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1.
EuroIntervention ; 20(9): 561-570, 2024 May 10.
Article in English | MEDLINE | ID: mdl-38726719

ABSTRACT

BACKGROUND: Vessel-level physiological data derived from pressure wire measurements are one of the important determinant factors in the optimal revascularisation strategy for patients with multivessel disease (MVD). However, these may result in complications and a prolonged procedure time. AIMS: The feasibility of using the quantitative flow ratio (QFR), an angiography-derived fractional flow reserve (FFR), in Heart Team discussions to determine the optimal revascularisation strategy for patients with MVD was investigated. METHODS: Two Heart Teams were randomly assigned either QFR- or FFR-based data of the included patients. They then discussed the optimal revascularisation mode (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) for each patient and made treatment recommendations. The primary endpoint of the trial was the level of agreement between the treatment recommendations of both teams as assessed using Cohen's kappa. RESULTS: The trial included 248 patients with MVD from 10 study sites. Cohen's kappa in the recommended revascularisation modes between the QFR and FFR approaches was 0.73 [95% confidence interval {CI} : 0.62-0.83]. As for the revascularisation planning, agreements in the target vessels for PCI and CABG were substantial for both revascularisation modes (Cohen's kappa=0.72 [95% CI: 0.66-0.78] and 0.72 [95% CI: 0.66-0.78], respectively). The team assigned to the QFR approach provided consistent recommended revascularisation modes even after being made aware of the FFR data (Cohen's kappa=0.95 [95% CI:0.90-1.00]). CONCLUSIONS: QFR provided feasible physiological data in Heart Team discussions to determine the optimal revascularisation strategy for MVD. The QFR and FFR approaches agreed substantially in terms of treatment recommendations.


Subject(s)
Coronary Angiography , Coronary Artery Disease , Fractional Flow Reserve, Myocardial , Percutaneous Coronary Intervention , Humans , Fractional Flow Reserve, Myocardial/physiology , Female , Male , Coronary Artery Disease/physiopathology , Coronary Artery Disease/therapy , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Middle Aged , Percutaneous Coronary Intervention/methods , Aged , Coronary Artery Bypass/methods , Clinical Decision-Making , Cardiac Catheterization/methods , Patient Care Team
3.
Vasc Med ; 29(2): 182-188, 2024 04.
Article in English | MEDLINE | ID: mdl-38457137

ABSTRACT

BACKGROUND: Although the 1-year clinical outcomes of fluoropolymer-based drug-eluting stents (FP-DES) were favorable for the treatment of real-world femoropopliteal lesions in symptomatic peripheral artery disease (PAD), their performance beyond 1 year remained unknown. The current study determined the 3-year clinical course of FP-DES implantation for real-world femoropopliteal lesions. METHODS: This multicenter, prospective, observational study evaluated 1204 limbs (chronic limb-threatening ischemia, 34.8%; mean lesion length, 18.6 ± 9.9 cm, chronic total occlusion: 53.2%) of 1097 patients with PAD (age, 75 ± 9 years; diabetes mellitus, 60.8%) undergoing FP-DES implantation for femoropopliteal lesions. The primary outcome measure was 3-year restenosis. The secondary outcome measures included 3-year occlusive restenosis, stent thrombosis, target lesion revascularization (TLR), and aneurysmal degeneration. RESULTS: The 3-year cumulative occurrence of restenosis was 27.3%, whereas that of occlusive restenosis, stent thrombosis, and TLR was 16.1%, 7.3%, and 19.6%, respectively. The annual occurrence of restenosis decreased by 12.0%, 9.5%, and 5.8% in the first, second, and third year, respectively (p < 0.001). Similarly, the rates of occlusive restenosis and stent thrombosis decreased (p < 0.001 and p = 0.007, respectively), whereas the rate of TLR remained unchanged for 3 years (p = 0.15). The incidence of aneurysmal degeneration at 3 years (15.7%) did not significantly differ from that at 1 and 2 years (p = 0.69 and 0.20, respectively). CONCLUSIONS: This study highlights the favorable long-term clinical course of FP-DES in real-world practice, emphasizing the importance of monitoring for occlusive restenosis and stent thrombosis while considering the potential onset of aneurysmal degeneration.


