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Belmonte M, Paolisso P, Bertolone DT, Viscusi MM, Gallinoro E, de Oliveira EK, Shumkova M, Beles M, Esposito G, Addeo L, Botti G, Moya A, Leone A, Wyffels E, De Bruyne B, van Camp G, Bartunek J, Barbato E, Penicka M, Vanderheyden M. Combined Cardiac Damage Staging by Echocardiography and Cardiac Catheterization in Patients With Clinically Significant Aortic Stenosis. Can J Cardiol 2024; 40:643-654. [PMID: 37979721 DOI: 10.1016/j.cjca.2023.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Cardiac damage (CD) staging enhances risk stratification in patients with clinically significant aortic stenosis (AS). We aimed to assess the prognostic value and reclassification rate of right heart catheterization (RHC) compared with transthoracic echocardiography (TTE) in characterising CD staging at 3-year follow-up in patients with clinically significant AS, to identify patients that would benefit from RHC for prognostic stratification, and to test the prognostic value of combined CD staging. METHODS An observational cohort study of 432 AS patients undergoing TTE and RHC were divided into moderate or asymptomatic severe (m/asAS) and symptomatic severe (ssAS) AS. Kaplan-Meier curves were used to compare survival. The accuracy in prognostic stratification was tested by area under the receiver operating characteristic curve analysis and Delong test. RESULTS In both cohorts, TTE- and RHC-derived staging systems had prognostic value, although the agreement between them appeared moderate. A higher proportion of patients were assigned to stage 2 by TTE than by RHC. Patients in TTE-derived stage 2 had a high reclassification rate, with 40%-50% presenting with right chamber involvement (stages 3-4) according to RHC. Discordant cases were significantly older, with higher prevalence of atrial fibrillation, markedly elevated N-terminal pro-B-type natriuretic peptide, and higher indexed left atrial volume, E/e', and systolic pulmonary artery pressure vs concordant cases (P < 0.05). The combined CD staging, integrating TTE and RHC, was more accurate in predicting mortality than the TTE-derived system (P < 0.05). CONCLUSIONS In patients with m/asAS and ssAS, the combined CD staging, derived from TTE and RHC, was more accurate in predicting mortality than TTE alone. In a subset of AS patients, the integration of RHC may significantly improve prognostic stratification.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Elayne Kelen de Oliveira
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Lucio Addeo
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ana Moya
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Guy van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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2
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Belmonte M, Paolisso P, Gallinoro E, Bertolone DT, Caglioni S, Leone A, De Colle C, Viscusi MM, Bermpeis K, Storozhenko T, Mileva N, Sonck J, Wyffels E, Vanderheyden M, Collet C, De Bruyne B, Andreini D, Penicka M, Barbato E. Predictors of percutaneous coronary intervention derived from CCTA in patients with chronic coronary syndrome. J Cardiovasc Comput Tomogr 2024; 18:154-161. [PMID: 38238196 DOI: 10.1016/j.jcct.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/23/2023] [Accepted: 01/06/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND To identify anatomical and morphological plaque features predictors of PCI and create a multiparametric score to increase the predictive yield. Moreover, we assessed the incremental predictive value of FFRCT (Fractional Flow Reserve derived from CCTA) trans-lesion gradient (ΔFFRCT) when integrated into the score. METHODS Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with FFRCT available, referred to invasive coronary angiogram and assessment of fractional flow reserve. Plaque analysis was performed using validated semi-automated software. Logistic regression was performed to identify anatomical and morphological plaque features predictive of PCI. Optimal thresholds were defined by area under the receiver-operating characteristics curve (AUC) analysis. A scoring system was developed in a derivation cohort (70 % of the study population) and tested in a validation cohort (30 % of patients). RESULTS The overall study population included 340 patients (455 vessels), among which 238 patients (320 vessels) were included in the derivation cohort. At multivariate logistic regression analysis, absence of left main disease, diameter stenosis (DS), non-calcified plaque (NCP) volume, and percent atheroma volume (PAV) were independent predictors of PCI. Optimal thresholds were: DS ≥ 50 %, volume of NCP>113 mm3 and PAV>17 %. A weighted score (CT-PCI Score) ranging from 0 to 11 was obtained. The AUC of the score was 0.80 (95%CI 0.74-0.86). The integration of ΔFFRCT in the CT-PCI score led to a mild albeit not significant increase in the AUC (0.82, 95%CI 0.77-0.87, p = 0.328). CONCLUSIONS Plaque anatomy and morphology derived from CCTA could aid in identifying patients amenable to PCI.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Serena Caglioni
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Cona, Ferrara, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Niya Mileva
- Specialized Cardiovascular Hospital "Medica Cor", Ruse, Bulgaria; Medical University of Sofia, Sofia, Bulgaria
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniele Andreini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
| | - Emanuele Barbato
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy.
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3
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Dubois C, Adriaenssens T, Annemans L, Bosmans J, Callebaut B, Candolfi P, Cornelis K, Delbaere A, Green M, Kefer J, Lancellotti P, Rosseel M, Shore J, Van Der Heyden J, Vermeersch S, Wyffels E. Transcatheter aortic valve implantation versus surgical aortic valve replacement in severe aortic stenosis patients at low surgical mortality risk: a cost-effectiveness analysis in Belgium. Acta Cardiol 2024; 79:46-57. [PMID: 38450496 DOI: 10.1080/00015385.2023.2282283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/06/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 device has recently shown significant clinical benefits, compared to surgical aortic valve replacement (SAVR), in patients at low risk for surgical mortality (PARTNER 3 trial, NCT02675114). Currently in Belgium, TAVI use is restricted to high-risk or inoperable patients with severe symptomatic aortic stenosis (sSAS). This cost-utility analysis aimed to assess whether TAVI with SAPIEN 3 could lead to potential cost-savings compared with SAVR, in the low-risk sSAS population in Belgium. METHODS A previously published, two-stage, Markov-based cost-utility model was used. Clinical outcomes were captured using data from PARTNER 3 and the model was adapted for the Belgian context using cost data from the perspective of the Belgian National Healthcare System, indexed to 2022. A lifetime horizon was chosen. The model outputs included changes in direct healthcare costs, survival and health-related quality of life using TAVI versus SAVR. RESULTS TAVI with SAPIEN 3 provides meaningful clinical and cost benefits over SAVR, in terms of an increase in quality-adjusted life years (QALYs) of 0.94 and cost-saving of €3 013 per patient. While initial procedure costs were higher for TAVI compared with SAVR, costs related to rehabilitation, disabling stroke, treated atrial fibrillation, and rehospitalization were lower. The cost-effectiveness of TAVI over SAVR remained robust in sensitivity analyses. CONCLUSION TAVI with SAPIEN 3 may offer a meaningful alternative intervention to SAVR in Belgian low-risk patients with sSAS, showing both clinical benefits and cost savings associated with post-procedure patient management.
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Affiliation(s)
- Christophe Dubois
- Department of Cardiovascular Medicine; Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine; Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium
| | - Lieven Annemans
- Faculty of Medicine, Department of Public Health, Ghent University, Ghent, Belgium
| | | | | | | | | | | | - Michelle Green
- York Health Economics Consortium, University of York, Heslington, UK
| | - Joelle Kefer
- Cliniques Universitaires Saint-Luc, IREC, University of Louvain, Brussels, Belgium
| | - Patrizio Lancellotti
- University of Liège Hospital, Cardiology Department, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | | | - Judith Shore
- York Health Economics Consortium, University of York, Heslington, UK
| | | | | | - Eric Wyffels
- Onze-Lieve-Vrouw Ziekenhuis (OLVZ, Aalst, Belgium
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4
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Khokhar AA, Marrone A, Bermpeis K, Wyffels E, Tamargo M, Fernandez-Avilez F, Ruggiero R, Złahoda-Huzior A, Giannini F, Zelias A, Madder R, Dudek D, Beyar R. Latest Developments in Robotic Percutaneous Coronary Interventions. Interv Cardiol 2023; 18:e30. [PMID: 38213745 PMCID: PMC10782427 DOI: 10.15420/icr.2023.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/02/2023] [Indexed: 01/13/2024] Open
Abstract
Since the first robotic-assisted percutaneous coronary intervention procedure (R-PCI) was performed in 2004, there has been a steady evolution in robotic technology, combined with a growth in the number of robotic installations worldwide and operator experience. This review summarises the latest developments in R-PCI with a focus on developments in robotic technology, procedural complexity, tele-stenting and training methods, which have all contributed to the global expansion in R-PCI.
