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Zadori A, Kis Z, Toth T, Szigeti M, Temesvari A, Fontos G, Nyolczas N, Andreka P. Long-Term Efficacy and Safety of Left Atrial Appendage Closure Procedures. Int Heart J 2023; 64:188-195. [PMID: 36927928 DOI: 10.1536/ihj.22-639] [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: 03/18/2023]
Abstract
The aim of the present single-center, nonrandomized, retrospective study was to assess the safety and long-term efficacy of percutaneous left atrial appendage closure (LAAC) procedures and to compare the different LAAC devices and therapeutic regimes in this respect.Medical data of 136 patients (pts) (mean age, 72.5 ± 7.6 years; score for atrial fibrillation stroke risk estimation [CHA2DS2-VASc], 4.6 ± 1.6; and score for estimation of major bleeding risk for patients on anticoagulant therapy [HAS-BLED], 2.6 ± 0.9) who underwent percutaneous LAAC procedures in Gottsegen National Cardiovascular Center from January 2010 to January 2020 were analyzed.The rates of outpatient cardiac mortality, ischemic brain event, and major bleeding were 3.8, 1, and 1.9/100 pt years, respectively. The rate of successful device deployment was 96.4%. There was one case of procedural mortality (0.7%), one case of device dislocation (0.7%), one case of ischemic stroke (0.7%), and one case of myocardial infarction (0.7%). Two cases of pericardial tamponades (1.5%) and four cases of major femoral complications (3%) occurred. Although the implantation success of different occluder types was similar, significant differences were found concerning procedural characteristics. Patients on single antiplatelet therapy (SAPT) in the first 3 months after the LAAC procedure did not suffer from stroke or embolic events.The present study confirmed the safety and effectivity of percutaneous LAAC. Robust relative stroke risk reduction and less pronounced but significant bleeding risk reduction were observed. Device implantation success was high. The perioperative complication rate was relatively low. The results of long-term observations regarding ischemic events confirmed the safety of using a simplified antithrombotic regime after LAAC in pts with high bleeding risk.
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Affiliation(s)
| | | | | | - Matyas Szigeti
- Imperial Clinical Trials Unit, Stadium House.,Physiological Controls Research Center
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Csanadi B, Fulop G, Szoke S, Szonyi T, Dekany G, Pinter T, Takacs P, Abdelkrim A, Beres A, Fontos G, Andreka P, Nyolczas N, Piroth Z. Correlation of FFR measured after DES implantation with clinical parameters and long-term clinical outcome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2025] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
The role of fractional flow reserve (FFR) measured directly after drug eluting stent (DES) implantation (post-PCI FFR) is not clear in predicting major adverse cardiac events (MACE), and it is not known which clinical parameters affect post-PCI FFR.
Aim
We aimed to clarify the relationship between post-PCI FFR and clinical parameters, post-PCI FFR and long-term MACE and determine the best post-PCI FFR cut-off in MACE prediction.
Method
Patients who underwent post-PCI (DES) FFR measurement at our center between March 2009 and January 2021 were included. We examined the relationship between post-PCI FFR and gender, age, hypertension, diabetes mellitus, hyperlipidemia, indication (acute (ACS) vs. chronic coronary syndrome (CCS)), stent diameter, in-stent restenosis vs de novo lesion category, proximal vs. non-proximal lesion location, LAD (vs. non-LAD) location, and pre-PCI FFR. We sought to determine the correlation between post-PCI FFR and target vessel-related MACE (cardiovascular death (CVD), non-fatal myocardial infarction (MI), recurrent revascularization (TVR)). Optimal cut-off was determined by ROC curves.
Results
Post-PCI FFR measurement was performed in 500 coronary arteries of 434 patients. LAD location (0.86 vs. non-LAD 0.91, p<0.001), male gender (0.87 vs. 0.89, p=0.001), younger age (p=0.0215), smaller stent diameter (p=0.0028) and lower pre-PCI FFR (p=0.0006) proved to be independent predictors of lower post-PCI FFR, no other parameter showed a significant correlation with post-PCI FFR. During a median follow-up of 37 months, 24 CVD, 15 MI and 47 TVR occurred. Follow-up was complete in 96.2% of patients. There was a significant inverse correlation between post-PCI FFR and MACE (p<0.001). Diabetes mellitus (p=0.0024) and in-stent restenosis (0.0356) were also independent predictors of MACE. The best post-PCI FFR cut-off for the total patient population, LAD and non-LAD lesions were 0.83 (p<0.0001), 0.83 (p<0.0001), and 0.88 (p=0.0091), respectively.