Subject(s)
Drug-Eluting Stents , Peripheral Arterial Disease , Thrombosis , Humans , Aged , Aged, 80 and over , Femoral Artery/diagnostic imaging , Popliteal Artery/diagnostic imaging , Fluorocarbon Polymers , Treatment Outcome , Prospective Studies , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/therapy , Disease Progression , Vascular Patency , Prosthesis Design
5.
JACC Cardiovasc Interv ; 17(5): 608-618, 2024 Mar 11.
Article in English | MEDLINE | ID: mdl-38479962

ABSTRACT

BACKGROUND: Whether intraluminal drug-coated balloon (DCB) angioplasty is superior to subintimal DCB angioplasty regarding femoropopliteal (FP) chronic total occlusion (CTO) outcomes has not been systematically determined. OBJECTIVES: The aim of this study was to compare the 1-year clinical outcomes of intraluminal and subintimal DCB angioplasty for the treatment of patients with symptomatic FP CTO. METHODS: This subanalysis of POPCORN (Prospective Multi-Center Registry of Drug-Coated Balloon for Femoropopliteal Disease) evaluated 469 lesions in 469 symptomatic patients with lower extremity artery disease who presented with FP CTO and underwent DCB treatment. Wire passage (intraluminal vs subintimal) was evaluated using intravascular ultrasound. The outcome measure, 1-year freedom from restenosis, was compared between subintimal and intraluminal DCB angioplasty groups after propensity score matching analysis. The Institutional Review Boards of participating centers approved this study. Informed consent was obtained from the participants or their families. RESULTS: During the median follow-up period of 14.2 months, restenosis occurred in 140 patients. After propensity score matching, the subintimal group had a significantly lower 1-year rate of freedom from restenosis than the intraluminal group (77.0% vs 84.2%, respectively; P = 0.024). Interaction analysis revealed a more marked increased risk for restenosis in the subintimal DCB angioplasty group in patients with severe calcification, low-dose DCB use, or smoking. CONCLUSIONS: The present study revealed that intraluminal DCB angioplasty was superior to subintimal DCB angioplasty for FP CTO treatment, with a significantly better 1-year rate of freedom from restenosis.


Subject(s)
Angioplasty, Balloon , Peripheral Arterial Disease , Humans , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Popliteal Artery/diagnostic imaging , Popliteal Artery/surgery , Prospective Studies , Treatment Outcome , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/therapy , Peripheral Arterial Disease/etiology , Angioplasty, Balloon/adverse effects , Coated Materials, Biocompatible , Vascular Patency
6.
Clin Case Rep ; 12(2): e8463, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38314190

ABSTRACT

Key Clinical Message: Left atrial posterior wall on the vertebra is often difficult to obtain stable tissue contact with ablation-catheter. Laser balloon ablation is effective because the compression from the vertebra can be visualized through endoscopy. Abstract: When performing pulmonary vein isolation (PVI) with radiofrequency, left atrial posterior wall on the vertebra is often difficult to obtain stable tissue contact with ablation-catheter because of the movement of the ablation point. Laser balloon ablation is effective for the achievement of durable PVI in cases with such anatomical characteristics because the compression from the vertebra can be visualized through endoscopy.

9.
Eur Heart J Open ; 3(5): oead104, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37908440

ABSTRACT

Aims: Doxorubicin is used in classical chemotherapy for several cancer types. Doxorubicin-induced cardiomyopathy (DOX-CM) is a critical issue among cancer patients. However, differentiating the diagnosis of DOX-CM from that of other cardiomyopathies is difficult. Therefore, in this study, we aimed to determine novel histopathological characteristics to diagnose DOX-CM. Methods and results: Twelve consecutive patients with DOX-CM who underwent cardiac histopathological examination in two medical centres were included. Twelve patients with dilated cardiomyopathy, who were matched with DOX-CM patients in terms of age, sex, and left ventricular ejection fraction, formed the control group. Another control group comprised five consecutive patients with cancer therapy-related cardiac dysfunction induced by tyrosine kinase inhibitors or vascular endothelial growth factor inhibitors were the controls. The positive area of tenascin-C, number of infiltrating macrophages, and presence of p62- and ubiquitin-positive cardiomyocytes were evaluated. Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were used for in vitro investigation. The myocardium exhibited significantly greater tenascin-C-positive area and macrophage number in the DOX-CM group than in the control groups (P < 0.01). The tenascin-C-positive area correlated with the number of both CD68- and CD163-positive cells (r = 0.748 and r = 0.656, respectively). Immunostaining for p62 was positive in 10 (83%) patients with DOX-CM. Furthermore, western blotting analysis revealed significant increase in tenascin-C levels in hiPSC-CMs upon doxorubicin treatment (P < 0.05). Conclusion: The combined histopathological assessment for tenascin-C, macrophages, and p62/ubiquitin may serve as a novel tool for the diagnosis of DOX-CM. Doxorubicin may directly affect the expression of tenascin-C in the myocardium.

