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Kuzemczak M, Lipiecki J, Jeyalan V, Farhat H, Kleczyński P, Legutko J, Minten L, Bennett J, Poels E, Dens J, Spyridopoulos I, Kunadian V, Pawłowski T, Gil R, Egred M, Zaman A, Alkhalil M. Clinical outcomes of coronary intravascular lithotripsy in patients with stent failure (COIL registry). Int J Cardiol 2023; 391:131274. [PMID: 37598907 DOI: 10.1016/j.ijcard.2023.131274] [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: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) has been demonstrated to be an effective treatment of calcified de novo coronary lesions. Safety data on the use of IVL within stented segments are lacking. We sought to evaluate the safety, feasibility, and long-term outcomes of IVL in patients with stent failure. METHODS This was a retrospective multi-centre registry that included consecutive patients with stent failure who had undergone IVL treatment. The primary efficacy endpoint was procedural success defined as residual stenosis <30% (determined by quantitative coronary angiography analysis) in patients who survived hospital admission without in-hospital adverse events. Major adverse cardiovascular events (MACE) were defined as the composite endpoints of cardiovascular death, spontaneous myocardial infarction, and target vessel revascularisation at one-year follow up. RESULTS 102 patients were included in this study. Mean age was 73 ± 9 years and 81% were male. The duration from previous stent implantation and IVL treatment was 24 (interquartile range 7-76) months, of which 10.8% received IVL for acute under-expanded stent. IVL treatment allowed significant improvement in both minimal lumen diameter (1.14 ± 0.60 to 2.53 ± 0.59, P < 0.001) and degree of stenosis (66.8 ± 19.9 to 20.3 ± 11.3%, P < 0.001). The rate of procedural success was 78.4% (80/102 of patients). The one-year MACE was 15.7%. Ostial disease (HR 5.16; 95% CI 1.19 to 22.33; P = 0.028) and lesion length (HR 1.05; 95% CI 1.01 to 1.10; P = 0.010) were independently associated with one-year MACE. CONCLUSIONS In patients with stent failure, IVL is a safe and feasible treatment for this high-risk group.
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Affiliation(s)
- Michał Kuzemczak
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Poznań University of Medical Sciences, Division of Emergency Medicine, Poznań, Poland
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Visvesh Jeyalan
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hicham Farhat
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland; Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland; Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland
| | - Lennert Minten
- Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Ioakim Spyridopoulos
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Vijay Kunadian
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Tomasz Pawłowski
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Robert Gil
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Mohaned Egred
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Azfar Zaman
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.
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Kałmucki P, Lipiecki J, Witte KK, Goldberg SL, Baszko A, Siminiak T. Percutaneous mitral annuloplasty with the Carillon device: Outcomes in proportionate and disproportionate functional mitral regurgitation. Am Heart J 2023; 265:137-142. [PMID: 37516263 DOI: 10.1016/j.ahj.2023.07.010] [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] [Received: 04/06/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND It has been suggested that the disparity of outcomes between the studies of transcutaneous edge-to-edge repair (TEER) for functional mitral regurgitation (FMR) in heart failure with reduced ejection fraction (HFrEF) could be due to systematic differences in the populations studied. One proposal is that there are 2 broad groups: those with proportional FMR who respond less favorably, and those in whom the FMR is greater than expected (disproportionate) FMR where edge-to-edge TEER seems to be more effective. Whether this grouping is relevant for other percutaneous interventions for FMR is unknown. OBJECTIVES We sought to compare clinical and echocardiographic outcomes of patients with HFrEF and proportionate and disproportionate FMR treated with indirect annuloplasty using the Carillon device. METHODS This is a pooled analysis from 3 trials of patients with FMR. Key patient eligibility in these trials specified persistent grade 2+ to 4+ FMR with >5.5 cm left ventricular (LV) end-diastolic diameter (LVEDD) and reduced ejection fraction. Patients with an effective regurgitant orifice area/LV end-diastolic volume (EROA/LVEDV) ratio under 0.15 were assigned to the proportionate FMR group (n = 74;65%) and those with a ratio above 0.15 were classed as having disproportionate FMR (n = 39;35%). RESULTS At 12 months following treatment, both groups showed improvements in all MR variables including regurgitation volume, EROA and vena contracta. Moreover, in patients with proportionate MR there were clinically relevant and statistically significant improvements in LV volumes and diameters. There was no independent relationship between the degree of proportionality as a continuous variable and the remodeling response to Carillon therapy (change in LVEDV r = 0.17; change in LVESV r = 0.14). CONCLUSION Percutaneous mitral annuloplasty with the Carillon device reduces MR in patients with both proportionate and disproportionate FMR, and also results in LV reverse remodeling in those with proportionate FMR. The effect on remodeling remains to be verified in a large-scale trial.
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Affiliation(s)
- Piotr Kałmucki
- Poznan University of Medical Sciences, HCP Medical Center, Poznan, Poland
| | | | | | - Steven L Goldberg
- Tyler Heart Institute at Community Hospital of the Monterey Peninsula, Monterey, CA; Cardiac Dimensions, Kirkland, WA
| | - Artur Baszko
- Poznan University of Medical Sciences, HCP Medical Center, Poznan, Poland
| | - Tomasz Siminiak
- Poznan University of Medical Sciences, HCP Medical Center, Poznan, Poland.
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Farhat H, Kuzemczak M, Durel N, Caillot N, Pawłowski T, Lipiecki J. Rotational Atherectomy Versus Intravascular Lithotripsy for Calcified In-Stent Restenosis: A Single-Center Study With 1-Year Follow-Up. Am J Cardiol 2023; 205:413-419. [PMID: 37659262 DOI: 10.1016/j.amjcard.2023.07.174] [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: 03/21/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 09/04/2023]
Abstract
Although rotational atherectomy (RA) and intravascular lithotripsy (IVL) have been proved to be effective for calcified de novo coronary lesions, their use in patients with in-stent restenosis (ISR) is still controversial. No comparison of these techniques in patients with ISR has been published so far. We sought to evaluate safety and feasibility of RA and IVL in patients with calcified ISR. Furthermore, we aimed to compare in-hospital and 1-year clinical outcomes between both groups. This is a retrospective single-center study evaluating patients with calcified ISR treated with RA (between 2012 and 2021) and IVL (between 2019 and 2021). Inhospital and 1-year clinical outcomes were compared between IVL and RA patients. In total, 28 patients with ISR who underwent RA were compared with 24 ISR subjects after IVL. The procedural success rate was 100% in both the groups. Quantitative coronary analysis demonstrated a similar degree of stenosis prior (66.4 ± 11.4 vs 68.8 ± 19.7, p = nonsignificant [NS]), and after the procedure (21.5 ± 20.5 vs 22.8 ± 12.1, p = NS) with no difference in acute luminal gain (1.34 ± 0.60 vs 1.38 ± 0.59, p = NS). There was one in-hospital major adverse cardiovascular event in the RA group. At 1-year follow-up, no difference was observed with respect to major adverse cardiovascular event rate (14.3% vs 16.7%, p = NS) and target vessel revascularization (7.1% vs 12.5%, p = NS). In conclusion, RA and IVL are safe and feasible techniques for calcified ISR yielding comparable results at 1-year follow-up. Further clinical studies are warranted to confirm our findings and shed more light on patient and lesion characteristics associated with the best outcomes.