Conclusion
LAD location, male gender, younger age, smaller stent diameter and lower pre-PCI FFR value result in lower post-PCI FFR. There is no significant difference between post-PCI FFR measured in ACS vs. CCS. FFR measured after PCI, diabetes mellitus and in-stent restenosis are significant predictors of MACE-free long-term survival. The best post-PCI FFR cut-off to predict MACE was 0.83 for the whole patient population and for LAD and 0.88 for non-LAD lesions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Csanadi
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - G Fulop
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - S Szoke
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - T Szonyi
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - G Dekany
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - T Pinter
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - P Takacs
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - A Abdelkrim
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - A Beres
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - G Fontos
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - P Andreka
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - N Nyolczas
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - Z Piroth
- Gottsegen National Cardiovascular Center , Budapest , Hungary
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Vertesaljai M, Denes M, Temesvari A, Fontos G, Andreka P. Percutaneous paravalvular leak closure: a single-centre experience of 54 cases. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.140] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Clinically significant paravalvular leak (PVL) occurs in 5-10% of patients undergoing surgical aortic and 5-17% patients undergoing surgical mitral valve replacement and even more often after trancutaneous aortic valve implantation (TAVI). Surgical repair of a PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL (pPVLC) has emerged as an alternative to surgical repair.
Aim
We retrospectively analysed the success rate and clinical outcomes of patients with significant PVL, who were turned down from re-do cardiac surgery, and treated with pPVLC at our tertiary referral centre.
Methods
Patients who were admitted for pPVLC between 27th of September, 2009 and 21st of April, 2021 were enrolled into the study. 30-day and 1-year mortality rates were assessed. Technically successful pPVLC was defined as stable device position, and minimum 1 grade reduction in PVL severity.
Results
pPVLC was performed in 54 cases (32 males, 22 females, mean age: 69.5 ± 10.9 yrs). The main indication for closure was heart failure (81%) and haemolysis (19%). The median time since valve surgery was 4.5 yrs (IQR: 0.9-15.2 yrs). Regarding the leaks, 70% (n = 38) were in mitral position (mechanical vale: 33 cases, bioprosthesis: 5 cases) and 30% (n = 16) in aortic position (mechanical valve: 12 cases, bioprosthesis: 2 cases, TAVI: 2 cases). A total of 53 leaks were identified in mitral position (one leak: 25 cases, two leaks: 11 cases, three leaks: 2 cases), and 25 leaks in aortic position (9 cases, 5 cases and two cases resp.). In mitral position 1 device was used in 73% of cases, 2 devices in 21%, and 3 devices in 6%. In aortic position: 62%, 19%, and 19 % resp. Techinal succes was achieved in 49 case (91%). The 30-day mortality was 8%, the 1-year mortality 21%.
Conclusions
Patients with significant PVL represent an extreme or even prohibitive surgical risk cohort. In these high risk individuals percutaneous PVL offers a safe alternative to surgical PVL repair and appears particularly effective in patients presenting with heart failure or haemolysis.
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Affiliation(s)
- M Vertesaljai
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - M Denes
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - A Temesvari
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - G Fontos
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - P Andreka
- Gottsegen National Cardiovascular Center, Budapest, Hungary
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Piroth Z, Fulop G, Klerk BB, Omerovic E, Andreka P, Fontos G, Neumann FJ, Richardt G, Abdelghani M, Smits P. TCT-193 The Correlation and Relative Prognostic Value of FFR and Pd/Pa of Nonculprit Lesions in STEMI. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1046] [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: 10/20/2022]
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Dekany G, Fontos G, Satish S, Szabo G, Pinter T, Piroth Z, Vertesaljai M, Pal M, Mandzak A, Gulyas Z, Gharehdaghi S, Ferenci T, Andreka P. The prognostic value of immediate post-TAVI hemodynamic evaluation is superior to aortography and transoesophageal echocardiography in predicting patient survival. Int J Cardiol 2020; 329:153-161. [PMID: 33359335 DOI: 10.1016/j.ijcard.2020.12.058] [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] [Received: 06/08/2020] [Revised: 11/05/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although post-TAVI PAR is commonly seen, its exact evaluation, grading and the true impact on patients' survival are still debated. This single center study aimed to evaluate the effect of post transcatheter aortic valve implantation (TAVI) paravalvular aortic regurgitation (PAR) on patients' survival. The outcome was evaluated by the three most commonly used techniques just after TAVI in the interventional arena. METHODS 201 high risk patients with severe symptomatic aortic stenosis underwent TAVI with the self-expandable system. The severity of post-TAVI PAR was prospectively evaluated by aortography and transesophageal echocardiography (TEE) using a four-class scheme and hemodynamic evaluation by calculation of the regurgitation index (RI). Median follow up time was 763 days. RESULTS Post-TAVI PAR results of the three different modalities were concordant with each other (all p < 0.001). Patients with grade 0-I PAR by aortography had better long term outcomes compared to those who had grade II-III PAR (unadjusted HR 1.77 [95% CI, 1.04-3.01], p = 0.03). Although in multivariate analysis neither aortography nor TEE were shown to be significant predictors of survival, hemodynamic assessment using the exact RI result was a significant predictor of survival and its effect was found to be linear (adjusted HR 0.72 [95% CI, 0.52-0.98] for 10% point increase in RI, p = 0.03595). CONCLUSIONS Among the three modalities that are frequently used to evaluate the outcome, post-TAVI RI showed the highest added predictive value for survival.