12.
Eur Heart J Case Rep ; 7(5): ytad235, 2023 May.
Article in English | MEDLINE | ID: mdl-37207105

ABSTRACT

Background: Infective endocarditis (IE) lesions rarely exist only in the endocardium, except on the valves. Such lesions are usually treated with the same strategy used to treat valvular IE. Depending on the causative organisms and degree of intracardiac structure destruction, it might be cured with conservative treatment consisting of antibiotics alone. Case summary: A 38-year-old woman had a continuous high fever. Echocardiography revealed a vegetation located on the endocardial side of the posterior wall of the left atrium, from the valve ring on the side of the posteromedial scallop, which was exposed to a mitral regurgitation jet. Mural endocarditis caused by methicillin-sensitive Staphylococcus aureus (MSSA) was diagnosed based on blood cultures. Splenic infarction developed despite various types of appropriate antibiotics. The vegetations increased in size over time to >10 mm. The patient underwent surgical resection and had an uneventful post-operative course. There was no evidence of exacerbation or recurrence during the post-operative outpatient follow-up visits. Discussion: Even in cases of isolated mural endocarditis, infections caused by MSSA that are resistant to multiple antibiotics can be challenging to manage with antibiotics alone. Specifically, for cases of MSSA IE that show resistance to various antibiotics, early consideration should be given to surgical intervention as part of the treatment process.

15.
Intern Med ; 62(14): 2085-2088, 2023 Jul 15.
Article in English | MEDLINE | ID: mdl-36418104

ABSTRACT

Peripartum cardiomyopathy (PPCM) is a left ventricular systolic dysfunction associated with heart failure (HF) in late-term pregnancy or peripartum. A 29-year-old pregnant woman with no history of cardiac disease noted lower extremity edema around 34 weeks' gestation with significant weight gain. She delivered twins via caesarean section, and the edema regressed postpartum. On postpartum day 4, however, she experienced difficulty breathing at night and was diagnosed with HF owing to PPCM. HF treatment along with cabergoline was initiated. With low prolactin blood levels, her symptoms and cardiac function improved over time. This case demonstrated the usefulness of anti-prolactin therapy with cabergoline in PPCM.


Subject(s)
Cardiomyopathies , Heart Failure , Pregnancy Complications, Cardiovascular , Puerperal Disorders , Pregnancy , Female , Humans , Adult , Cabergoline/therapeutic use , Cesarean Section , Peripartum Period , Cardiomyopathies/diagnosis , Heart Failure/drug therapy , Heart Failure/etiology , Puerperal Disorders/diagnosis , Puerperal Disorders/drug therapy , Pregnancy Complications, Cardiovascular/drug therapy , Pregnancy Complications, Cardiovascular/diagnosis
16.
Circ J ; 87(5): 619-628, 2023 04 25.
Article in English | MEDLINE | ID: mdl-36418112