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Affiliation(s)
- Hicham Farhat
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Michał Kuzemczak
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Department of Emergency Medicine, Poznan University of Medical Sciences, Poznań, Poland.
| | - Nicolas Durel
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Nicolas Caillot
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Tomasz Pawłowski
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
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Lipiecki J, Kuzemczak M. Editorial commentary: Functional mitral regurgitation - a moving target in patients with heart failure. Trends Cardiovasc Med 2023; 33:393-394. [PMID: 35341989 DOI: 10.1016/j.tcm.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Janusz Lipiecki
- Pole Santé République, Centre de Cardiologie Interventionnelle, Clermont-Ferrand, France.
| | - Michał Kuzemczak
- Central Clinical Hospital of the Ministry of Interior and Administration, Department of Invasive Cardiology, Warsaw, Poland; Poznan University of Medical Sciences, Poznań, Poland
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Garot P, Brunel P, Dibie A, Morelle JF, Abdellaoui M, Levy R, Carrié D, Karsenty B, Robin C, Berland J, Copt S, Sadozai Slama S, Oldroyd K, Morice MC, Lipiecki J. Comparison of outcomes in patients with or without ARC-HBR criteria undergoing PCI with polymer-free biolimus coated stents: The BioFreedom France study. Catheter Cardiovasc Interv 2023; 101:60-71. [PMID: 36378683 DOI: 10.1002/ccd.30481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/22/2022] [Revised: 08/12/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The polymer-free biolimus coated stent (BioFreedom) was shown to be superior to bare metal stents in the LEADERS FREE randomized trial in high bleeding risk (HBR) patients treated with 1-month dual antiplatelet therapy (DAPT). However, there is limited outcome data with this device in an all-comers' population. METHODS We conducted a prospective single-arm study of patients undergoing percutaneous coronary intervention with the polymer-free biolimus coated stent in 25 centers in France with wide inclusion criteria including multivessel disease, complex lesions, and acute coronary syndromes. The primary endpoint was the incidence of target lesion failure (TLF), a composite of cardiac death or target-vessel myocardial infarction (MI) or clinically indicated target lesion revascularization (ci-TLR) at 1-year. The patient population was classified according to the presence (or not) of HBR criteria according to the recent ARC-HBR definition. RESULTS Between April 2019 and April 2020, 1497 patients were enrolled. TLF occurred in 101 (6.9%) patients, including cardiac death in 35 (2.4%), target vessel MI in 20 (1.4%) and ci-TLR in 65 (4.5%) of them. There were 491 HBR patients (32.8%) and 1006 non-HBR patients. The median duration of DAPT was 74 days in the HBR group versus 348 days in the non-HBR group (p < 0.0001). TLF occurred in 44 (9.2%) of the HBR group and in 57 (5.8%) of the non-HBR group (relative risk 1.62 [95% confidence interval: 1.10-2.41], p = 0015). Compared to the non-HBR group, HBR patients had higher rates of cardiac death (4.4% vs. 1.4%, p = 0.0005) and target vessel MI (2.9% vs. 0.6%, p = 0.0003), but similar rates of ci-TLR. BARC 3-5 bleeding occurred in 6.2% of the HBR group versus 1.4% of the non-HBR group (p < 0.0001). CONCLUSION In this multicenter all-comers study, HBR patients treated with a polymer-free biolimus coated stent had, compared to non-HBR patients, an increased risk of cardiac death and MI, and despite a shorter duration of DAPT, continued to have higher rates of BARC 3-5 bleeding.
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Affiliation(s)
- Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Philippe Brunel
- Institut Cardio-Vasculaire Dijon Bourgogne, Hôpital Privé Dijon Bourgogne, Ramsay-Santé, Dijon, France
| | - Alain Dibie
- Institut Mutualiste Montsouris, Paris, France
| | | | | | - Raphy Levy
- Hôpital Privé Saint-Martin, ELSAN, Bordeaux, France
| | | | | | | | | | - Samuel Copt
- Biosensors International, Morges, Switzerland
| | | | | | - Marie-Claude Morice
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
- Centre Européen de Recherche Cardiovasculaire (CERC), Ramsay-Santé, Massy, France
| | - Janusz Lipiecki
- Clinique des Domes, Pole Santé République, ELSAN, Clermont-Ferrand, France
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Garot P, Brunel P, Dibie A, Morelle JF, Abdellaoui M, Levy R, Carrié D, Karsenty B, Robin C, Berland J, Copt S, Sadozai S, Olroyd K, Morice MC, Lipiecki J. 2 years outcomes in patients with or without ARC-HBR criteria undergoing PCI with polymer-free biolimus coated stents: The Biofreedom France Study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.005] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Honton B, Lipiecki J, Monségu J, Leroy F, Benamer H, Commeau P, Motreff P, Cayla G, Banos JL, Bouchou G, Laperche C, Farah B, Rangé G, Lefèvre T, Amabile N. Mid-term outcome of de novo lesions vs. in stent restenosis treated by intravascular lithotripsy procedures: Insights from the French Shock Initiative. Int J Cardiol 2022; 365:106-111. [PMID: 35870637 DOI: 10.1016/j.ijcard.2022.07.023] [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: 02/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. METHODS Prospective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. RESULTS A total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. CONCLUSIONS In this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted.