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Affiliation(s)
- Arif A Khokhar
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS TrustLondon, UK
- Digital Innovations and Robotics Hub, Clinical Research Center IntercardKrakow, Poland
| | - Andrea Marrone
- Cardiovascular Institute, Azienda Ospedaliero-Universataria di FerraraCona, Italy
| | - Konstantinos Bermpeis
- Department of Cardiology, AHEPA University General HospitalThessaloniki, Greece
- Cardiovascular Center Aalst, OLV-ClinicAalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-ClinicAalst, Belgium
| | - Maria Tamargo
- Department of Cardiology, Hospital General Universitario Gregorio MaranonMadrid, Spain
| | | | | | - Adriana Złahoda-Huzior
- Digital Innovations and Robotics Hub, Clinical Research Center IntercardKrakow, Poland
- Department of Measurement and Electronics, AGH University of Science and TechnologyKrakow, Poland
| | - Francesco Giannini
- Interventional Cardiology Unit, IRCCS Galeazzi Sant’AmbrogioMilan, Italy
| | - Aleksander Zelias
- Digital Innovations and Robotics Hub, Clinical Research Center IntercardKrakow, Poland
- Center for Invasive Cardiology, Electrotherapy and AngiologyNowy Sacz, Poland
| | - Ryan Madder
- Frederik Meijer Heart and Vascular Institute, Spectrum HealthGrand Rapids, MI, US
| | - Dariusz Dudek
- Center of Digital Medicine and Robotics, Jagiellonian University Medical CollegeKrakow, Poland
- GVM Care & Research, Maria Cecilia HospitalCotignola, Italy
| | - Rafael Beyar
- Department of Cardiology, Rambam Health Care Campus and the TechnionHaifa, Israel
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5
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Gallinoro E, Bertolone DT, Mizukami T, Paolisso P, Bermpeis K, Munhoz D, Sakai K, Seki R, Ohashi H, Esposito G, Caglioni S, Mileva N, Leone A, Candreva A, Belmonte M, Storozhenko T, Viscusi MM, Vanderheyden M, Wyffels E, Bartunek J, Sonck J, Barbato E, Collet C, De Bruyne B. Continuous vs Bolus Thermodilution to Assess Microvascular Resistance Reserve. JACC Cardiovasc Interv 2023; 16:2767-2777. [PMID: 38030361 DOI: 10.1016/j.jcin.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Coronary flow reserve (CFR) and microvascular resistance reserve (MRR) can, in principle, be derived by any method assessing coronary flow. OBJECTIVES The aim of this study was to compare CFR and MRR as derived by continuous (CFRcont and MRRcont) and bolus thermodilution (CFRbolus and MRRbolus). METHODS A total of 175 patients with chest pain and nonobstructive coronary artery disease were studied. Bolus and continuous thermodilution measurements were performed in the left anterior descending coronary artery. MRR was calculated as the ratio of CFR to fractional flow reserve and corrected for changes in systemic pressure. In 102 patients, bolus and continuous thermodilution measurements were performed in duplicate to assess test-retest reliability. RESULTS Mean CFRbolus was higher than CFRcont (3.47 ± 1.42 and 2.67 ± 0.81 [P < 0.001], mean difference 0.80, upper limit of agreement 3.92, lower limit of agreement -2.32). Mean MRRbolus was also higher than MRRcont (4.40 ± 1.99 and 3.22 ± 1.02 [P < 0.001], mean difference 1.2, upper limit of agreement 5.08, lower limit of agreement -2.71). The correlation between CFR and MRR values obtained using both methods was significant but weak (CFR, r = 0.28 [95% CI: 0.14-0.41]; MRR, r = 0.26 [95% CI: 0.16-0.39]; P < 0.001 for both). The precision of both CFR and MRR was higher when assessed using continuous thermodilution compared with bolus thermodilution (repeatability coefficients of 0.89 and 2.79 for CFRcont and CFRbolus, respectively, and 1.01 and 3.05 for MRRcont and MRRbolus, respectively). CONCLUSIONS Compared with bolus thermodilution, continuous thermodilution yields lower values of CFR and MRR accompanied by an almost 3-fold reduction of the variability in the measured results.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Division of University Cardiology, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Koshiro Sakai
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Ruiko Seki
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Alessandro Candreva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Zurich University Hospital, Zurich, Switzerland; PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | | | | | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
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6
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Collet C, Johnson NP, Mizukami T, Fearon WF, Berry C, Sonck J, Collison D, Koo BK, Meneveau N, Agarwal SK, Uretsky B, Hakeem A, Doh JH, Da Costa BR, Oldroyd KG, Leipsic JA, Morbiducci U, Taylor C, Ko B, Tonino PAL, Perera D, Shinke T, Chiastra C, Sposito AC, Leone AM, Muller O, Fournier S, Matsuo H, Adjedj J, Amabile N, Piróth Z, Alfonso F, Rivero F, Ahn JM, Toth GG, Ihdayhid A, West NEJ, Amano T, Wyffels E, Munhoz D, Belmonte M, Ohashi H, Sakai K, Gallinoro E, Barbato E, Engstrøm T, Escaned J, Ali ZA, Kern MJ, Pijls NHJ, Jüni P, De Bruyne B. Impact of Post-PCI FFR Stratified by Coronary Artery. JACC Cardiovasc Interv 2023; 16:2396-2408. [PMID: 37821185 DOI: 10.1016/j.jcin.2023.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated. OBJECTIVES This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery. METHODS We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. RESULTS Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005). CONCLUSIONS The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.
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Affiliation(s)
- Carlos Collet
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium.
| | - Nils P Johnson
- Division of Cardiology, Department of Medicine, McGovern Medical School at University of Texas Health and Memorial Hermann Hospital, Houston, Texas, USA
| | - Takuya Mizukami
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Jeroen Sonck
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Damien Collison
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France; University of Burgundy Franche-Comté, Besançon, France
| | - Shiv Kumar Agarwal
- Division of Cardiology, Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Barry Uretsky
- Division of Cardiology, Central Arkansas Veterans Health System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Abdul Hakeem
- Division of Cardiovascular Diseases and Cardiovascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Bruno R Da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Keith G Oldroyd
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Jonathon A Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Victoria, Australia
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Divaka Perera
- National Institute for Health Research Guy's and St Thomas' Biomedical Research Centre, King's College London and Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Claudio Chiastra
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Andrei C Sposito
- Department of Internal Medicine, Discipline of Cardiology, University of Campinas, Campinas, Brazil
| | - Antonio Maria Leone
- Center of Excellence in Cardiovascular Sciences, Ospedale Fatebenefratelli Isola Tiberina Gemelli Isola, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzanck Institute Saint Laurent du Var, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gabor G Toth
- Division of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Abdul Ihdayhid
- Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Curtin University, Perth, Australia
| | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Eric Wyffels
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium
| | - Daniel Munhoz
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy; Department of Internal Medicine, Discipline of Cardiology, University of Campinas, Campinas, Brazil
| | - Marta Belmonte
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Hirofumi Ohashi
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Koshiro Sakai
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Javier Escaned
- Instituto de Investigacion Sanitaria Del Hospital Clinico San Carlos, Complutense University, Madrid, Spain
| | - Ziad A Ali
- St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Morton J Kern
- University of California Irvine and Veterans Affairs Long Beach Healthcare System, Irvine, California, USA
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Peter Jüni
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, onze lieve vrouw Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
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Wyffels E, Beles M, Baeyens A, Croeckaert K, De Potter T, Van Camp G, Collet C, Sonck J, Vanderheyden M, Bartunek J, Barbato E, Bermpeis K, Bertolone DT, Gallinoro E, Esposito G, Schoonjans G, Staelens F, Van Laer E, De Bruyne B. Corrigendum to ' Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory. Value Based Healthcare-Change in Practice.' [Health Policy, Volume 132, June 2023, 104826, ISSN 0168-8510]. Health Policy 2023:104829. [PMID: 37149401 DOI: 10.1016/j.healthpol.2023.104829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Eric Wyffels
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.
| | - Monika Beles
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Ann Baeyens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | | | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Van Camp
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Schoonjans
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Frank Staelens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Els Van Laer
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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8
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Wyffels E, Beles M, Baeyens A, Croeckaert K, De Potter T, Van Camp G, Collet C, Sonck J, Vanderheyden M, Bartunek J, Barbato E, Bermpeis K, Bertolone DT, Gallinoro E, Esposito G, Schoonjans G, Staelens F, Van Laer E, De Bruyne B. Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory. Value Based Healthcare-Change in Practice. Health Policy 2023; 132:104826. [PMID: 37087953 DOI: 10.1016/j.healthpol.2023.104826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/29/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
AIMS To assess the effects on outcomes and hospital revenues (societal cost) of a by default strategy of same day discharge (SDD) in patients undergoing a cardiac catheterization procedure in a Belgian Hospital. METHODS AND RESULTS Outcome and complete financial data were obtained in all consecutive patients with a cardiac catheterization performed in 2019 (n=5237) and in 2021 (n=5377). Patient-reported experience, patient satisfaction and Net promotor score were obtained prospectively for the SDD cohort in 2021. The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44 % (p<0.001). This translates to the saving of 889 conventional hospitalizations in 2021. All-cause death and readmission rate remained unchanged (0,17% vs 0,15% (p=0,004); and 0,7% vs 1,8% (p>0,05)) in 2019 and 2021, respectively. Patients satisfaction top box score was 91% and the Net Promotor Score was 89,5. The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and translates into an important decrease in physician income. CONCLUSION Implementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.
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Affiliation(s)
- Eric Wyffels
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.
| | - Monika Beles
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Ann Baeyens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | | | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Van Camp
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Schoonjans
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Frank Staelens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Els Van Laer
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Paolisso P, Beles M, Belmonte M, Gallinoro E, De Colle C, Mileva N, Bertolone DT, Deschepper C, Spapen J, Brouwers S, Degrieck I, Casselman F, Stockman B, Van Praet F, Penicka M, Collet C, Wyffels E, Vanderheyden M, Barbato E, Bartunek J, Van Camp G. Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics. Heart 2023; 109:634-642. [PMID: 36598073 DOI: 10.1136/heartjnl-2022-321874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Heart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team. OBJECTIVE To determine the outcome benefit of HVC approach compared with standard of care (SOC) for patients with moderate and asymptomatic severe aortic stenosis (mAS and asAS). METHODS Single-centre, observational registry of patients with mAS and asAS with at least one cardiac ambulatory consultation at our Cardiovascular Centre. Based on the outpatient strategy, patients were divided into HVC group, if receiving at least one visit at HVC, and SOC group, if followed by routine cardiac consultations. RESULTS 2129 patients with mAS and asAS were divided into those followed in HVC (n=251) versus SOC group (n=1878). The mean age was 76.5±12.4 years; 919 (43.2%) had asAS. During a follow-up of 4.8±1.8 years, 822 patients (38.6%) died, 307 (14.4%) were hospitalised for heart failure and 596 (28%) underwent aortic valve replacement (AVR). After propensity score matching, the number of consultations per year, exercise stress tests, brain natriuretic peptide (BNP) determinations and CTs were higher in the HVC cohort (p<0.05 for all). A shorter time between indication of AVR and less advanced New York Heart Association class was reported in the HVC cohort (p<0.001 and p=0.032). Compared with SOC, the HVC approach was associated with reduced all-cause mortality (HR=0.63, 95% CI 0.40 to 0.98, p=0.038) and cardiovascular death (p=0.030). At multivariable analysis, the HVC remained an independent predictor of all-cause mortality (HR=0.54, 95% CI 0.34 to 0.85, p=0.007). CONCLUSIONS In patients with mAS and asAS, the HVC approach was associated with more efficient management and outcome benefit compared with SOC.