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Affiliation(s)
- Gabor Dekany
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary.
| | - Geza Fontos
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Sai Satish
- Appolo Hospital, Department of Cardiology Chennai, India
| | | | - Tunde Pinter
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Zsolt Piroth
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Matyas Pal
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Adrienn Mandzak
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Zalan Gulyas
- Military Hospital, Department of Cardiology, Budapest, Hungary
| | | | - Tamas Ferenci
- Obuda University Physiological Controls Research Centre, Budapest, Hungary; Corvinus University of Budapest, Department of Statistics, Budapest, Hungary
| | - Peter Andreka
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
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6
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Dekany G, Piroth ZG, Fontos G, Pinter T, Vertesaljai M, Pal M, Satish S, Fereci T, Mandzak A, Szabo G, Gulyás Z, Andreka P. TCT CONNECT-469 Paravalvular Aortic Regurgitation After TAVI. Aortography, Echocardiography and Hemodynamic Assessment in Relation to Survival. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.498] [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: 12/01/2022]
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7
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Hara H, van Klaveren D, Takahashi K, Kogame N, Chichareon P, Modolo R, Tomaniak M, Ono M, Kawashima H, Wang R, Gao C, Niethammer M, Fontos G, Angioi M, Ribeiro VG, Barbato E, Leandro S, Hamm C, Valgimigli M, Windecker S, Jüni P, Steg PG, Verbeeck J, Tijssen JGP, Sharif F, Onuma Y, Serruys PW. Comparative Methodological Assessment of the Randomized GLOBAL LEADERS Trial Using Total Ischemic and Bleeding Events. Circ Cardiovasc Qual Outcomes 2020; 13:e006660. [PMID: 32762446 DOI: 10.1161/circoutcomes.120.006660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Time-to-first-event analysis considers only the first event irrespective of its severity. There are several methods to assess trial outcomes beyond time-to-first-event analysis, such as analyzing total events and ranking outcomes. In the GLOBAL LEADERS study, time-to-first-event analysis did not show superiority of ticagrelor monotherapy following one-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention to conventional 12-month DAPT followed by aspirin monotherapy in the reduction of the primary composite end point of all-cause mortality or new Q-wave myocardial infarction. This study sought to explore various analytical approaches in assessing total ischemic and bleeding events after percutaneous coronary intervention in the GLOBAL LEADERS study. METHODS AND RESULTS Total ischemic and bleeding events were defined as all-cause mortality, any stroke, any myocardial infarction, any revascularization, or Bleeding Academic Research Consortium grade 2 or 3 bleeding. We used various analytical approaches to analyze the benefit of ticagrelor monotherapy over conventional DAPT. For ischemic and bleeding events at 2 years after percutaneous coronary intervention, ticagrelor monotherapy demonstrated a 6% risk reduction, compared with conventional 12-month DAPT in time-to-first-event analysis (hazard ratio, 0.94 [95% CI, 0.88-1.01]; log-rank P=0.10). In win ratio analysis, win ratio was 1.05 (95% CI, 0.97-1.13; P=0.20). Negative binomial regression and Andersen-Gill analyses which include repeated events showed statistically significant advantage for ticagrelor monotherapy (rate ratio, 0.92 [95% CI, 0.85-0.99; P=0.020] and hazard ratio, 0.92 [95% CI, 0.85-0.99; P=0.028], respectively), although in weighted composite end point analysis, the hazard ratio was 0.93 (95% CI, 0.84-1.04; log-rank P=0.22). CONCLUSIONS Statistical analyses considering repeated events or event severity showed that ticagrelor monotherapy consistently reduced ischemic and bleeding events by 5% to 8%, compared with conventional 1-year DAPT. Applying multiple statistical methods could emphasize the multiple facets of a trial and result in accurate and more appropriate analyses. Considering the recurrence of ischemic and bleeding events, ticagrelor monotherapy appeared to be beneficial after percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01813435.