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Affiliation(s)
- Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
| | - Janusz Lipiecki
- Department of Interventional Cardiology, Pole Santé République, Clermont-Ferrand, France
| | - Jacques Monségu
- Department of Interventional Cardiology, Institut Cardio Vasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Fabrice Leroy
- Department of Interventional Cardiology, Clinique La Louviere, Lille, France
| | - Hakim Benamer
- Department of Interventional Cardiology, Hôpital La Roseraie, Aubervilliers, France
| | - Philippe Commeau
- Department of Interventional Cardiology, Polyclinique Les Fleurs, Ollioules, France
| | - Pascal Motreff
- Department of Interventional Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Guillaume Cayla
- Department of Interventional Cardiology, Nimes University Hospital, University of Montpellier-Nimes, France
| | - Jean Luc Banos
- Department of Interventional Cardiology, Centre cardiologique du Pays Basque, Bayonne, France
| | - Gael Bouchou
- Department of Interventional Cardiology, Saint Etienne University Hospital, Saint Etienne, France
| | - Clémence Laperche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Bruno Farah
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Grégoire Rangé
- Department of Interventional Cardiology, Centre Hospitalier, Chartres, France
| | - Thierry Lefèvre
- Department of Interventional Cardiology, Institut Cardio-Vasculaire Paris Sud, Ramsay Générale de Santé, Massy, France
| | - Nicolas Amabile
- Department of Interventional Cardiology, Institut Mutualiste Montsouris, Paris, France
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Mauler-Wittwer S, Sievert H, Ioppolo AM, Mahfoud F, Carrié D, Lipiecki J, Nickenig G, Fajadet J, Eckert S, Morice MC, Garot P. Study Evaluating the Use of RenalGuard to Protect Patients at High Risk of AKI. JACC Cardiovasc Interv 2022; 15:1639-1648. [DOI: 10.1016/j.jcin.2022.05.036] [Citation(s) in RCA: 1] [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] [Received: 02/28/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 12/12/2022]
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Lipiecki J, Rampat R, Piot C, Benamer H, Brunelle F, Lefèvre T, El Mahmoud R, Varenne O, Gommeaux A, Malquarti V, Angoulvant D, Cruchon C, Oldroyd K, Spaulding C. Clinical Outcomes in Patients Treated With Biodegradable-Polymer Biolimus-Eluting Stents and 6 Months of Dual-Antiplatelet Therapy: The French eBiomatrix 6-Month DAPT Registry. J Invasive Cardiol 2022; 34:E363-E368. [PMID: 35451995] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dual-antiplatelet treatment (DAPT) has conventionally been prescribed for 1 year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Recent evidence suggests that a duration of only 6 months may be equally safe and effective when using contemporary DES options. OBJECTIVE The aim of this study was to assess clinical outcomes in patients treated with the BioMatrix biodegradable-polymer coated biolimus-eluting stent (BP-BES; Biosensors International) who received only 6 months of DAPT. METHODS This prospective "all-comers" registry enrolled 2038 patients in France. Following PCI, DAPT was started for a recommended period of 6 months. Patients were followed up at 6 and 24 months. The primary endpoint of major adverse cardiac and cerebrovascular event (MACCE) was a composite of all-cause death, cerebrovascular accidents, non-fatal myocardial infarction, or clinically driven target-vessel revascularization. Secondary endpoints included stent thrombosis (ST) and major bleeding (MB). RESULTS The mean age of the study population was 67 ± 10.5 years and 77% of patients were male. Follow-up data were available in 96.9% and 95.3% of patients at 6 and 24 months, respectively. At 6 months, the incidences of MACCE, ST, and MB were 3.1%, 0.3%, and 0.4%, respectively. At 24 months, 21.2% of patients were still on DAPT and the cumulative incidences of MACCE, ST, and MB were 9.7%, 0.54%, and 0.79%, respectively. CONCLUSIONS In this unselected population of patients undergoing PCI with a BP-BES, a 6-month duration of DAPT after implantation is safe and effective.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Christian Spaulding
- Département de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France.
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Lipiecki J, Brunel P, Dibie A, Morelle J, Abdellauoi M, Levy R, Carrié D, Karsenty B, Robin C, Berland J, Maillard L, Pankert M, Depoli F, Delarche N, Boiffard E, Champagne S, Piot C, Morel O, Chapon P, Garot P. Biofreedom France registry: A prospective evaluation of clinical outcomes in real-world patients treated by coronary angioplasty with Biolimus A9 polymer-free Biofreedom stents. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.012] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Witte KK, Kaye DM, Lipiecki J, Siminiak T, Goldberg SL, von Bardeleben RS, Sievert H, Levy WC, Starling RC. Treating symptoms and reversing remodelling: clinical and echocardiographic 1-year outcomes with percutaneous mitral annuloplasty for mild to moderate secondary mitral regurgitation. Eur J Heart Fail 2021; 23:1971-1978. [PMID: 34288287 DOI: 10.1002/ejhf.2310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/13/2020] [Revised: 06/20/2021] [Accepted: 07/16/2021] [Indexed: 01/17/2023] Open
Abstract
AIMS To determine the effects of percutaneous mitral annuloplasty on symptoms, walk distance and left ventricular (LV) structure and function in patients with mild or moderate secondary mitral regurgitation (SMR). METHODS AND RESULTS This was a pooled analysis of patients (n = 68) who, despite guideline-directed medical therapy had symptomatic heart failure (HF) with mild (n = 25) or moderate (n = 43) SMR treated with percutaneous mitral annuloplasty as part of the TITAN, TITAN II, or REDUCE-FMR trials. Primary outcomes were changes in symptoms, 6-min walk distance, and quality of life assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) after 1 year. Secondary analyses included changes in LV structure and function. At 1 year, New York Heart Association class status was maintained (48%) or improved (46%) in most patients, mean KCCQ scores increased from baseline by 10 units [95% confidence interval (CI) 3 to17; P < 0.01] and mean 6-min walk test distance increased by 34 m (95% CI 12 to 57; P < 0.01). SMR grade improved in 25% of patients and was maintained in 58% of patients with changes in mean regurgitant volume of -7 mL (95% CI -11 to -3; P < 0.001), vena contracta -0.11 cm (95% CI -0.20 to -0.02; P < 0.05), and effective regurgitant orifice area -0.03 cm2 (95% CI -0.06 to -0.01; P < 0.05). There were non-significant improvements in LV ejection fraction and volumes. Survival over 1 year was 89% with no difference between mild (96%) and moderate (86%) SMR (log-rank P = 0.22). Progression-free survival was 70% (82% in mild vs. 63% in moderate SMR; P = 0.16). Freedom from HF hospitalization was 73% (87% in mild SMR vs. 66% in moderate SMR; P = 0.07). CONCLUSION Among patients with symptomatic HF and mild or moderate SMR on guideline-directed medical therapy, percutaneous mitral annuloplasty was associated with improvements in symptoms, SMR, a stabilization of LV structure and function, and high survival rates.