ABSTRACT

BACKGROUND: The vessel healing process after implantation of biodegradable polymer (BP) and durable polymer (DP) everolimus-eluting stent (EES) in ST-elevation myocardial infarction (STEMI) lesions remains unclear.Methods and Results: We conducted a multicenter prospective randomized controlled trial to compare early (2 weeks) and mid-term (12 months) vascular responses after implantation of BP-EES vs. DP-EES in STEMI patients. In this prespecified subanalysis, serial coronary angioscopy (CAS) analysis was performed in 15 stents in the BP-EES arm (n=10 patients) and 14 stents in the DP-EES arm (n=10 patients). At the 2-week follow-up, there was no significant difference in the estimated marginal means of the neointimal coverage grade (primary endpoint) between the 2 arms (mean [±SE] 0.00±0.00 in both arms; P>0.999). There were no significant differences between the BP-EES and DP-EES groups in the yellow color grade (1.046±0.106 vs. 0.844±0.114, respectively; P=0.201) or the presence of thrombus (77.8% vs. 88.8%, respectively; P=0.205). At 12 months, competent strut coverage, defined as yellow color grade ≤1, no thrombus, and a neointimal coverage grade ≥1 was achieved more frequently in the BP-EES than DP-EES arm (85.2% vs. 53.1%; adjusted odds ratio 2.11 [95% confidence interval 1.26-3.53]; P=0.023). CONCLUSIONS: Neointimal coverage 2 weeks after implantation of BP-EES and DP-EES in STEMI lesions was comparable on CAS evaluation. However, at 1 year, BP-EES was independently associated with competent strut coverage.


Subject(s)
Coronary Artery Disease , Drug-Eluting Stents , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Everolimus , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , Sirolimus , Coronary Artery Disease/therapy , Polymers , Angioscopy , Prospective Studies , Treatment Outcome , Absorbable Implants
17.
Cardiovasc Interv Ther ; 38(1): 75-85, 2023 Jan.
Article in English | MEDLINE | ID: mdl-35896895

ABSTRACT

The early and mid-term arterial healing profile of biodegradable polymer-coated everolimus-eluting stents (BP-EES) is unclear, especially in ST-segment elevation myocardial infarction (STEMI) culprit lesions. This study aimed to compare early- and mid-term arterial healing between durable polymer-coated everolimus-eluting stents (DP-EES) and BP-EES in STEMI patients. In a prospective, multicenter, non-inferiority trial, STEMI patients were randomized to receive BP-EES (n = 60) or DP-EES (n = 60). The primary endpoint of this study was the mean percentage of covered struts (%covered struts) on FD-OCT 2 weeks post-PCI. Key secondary endpoints included the percentage of uncovered struts, frequency of abnormal intra-stent tissue, and percentage of malapposed struts by FD-OCT 2 weeks and 12 months post-PCI. They underwent serial frequency-domain optical coherence tomography (FD-OCT) evaluations immediately after percutaneous coronary intervention, and at 2 weeks and at 12 months after the procedure. The primary endpoint of %covered struts at 2 weeks was 71.4% in BP-EES and 72.3% in DP-EES [risk difference - 0.94%, lower limit of one-sided 95% confidence interval (CI) - 5.6; Pnon-inferiority = 0.0756]. At 12 months, the mean percentage of uncovered struts was significantly lower [1.73% (95% CI 0.28-3.17) vs. 4.81% (95% CI 3.52-6.09); p = 0.002], and the average malapposed volume was significantly smaller in the BP-EES group than in the DP-EES group (p = 0.002). At 12 months, BP-EES had a significantly larger average neointimal area with a significantly smaller average intra-stent tissue unevenness score than DP-EES, suggesting more uniform neointimal coverage with BP-EES. Strut coverage was comparable between BP-EES and DP-EES at 2 weeks. Non-inferiority could not be proven because of an insufficient sample size. The significantly better arterial healing with BP-EES at 12 months suggests a safer profile for STEMI culprit lesions.Trial registration: jRCTs022180024 https://jrct.niph.go.jp/en-latest-detail/jRCTs022180024.


Subject(s)
Drug-Eluting Stents , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Everolimus/pharmacology , Everolimus/therapeutic use , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/surgery , Polymers , Percutaneous Coronary Intervention/adverse effects , Prospective Studies , Treatment Outcome , Absorbable Implants , Stents
18.
Heart Vessels ; 38(6): 876-877, 2023 Jun.
Article in English | MEDLINE | ID: mdl-36048203
20.
Clin Case Rep ; 10(11): e6504, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36415707

ABSTRACT

Symptomatic cardiac involvement of malignant lymphoma is rare. Silent invasion of malignant lymphoma makes it difficult to diagnose it in the early phase of clinical course. We describe a case with cardiac involvement of diffuse large B-cell lymphoma presenting various types of arrythmias that were not diagnosed until autopsy.

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