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Affiliation(s)
- Pasquale Paolisso
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Monika Beles
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Marta Belmonte
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | - Cristina De Colle
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Niya Mileva
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Dario Tino Bertolone
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | - Jerrold Spapen
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Sofie Brouwers
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Ivan Degrieck
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Bernard Stockman
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Martin Penicka
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Carlos Collet
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Eric Wyffels
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | | | - Emanuele Barbato
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Jozef Bartunek
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Guy Van Camp
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
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10
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SAKAI KOSHIRO, Collet CA, Mizukami T, Caglioni S, Bouisset F, Munhoz D, Vanderheyden M, Wyffels E, Bartunek J, Sonck J, Barbato E, De Bruyne B. VASCULAR REMODELING IN CORONARY MICROVASCULAR DYSFUNCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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11
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Gallinoro E, Bertolone DT, Fernandez-Peregrina E, Paolisso P, Bermpeis K, Esposito G, Gomez-Lopez A, Candreva A, Mileva N, Belmonte M, Mizukami T, Fournier S, Vanderheyden M, Wyffels E, Bartunek J, Sonck J, Barbato E, Collet C, De Bruyne B. Reproducibility of bolus versus continuous thermodilution for assessment of coronary microvascular function in patients with ANOCA. EUROINTERVENTION 2023:EIJ-D-22-00772. [PMID: 36809253 DOI: 10.4244/eij-d-22-00772] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND A bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged as the standard for assessing coronary microvascular dysfunction (CMD). Continuous thermodilution has recently been introduced as a tool to quantify absolute coronary flow and microvascular resistance directly. Microvascular resistance reserve (MRR) derived from continuous thermodilution has been proposed as a novel metric of microvascular function, which is independent of epicardial stenoses and myocardial mass. AIMS We aimed to assess the reproducibility of bolus and continuous thermodilution in assessing coronary microvascular function. METHODS Patients with angina and non-obstructive coronary artery disease (ANOCA) at angiography were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were obtained in duplicate in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo either bolus thermodilution first or continuous thermodilution first. RESULTS A total of 102 patients were enrolled. The mean fractional flow reserve (FFR) was 0.86±0.06. Coronary flow reserve (CFR) calculated with continuous thermodilution (CFRcont) was significantly lower than bolus thermodilution-derived CFR (CFRbolus; 2.63±0.65 vs 3.29±1.17; p<0.001). CFRcont showed a higher reproducibility than CFRbolus (variability: 12.7±10.4% continuous vs 31.26±24.85% bolus; p<0.001). MRR showed a higher reproducibility than IMR (variability 12.4±10.1% continuous vs 24.2±19.3% bolus; p<0.001). No correlation was found between MRR and IMR (r=0.1, 95% confidence interval: -0.09 to 0.29; p=0.305). CONCLUSIONS In the assessment of coronary microvascular function, continuous thermodilution demonstrated significantly less variability on repeated measurements than bolus thermodilution.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Alessandro Candreva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Zurich University Hospital, Zurich, Switzerland.,Department of Mechanical and Aerospace Engineering, PolitoBIO Med Lab, Politecnico di Torino, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | | | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
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12
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Vandeloo B, Andreini D, Brouwers S, Mizukami T, Monizzi G, Lochy S, Mileva N, Argacha JF, De Boulle M, Muyldermans P, Belmonte M, Sonck J, Gallinoro E, Munhoz D, Roosens B, Trabattoni D, Galli S, Seki R, Penicka M, Wyffels E, Mushtaq S, Nagumo S, Pardaens S, Barbato E, Bartorelli AL, De Bruyne B, Cosyns B, Collet C. Diagnostic performance of exercise stress tests for detection of epicardial and microvascular coronary artery disease: the UZ Clear study. EUROINTERVENTION 2023; 18:e1090-e1098. [PMID: 36147027 PMCID: PMC9909457 DOI: 10.4244/eij-d-22-00270] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/02/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cardiac stress tests remain the cornerstone for evaluating patients suspected of having obstructive coronary artery disease (CAD). Coronary microvascular dysfunction (CMD) can lead to abnormal non-invasive tests. AIMS We sought to assess the diagnostic performance of exercise stress tests with indexes of epicardial and microvascular resistance as reference. METHODS This was a prospective, single-arm, multicentre study of patients with an intermediate pretest probability of CAD and positive exercise stress tests who were referred for invasive angiography. Patients underwent an invasive diagnostic procedure (IDP) with measurement of fractional flow reserve (FFR) and index of microvascular resistance (IMR) in at least one coronary vessel. Obstructive CAD was defined as diameter stenosis (DS) >50% by quantitative coronary angiography (QCA). The objective was to determine the false discovery rate (FDR) of cardiac exercise stress tests with both FFR and IMR as references. RESULTS One hundred and seven patients (137 vessels) were studied. The mean age was 62.1±8.7, and 27.1% were female. The mean diameter stenosis was 37.2±27.5%, FFR was 0.84±0.10, coronary flow reserve was 2.74±2.07, and IMR 20.3±11.9. Obstructive CAD was present in 39.3%, whereas CMD was detected in 20.6%. The FDR was 60.7% and 62.6% with QCA and FFR as references (p-value=0.803). The combination of FFR and IMR as clinical reference reduced the FDR by 25% compared to QCA (45.8% vs 60.7%; p-value=0.006). CONCLUSIONS In patients with evidence of ischaemia, an invasive functional assessment accounting for the epicardial and microvascular compartments led to an improvement in the diagnostic performance of exercise tests, driven by a significant FDR reduction.
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Affiliation(s)
- Bert Vandeloo
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
| | | | - Stijn Lochy
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Medical Faculty, Medical University Sofia, Sofia, Bulgaria
| | - Jean-François Argacha
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Matthias De Boulle
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Philip Muyldermans
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Marta Belmonte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences University Federico II, Naples, Italy
- Department of Internal Medicine, Discipline of Cardiology, University of Campinas (Unicamp), Campinas, Brazil
| | - Bram Roosens
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | | | | | - Ruiko Seki
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences University Federico II, Naples, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Cosyns
- Centrum voor Hart- en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universtair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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Tino Bertolone D, Gallinoro E, Caglioni S, Paolisso P, Bermpeis K, De Colle C, Esposito G, Leone A, Belmonte M, Storozhenko T, Sonck J, Wyffels E, Collet C, Vanderheyden M, Bartunek J, De Bruyne B, Barbato E. 742 PROGNOSTIC IMPACT OF HIGH BLEEDING RISK IN PATIENTS WITH CALCIFIED CORONARY ARTERY DISEASE UNDERGOING ROTATIONAL ATHERECTOMY PCI. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Percutaneous coronary interventions (PCI) in calcified coronary artery lesions is associated with higher rate of cardiovascular adverse events and mortality.
The aim of our study was to evaluate the prognostic impact of High Bleeding Risk (HBR) condition, as defined by the Academic Research Consortium (ARC) HBR criteria, on clinical outcomes in patients with complex calcified coronary artery disease undergoing PCI after lesion preparation using Rotational Atherectomy (RA).
Methods
In this observational retrospective study, all patients with calcified coronary artery disease undergoing RA-assisted PCI between 2011 and 2021 were included. According to ARC-HBR criteria, patients were considered at HBR if at least one major criterion or two minor criteria were met. The primary endpoint was the occurrence of major adverse cardiac and cerebrovascular events (MACCE) at 4 years defined as the composite of cardiovascular death, myocardial infarction, stroke and target vessel revascularization (TVR). Secondary endpoints were cardiovascular death, bleeding events and TVR.
Results
The final population consisted of 343 patients. Median follow-up was 39 months. Among patients, 198 (57,7%) met the HBR criteria while 145 (42,7%) did not. Patients with HBR criteria were older [78.21 vs 71.68; p < 0.001], with lower GFR (ml/min/1.73m2) [53.67 vs 77.51; p < 0.001] and lower hemoglobin levels [Hb: g/dl; 11.93 vs 13.74; p < 0.001] compare with patients without HBR. The rate of MACCE was significantly higher in patients at HBR compare with patients not at HBR (HR 1.86 [1.08-3.26]; p = 0.026) mainly driven by an increased risk of cardiovascular death. No significant differences were found concerning the rates of TVR (HR 0.48 [0.21-1.04]; p = 0.057), stroke (HR=7.7 [0.98-61.09], p=0.05) and MI (HR 2.2[0.58-8.35], p=0.241) between the two groups. Bleedings were more frequent in patients at HBR (HR 12.31 [2.93-51.64]; p < 0.001) compared to patients without HBR.
Conclusion
In patients with calcified coronary artery disease PCI, despite the use of dedicated tools for optimal lesion preparation such as RA, those at HBR still present higher risk of MACCE and cardiovascular death. Conversely, rates of TVR and MI were comparable, suggesting frailty and comorbidities as primary causes of worse outcomes in patients at HBR.
Figure Legend:
Panel A: the rate of MACCE was significantly higher in patients at HBR compare with patients not at HBR (HR 1.86 [1.08-3.26]; p = 0.026),) mainly driven by an increased risk of cardiovascular death (Panel B).
Panel C: the rates of TVR were not significant different between the two groups (HR 0.48 [0.21-1.04]; p = 0.057).
Panel D: Bleedings were more frequent in patients at HBR (HR 12.31 [2.93-51.64]; p < 0.001) compared to patients without HBR.
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Affiliation(s)
- Dario Tino Bertolone
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
- Department Of Translational Medical Sciences, University Of Campania ”Luigi Vanvitelli” , Naples , Italy
| | | | - Pasquale Paolisso
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | | | - Cristina De Colle
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Giuseppe Esposito
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Attilio Leone
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Marta Belmonte
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
- Department Of Cardiology, Lausanne University Hospital , Lausanne , Switzerland
| | - Emanuele Barbato
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
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14
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Belmonte M, Paolisso P, Bertolone DT, Gallinoro E, Caglioni S, Leone A, Colle CD, Bermpeis K, Storozhenko T, Sonck J, Wyffels E, Penicka M, Collet C, De Bruyne B, Barbato E, Andreini D. 723 PREDICTORS OF PERCUTANEOUS CORONARY INTERVENTION DERIVED FROM CORONARY CT ANGIOGRAPHY IN PATIENTS WITH CHRONIC CORONARY SYNDROME. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Aims
To assess whether quantitative and qualitative plaque features derived from coronary CT angiography (CCTA) could predict subsequent coronary revascularization by percutaneous coronary intervention (PCI) in patients with suspected chronic coronary syndrome (CCS).
Methods
From April 2019 to October 2020, all consecutive patients with suspected CCS undergoing CCTA and computation of Fractional Flow Reserve derived from CCTA (FFRCT), with consequent referral to coronary angiography and invasive physiological assessment, were included. The FFRCT 3D-model was used to calculate i) FFRCT value, in distal coronary segments where invasive FFR was measured, ii) trans-lesion gradient, defined as the difference in FFRCT units across the lesion derived from CTA, iii) vessel gradient, i.e., the difference in FFRCT units along the vessel. Quantitative and qualitative plaque analysis at CCTA was performed by experienced operators as recommended by current guidelines.