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Affiliation(s)
- Klaus K Witte
- Department of Internal Medicine I, University Clinic, RWTH Aachen University, Aachen, Germany
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | | | - Tomasz Siminiak
- HCP Medical Center, Poznan University of Medical Sciences, Poznan, Poland
| | - Steven L Goldberg
- Tyler Heart Institute at Community Hospital of the Monterey Peninsula, Monterey, CA, USA
- Cardiac Dimensions, Kirkland, WA, USA
| | | | - Horst Sievert
- CardioVascular Center Sankt Katherinen, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, UK
| | - Wayne C Levy
- Advanced Heart Failure, Division of Cardiology, University of Washington Heart Institute, Seattle, WA, USA
| | - Randall C Starling
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Kuzemczak M, Lipiecki J, Siminiak T. Transcatheter Mitral Valve Repair: When Is the Last Moment Before Crossing the Styx River? J Am Coll Cardiol 2021; 77:2982. [PMID: 34112327 DOI: 10.1016/j.jacc.2021.03.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/19/2022]
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13
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Khan MS, Siddiqi TJ, Butler J, Friede T, Levy WC, Witte KK, Lipiecki J, Sievert H, Coats AJS. Functional outcomes with Carillon device over 1 year in patients with functional mitral regurgitation of Grades 2+ to 4+: results from the REDUCE-FMR trial. ESC Heart Fail 2021; 8:872-878. [PMID: 33619896 PMCID: PMC8006711 DOI: 10.1002/ehf2.13273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/17/2023] Open
Abstract
AIMS The objective of this study was to compare functional outcomes through 1 year in patients with core-lab verified moderate to severe (Grades 2+ to 4+) functional mitral regurgitation (FMR) treated with the Carillon device or control in the blinded sham-controlled REDUCE-FMR (Carillon Mitral Contour System for Reducing Functional Mitral Regurgitation) study. METHODS AND RESULTS The main outcomes of this analysis were the change in 6 min walk test (6MWT) distance, incidence of heart failure hospitalization or death, change in New York Heart Association (NYHA) class, and change in Kansas City Cardiomyopathy Questionnaire (KCCQ) score through 1 year of follow-up. The minimum clinically important difference (MCID) was defined as a ≥30 m increase in 6MWT distance, an NYHA decrease in ≥1 class, and a ≥3 point increase in KCCQ score. The proportion of patients achieving the MCID in each treatment group was compared using Fisher's exact test, and the number needed to treat (NNT) with the Carillon device was calculated. Among 83 patients (62 Carillon and 21 sham), no statistically significant group differences were observed in the baseline characteristics. All outcomes at 1 year numerically favoured the Carillon group, including MCID for the 6MWT distance (59% vs. 23%, P = 0.029; NNT = 2.8), NYHA class (48% vs. 33%, P = 0.38; NNT = 6.9), KCCQ score (69% vs. 47%, P = 0.14; NNT = 4.5), and freedom from heart failure hospitalization or death (60% vs. 48%, P = 0.45; NNT = 8.3). CONCLUSIONS REDUCE-FMR was the first blinded sham-controlled trial to report outcomes with percutaneous therapy for the treatment of FMR. Trends towards improvement in mean 6MWT distance, KCCQ score, and NYHA class were observed with the Carillon device. A substantially higher number of patients achieved MCID for all patient-centred outcomes with the Carillon device compared with the sham procedure.
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Affiliation(s)
| | - Tariq Jamal Siddiqi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Wayne C Levy
- UW Heart Institute, University of Washington, Seattle, WA, USA
| | - Klaus K Witte
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
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Lipiecki J, Fahrat H, Monzy S, Caillot N, Siminiak T, Johnson T, Vogt S, Stark MA, Goldberg SL. Long-term prognosis of patients treated by coronary sinus-based percutaneous annuloplasty: single centre experience. ESC Heart Fail 2020; 7:3329-3335. [PMID: 33047896 PMCID: PMC7755003 DOI: 10.1002/ehf2.12955] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/28/2020] [Accepted: 07/30/2020] [Indexed: 01/17/2023] Open
Abstract
AIMS This study aims to report long-term mortality, echocardiographic, and clinical outcomes of patients receiving treatment for functional mitral regurgitation (FMR) with the Carillon device. METHODS AND RESULTS This was a single centre analysis of prospectively collected data from patients treated with the Carillon Mitral Contour System for symptomatic congestive heart failure despite guideline-directed medical therapy, who were included from a single centre from the TITAN II study. All patients presented with New York Heart Association (NYHA) class 2 or greater symptoms, grade 2+ to 4+ FMR, left ventricular enlargement, and reduced ejection fraction. Surviving patients were evaluated for long-term follow-up post-procedure, averaging 6.9 years. Fifteen (15) patients (mean age 72 years, 60% male, 100% NYHA class III or IV, 50% MR grade 3+ or 4+) were treated with the Carillon device. The Kaplan-Meier mortality rate was 40% at 6 years of follow-up. Long-term survival through 6 years was associated with echocardiographic improvement in mitral regurgitation (change in effective regurgitant orifice area in survivors versus non-survivors from baseline to 1 year follow-up, -9.0 ± 5.6 vs. -1.7 ± 1.5, P = 0.02) and clinical status at 12 months (difference in NYHA at 1 year follow-up between survivors versus non-survivors, P = 0. 05) which was sustained throughout follow-up. All patients at 6 year follow-up had ≤2+ MR, with 6 of 7 having 0-1+ MR. Left ventricular end-diastolic volume was reduced from 154.0 ± 65.7 mL at baseline to 104.5 ± 59.2 mL at 6 year follow-up, P = 0.03 in survivors with both measurements. CONCLUSIONS Among patients with congestive heart failure treated with the Carillon device, long-term survival is associated with favourable 1 year and sustained improvements in mitral regurgitation, left ventricular volume, ejection fraction, and clinical status.