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Affiliation(s)
- Hironori Hara
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (H.H., K.T., N.K., P.C., R.M., M.O., H.K., J.G.P.T.)
| | - David van Klaveren
- Department of Public Health, Center for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands (D.v.K.).,Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (D.v.K.)
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (H.H., K.T., N.K., P.C., R.M., M.O., H.K., J.G.P.T.)
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (H.H., K.T., N.K., P.C., R.M., M.O., H.K., J.G.P.T.)
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (H.H., K.T., N.K., P.C., R.M., M.O., H.K., J.G.P.T.).,Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Thailand (P.C.)
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (H.H., K.T., N.K., P.C., R.M., M.O., H.K., J.G.P.T.).,Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Brazil (R.M.)
| | - Mariusz Tomaniak
- Department of Cardiology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands (M.T.).,First Department of Cardiology, Medical University of Warsaw, Poland (M.T.)
| | - Masafumi Ono
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (H.H., K.T., N.K., P.C., R.M., M.O., H.K., J.G.P.T.)
| | - Hideyuki Kawashima
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (H.H., K.T., N.K., P.C., R.M., M.O., H.K., J.G.P.T.)
| | - Rutao Wang
- Department of Cardiology, Radboud University, Nijmegen, the Netherlands (R.W., C.G.)
| | - Chao Gao
- Department of Cardiology, Radboud University, Nijmegen, the Netherlands (R.W., C.G.)
| | - Margit Niethammer
- Medizinische Klinik I, Herz-Thorax Zentrum, Klinikum Fulda, Germany (M.N.)
| | | | - Michael Angioi
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary (G.F.).,Department of Interventional Cardiology Clinique Louis Pasteur Essey-les-Nancy, France (M.A.)
| | | | - Emanuele Barbato
- Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy (E.B.)
| | - Sergio Leandro
- Instituto Nacional De Cardiologia, Rio de Janeiro, Brazil (S.L.)
| | - Christian Hamm
- Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany (C.H.)
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland (M.V., S.W.)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland (M.V., S.W.)
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto, Canada (P.J.)
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Clinical Trials), Université de Paris, Hôpital Bichat, Assistance-Publique-Hôpitaux de Paris, and INSERM Unité 1148, France (P.G.S.).,Imperial College, Royal Brompton Hospital, London, United Kingdom (P.G.S.)
| | | | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (H.H., K.T., N.K., P.C., R.M., M.O., H.K., J.G.P.T.)
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (F.S., Y.O., P.W.S.)
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (F.S., Y.O., P.W.S.)
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (F.S., Y.O., P.W.S.).,NHLI, Imperial College London, United Kingdom (P.W.S.)
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Pal M, Dekany G, Mandzak A, Piroth ZS, Fontos G, Andreka P. P1811 Prognostic impact of different subtypes of severe aortic stenosis undergoing transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1162] [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: 11/14/2022] Open
Abstract
Abstract
Background
Outcomes for different subtypes of aortic stenosis defined by transvalvular flow and gradient after transcatheter aortic valve implantation (TAVI) are still subjects of debate.
Purpose
The aim of the study was to evaluate the prognostic impact of the initial transvalvular flow rate and aortic mean gradient on survival and to assess the changes of left ventricular function after TAVI.
Patients and Methods
From 2008. to 2017.06.30. TAVI was performed in 300 cases in our Institute (127 men, 173 women, mean age 80,0 ± 5,8 years) with severe (aortic valve area <1,0 cm²) symptomatic aortic stenosis (AS) and contraindication or high risk for surgery. Median time for follow-up was 28 (0-115) months, Echocardiography was performed before and 12 months after TAVI. Patients were divided into four groups according to flow (F) , aortic mean gradient (Gr) and ejection fraction (EF):
HG
Gr ≥ 40 mmHg (n = 237)
LF-LG : F ≤ 35 ml/m2, Gr < 40 mmHg and EF < 50% (n = 41)
PLF-LG: F ≤ 35 ml/m2, Gr < 40 mmHg and EF ≥50% (n = 9)
NF-LG: F > 35 ml/m2 and Gr < 40 mmHg (n = 13)
Our primary objective was the analysis of 30-day, 1-year and 3-year all-cause mortality of these groups, secondary goal was to observe the changes in EF after 12 months in the survivors.