Results
Overall, 108 patients (143 vessels) were included. The mean age was 65±8.6 years, and 11% were diabetics. At baseline, 87 (80%) patients had chest pain. Left ventricular ejection fraction was 59±4.6%. Sixty (55.5%) patients underwent PCI, 8 (7.5%) were treated with coronary artery bypass graft (CABG), and 40 (37%) were referred to medical therapy (MT). At CCTA, the lesions undergoing PCI were significantly longer (38.85±17mm, p<0.001), with more severe diameter stenosis (45.43±16.69, p=0.002), lower minimal lumen area (MLA) (2.30± 1.33mm, p=0.013), higher plaque volume (292.31±158.32mm3, p<0.001), greater fibrous-fatty and necrotic core volume (18.87±20.7 and 14.78±27.42, p<0.001), greater maximum calcium arc in the lesion (108.63±65.9, p<0.001) and lower calcium arc the MLA (88.5±10 p=0.037) than the others referred to CABG/MT. In the PCI group, FFRCT was significantly lower (0.69± 0.11, p<0.001), while trans-lesion and vessel gradients were higher (0.09±0.04 and 0.27±0.10 respectively, p<0.001) than the other groups. On multivariate regression model, corrected for all confounding factors, longer lesions (OR 1.11, CI 1,01-1,21, p=0.022), higher maximum calcium arc (OR 1.02, CI 1.01-1.04, p= 0.007) and lower calcium arc at the MLA (OR 0.99, CI 0.98-0.99, p=0.031) were shown to be independent predictors of referral for PCI.
Conclusion
Lesion length and calcium arc derived from CCTA predict subsequent revascularization by PCI in patients suspected of CAD.
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Affiliation(s)
| | | | | | | | | | - Attilio Leone
- Cardiovascular Center Olv Aalst , Aalst , Belgium
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Olv Aalst , Aalst , Belgium
| | - Eric Wyffels
- Cardiovascular Center Olv Aalst , Aalst , Belgium
| | | | | | | | - Emanuele Barbato
- Cardiovascular Center Olv Aalst , Aalst , Belgium
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
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15
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Paolisso P, Belmonte M, Bermpeis K, Gallinoro E, Bertolone DT, Leone A, Caglioni S, Bassas AI, De Colle C, Vanderheyden M, Casselman F, Degrieck I, Barbato E, Wyffels E, Penicka M. Successful Transcatheter Aortic Valve Replacement in Patient With Aortic Annulus Pseudoaneurysm After Balloon Aortic Valvuloplasty. JACC Cardiovasc Interv 2022; 15:2448-2451. [PMID: 36480989 DOI: 10.1016/j.jcin.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Serena Caglioni
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Cona, Ferrara, Italy
| | | | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Ivan Degrieck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
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16
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Paolisso P, Gallinoro E, Belmonte M, Bertolone DT, Bermpeis K, Esposito G, Seki R, Fabbricatore D, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. Microvascular dysfunction in patients with diabetes mellitus: assessment of absolute coronary flow and microvascular resistance reserve. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset of systolic and diastolic dysfunction (DDF). Continuous intracoronary thermodilution allows an accurate and reproducible assessment of absolute coronary blood flow and microvascular resistance thus allowing the evaluation of coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR), a novel index specific for microvascular function, which is independent from the myocardial mass. In the present study we compared absolute coronary flow and resistance, CFR and MRR assessed by continuous intracoronary thermodilution in diabetic versus non-diabetic patients. Left atrial reservoir strain (LASr), an early marker of DDF was compared between the two groups.
Methods
In this observational retrospective study, 108 patients with suspected angina and non-obstructive coronary artery disease (NOCAD) consecutively undergoing elective coronary angiography (CAG) from September 2018 to June 2021 were enrolled. The invasive functional assessment of microvascular function was performed in the left anterior descending artery (LAD) with intracoronary continuous thermodilution. Patients were classified according to the presence of DM. Absolute resting and hyperemic coronary flow (in mL/min) and resistance (in WU) were compared between the two cohorts. FFR was measured to assess coronary epicardial lesions, while CFR and MRR were calculated to assess microvascular function. LAS, assessed by speckle tracking echocardiography, was used to detect early myocardial structural changes potentially associated with microvascular dysfunction.
Results
The median FFR value was 0.83 [0.79–0.87] without any significant difference between the two groups. Absolute resting and hyperemic flow in the left anterior descending coronary were similar between diabetic and non-diabetic patients. Similarly, resting and hyperemic resistances did not change significantly between the two groups. In the DM cohort the CFR and MRR were significantly lower compared to the control group (CFR=2.4±0.6 and 2.9±0.8; MRR=2.8±0.9 and 3.5±1 for diabetic and non-diabetic patients respectively, [p<0.05 for both], Figure 1 and 2). Likewise, diabetic patients had a significantly lower reservoir, contractile and conductive LAS (all p<0.05).
Conclusions
Compared with non-diabetic patients, CFR and MRR were lower in patients with DM and non-obstructive epicardial coronary arteries, while both resting and hyperemic coronary flow and resistance were similar. LASr was lower in diabetic patients, confirming the presence of a subclinical DDF associated to the microcirculatory impairment. Continuous intracoronary thermodilution-derived indexes provide a reliable and operator-independent assessment of coronary macro- and microvasculature and might potentially facilitate widespread clinical adoption of invasive physiologic assessment of suspected microvascular disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Paolisso
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Gallinoro
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Belmonte
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - D T Bertolone
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - K Bermpeis
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - G Esposito
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - R Seki
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - J Bartunek
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - E Wyffels
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - J Sonck
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - C Collet
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - B De Bruyne
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst , Aalst , Belgium
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17
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Gallinoro E, Paolisso P, Di Gioia G, Bermpeis K, Fernandez-Peregrina E, Candreva A, Esposito G, Fabbricatore D, Bertolone DT, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long-Term Survival. J Am Heart Assoc 2022; 11:e026656. [PMID: 36129045 DOI: 10.1161/jaha.122.026656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Deferring revascularization in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favorable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction is unclear. We aimed to investigate whether FFR provides adjunctive clinical benefit compared with coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced left ventricular ejection fraction. Methods and Results Consecutive patients with reduced left ventricular ejection fraction (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We included patients with at least 1 intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR guided) or angiography alone (angiography guided). The primary end point was the cumulative incidence of all-cause death at 10 years. The secondary end point (incidence of major adverse cardiovascular and cerebrovascular events) was a composite of all-cause death, myocardial infarction, any revascularization, and stroke. A total of 840 patients were included (206 in the FFR-guided group and 634 in the angiography-guided group). Median follow-up was 7 years (interquartile range, 3.22-11.08 years). After 1:1 propensity-score matching, baseline characteristics between the 2 groups were similar. All-cause death was significantly lower in the FFR-guided group compared with the angiography-guided group (94 [45.6%] versus 119 [57.8%]; hazard ratio [HR], 0.65 [95% CI, 0.49-0.85]; P<0.01). The rate of major adverse cardiovascular and cerebrovascular events was lower in the FFR-guided group (123 [59.7%] versus 139 [67.5%]; HR, 0.75 [95% CI, 0.59-0.95]; P=0.02). Conclusions In patients with reduced left ventricular ejection fraction, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and major adverse cardiovascular and cerebrovascular events at 10 years.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Translational Medical Sciences University of Campania "Luigi Vanvitelli" Naples Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Giuseppe Di Gioia
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | | | | | - Alessandro Candreva
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Cardiology Zurich University Hospital Zurich Switzerland.,PoliToBIO Med Lab Department of Mechanical and Aerospace Engineering Politecnico di Torino Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Davide Fabbricatore
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Marc Vanderheyden
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Cardiology Lausanne University Hospital Lausanne Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
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18
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Bertolone DT, Bermpeis K, Gallinoro E, Esposito G, Paolisso P, De Colle C, Sonck J, Collet C, De Bruyne B, Barbato E, Van Praet F, Wyffels E. First report of totally robotically assisted hybrid coronary artery revascularization combining RE-MIDCAB and R-PCI: Case report. J Card Surg 2022; 37:2907-2911. [PMID: 35690894 DOI: 10.1111/jocs.16674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
A 62-year-old man presents to the Cardiology Department with a history of angina on exertion. Invasive coronary angiography revealed a severe three vessels coronary artery disease. The "Hybrid Heart Team" successfully performed a fully robotically assisted hybrid revascularization combining robotically enhanced-minimally invasive direct coronary artery bypass on the left anterior descending (LAD) and robotically assisted percutaneous coronary intervention on non-LAD lesions.
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Affiliation(s)
- Dario T Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Frank Van Praet
- Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
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19
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Bertolone DT, Gallinoro E, Esposito G, Paolisso P, Bermpeis K, De Colle C, Fabbricatore D, Mileva N, Valeriano C, Munhoz D, Belmonte M, Vanderheyden M, Bartunek J, Sonck J, Wyffels E, Collet C, Mancusi C, Morisco C, De Luca N, De Bruyne B, Barbato E. Contemporary Management of Stable Coronary Artery Disease. High Blood Press Cardiovasc Prev 2022; 29:207-219. [PMID: 35147890 PMCID: PMC9050764 DOI: 10.1007/s40292-021-00497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/30/2021] [Indexed: 10/28/2022] Open
Abstract
Coronary artery disease (CAD) continues to be the leading cause of mortality and morbidity in developed countries. Assessment of pre-test probability (PTP) based on patient's characteristics, gender and symptoms, help to identify more accurate patient's clinical likelihood of coronary artery disease. Consequently, non-invasive imaging tests are performed more appropriately to rule in or rule out CAD rather than invasive coronary angiography (ICA). Coronary computed tomography angiography (CCTA) is the first-line non-invasive imaging technique in patients with suspected CAD and could be used to plan and guide coronary intervention. Invasive coronary angiography remains the gold-standard method for the identification and characterization of coronary artery stenosis. However, it is recommended in patients where the imaging tests are non-conclusive, and the clinical likelihood is very high, remembering that in clinical practice, approximately 30 to 70% of patients with symptoms and/or signs of ischemia, referred to coronary angiography, have non obstructive coronary artery disease (INOCA). In this contest, physiology and imaging-guided revascularization represent the cornerstone of contemporary management of chronic coronary syndromes (CCS) patients allowing us to focus specifically on ischemia-inducing stenoses. Finally, we also discuss contemporary medical therapeutic approach for secondary prevention. The aim of this review is to provide an updated diagnostic and therapeutic approach for the management of patients with stable coronary artery disease.
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Affiliation(s)
- Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. .,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
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20
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Gallinoro E, Paolisso P, Di Gioia G, Bermpeis K, Fernandez-peregrina E, Candreva A, Esposito G, Fabbricatore D, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. 451 Deferral of coronary revascularization in patients with reduced ejection fraction based on physiological assessment: impact on long-term survival. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Deferring percutaneous coronary intervention (PCI) in patients with non-significant stenoses based on fractional flow reserve (FFR) is associated with favourable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction (LVEF) is unclear. To investigate whether FFR provides adjunctive clinical benefit compared to coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced LVEF.