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Affiliation(s)
- Janusz Lipiecki
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Hicham Fahrat
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Séverine Monzy
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Nicolat Caillot
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Tomasz Siminiak
- Poznan University of Medical Sciences, HCP Medical CenterPoznanPoland
| | | | | | | | - Steven L. Goldberg
- Cardiac DimensionsKirklandWAUSA
- Tyler Heart Institute at Community Hospital of the Monterey PeninsulaMontereyCAUSA
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Garot P, Sievert H, Mahfoud F, Carrie D, Lipiecki J, Nickenig G, Remppis A, Eckert S, Fajadet J, Morice M. Results of the multicenter, prospective, randomised STRENGTH (Study To evaluate the use of RENalGuard to proTect patients at High risk of acute kidney injury) study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2555] [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
Aim
Radio-contrast agents are widely used in coronary, peripheral and structural interventions. Use of these iodine-containing agents can be associated with contrast-induced acute kidney injury (CI-AKI) that can cause substantial morbidity and mortality. The RenalGuard system induces a forced diuresis with a matched hydration and has been shown beneficial in patients requiring coronary angiogram and PCI.
Methods
STRENGTH is a prospective, randomised (1:1), open-labeled, parallel-group, multicenter (10 centers in Germany and France) study where patients at high risk of CI-AKI were randomly assigned to RenalGuard® therapy or conventional strategy including preventive hydration before complex percutaneous cardiovascular intervention (PCI, peripheral and structural). In the RenalGuard arm, matched fluid replacement was started 60 minutes pre-procedure and maintained for up to 4 hours afterwards. Patients were given an initial i.v. bolus of up to 250 ml of normal saline over 30 minutes and then an i.v. bolus of furosemide (0.5 mg/kg). To be enrolled, patients had to have moderate to severe renal failure (defined as 15≤eGFR≤40 mL/min/m2) and a high-volume contrast requiring cardiovascular procedure (estimated contrast volume>3 times eGFR value). The main exclusion criterion was administration of iodine contrast media within 5 days before index procedure. The primary endpoint was CI-AKI defined as an increase in sCr ≥0.3 mg/dL or an increase of 25% of basal value or requiring dialysis within 5 days after procedure. The primary analysis for efficacy is performed in a modified intention-to-treat basis. The trial was designed and monitored by an independent CRO (Cardiovascular European Research Center, CERC, Massy, France).
Results
A total of 259 patients aged 79.1±8.8 yrs were included in the study. Among them, 129 were assigned to RenalGuard therapy and 130 to preventive saline hydration. Their mean baseline eGFR was 32 (25; 37) vs. 33 (25; 39) mL/min/m2, respectively (p=0.88). Total fluid intake volume within 24hrs before the procedure was 2383±1146 vs. 1386±842mL, respectively (p<0.0001). Procedure type was complex PCI (48%), TAVI (25%), peripheral intervention (18%), other structural intervention (9%) with no difference between groups (p=0.56). The total amount of contrast used for the procedure was 116.3±68.2mL in the RenalGuard arm vs. 104.1±56.7 mL in the conventional arm (p=0.26). A staged procedure was performed in 24 patients, including 16 in the RenalGuard and 8 in the control arm with a mean interval from the first intervention of 43±29 days and 24±19 days, respectively. For this second procedure, the total amount of contrast was 80±59 vs. 87±73mL.
Conclusion
The primary and secondary endpoints of the Study To evaluate the use of RENalGuard to proTect patients at High risk of CI-AKI comparing RenalGuard therapy to conventional hydration in 259 patients requiring complex percutaneous cardiovascular intervention will be presented.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): CERC
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Affiliation(s)
- P Garot
- Institut Cardiovasculaire Paris Sud, Quincy, France
| | - H Sievert
- Cardiovascular center Frankfurt, Frankfurt, Germany
| | - F Mahfoud
- Universitätsklinikum des Saarlandes und Medizinische Fakultät, Homburg, Germany
| | - D Carrie
- Hôpital Rangueil-Larrey, Toulouse, France
| | - J Lipiecki
- Pôle Santé République, Clermont Ferrand, France
| | - G Nickenig
- Universitätsklinikum Bonn, Bonn, Germany
| | - A Remppis
- Herz- und Gefäßzentrum, Bad Bevensen, Germany
| | - S Eckert
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
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Lipiecki J, Kuzemczak M, Siminiak T. Transcatheter treatment of functional mitral valve regurgitation. Trends Cardiovasc Med 2020; 31:487-494. [DOI: 10.1016/j.tcm.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022]
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Lipiecki J, Kaye DM, Witte KK, Haude M, Kapadia S, Sievert H, Goldberg SL, Levy WC, Siminiak T. Long-Term Survival Following Transcatheter Mitral Valve Repair: Pooled Analysis of Prospective Trials with the Carillon Device. Cardiovascular Revascularization Medicine 2020; 21:712-716. [DOI: 10.1016/j.carrev.2020.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 01/17/2023]
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18
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Witte KK, Lipiecki J, Siminiak T, Meredith IT, Malkin CJ, Goldberg SL, Stark MA, von Bardeleben RS, Cremer PC, Jaber WA, Celermajer DS, Kaye DM, Sievert H. The REDUCE FMR Trial: A Randomized Sham-Controlled Study of Percutaneous Mitral Annuloplasty in Functional Mitral Regurgitation. JACC Heart Fail 2019; 7:945-955. [PMID: 31521683 DOI: 10.1016/j.jchf.2019.06.011] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to evaluate the effects of the Carillon device on mitral regurgitation severity and left ventricular remodeling. BACKGROUND Functional mitral regurgitation (FMR) complicates heart failure with reduced ejection fraction and is associated with a poor prognosis. METHODS In this blinded, randomized, proof-of-concept, sham-controlled trial, 120 patients receiving optimal heart failure medical therapy were assigned to a coronary sinus-based mitral annular reduction approach for FMR or sham. The pre-specified primary endpoint was change in mitral regurgitant volume at 12 months, measured by quantitative echocardiography according to an intention-to-treat analysis. RESULTS Patients (69.8 ± 9.5 years of age) were randomized to either the treatment (n = 87) or the sham-controlled (n = 33) arm. There were no significant differences in baseline characteristics between the groups. In the treatment group, 73 of 87 (84%) had the device implanted. The primary endpoint was met, with a statistically significant reduction in mitral regurgitant volume in the treatment group compared to the control group (decrease of 7.1 ml/beat [95% confidence interval [CI]: -11.7 to -2.5] vs. an increase of 3.3 ml/beat [95% CI: -6.0 to 12.6], respectively; p = 0.049). Additionally, there was a significant reduction in left ventricular volumes in patients receiving the device versus those in the control group (left ventricular end-diastolic volume decrease of 10.4 ml [95% CI: -18.5 to -2.4] vs. an increase of 6.5 ml [95% CI: -5.1 to 18.2]; p = 0.03 and left ventricular end-systolic volume decrease of 6.2 ml [95% CI: -12.8 to 0.4] vs. an increase of 6.1 ml [95% CI: -1.42 to 13.6]; p = 0.04). CONCLUSIONS The Carillon device significantly reduced mitral regurgitant volume and left ventricular volumes in symptomatic patients with functional mitral regurgitation receiving optimal medical therapy. (Carillon Mitral Contour System for Reducing Functional Mitral Regurgitation [REDUCE FMR]; NCT02325830).