Results
In the whole patient group 30-day all-cause mortality was 4,3%, 1-year 17,0% and 3-year 62,0%. The NFLG group had the most favourable outcomes (mortality: 30d 0, 1-year: 7,7%, 3-year: 46,2%). Mortality was low in the HG group in the 1st year (30-day: 3,8%, 1-y: 14,3%), but it increased to 62,8% at 3-year. Mortality rates were intermediate in the PLF-LG group (30-day 0, 1-year 22,2%, 3-year 55,6%) and were the highest in LF-LG (30-day 12,2%, p = 0,03 vs HG, 1-year 34,2% p = 0,005 vs. HG, 3-year 75,6%).
Among clinical and echocardiographic variables only moderate or severe paravalvular aortic regurgitation (p = 0,03) and severe renal dysfunction (GFR <30 ml/min, p = 0,02) were independent predictors of all-cause 1-year mortality.
In patients with severe (EF < 30%) , moderate (EF 30-40%) or mild ( EF 41-50%) systolic dysfunction the EF improved after TAVI (23,5 ± 3,5% vs. 30,3 ± 7,9% p < 0,001, 33,6 ±3,6% vs. 43,0 ± 10,5% p = 0,003, 45,5 ± 3,1% vs. 54,3 ± 8,7% p < 0,001) regardless of the initial flow and gradient subtype of AS.
Conclusions
Low flow-low gradient aortic stenosis is associated with worse short or long term prognosis after TAVI, therefore this subtype of AS needs detailed risk stratification before-, and careful management after TAVI. Improvement of initial left ventricular dysfuncion can be expected after TAVI.
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Affiliation(s)
- M Pal
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - G Dekany
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - A Mandzak
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - Z S Piroth
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - G Fontos
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - P Andreka
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
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9
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Chichareon P, Modolo R, Tomaniak M, Kogame N, Fontos G, Lantelme P, Barraud P, Hamm C, Steg G, Juni P, Vranckx P, Valgimigli M, Windecker S, Onuma Y, Serruys PW. 3331Impact of baseline hemoglobin level and white blood cell count in real-world patients undergoing contemporary percutaneous coronary intervention: insights from the GLOBAL LEADER study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0083] [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
Introduction
The impact of hemoglobin (Hb) level and white blood cell count (WBC) on the outcomes in all-comers PCI patients is unknown.
Purpose
We sought to assess the association between baseline Hb level, WBC count on 2-year outcomes after PCI in all-comers patients in the GLOBAL LEADERS study. We compared the outcomes between anemic and non-anemic patients according to WHO definition.
Methods
GLOBAL LEADERS study assessed the efficacy and safety of two antiplatelet strategies in 15,991 patients undergoing PCI. The primary endpoint was all-cause mortality or new Q wave myocardial infarction (MI) at 2 years. Secondary safety endpoint was BARC 3 or 5 bleeding at 2 years.
The association between WBC count, Hb level and outcomes at 2 years were assessed in the multivariable Cox model adjusted for age, diabetes, ejection fraction and renal impairment. For Hb level, patients were categorized according to the WHO definition of anemia (Hb <12 g/dL in women, Hb <13 g/dL in men).
Results
Of 15991 patients randomized in the GLOBAL LEADER study, baseline WBC count and Hb levels were available in 14960 (93.7%) patients and 15215 (95.3%) patients, respectively.
Hb level had an inverse association with adverse events after PCI. In the multivariable Cox model, Hb level was an independent predictor for ischemic and bleeding outcomes at 2 years while the WBC count was not (see table).
Compared with non-anemic patients, anemic patients had significantly higher risk of primary endpoint (adjusted HR 2.07, 95% CI 1.72–2.49), BARC 3 or 5 bleeding (adjusted HR 1.49 95% CI 1.14–1.96), all-cause mortality (adjusted HR 2.33, 95% CI 1.89–2.86), any MI (adjusted HR 1.41, 95% CI 1.11–1.80), and any revascularization (adjusted HR 1.20, 95% CI 1.03–1.39).
Hb level, WBC count and 2-year outcomes Outcomes at 2 years Hemoglobin level (mg/dL) WBC count (109/L) HR (95% CI) P value HR (95% CI) P value All-cause mortality or new Q wave MI 0.87 (0.82–0.91) <0.0001 1.00 (0.999–1.002) 0.33 All-cause mortality 0.82 (0.78–0.87) <0.0001 1.00 (0.999–1.002) 0.37 Any myocardial infarction 0.93 (0.87–0.99) 0.0165 1.00 (0.996–1.001) 0.23 Any revascularization 0.96 (0.93–1.00) 0.0302 1.00 (1.00–1.001) 0.25 BARC 3 or 5 bleeding 0.85 (0.79–0.91) <0.0001 1.00 (0.997–1.002) 0.76
Conclusion
In the all-comers patients undergoing PCI, the baseline Hb level was significantly associated with the ischemic and bleeding outcomes at 2 years whereas baseline WBC count was not. Baseline WBC count may not be useful as a prognostic factor after PCI.