Methods and results
Consecutive patients (n = 4577) with reduced LVEF (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We eventually included patients with at least one intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR-guided) or angiography alone (angiography-guided). The primary endpoint of the study was the cumulative incidence of all-cause death at 10 years. The secondary endpoint [the incidence of major adverse cardiovascular and cerebrovascular events (MACCE)], was a composite of all-cause death, myocardial infarction, any revascularization and stroke. A total of 840 patients were included (206 in the FFR-guided and 634 in the angiography-guided group). Median clinical follow-up was 7 years [IQR: (3.22–11.08)]. After 1:1 propensity score matching, baseline characteristics between the two groups were similar. All-cause death was significantly lower in the FFR-guided group compared with the angiography-guided group [94 (45.6%) vs. 119 (57.8%), HR: 0.65 (95% CI: 0.49–0.85), P < 0.01]. The rate of major adverse cardiovascular and cerebrovascular events [(MACCE), a composite of all-cause death, myocardial infarction, any revascularization, and stroke) was lower in the FFR-guided group [123 (59.7%) vs. 139 (67.5%), HR: 0.75 (95% CI: 0.59–0.95), P = 0.02].
Conclusions
In patients with reduced LVEF, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and MACCE at 10 years.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Translational Medical Sciences, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | - Giuseppe Di Gioia
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | | | | | | | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | | | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
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21
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Gallinoro E, Paolisso P, Candreva A, Bermpeis K, Fabbricatore D, Esposito G, Bertolone D, Fernandez Peregrina E, Munhoz D, Mileva N, Penicka M, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. Microvascular Dysfunction in Patients With Type II Diabetes Mellitus: Invasive Assessment of Absolute Coronary Blood Flow and Microvascular Resistance Reserve. Front Cardiovasc Med 2021; 8:765071. [PMID: 34738020 PMCID: PMC8562107 DOI: 10.3389/fcvm.2021.765071] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset of diastolic and systolic dysfunction. Continuous intracoronary thermodilution allows an accurate and reproducible assessment of absolute coronary blood flow and microvascular resistance thus allowing the evaluation of coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR), a novel index specific for microvascular function, which is independent from the myocardial mass. In the present study we compared absolute coronary flow and resistance, CFR and MRR assessed by continuous intracoronary thermodilution in diabetic vs. non-diabetic patients. Left atrial reservoir strain (LASr), an early marker of diastolic dysfunction was compared between the two groups. Methods: In this observational retrospective study, 108 patients with suspected angina and non-obstructive coronary artery disease (NOCAD) consecutively undergoing elective coronary angiography (CAG) from September 2018 to June 2021 were enrolled. The invasive functional assessment of microvascular function was performed in the left anterior descending artery (LAD) with intracoronary continuous thermodilution. Patients were classified according to the presence of DM. Absolute resting and hyperemic coronary blood flow (in mL/min) and resistance (in WU) were compared between the two cohorts. FFR was measured to assess coronary epicardial lesions, while CFR and MRR were calculated to assess microvascular function. LAS, assessed by speckle tracking echocardiography, was used to detect early myocardial structural changes potentially associated with microvascular dysfunction. Results: The median FFR value was 0.83 [0.79-0.87] without any significant difference between the two groups. Absolute resting and hyperemic flow in the left anterior descending coronary were similar between diabetic and non-diabetic patients. Similarly, resting and hyperemic resistances did not change significantly between the two groups. In the DM cohort the CFR and MRR were significantly lower compared to the control group (CFR = 2.38 ± 0.61 and 2.88 ± 0.82; MRR = 2.79 ± 0.87 and 3.48 ± 1.02 for diabetic and non-diabetic patients respectively, [p < 0.05 for both]). Likewise, diabetic patients had a significantly lower reservoir, contractile and conductive LAS (all p < 0.05). Conclusions: Compared with non-diabetic patients, CFR and MRR were lower in patients with DM and non-obstructive epicardial coronary arteries, while both resting and hyperemic coronary flow and resistance were similar. LASr was lower in diabetic patients, confirming the presence of a subclinical diastolic dysfunction associated to the microcirculatory impairment. Continuous intracoronary thermodilution-derived indexes provide a reliable and operator-independent assessment of coronary macro- and microvasculature and might potentially facilitate widespread clinical adoption of invasive physiologic assessment of suspected microvascular disease.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli', Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Dario Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Discipline of Cardiology, Department of Internal Clinical Medicine, University of Campinas, Campinas, Brazil
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | | | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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22
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De Bruyne B, Pijls NHJ, Gallinoro E, Candreva A, Fournier S, Keulards DCJ, Sonck J, Van't Veer M, Barbato E, Bartunek J, Vanderheyden M, Wyffels E, De Vos A, El Farissi M, Tonino PAL, Muller O, Collet C, Fearon WF. Microvascular Resistance Reserve for Assessment of Coronary Microvascular Function: JACC Technology Corner. J Am Coll Cardiol 2021; 78:1541-1549. [PMID: 34620412 DOI: 10.1016/j.jacc.2021.08.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023]
Abstract
The need for a quantitative and operator-independent assessment of coronary microvascular function is increasingly recognized. We propose the theoretical framework of microvascular resistance reserve (MRR) as an index specific for the microvasculature, independent of autoregulation and myocardial mass, and based on operator-independent measurements of absolute values of coronary flow and pressure. In its general form, MRR equals coronary flow reserve (CFR) divided by fractional flow reserve (FFR) corrected for driving pressures. In 30 arteries, pressure, temperature, and flow velocity measurements were obtained simultaneously at baseline (BL), during infusion of saline at 10 mL/min (rest) and 20 mL/min (hyperemia). A strong correlation was found between continuous thermodilution-derived MRR and Doppler MRR (r = 0.88; 95% confidence interval: 0.72-0.93; P < 0.001). MRR was independent from the epicardial resistance, the lower the FFR value, the greater the difference between MRR and CFR. Therefore, MRR is proposed as a specific, quantitative, and operator-independent metric to quantify coronary microvascular dysfunction.
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Affiliation(s)
- Bernard De Bruyne
- Cardiovascular Center Aalst, Aalst, Belgium; Lausanne University Centre Hospital, Lausanne, Switzerland.
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy. https://twitter.com/Egallinoro
| | - Alessandro Candreva
- Cardiovascular Center Aalst, Aalst, Belgium. https://twitter.com/alecandreva
| | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. https://twitter.com/jeroen_sonck
| | - Marcel Van't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. https://twitter.com/EmanueleBarba13
| | | | | | | | - Annemiek De Vos
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Mohamed El Farissi
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Olivier Muller
- Lausanne University Centre Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, Aalst, Belgium. https://twitter.com/ColletCarlos
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA
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23
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Van Camp G, Beles M, Penicka M, Schelfaut D, Wouters S, De Raedt H, Wyffels E, Spapen J, Nasser R, Balogh Z, Albano M, De Beenhouwer H, Van Vaerenbergh K, Van Praet F, Degrieck I, Stockman B, Casselman F, Collet C. Importance of In-Hospital Prospective Registry and Infectious Endocarditis Heart Team to Monitor and Improve Quality of Care in Patients with Infectious Endocarditis. J Clin Med 2021; 10:jcm10173832. [PMID: 34501278 PMCID: PMC8432016 DOI: 10.3390/jcm10173832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: To investigate the value of prospective in-hospital registry data and the impact of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized patients with IE. Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized in one centre with the definite diagnosis of infectious endocarditis (IE) and entered in a prospective registry. From 2017, an IEHT was introduced. Propensity score matching was used to assess the impact of an IEHT approach on clinical outcomes. Results: Median age was 72.5 y (62.75–80.00), diabetes was present in 33.1%, chronic kidney disease in 27.5%, COPD in 17.5%, and a history of ischaemic heart disease in 30.6%. Prosthetic valve IE was observed in 43.8% and device-related IE in 16.9% of patients. Staphylococcus (37.5%) was the most frequent pathogen followed by streptococcus (24.4%) and enterococcus (23.1%). Overall, 30-day and 1-year mortality were 19.4% and 37.5%, respectively. The introduction of prospective data collection and IE heart team was associated with a trend towards reduction of adjusted 1-year mortality (26.5% IEHT vs. 41.2% controls, p = 0.0699). An IEHT clinical decision-making approach was independently associated with a shorter length of stay (p = 0.04). Conclusions: Use of a prospective registry of IE coupled with a heart team approach was associated with more efficient patient management and a trend towards lower mortality. Prospective data collection and dedicated IEHT have the potential to improve patient care and clinical outcomes.
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Affiliation(s)
- Guy Van Camp
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
- Correspondence:
| | - Monika Beles
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Martin Penicka
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Dan Schelfaut
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Stijn Wouters
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Herbert De Raedt
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Eric Wyffels
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Jerrold Spapen
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Riwa Nasser
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Zsuzsanna Balogh
- Gottsegen Gyorgy National Institute of Cardilogy, Haller u. 29, 1096 Budapest, Hungary;
| | - Marzia Albano
- Cardiology Unit, S. Maria Nuova Hospital, Via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Hans De Beenhouwer
- Department of Microbiology, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (H.D.B.); (K.V.V.)
| | | | - Frank Van Praet
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Ivan Degrieck
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Bernard Stockman
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Filip Casselman
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Carlos Collet
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
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24
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Candreva A, Mizukami T, Sonck J, Munhoz D, Nagumo S, Di Gioia G, Gallinoro E, Mileva N, Bartunek J, Wyffels E, Barbato E, De Bruyne B, Perera D, Collet C. Hyperemic hemodynamic characteristics of serial coronary lesions assessed by pullback pressure gradients. Catheter Cardiovasc Interv 2021; 98:E647-E654. [PMID: 34264014 DOI: 10.1002/ccd.29868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 07/01/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To characterize hemodynamics of serial coronary stenoses using fractional flow reserve (FFR) pullbacks and the pullback pressure gradients (PPG) index. BACKGROUND The cross-talk between stenoses within the same coronary artery makes the prediction of the functional contribution of each lesion challenging. METHODS AND RESULTS One-hundred seventeen patients undergoing coronary angiography for stable angina were prospectively recruited. Serial lesions were defined as two or more narrowings with visual diameter stenosis >50% on conventional angiography. Motorized FFR pullback tracings were obtained at 1 mm/s. Pullbacks were visually adjudicated as presenting two, one, and no focal pressure drops. The pattern of disease (i.e., focal or diffuse) was quantified using the PPG index. Twenty-five vessels presented serial lesions (mean PPG 0.48 ± 0.17). Two, one or no focal pressure drops were observed in 40% (n = 10; PPG 0.59 ± 0.17), 52% (n = 13; PPG 0.44 ± 0.12) and 8% of cases (n = 2; PPG 0.27 ± 0.01; p-value = 0.01). Distal FFR was similar between vessels with two, one and no focal pressure drops in the pullback curve (p-value = 0.27). The PPG index independently predicted the presence of two focal pressure drops in the pullback curve (p = 0.04). CONCLUSIONS FFR pullbacks in serial coronary lesions exhibit three distinct functional patterns. High PPG was associated with pullback curves presenting two pressure drops. The PPG provides a quantitative assessment of the pattern of coronary artery disease in cases with serial lesions and might be useful to assess the appropriateness of percutaneous revascularization.