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Affiliation(s)
- Klaus K Witte
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
| | | | - Tomasz Siminiak
- Poznan University of Medical Sciences, HCP Medical Center, Poznan, Poland
| | - Ian T Meredith
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Christopher J Malkin
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Steven L Goldberg
- Tyler Heart Institute at Community Hospital of the Monterey Peninsula, Monterey, California; Cardiac Dimensions, Kirkland, Washington
| | | | | | - Paul C Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Horst Sievert
- CardioVascular Center Sankt Katherinen, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom
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Goldberg SL, Kapadia S, Witte KK, Kaye DM, Lipiecki J, Siminiak T, Malkin CJ, Sievert H. Impact of Carillon on COAPT Eligible/Non-Eligible Patients. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.486] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Goldberg SL, Levy WC, Witte KK, Lipiecki J, Siminiak T, Kaye DM, Malking CJ, Sievert H. Ejection Fraction Relative to Improvements in Mitral Regurgitation and Left Ventricular Remodeling after Implantation of Carillon Device. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.488] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Lipiecki J, Brunel P, Morice MC, Roguelov C, Walsh SJ, Richardt G, Eerdmans P, Zambahari R, Berland J, Copt S, Stoll HP, Urban P. Biolimus A9 polymer-free coated stents in high bleeding risk patients undergoing complex PCI: evidence from the LEADERS FREE randomised clinical trial. EUROINTERVENTION 2018; 14:e418-e425. [DOI: 10.4244/eij-d-18-00293] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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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22
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Urban P, Gregson J, Lurz P, Chevalier B, Morice MC, Lipiecki J, Neumann FJ, Lee S, Erglis A, Greene S, Pocock S. TCT-545 Individualizing DAPT Duration after Coronary Stenting for Patients at High Bleeding Risk – The LEADERS FREE trade-off score. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.720] [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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23
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Goldberg SL, Meredith I, Marwick T, Haluska BA, Lipiecki J, Siminiak T, Mehta N, Kaye DM, Sievert H. A randomized double-blind trial of an interventional device treatment of functional mitral regurgitation in patients with symptomatic congestive heart failure-Trial design of the REDUCE FMR study. Am Heart J 2017; 188:167-174. [PMID: 28577672 DOI: 10.1016/j.ahj.2017.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/25/2017] [Indexed: 11/25/2022]
Abstract
The Carillon Mitral Contour System has been studied in 3 nonrandomized trials in patients with symptomatic congestive heart failure and functional mitral regurgitation. The REDUCE FMR study is a uniquely designed, double-blind trial evaluating the impact of the Carillon device on reducing regurgitant volume, as well as assessing the safety and clinical efficacy of this device. Carillon is a coronary sinus-based indirect annuloplasty device. Eligible patients undergo an invasive venogram to assess coronary sinus vein suitability for the Carillon device. If the venous dimensions are suitable, they are randomized on a 3:1 basis to receive a device or not. Patients and assessors are blinded to the treatment assignment. The primary end point is the difference in regurgitant volume at 1 year between the implanted and nonimplanted groups. Other comparisons include clinical parameters such as heart failure hospitalizations, 6-minute walk test, Kansas City Cardiomyopathy Questionnaire (KCCQ), and other echocardiographic parameters. An exercise echo substudy will also be included.
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Maupas E, Lipiecki J, Levy R, Faurie B, Karsenty B, Moulichon ME, Brunelle F, Maillard L, de Poli F, Lefèvre T. Safety and efficacy outcomes of 3rd generation DES in an all-comer population of patients undergoing PCI: 12-month and 24-month results of the e-Biomatrix French registry. Catheter Cardiovasc Interv 2017; 90:890-897. [PMID: 28544186 PMCID: PMC5724651 DOI: 10.1002/ccd.27081] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/14/2017] [Accepted: 03/25/2017] [Indexed: 12/02/2022]
Abstract
Objectives The French Ebiomatrix registry aimed to confirm the results of the Leaders trial in an all‐comer population in France. Background The Leaders trial showed the Biolimus‐eluting‐sent (BES) to be equivalent to the Cypher stent in terms of safety and efficacy at 1 year and superior regarding stent thrombosis after 1 year. Methods BES recipients were enrolled in 42 French centers with up to 24‐month clinical follow up. Results 2365 patients were included. Mean age: 65.7 ±11.2 years, 76.1% males, 31.8% had diabetes, 36.5% ACS (28.7% non‐ST‐elevation MI and 7.8% with ST‐elevation MI). 1.7 ± 1.0 stents/patient were implanted and procedural success was 99.5%. 12‐month follow‐up was completed in 94.3% patients and 24 months in 91.4%. MACCE rates at 12 and 24 months were 5.8% and 9% (all cause‐death 1.5% and 2.2%; stent thrombosis definite/probable 0.4% and 0.6%), respectively. MACCE were not significantly higher in diabetic patients compared with non‐diabetics but cardiac death was higher (1.6% vs. 0.6%, P = 0.01 at 1 year and 1.9% vs. 0.6, P = 0.005 at 2 years) as was stent thrombosis (0.9% vs. 0.2%, P = 0.009 and 1.2 vs. 0.3% P = 0.008). Compared with non‐ACS patients, MACCE was significantly higher in the ACS subgroup (7.5% vs. 4.8%, P = 0.001 at 1 year and 10.3% vs.8.1%, P = 0.07 at 2 years). Conclusion In this large real‐world registry, the BES with biodegradable polymer showed excellent acute and mid‐term outcomes with a 5.8% and 9% rate of MACCE at one and 2 years and a very low rate of stent thrombosis between 1 and 2 years (0.2%), thus demonstrating the replicability of the LEADERS trial in a registry population. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Thierry Lefèvre