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Affiliation(s)
- P Chichareon
- Amsterdam University Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - R Modolo
- Amsterdam University Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - M Tomaniak
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - N Kogame
- Amsterdam University Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - G Fontos
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - P Lantelme
- Hospital La Croix-Rousse - Hcl, Lyon, France
| | - P Barraud
- Clinique des Domes, Clermont Ferrand, France
| | - C Hamm
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - G Steg
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Juni
- St. Michael's Hospital, Toronto, Canada
| | - P Vranckx
- Virga Jesse Hospital, Hasselt, Belgium
| | - M Valgimigli
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - S Windecker
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - P W Serruys
- Imperial College London, London, United Kingdom
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Piroth Z, Ferenci T, Fontos G, Szonyi T, Nemeth J, Szoke S, Chaurasia AK, Andreka P. Five-year outcome of consecutive unprotected left main percutaneous coronary interventions. Acta Cardiol 2017. [DOI: 10.1080/ac.71.6.3178183] [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: 10/19/2022]
Affiliation(s)
- Zsolt Piroth
- Hungarian Institute of Cardiology, Budapest, Hungary
| | - Tamas Ferenci
- Óbuda University, John von Neumann Faculty of Informatics, Physiological Controls Group, Budapest, Hungary
| | - Geza Fontos
- Hungarian Institute of Cardiology, Budapest, Hungary
| | - Tibor Szonyi
- Hungarian Institute of Cardiology, Budapest, Hungary
| | - Jozsef Nemeth
- Hungarian Institute of Cardiology, Budapest, Hungary
| | - Sandor Szoke
- Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Peter Andreka
- Hungarian Institute of Cardiology, Budapest, Hungary
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Piroth Z, Ferenci T, Fontos G, Szonyi T, Nemeth J, Szoke S, Chaurasia AK, Andreka P. Five-year outcome of consecutive unprotected left main percutaneous coronary interventions. Acta Cardiol 2016; 71:654-662. [PMID: 27920452 DOI: 10.2143/ac.71.6.3178183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Koschutnik M, Ionin VA, Boeckstaens S, Zakhama L, Hinojar R, Chiu DYY, Kovacs A, Kochmareva EA, Saliba E, Stanojevic D, Aalen J, Chen XH, Zito C, Demerouti E, Smarz K, Krljanac G, Christensen NL, Cavalcante JL, Pal M, Magne J, Giannakopoulos G, Liu D, Chien CY, Moustafa TAMER, Schwaiger M, Zotter-Tufaro C, Aschauer S, Duca F, Kammerlander A, Bonderman D, Mascherbauer J, Zaslavskaya EL, Soboleva AV, Listopad OV, Malikov KN, Baranova EI, Shlyakhto EV, Van Der Hoogstraete M, Coltel N, De Laet N, Beernaerts C, Desmet K, Gillis K, Droogmans S, Cosyns B, Antit S, Herbegue B, Slama I, Belaouer A, Chenik S, Boussabah E, Thameur M, Masmoudi M, Benyoussef S, Fernandez-Golfin C, Gonzalez-Gomez A, Casas E, Garcia Martin A, Pardo A, Del Val D, Ruiz S, Moya JL, Barrios V, Jimenez Nacher JJ, Zamorano JL, Kalra PA, Green D, Hughes J, Sinha S, Abidin N, Muraru D, Lakatos BK, Surkova E, Peluso D, Toser Z, Tokodi M, Merkely B, Badano LP, Volkova AL, Rusina VA, Kokorin VA, Gordeev IG, Baudet M, Chartrand Lefebvre C, Chen-Tournoux A, Hodzic A, Tournoux F, Apostolovic S, Jankovic-Tomasevic R, Djordjevic-Radojkovic D, Salinger-Martinovic S, Kostic T, Tahirovic E, Dungen HD, Andersen OS, Gude E, Andreassen A, Aalen OO, Larsen CK, Remme EW, Smiseth OA, Xu HG, Liu FC, Zha DG, Cui K, Zhang AD, Trio O, Soraci E, Cusma Piccione M, D'amico G, Ioppolo A, Alibani L, Falanga G, Todaro MC, Oreto L, Nucifora G, Vizzari G, Pizzino F, Di Bella G, Carerj S, Boutsikou M, Perreas K, Katselis CH, Samanidis G, Antoniou TH, Karatasakis G, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Bartoszewicz Z, Budaj A, Trifunovic D, Asanin M, Savic L, Matovic D, Petrovic M, Zlatic N, Mrdovic I, Dahl JS, Carter-Storch R, Bakkestroem R, Soendergaard E, Videbaek L, Moeller JE, Rijal S, Abdelkarim I, Althouse AD, Sharbaugh MS, Fridman Y, Han W, Soman P, Forman DE, Schindler JT, Gleason TG, Lee JE, Schelbert EB, Dekany G, Mandzak A, Chaurasia AK, Gyovai J, Hegedus N, Piroth ZS, Szabo GY, Fontos G, Andreka P, Cosyns B, Popescu BA, Carstensen HG, Dahl J, Desai M, Kearney L, Marwick T, Sato K, Takeuchi M, Zito C, Mohty D, Lancellotti P, Habib G, Noble S, Frei A, Mueller H, Hu K, Liebner E, Weidemann F, Herrmann S, Ertl G, Voelker W, Gorski A, Leyh R, Stoerk S, Nordbeck P, Tsai WC, Moustafa