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Affiliation(s)
- Alessandro Candreva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Division of Clinical Pharmacology, Show University School of Medicine, Tokyo, Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Division of Clinical Pharmacology, Show University School of Medicine, Tokyo, Japan
| | - Giuseppe Di Gioia
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Divaka Perera
- Cardiovascular Division, St. Thomas' Hospital Campus, King's College London, London, UK
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
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25
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Mizukami T, Sonck J, Gallinoro E, Kodeboina M, Canvedra A, Nagumo S, Bartunek J, Wyffels E, Vanderheyden M, Shinke T, De Bruyne B, Collet C. Duration of Hyperemia With Intracoronary Administration of Papaverine. J Am Heart Assoc 2021; 10:e018562. [PMID: 33459027 PMCID: PMC7955433 DOI: 10.1161/jaha.120.018562] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takuya Mizukami
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium.,Clinical Research Institute for Clinical Pharmacology and Therapeutics Showa University Tokyo Japan.,Department of Cardiology Gifu Heart Center Gifu Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples, Federico II Naples Italy
| | | | - Monika Kodeboina
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium
| | | | - Sakura Nagumo
- Department of Cardiology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Jozef Bartunek
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium
| | | | - Toshiro Shinke
- Division of Cardiology Department of Medicine Showa University School of Medicine Tokyo Japan
| | - Bernard De Bruyne
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium.,Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst Onze-Lieve-Vrouw Clinic Aalst Belgium
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26
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Monizzi G, Sonck J, Nagumo S, Buytaert D, Van Hoe L, Grancini L, Bartorelli AL, Vanhoenacker P, Simons P, Bladt O, Wyffels E, De Bruyne B, Andreini D, Collet C. Quantification of calcium burden by coronary CT angiography compared to optical coherence tomography. Int J Cardiovasc Imaging 2020; 36:2393-2402. [DOI: 10.1007/s10554-020-01839-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/03/2020] [Indexed: 12/26/2022]
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27
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Gigante C, Mizukami T, Sonck J, Nagumo S, Tanzilli A, Bartunek J, Vanderheyden M, Wyffels E, Barbato E, Pompilio G, Mushtaq S, Bartorelli A, De Bruyne B, Andreini D, Collet C. Graft patency and progression of coronary artery disease after CABG assessed by angiography-derived fractional flow reserve. Int J Cardiol 2020; 316:19-25. [DOI: 10.1016/j.ijcard.2020.04.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
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28
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Pellicano M, Di Gioia G, Ciccarelli G, Xaplanteris P, Delrue L, Toth GG, Van Durme F, Heyse A, Wyffels E, Vanderheyden M, Bartunek J, De Bruyne B, Barbato E. Procedural microvascular activation in long lesions treated with bioresorbable vascular scaffolds or everolimus-eluting stents: the PROACTIVE trial. EUROINTERVENTION 2020; 16:e147-e154. [PMID: 31085503 DOI: 10.4244/eij-d-18-01138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
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Di Gioia G, Sonck J, Ferenc M, Chen SL, Colaiori I, Gallinoro E, Mizukami T, Kodeboina M, Nagumo S, Franco D, Bartunek J, Vanderheyden M, Wyffels E, De Bruyne B, Lassen JF, Bennett J, Vassilev D, Serruys PW, Stankovic G, Louvard Y, Barbato E, Collet C. Clinical Outcomes Following Coronary Bifurcation PCI Techniques. JACC Cardiovasc Interv 2020; 13:1432-1444. [DOI: 10.1016/j.jcin.2020.03.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 01/01/2023]
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Nagumo S, Gigante C, Mizukami T, Sonck J, Tanzilli A, Bartunek J, Vanderheyden M, Wyffels E, Barbato E, De Bruyne B, Andreini D, Collet C. GRAFT PATENCY AND PROGRESSION OF CORONARY ARTERY DISEASE AFTER CABG ASSESSED BY ANGIOGRAPHY-DERIVED FRACTIONAL FLOW RESERVE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Di Gioia G, Fournier S, Milkas A, Colaiori I, Hamilos M, Muller O, Bartunek J, Vanderheyden M, Wyffels E, Barbato E, De Bruyne B. 3286Fractional flow reserve-guided treatment strategy for left main coronary artery stenoses. Ten-year clinical outcome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Revascularization decisions regarding left main (LM) coronary stenoses are often very challenging. Non-invasive tests can yield false negative results. On the other hand, some technical aspects of fractional flow reserve (FFR) measurement, as well as the interpretation of their results, are less codified than for other coronary segments.
Purpose
To investigate the 10-year clinical outcome of patients with isolated angiographically intermediate LM coronary stenosis in whom the treatment strategy was based on Fractional Flow Reserve (FFR) measurements.
Methods
From 1999 to 2009 we included 96 patients with isolated intermediate LM coronary disease (DS% 30–70%) evaluated with FFR measurement. When FFR was >0.80, patients were deferred to medical therapy (Deferral-group, n=71). When FFR was ≤0.8, surgical revascularization therapy was proposed (Revascularization-group, n=25). Death, the occurrence of myocardial infarction (MI) and the need for target vessel revascularization (TVR) were evaluated in both groups.
Results
There were no significant differences in clinical characteristics between the 2 groups. Mean DS% was 35% in the Deferral-group and 43% in the Revascularization-group (p<0.01). Average FFR was 0.88 in the Deferral-group and 0.71 in the Revascularization-group (p<0.01). In the latter, the 10-year survival estimate was 72% while it was 77% in the Deferral group (HR [95% CI]: 1.28 [0.53–3.10]; p=NS). No difference was found between the 2 groups in terms of MI (4.5% vs. 1.6%; HR [95% CI]: 3.5 [0.22–56.0]; p=NS) or TVR (9% vs. 12%; HR [95% CI]: 0.94 [0.20–4.43]; p=NS).
Conclusions
The use of FFR to defer revascularization in patients with non-significant isolated LM stenosis is safe and is associated with favourable clinical outcome at 10 years.
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Affiliation(s)
| | | | - A Milkas
- Olv Clinic Aalst, Aalst, Belgium
| | | | | | - O Muller
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | | | | | | | - E Barbato
- Federico II University of Naples, Department of advanced biomedical sciences, Naples, Italy
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Fournier S, Toth GG, De Bruyne B, Colaiori I, Xaplanteris P, Di Gioia G, Bartunek J, Vanderheyden M, Wyffels E, Casselman F, Van Praet F, Stockman B, Degrieck I, Barbato E. P3175Long-term natural history of coronary artery bypass grafts depending on the initial haemodynamic significance of the native stenotic coronary arteries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Fournier
- Cardiovascular Center Aalst, Aalst, Belgium
| | - G G Toth
- Graz University of Technology, Graz, Austria
| | | | - I Colaiori
- Cardiovascular Center Aalst, Aalst, Belgium
| | | | - G Di Gioia
- Cardiovascular Center Aalst, Aalst, Belgium
| | - J Bartunek
- Cardiovascular Center Aalst, Aalst, Belgium
| | | | - E Wyffels
- Cardiovascular Center Aalst, Aalst, Belgium
| | | | | | - B Stockman
- Cardiovascular Center Aalst, Aalst, Belgium
| | - I Degrieck
- Cardiovascular Center Aalst, Aalst, Belgium
| | - E Barbato
- Cardiovascular Center Aalst, Aalst, Belgium
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Rueda Ochoa OL, Milkas AN, Fournier S, Muller O, Cicarrelli G, Xaplanteris P, Van Rooij F, Ikram MA, Wyffels E, Vanderheyden M, Bartunek J, Franco OH, Barbato E, De Bruyne B, Kavousi M. P3649Evaluating the 10-year survival after an FFR-guided strategy in patients with proximal isolated stenosis in the left anterior descending coronary artery: impact of control selection. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O L Rueda Ochoa
- Industrial University of Santander, Department of Basic Sciences, Bucaramanga, Colombia
| | - A N Milkas
- Naval Hospital of Athens, Cardiology, Athens, Greece
| | - S Fournier
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
| | - O Muller
- University of Lausanne, Department of Cardiology, Lausanne, Switzerland
| | | | | | - F Van Rooij
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
| | - M A Ikram
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
| | - E Wyffels
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - M Vanderheyden
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - J Bartunek
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - O H Franco
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
| | - E Barbato
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | | | - M Kavousi
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
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Fournier S, Toth GG, De Bruyne B, Ciccarelli G, Xaplanteris P, Milkas A, Strisciuglio T, Bartunek J, Vanderheyden M, Wyffels E, Casselman F, Van Praet F, Stockman B, Degrieck I, Barbato E. 4171Six-year follow-up of Fractional Flow Reserve-guided versus angiography-guided coronary artery bypass graft surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Fournier
- Cardiovascular Center Aalst, Aalst, Belgium
| | - G G Toth
- Graz University of Technology, Graz, Austria
| | | | | | | | - A Milkas
- Cardiovascular Center Aalst, Aalst, Belgium
| | | | - J Bartunek
- Cardiovascular Center Aalst, Aalst, Belgium
| | | | - E Wyffels
- Cardiovascular Center Aalst, Aalst, Belgium
| | | | | | - B Stockman
- Cardiovascular Center Aalst, Aalst, Belgium
| | - I Degrieck
- Cardiovascular Center Aalst, Aalst, Belgium
| | - E Barbato
- Cardiovascular Center Aalst, Aalst, Belgium
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Fournier S, Toth GG, De Bruyne B, Johnson NP, Ciccarelli G, Xaplanteris P, Milkas A, Strisciuglio T, Bartunek J, Vanderheyden M, Wyffels E, Casselman F, Van Praet F, Stockman B, Degrieck I, Barbato E. Six-Year Follow-Up of Fractional Flow Reserve-Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Interv 2018; 11:e006368. [DOI: 10.1161/circinterventions.117.006368] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Stephane Fournier
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
| | - Gabor G. Toth
- Department of Cardiology, Medical University of Graz, Austria (G.G.T.)
| | - Bernard De Bruyne
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
| | - Nils P. Johnson
- Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX (N.P.J.)
| | - Giovanni Ciccarelli
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
| | - Panagiotis Xaplanteris
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
| | - Anastasios Milkas
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
| | - Teresa Strisciuglio
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (T.S., E.B.)
| | - Jozef Bartunek
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
| | - Marc Vanderheyden
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
| | - Eric Wyffels
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
| | - Filip Casselman
- Department of Cardiovascular Surgery (F.C., F.V.P., B.S., I.D.), Cardiovascular Center Aalst OLV Hospital, Belgium
| | - Frank Van Praet
- Department of Cardiovascular Surgery (F.C., F.V.P., B.S., I.D.), Cardiovascular Center Aalst OLV Hospital, Belgium
| | - Bernard Stockman
- Department of Cardiovascular Surgery (F.C., F.V.P., B.S., I.D.), Cardiovascular Center Aalst OLV Hospital, Belgium
| | - Ivan Degrieck
- Department of Cardiovascular Surgery (F.C., F.V.P., B.S., I.D.), Cardiovascular Center Aalst OLV Hospital, Belgium
| | - Emanuele Barbato
- From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.)