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
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Sievert H, Haude M, Degen H, Lipiecki J, Goldberg S, Siminiak T. TCT-639 The Impact of Mitral Regurgitation Severity on Efficacy of Percutaneous Mitral Valve Annuloplasty in Functional Mitral Regurgitation. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.781] [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: 11/25/2022]
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Lipiecki J, Siminiak T, Sievert H, Müller-Ehmsen J, Degen H, Wu JC, Schandrin C, Kalmucki P, Hofmann I, Reuter D, Goldberg SL, Haude M. Coronary sinus-based percutaneous annuloplasty as treatment for functional mitral regurgitation: the TITAN II trial. Open Heart 2016; 3:e000411. [PMID: 27493761 PMCID: PMC4947801 DOI: 10.1136/openhrt-2016-000411] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/21/2016] [Accepted: 06/07/2016] [Indexed: 11/24/2022] Open
Abstract
Objective Functional (or secondary) mitral regurgitation (FMR) is associated with greater morbidity and worse outcomes in patients with congestive heart failure (CHF) and cardiomyopathy. The Carillon® Mitral Contour System® is a coronary sinus-based percutaneous therapy to reduce FMR. We evaluated the safety and efficacy of a modified version of the Carillon device in the treatment of patients with cardiomyopathy and FMR. Methods 36 patients with CHF, depressed left ventricular function (ejection fraction <40%) and at least moderate FMR underwent the Carillon device implant. Results There was 1 major adverse event within 30 days—a death (not device related)—occurring 17 days after the implant. Reductions in FMR and improvements in functional class and 6 min walk tests were seen, similar to prior studies. Device fractures in the high strain region of the proximal anchor (seen in prior studies) were not seen in this study. Conclusions The modified Carillon device was associated with improvements in clinical and echocardiographic parameters in treating patients with FMR, while successfully addressing the issue of anchor fracture. This version of the Carillon device will be used in a blinded randomised trial of symptomatic patients with FMR.
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Affiliation(s)
- Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République Clermont-Ferrand , France
| | - Tomasz Siminiak
- Poznan University of Medical Sciences, HCP Medical Center , Poznan , Poland
| | - Horst Sievert
- CardioVascular Center Sankt Katherinen , Frankfurt , Germany
| | | | | | - Justina C Wu
- Brigham and Women's Hospital , Boston, Massachusetts , USA
| | - Christian Schandrin
- Centre de Cardiologie Interventionnelle, Pôle Santé République Clermont-Ferrand , France
| | - Piotr Kalmucki
- Poznan University of Medical Sciences, HCP Medical Center , Poznan , Poland
| | - Ilona Hofmann
- CardioVascular Center Sankt Katherinen , Frankfurt , Germany
| | - David Reuter
- Seattle Children's Hospital , Seattle, Washington , USA
| | - Steven L Goldberg
- Rocky Mountain Heart and Lung, Kalispell , Rocky Mountain, Montana , USA
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Lipiecki J, Carrié D, Garot P, Ber-land J, Abdellaoui M, Morice MC, Abizaid A, Meredith I, Greene S, Pocock S, Urban P. 0484: The LEADERS FREE Trial: a double blind randomized comparison of a BMS and a polymer-free Drug Coated Stent (DCS) in 2,466 patients at high bleeding risk and treated with one month DAPT only. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30008-8] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Urban P, Meredith IT, Abizaid A, Pocock SJ, Carrié D, Naber C, Lipiecki J, Richardt G, Iñiguez A, Brunel P, Valdes-Chavarri M, Garot P, Talwar S, Berland J, Abdellaoui M, Eberli F, Oldroyd K, Zambahari R, Gregson J, Greene S, Stoll HP, Morice MC. Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk. N Engl J Med 2015; 373:2038-47. [PMID: 26466021 DOI: 10.1056/nejmoa1503943] [Citation(s) in RCA: 587] [Impact Index Per Article: 65.2] [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: 01/12/2023]
Abstract
BACKGROUND Patients at high risk for bleeding who undergo percutaneous coronary intervention (PCI) often receive bare-metal stents followed by 1 month of dual antiplatelet therapy. We studied a polymer-free and carrier-free drug-coated stent that transfers umirolimus (also known as biolimus A9), a highly lipophilic sirolimus analogue, into the vessel wall over a period of 1 month. METHODS In a randomized, double-blind trial, we compared the drug-coated stent with a very similar bare-metal stent in patients with a high risk of bleeding who underwent PCI. All patients received 1 month of dual antiplatelet therapy. The primary safety end point, tested for both noninferiority and superiority, was a composite of cardiac death, myocardial infarction, or stent thrombosis. The primary efficacy end point was clinically driven target-lesion revascularization. RESULTS We enrolled 2466 patients. At 390 days, the primary safety end point had occurred in 112 patients (9.4%) in the drug-coated-stent group and in 154 patients (12.9%) in the bare-metal-stent group (risk difference, -3.6 percentage points; 95% confidence interval [CI], -6.1 to -1.0; hazard ratio, 0.71; 95% CI, 0.56 to 0.91; P<0.001 for noninferiority and P=0.005 for superiority). During the same time period, clinically driven target-lesion revascularization was needed in 59 patients (5.1%) in the drug-coated-stent group and in 113 patients (9.8%) in the bare-metal-stent group (risk difference, -4.8 percentage points; 95% CI, -6.9 to -2.6; hazard ratio, 0.50; 95% CI, 0.37 to 0.69; P<0.001). CONCLUSIONS Among patients at high risk for bleeding who underwent PCI, a polymer-free umirolimus-coated stent was superior to a bare-metal stent with respect to the primary safety and efficacy end points when used with a 1-month course of dual antiplatelet therapy. (Funded by Biosensors Europe; LEADERS FREE ClinicalTrials.gov number, NCT01623180.).