TAMER, Aldydamony MOHAMD, Aldydamony MOHAMD. Poster Session 5The imaging examination and quality assessmentP1064The natural course of heart failure with preserved ejection fraction (HFpEF) - insights from an exploratory echocardiographic registryP1065Epicardial fat and effectiveness of catheter radiofrequency ablation in patients with atrial fibrillation and metabolic syndromeP1066Systematic disinfection of echocardiographic probe after each examination to reduce the persistence of pathogens as a potential source of nosocomial infectionsP1067Left atrial mechanical function assessed by two-dimensional echocardiography in hypertensive patientsP1068Real live applications of three-dimensional echocardiographic quantification of the left ventricular volumes and function using an automated adaptive analytics algorithmP10693D echocardiographic left ventricular dyssynchrony indices in end stage kidney disease: associations and outcomesP1070Relative contribution of right ventricular longitudinal shortening and radial displacement to global pump function in healthy volunteersP1071ECHO-parameters, associated with short-term mortality and long-term complications in patients with pulmonary embolism of high and intermediate riskP1072Increased epicardial fat is an independent marker of heart failure with preserved ejection fraction.P1073Influence of optimized beta-blocker therapy on diastolic dysfunction determined echocardiographically in heart failure patientsP1074Early diastolic mitral flow velocity/ annular velocity ratio is a sensitive marker of elevated filling pressure in left ventricular dyssynchronyP1075Left ventricular diastolic function in STEMI patients receiving early and late reperfusion by percutaneous coronary intervention P1076Could anatomical and functional features predict cerebrovascular events in patients with patent foramen ovale?P1077Efficacy of endarterectomy of the left anterior descending artery: evaluation by adenosine echocardiography?P1078Left ventricular diastolic dysfunction after acute myocardial infarction with preserved ejection fraction is related to lower exercise capacityP1079Potentially predictors of ventricular arrhythmia during six months follow up in STEMI patientsP1080Association between left atrial dilatation and invasive haemodynamics at rest and during exercise in asymptimatic aortic stenosisP1081Cardiac amyloidosis and aortic stenosis - the convergence of two aging processes and its association with outcomesP1082Prognostic impact of initial left ventricular dysfunction and mean gradient after transcatheter aortic valve implantationP1083Distribution and prognostic significance of left ventricular global longitudinal strain in asymptomatic significant aortic stenosis: an individual participant data meta-analysisP1084Discrepancies between echocardiographic and invasive assessment of aortic stenosis in multimorbid elderly patientsP1085Echocardiographic determinants and outcome of patients with low-gradient moderate and severe aortic valve stenosis: implications for aortic valve replacementP1086Atrial deformation correlated with functional capacity in mitral stenosisP1087Net atrioventricular compliance can predict reduction of pulmonary artery pressure after percutaneous mitral balloon commissurotomy. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lesiak M, Bartorelli AL, Grundeken MJ, Genereux P, Wykrzykowska JJ, Francese DP, Kumsars I, Kini A, Lefevre T, Garcia-Garcia HM, Fontos G, Stella PR, Ungi I, Laak LL, Kaplan A, Onuma Y, Leon M, Serruys PW. TCT-491 Incidence of Peri-Procedural Myocardial Infarction after Bifurcation Percutaneous Coronary Intervention According to Different Definitions: Insight from the Tryton IDE randomized trial. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Piroth Z, Ferenci T, Fontos G, Szonyi T, Nemeth J, Szoke S, Chaurasia AK, Andreka P. TCT-496 5-year outcome of consecutive left main coronary artery percutaneous coronary interventions. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.512] [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: 10/23/2022]
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Toth G, Fontos G, Andreka P. Acute coronary syndrome with unexpected background: rupture of left valsalva sinus aneurysm. J Am Coll Cardiol 2011; 58:e5. [PMID: 21737010 DOI: 10.1016/j.jacc.2010.11.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/21/2010] [Accepted: 11/03/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Gabor Toth
- Hungarian Institute of Cardiology, Budapest, Hungary