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (T.S., E.B.)
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Toth G, Hamilos M, Pyxaras S, Mangiacapra F, Nelis O, De Vroey F, Di Serafino L, Muller O, Van Mieghem C, Wyffels E, Heyndrickx GR, Bartunek J, Vanderheyden M, Barbato E, Wijns W, De Bruyne B. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J 2014; 35:2831-8. [DOI: 10.1093/eurheartj/ehu094] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pyxaras SA, Tu S, Barbato E, Wyffels E, Reiber JH, Wijns W. Co-registration of fractional flow reserve and optical coherence tomography with the use of a three-dimensional angiographic roadmap: an opportunity for optimisation of complex percutaneous coronary interventions. EUROINTERVENTION 2013; 9:889. [DOI: 10.4244/eijv9i7a146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mangiacapra F, Peace AJ, Di Serafino L, Pyxaras SA, Bartunek J, Wyffels E, Heyndrickx GR, Wijns W, De Bruyne B, Barbato E. Intracoronary EnalaPrilat to Reduce MICROvascular Damage During Percutaneous Coronary Intervention (ProMicro) study. J Am Coll Cardiol 2013; 61:615-21. [PMID: 23290547 DOI: 10.1016/j.jacc.2012.11.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 11/10/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study investigated the influence of intracoronary enalaprilat on coronary microvascular function and peri-procedural outcome measures in patients with stable angina undergoing percutaneous coronary intervention (PCI). BACKGROUND Intracoronary angiotensin-converting enzyme inhibitors have been shown to relieve myocardial ischemia in stable patients and to improve epicardial flow in patients with ST-segment elevation myocardial infarction. Yet, it is still unclear whether these effects are mediated by a modulation of the coronary microcirculation. METHODS We randomly assigned 40 patients to receive either an intracoronary bolus of enalaprilat (50 μg) or placebo before elective PCI. The index of microvascular resistance was measured at baseline, 10 minutes after study drug administration, and after PCI. High-sensitivity cardiac troponin T was measured as a marker of myocardial injury. RESULTS Infusion of enalaprilat resulted in a significant reduction in index of microvascular resistance (27 ± 11 at baseline vs. 19 ± 9 after drug vs. 15 ± 8 after PCI), whereas a significant post-procedural increase in index of microvascular resistance levels was observed in the placebo group (24 ± 15 at baseline vs. 24 ± 15 after drug vs. 33 ± 19 after PCI). Index of microvascular resistance levels after PCI were significantly lower in the enalaprilat group (p < 0.001). Patients pre-treated with enalaprilat also showed lower peak values (mean: 21.7 ng/ml, range: 8.2 to 34.8 ng/ml vs. mean: 32.3 ng/ml, range: 12.6 to 65.2 ng/ml, p = 0.048) and peri-procedural increases of high-sensitivity cardiac troponin T (mean: 9.9 ng/ml, range: 2.7 to 19.0 ng/ml vs. mean: 26.6 ng/ml, range: 6.3 to 60.5 ng/ml, p = 0.025). CONCLUSIONS Intracoronary enalaprilat improves coronary microvascular function and protects myocardium from procedure-related injury in patients with coronary artery disease undergoing PCI. Larger studies are warranted to investigate whether these effects of enalaprilat could result into a significant clinical benefit.
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Muller O, Mangiacapra F, Ntalianis A, Verhamme KM, Trana C, Hamilos M, Bartunek J, Vanderheyden M, Wyffels E, Heyndrickx GR, van Rooij FJ, Witteman JC, Hofman A, Wijns W, Barbato E, De Bruyne B. Long-Term Follow-Up After Fractional Flow Reserve–Guided Treatment Strategy in Patients With an Isolated Proximal Left Anterior Descending Coronary Artery Stenosis. JACC Cardiovasc Interv 2011; 4:1175-82. [DOI: 10.1016/j.jcin.2011.09.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/07/2011] [Accepted: 09/09/2011] [Indexed: 10/15/2022]
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Ntalianis A, Trana C, Muller O, Mangiacapra F, Peace A, De Backer C, De Block L, Wyffels E, Bartunek J, Vanderheyden M, Heyse A, Van Durme F, Van Driessche L, De Jans J, Heyndrickx GR, Wijns W, Barbato E, De Bruyne B. Effective radiation dose, time, and contrast medium to measure fractional flow reserve. JACC Cardiovasc Interv 2010; 3:821-7. [PMID: 20723854 DOI: 10.1016/j.jcin.2010.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 06/07/2010] [Accepted: 06/09/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study sought to define the additional effective radiation dose, procedural time, and contrast medium needed to obtain fractional flow reserve (FFR) measurements after a diagnostic coronary angiogram. BACKGROUND The FFR measurements performed at the end of a diagnostic angiogram allow the obtaining of functional information that complements the anatomic findings. METHODS In 200 patients (mean age 66 +/- 10 years) undergoing diagnostic coronary angiography, FFR was measured in at least 1 intermediate coronary artery stenosis. Hyperemia was achieved by intracoronary (n = 180) or intravenous (n = 20) adenosine. The radiation dose (mSv), procedural time (min), and contrast medium (ml) needed for diagnostic angiography and FFR were recorded. RESULTS A total of 296 stenoses (1.5 +/- 0.7 stenoses per patient) were assessed. The additional mean radiation dose, procedural time, and contrast medium needed to obtain FFR expressed as a percentage of the entire procedure were 30 +/- 16% (median 4 mSv, range 2.4 to 6.7 mSv), 26 +/- 13% (median 9 min, range 7 to 13 min), and 31 +/- 16% (median 50 ml, range 30 to 90 ml), respectively. The radiation dose and contrast medium during FFR were similar after intravenous and intracoronary adenosine, though the procedural time was slightly longer with intravenous adenosine (median 11 min, range 10 to 17 min, p = 0.04) than with intracoronary adenosine (median 9 min, range 7 to 13 min). When FFR was measured in 3 or more lesions, radiation dose, procedural time, and contrast medium increased. CONCLUSIONS The additional radiation dose, procedural time, and contrast medium to obtain FFR measurement are low as compared to other cardiovascular imaging modalities. Therefore, the combination of diagnostic angiography and FFR measurements is warranted to provide simultaneously anatomic and functional information in patients with coronary artery disease.
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Melikian N, De Bondt P, Tonino P, De Winter O, Wyffels E, Bartunek J, Heyndrickx GR, Fearon WF, Pijls NHJ, Wijns W, De Bruyne B. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv 2010. [PMID: 20298990 DOI: 10.1016/j.jcin] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the correlation between myocardial ischemia detected by myocardial perfusion imaging (MPI) with single-photon emission computed tomography with intracoronary pressure-derived fractional flow reserve (FFR) in patients with multivessel coronary disease at angiography. BACKGROUND Myocardial perfusion imaging can underestimate the number of ischemic territories in patients with multivessel disease. However, there are limited data comparing MPI and FFR, a highly accurate functional index of myocardial ischemia, in multivessel coronary disease. METHODS Sixty-seven patients (201 vascular territories) with angiographic 2- or 3-vessel coronary disease were prospectively scheduled to undergo within 2 weeks MPI (rest/stress adenosine) and FFR in each vessel. RESULTS In 42% of patients, MPI and FFR detected identical ischemic territories (mean number of territories 0.9 +/- 0.8 for both; p = 1.00). In the remaining 36% MPI underestimated (mean number of territories; MPI: 0.46 +/- 0.6, FFR: 2.0 +/- 0.6; p < 0.001) and in 22% overestimated (mean number of territories; MPI: 1.9 +/- 0.8, FFR: 0.5 +/- 0.8; p < 0.001) the number of ischemic territories in comparison with FFR. There was poor concordance between the ability of the 2 methods to detect myocardial ischemia on both a per-patient (kappa = 0.14 [95% confidence interval: -0.10 to 0.39]) and per-vessel (kappa = 0.28 [95% confidence interval: 0.15 to 0.42]) basis. CONCLUSIONS Myocardial perfusion imaging with single-photon emission computed tomography has poor concordance with FFR and tends to underestimate or overestimate the functional importance of coronary stenosis seen at angiography in comparison with FFR in patients with multivessel disease. These findings might have important consequences in using MPI to determine the optimal revascularization strategy in patients with multivessel coronary disease.
