score 2020 (SS-2020) when calculated using CCTA remains unknown. This study aimed to compare treatment recommendations based on the SS-2020 derived from coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA). Methods This interim analysis included 57 of the planned 114 patients with de-novo three-vessel disease, with or without left main coronary artery disease, enrolled in the ongoing FASTTRACK CABG trial. The anatomical SYNTAX scores derived from ICA or CCTA were evaluated by two separate teams of blinded core-lab analysts. Treatment recommendations were based on a maximal individual absolute risk difference in all-cause mortality between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) of 4.5% ([predicted PCI mortality] – [predicted CABG mortality]). The level of agreement was evaluated with Bland-Altman plots and Cohen’s Kappa. Results The mean age was 66.2±9.2 years and 89.5% of patients were male. Mean anatomical SYNTAX scores derived from ICA and CCTA were 35.1±11.5 and 35.6±11.4 (p=0.751), respectively. The Bland-Altman analysis showed mean differences of -0.26 and -0.93, with standard deviation of 3.69 and 5.23, for 5- and 10-year all-cause mortality, respectively. The concordance in recommended treatment for 5- and 10-year mortalities were 84.2% (48/57 patients) and 80.7% (46/57 patients), with Cohen’s κ coefficients of 0.672 and 0.551. Conclusion There was moderate to substantial agreement between treatment recommendations based on the SS-2020 derived using CCTA and ICA, suggesting that CCTA could be used as an alternative to ICA when making decisions regarding the modality of revascularization.