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Vertesaljai M, Piroth Z, Fontos G, Andreka G, Font G, Szantho G, Lueff S, Reti M, Masszi T, Ablonczy L, Juhasz ED, Simor T, Turner MS, Andreka P. Drugs, gene transfer, signaling factors: a bench to bedside approach to myocardial stem cell therapy. Heart Fail Rev 2007; 13:227-44. [PMID: 17668319 DOI: 10.1007/s10741-007-9047-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 07/03/2007] [Accepted: 07/10/2007] [Indexed: 12/13/2022]
Abstract
In the past few years, the dogma that the heart is a terminally differentiated organ has been challenged. Evidence from preclinical investigations emerged that there are cells, even in the heart itself, that may be able to restore impaired cardiac function after myocardial infarction. Although the exact mechanisms by which the infarcted heart can be repaired by stem cells are not yet fully defined, there is a new optimism among cardiologists that this treatment will prove successful in addressing the cause of heart failure after myocardial infarction-myocyte loss. Despite the promising preliminary data of human myocardial stem cell trials, scientists have also focused on the possibility of enhancing the underlying mechanisms of stem cell repair to gain healthier myocardial tissue. Attempts to induce neo-angiogenesis by transfecting stem cells with signaling factors (such as VEGF), to raise the number of endothelial progenitor cells with medical treatments (such as statins), to transfect stem cells with heat shock protein 70 (as a cardioprotective agent against ischemia) and to enhance the healing process after myocardial infarction with the use of various forms of stimulating factors (G-CSF, SCF, GM-CSF) have been made with notable results. In this article, we summarize the evidence from preclinical and clinical myocardial stem cell studies that have addressed the possibility of enhancing the regenerative capacity of cells used after myocardial infarction.
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Affiliation(s)
- Marton Vertesaljai
- Department of Adult Cardiology, Gottsegen Hungarian Institute of Cardiology, Haller u. 29, Budapest 1096, Hungary
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Andreka G, Vertesaljai M, Szantho G, Font G, Piroth Z, Fontos G, Juhasz ED, Szekely L, Szelid Z, Turner MS, Ashrafian H, Frenneaux MP, Andreka P. Remote ischaemic postconditioning protects the heart during acute myocardial infarction in pigs. Heart 2007; 93:749-52. [PMID: 17449499 PMCID: PMC1955207 DOI: 10.1136/hrt.2006.114504] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [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] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Ischaemic preconditioning results in a reduction in ischaemic-reperfusion injury to the heart. This beneficial effect is seen both with direct local preconditioning of the myocardium and with remote preconditioning of easily accessible distant non-vital limb tissue. Ischaemic postconditioning with a comparable sequence of brief periods of local ischaemia, when applied immediately after the ischaemic insult, confers benefits similar to preconditioning. OBJECTIVE To test the hypothesis that limb ischaemia induces remote postconditioning and hence reduces experimental myocardial infarct size in a validated swine model of acute myocardial infarction. METHODS Acute myocardial infarction was induced in 24 pigs with 90 min balloon inflations of the left anterior descending coronary artery. Remote ischaemic postconditioning was induced in 12 of the pigs by four 5 min cycles of blood pressure cuff inflation applied to the lower limb immediately after the balloon deflation. Infarct size was assessed by measuring 72 h creatinine kinase release, MRI scan and immunohistochemical analysis. RESULTS Area under the curve of creatinine kinase release was significantly reduced in the postconditioning group compared with the control group with a 26% reduction in the infarct size (p<0.05). This was confirmed by MRI scanning and immunohistochemical analysis that revealed a 22% (p<0.05) and a 47.52% (p<0.01) relative reduction in the infarct size, respectively. CONCLUSION Remote ischaemic postconditioning is a simple technique to reduce infarct size without the hazards and logistics of multiple coronary artery balloon inflations. This type of conditioning promises clear clinical potential.
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Affiliation(s)
- Gyorgy Andreka
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
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