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Affiliation(s)
- Narbeh Melikian
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan 164, Aalst, Belgium
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Melikian N, Vercauteren S, Fearon W, Cuisset T, MacCarthy P, Davidavicius G, Aarnoudse W, Bartunek J, Vanderheyden M, Wyffels E, Wijns W, Heyndrickx G, Pijls N, De Bruyne B. Quantitative assessment of coronary microvascular function in patients with and without epicardial atherosclerosis. EUROINTERVENTION 2010. [DOI: 10.4244/eijv5i8a158] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Melikian N, Vercauteren S, Fearon WF, Cuisset T, MacCarthy PA, Davidavicius G, Aarnoudse W, Bartunek J, Vanderheyden M, Wyffels E, Wijns W, Heyndrickx GR, Pijls NHJ, de Bruyne B. Quantitative assessment of coronary microvascular function in patients with and without epicardial atherosclerosis. EUROINTERVENTION 2010; 5:939-945. [PMID: 20542779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIMS The influence of atherosclerosis and its risk factors on coronary microvascular function remain unclear as current methods of assessing microvascular function do not specifically test the microcirculation in isolation. We examined the influence of epicardial vessel atherosclerosis on coronary microvascular function using the index of myocardial resistance (IMR). METHODS AND RESULTS IMR (a measure of microvascular function) and fractional flow reserve (FFR, a measure of the epicardial compartment) were measured in 143 coronary arteries (116 patients). Fifteen patients (22 arteries, mean age 48+/-16 years) had no clinical evidence of atherosclerosis (control group). One hundred and one patients (121 arteries, mean age 63+/-11 years) had established atherosclerosis and multiple cardiovascular risk factors (atheroma group). Mean IMR in the control group (19+/-5, range 8-28) was significantly lower than in the atheroma group (25+/-13, range 6-75) (P<0.01). However, there was large overlap between IMR in both groups, with 69% of IMR values in patients with atheroma being within the control range. Mean FFR was also higher in the control group (0.96+/-0.02, range 0.93-1.00) than in the atheroma group (0.85+/-0.14, range 0.19-1.00) (P<0.01). There was no correlation between IMR and FFR (r=0.09; P=0.24), even when results in the control (r=0.02; P=0.92) and atheroma (r=0.15; P=0.10) groups were analysed in isolation. Using stepwise multiple regression analysis presence/absence of atheroma (ss=0.42; P=0.02) was the only independent determinant of IMR. CONCLUSIONS Mean IMR is higher in patients with epicardial atherosclerosis. However, there is a large overlap between IMR in patients with and without epicardial atherosclerosis.
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Melikian N, De Bondt P, Tonino P, De Winter O, Wyffels E, Bartunek J, Heyndrickx GR, Fearon WF, Pijls NH, Wijns W, De Bruyne B. Fractional Flow Reserve and Myocardial Perfusion Imaging in Patients With Angiographic Multivessel Coronary Artery Disease. JACC Cardiovasc Interv 2010; 3:307-14. [DOI: 10.1016/j.jcin.2009.12.010] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 11/30/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
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Hamilos M, Muller O, Cuisset T, Ntalianis A, Chlouverakis G, Sarno G, Nelis O, Bartunek J, Vanderheyden M, Wyffels E, Barbato E, Heyndrickx GR, Wijns W, De Bruyne B. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation 2009; 120:1505-12. [PMID: 19786633 DOI: 10.1161/circulationaha.109.850073] [Citation(s) in RCA: 269] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Significant left main coronary artery stenosis is an accepted indication for surgical revascularization. The potential of angiography to evaluate the hemodynamic severity of a stenosis is limited. The aims of the present study were to assess the long-term clinical outcome of patients with an angiographically equivocal left main coronary artery stenosis in whom the revascularization strategy was based on fractional flow reserve (FFR) and to determine the relationship between quantitative coronary angiography and FFR. METHODS AND RESULTS In 213 patients with an angiographically equivocal left main coronary artery stenosis, FFR measurements and quantitative coronary angiography were performed. When FFR was > or =0.80, patients were treated medically or another stenosis was treated by coronary angioplasty (nonsurgical group; n=138). When FFR was <0.80, coronary artery bypass grafting was performed (surgical group; n=75). The 5-year survival estimates were 89.8% in the nonsurgical group and 85.4% in the surgical group (P=0.48). The 5-year event-free survival estimates were 74.2% and 82.8% in the nonsurgical and surgical groups, respectively (P=0.50). Percent diameter stenosis at quantitative coronary angiography correlated significantly with FFR (r=-0.38, P<0.001), but a very large scatter was observed. In 23% of patients with a diameter stenosis <50%, the left main coronary artery stenosis was hemodynamically significant by FFR. CONCLUSIONS In patients with equivocal stenosis of the left main coronary artery, angiography alone does not allow appropriate individual decision making about the need for revascularization and often underestimates the functional significance of the stenosis. The favorable outcome of an FFR-guided strategy suggests that FFR should be assessed in such patients before a decision is made "blindly" about the need for revascularization.
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Affiliation(s)
- Michalis Hamilos
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan, 164, B-9300 Aalst, Belgium.
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Manoharan G, Ntalianis A, Muller O, Hamilos M, Sarno G, Melikian N, Vanderheyden M, Heyndrickx GR, Wyffels E, Wijns W, De Bruyne B. Severity of coronary arterial stenoses responsible for acute coronary syndromes. Am J Cardiol 2009; 103:1183-8. [PMID: 19406256 DOI: 10.1016/j.amjcard.2008.12.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 12/21/2008] [Accepted: 12/21/2008] [Indexed: 10/21/2022]
Abstract
Acute myocardial infarctions were generally believed to result from plaque rupture and thrombosis at the site of a "mild to moderate" coronary stenosis. To assess the severity of coronary stenoses that predisposed to acute coronary syndrome, the 317 patients prospectively included were (1) 102 patients with acute ST-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI), (2) 135 patients with non-STEMI or unstable angina pectoris (UAP) referred for semiurgent PCI, and (3) 80 patients with stable angina pectoris (SAP) admitted for elective PCI. Patients with STEMI were included if thrombus aspiration could restore normal antegrade coronary blood flow. After aspiration (but before PCI), a high-quality angiogram was obtained and the reference diameter, minimal luminal diameter, and percentage of diameter stenosis of the culprit lesion were quantified. In patients with non-STEMI/UAP and SAP, aspiration was not performed. Average diameter of stenosis was similar in patients with STEMI and those with SAP (66 +/- 12% vs 65 +/- 10%, respectively; p = NS), but was slightly larger in patients with non-STEMI/UAP (71 +/- 12%; p <0.05 vs both STEMI and SAP). In patients with STEMI, only 11% of culprit stenoses were found to have diameter stenosis <50% after removal of the thrombus. In conclusion, most STEMIs occurred at the site of severe coronary stenosis. Diameter stenosis severity was <50% in a minority of cases.
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Cuisset T, Hamilos M, Sarma J, Sarno G, Wyffels E, Vanderheyden M, Barbato E, Bartunek J, De Bruyne B, Wijns W. Relation of low response to clopidogrel assessed with point-of-care assay to periprocedural myonecrosis in patients undergoing elective coronary stenting for stable angina pectoris. Am J Cardiol 2008; 101:1700-3. [PMID: 18549843 DOI: 10.1016/j.amjcard.2008.02.054] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 02/02/2008] [Accepted: 02/02/2008] [Indexed: 11/16/2022]
Abstract
Impaired responses to antiplatelet therapy assessed by laboratory tests are associated with an increased risk of recurrent ischemic events after percutaneous coronary intervention (PCI). This study was designed to determine the relation between responses to aspirin and clopidogrel as assessed by a point-of-care assay (Verify Now, Accumetrics, San Diego, California) and periprocedural myocardial infarction (PMI) in patients undergoing elective PCI for stable angina. One hundred twenty-two consecutive patients undergoing elective coronary stenting prospectively received aspirin 500 mg and clopidogrel 600 mg >or=12 hours before PCI. Clopidogrel response was measured with P2Y12 reaction units (PRUs) and percent inhibition P2Y12 from baseline (percent inhibition P2Y12) and aspirin response with aspirin reaction units (ARUs). Troponin T level was considered positive if it was >0.03 ng/ml. Responses to aspirin and clopidogrel were correlated (r=0.42, p <0.0001). PMI occurred in 27 patients (22%) who showed significantly lower percent inhibition P2Y12 (25.3+/-26 vs 38.3+/-25, p=0.01) and a trend toward higher PRU values (221+/-87 vs 193+/-94, p=0.21). We did not find any difference for aspirin response as assessed by ARUs in patients with or without PMI (460+/-82 vs 454+/-73, p = 0.82). Stratification of percent inhibition P2Y12 isolated a quartile of clopidogrel nonresponders (inhibition P2Y12 <15%) with significantly higher incidence of PMI (44% vs 15%, odds ratio 4.6, 95% confidence interval 1.9 to 11.5, p=0.001). In conclusion, point-of-care assessment of clopidogrel response reliably predicted PMI after low- to medium-risk elective PCI for stable angina.
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Cuisset T, Hamilos M, Melikian N, Wyffels E, Sarma J, Sarno G, Barbato E, Bartunek J, Wijns W, De Bruyne B. Direct Stenting for Stable Angina Pectoris Is Associated With Reduced Periprocedural Microcirculatory Injury Compared With Stenting After Pre-Dilation. J Am Coll Cardiol 2008; 51:1060-5. [DOI: 10.1016/j.jacc.2007.11.059] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 11/06/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
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Abstract
OBJECTIVES We sought to investigate the vascular mechanisms of dobutamine-induced myocardial ischemia. BACKGROUND Dobutamine stress is often used as a surrogate for exercise. The effects of dobutamine on the epicardial arteries are incompletely understood and possibly different from those of physical exercise. METHODS Intravenous (IV) dobutamine (40 microg/kg per min) was administered in 19 patients with normal, 23 patients with mildly atherosclerotic, and 12 patients with stenotic coronary arteries. In another two groups of patients with stenotic arteries, IV dobutamine was preceded by 1) an intracoronary (IC) bolus of the alpha-adrenergic blocker phentolamine (12 microg/kg, n = 12); and 2) an IC infusion of the nitric oxide substrate L-arginine (150 micromol/l per min for 20 min, n = 11). Intravenous saline instead of dobutamine was infused into eight patients with normal arteries. After dobutamine (or saline), an IC bolus of isosorbide dinitrate (ISDN, 0.2 mg) was given. Coronary vasomotion was evaluated by quantitative coronary angiography on angiograms obtained after each dose of dobutamine, saline, phentolamine, L-arginine, and ISDN. RESULTS Dobutamine increased the rate-pressure product and heart rate similarly in all patients except those who received saline. Dobutamine induced vasodilation in normal (change in luminal diameter [DeltaLD] vs. baseline: 19 +/- 2%) and in mildly atherosclerotic arteries (DeltaLD: 8 +/- 2%, p < 0.05 vs. normal). In stenotic arteries, dobutamine did not induce significant vasomotion (DeltaLD: -3 +/- 3%); the latter was improved by L-arginine (DeltaLD: 10 +/- 3%, p < 0.05 vs. stenotic arteries) and fully restored by phentolamine (DeltaLD: 19 +/- 3%, p < 0.05 vs. stenotic arteries). CONCLUSIONS Endothelial dysfunction and enhanced alpha-adrenergic tone contribute to the loss of dobutamine-induced vasodilation in coronary atherosclerosis. In contrast to physical exercise, dobutamine does not induce "paradoxical vasoconstriction" of atherosclerotic coronary arteries.
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