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Affiliation(s)
- Philip Urban
- From Hôpital de la Tour, Geneva (P.U.), Triemli Hospital, Zurich (F.E.), and Biosensors Europe, Morges (S.G., H.-P.S.) - all in Switzerland; MonashHeart and Monash University, Melbourne, VIC, Australia (I.T.M.); Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); London School of Hygiene and Tropical Medicine, London (S.J.P., J.G.), the Dorset Heart Centre Royal Bournemouth Hospital, Bournemouth (S.T.), and West of Scotland Regional Heart and Lung Centre Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; Toulouse Rangueil Hospital, Toulouse (D.C.), Pôle Santé République, Clermont-Ferrand (J.L.), Clinique de la Fontaine, Dijon (P.B.), Hôpital Claude Galien, Institut Cardiovasculaire Paris Sud (ICPS), Générale de Santé, Quincy-sous-Sénart (P.G.), Clinique Saint Hilaire, Rouen (J.B.), Groupe Hospitalier Mutualiste de Grenoble, Grenoble (M.A.), and ICPS, Générale de Santé, Massy (M.-C.M.) - all in France; Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Essen (C.N.), and Herzzentrum Segeberger Kliniken, Bad Segeberg (G.R.) - both in Germany; Complejo Hospital Meixoeiro, Vigo, (A.I.), and Arrixaca University Hospital, Murcia (M.V.-C.) - both in Spain; and the Institute Jantung Negara, Kuala Lumpur, Malaysia (R.Z.)
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Affiliation(s)
- Steven L Goldberg
- Rocky Mountain Heart & Lung, Kalispell Regional Medical Center, Kalispell, MT, USA
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Borisenko O, Haude M, Hoppe UC, Siminiak T, Lipiecki J, Goldberg SL, Mehta N, Bouknight OV, Bjessmo S, Reuter DG. Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings. BMC Cardiovasc Disord 2015; 15:43. [PMID: 25971307 PMCID: PMC4443594 DOI: 10.1186/s12872-015-0039-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the cost-effectiveness of the percutaneous mitral valve repair (PMVR) using Carillon® Mitral Contour System® (Cardiac Dimensions Inc., Kirkland, WA, USA) in patients with congestive heart failure accompanied by moderate to severe functional mitral regurgitation (FMR) compared to the prolongation of optimal medical treatment (OMT). METHODS Cost-utility analysis using a combination of a decision tree and Markov process was performed. The clinical effectiveness was determined based on the results of the Transcatheter Implantation of Carillon Mitral Annuloplasty Device (TITAN) trial. The mean age of the target population was 62 years, 77% of the patients were males, 64% of the patients had severe FMR and all patients had New York Heart Association functional class III. The epidemiological, cost and utility data were derived from the literature. The analysis was performed from the German statutory health insurance perspective over 10-year time horizon. RESULTS Over 10 years, the total cost was €36,785 in the PMVR arm and €18,944 in the OMT arm. However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years. The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY. Results were robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective. CONCLUSIONS Percutaneous mitral valve repair may be cost-effective in inoperable patients with FMR due to heart failure.
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Affiliation(s)
| | - Michael Haude
- Medical Clinic I, Neuss City Clinic, Lukas Krankenhaus GmbH, Preußenstraße 84, 41464, Neuss, Germany.
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, A-5020, Salzburg, Austria.
| | - Tomasz Siminiak
- Department of Cardiology, Interventional Cardiology, HCP Medical Center, Poznan University of Medical Sciences, ul. 28 czerwca 1956 Nr 194, 61-485, Poznan, Poland.
| | - Janusz Lipiecki
- Pole Sante Republique, 105 Avenue de la République, 63050, Clermont-Ferrand, France.
| | - Steve L Goldberg
- Department of Cardiology, University of Washington, Seattle, WA, USA.
| | - Nawzer Mehta
- Cardiac Dimensions Incorporated, 5540 Lake Washington Blvd NE, Kirkland, WA, 98033, USA.
| | - Omari V Bouknight
- Cardiac Dimensions Incorporated, 5540 Lake Washington Blvd NE, Kirkland, WA, 98033, USA.
| | - Staffan Bjessmo
- Synergus AB, Svardvagen 19, 182 33, Danderyd, Sweden. .,Department of Learning Informatics, Medical Management Centre, Management and Ethics, Karolinska Institutet, Solnavägen 1, 171 77, Solna, Sweden.
| | - David G Reuter
- Division of Pediatric Emergency Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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Limbruno U, Picchi A, Galli S, Huber K, Lipiecki J, Bernstein D, Deliargyris E, Anthopoulos P, Nienaber C, Hamon M. Bivalirudin use in patients undergoing percutaneous coronary intervention for acute myocardial infarction. Insights from the prospective, multi-centre EUROVISION registry. Acute Card Care 2014; 16:127-31. [PMID: 25101656 DOI: 10.3109/17482941.2014.944542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The effectiveness of bivalirudin in patients undergoing percutaneous coronary intervention for acute myocardial infarction has been tested in clinical trials, but its use in a real-world scenario has never been reported. METHODS From the total number of patients enrolled in the EUROVISION registry, 678 subjects affected by ST-elevation myocardial infarction were selected and included in the analysis. Posology and usage patterns of bivalirudin, as evaluated by dose and time of drug bolus and infusion administered, were evaluated. The 30-day outcome has been assessed by efficacy and safety endpoints. RESULTS All patients received an initial intravenous bolus of bivalirudin (0.70±0.25 mg/kg) followed by an infusion (1.58±0.47 mg/kg/h; duration: 60 [30, 107] min) in 99.3% of cases. An additional bolus (0.49±0.06 mg/kg) was administered in 9.3% of patients. Bivalirudin infusion was prolonged after procedure in 62.2%. Death occurred in 2.1% of patients, non-fatal myocardial reinfarction in 0.3%, unplanned revascularization in 0.6% and non-fatal stroke in 0.4%. Acute stent thrombosis was not observed. Major bleeding occurred in 1.5% of patients. CONCLUSIONS Bivalirudin usage in the setting of primary PCI provided excellent results in terms of 30-day outcome even in a real-world population.
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Affiliation(s)
- U Limbruno
- Misericordia Hospital , ASL 9 Grosseto , Italy
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Hamon M, Nienaber CA, Galli S, Huber K, Lipiecki J, Hill JM, Amabile N, Bernstein D, Deliargyris E, Lafont A, Steg PG. Bivalirudin in percutaneous coronary intervention: The EUROpean BiValIrudin UtiliSatION in Practice (EUROVISION) Registry. Int J Cardiol 2014; 173:290-4. [DOI: 10.1016/j.ijcard.2014.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/26/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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Hamon M, Lipiecki J, Carrié D, Burzotta F, Durel N, Coutance G, Boudou N, Colosimo C, Trani C, Dumonteil N, Morello R, Viader F, Claise B, Hamon M. Silent cerebral infarcts after cardiac catheterization: a randomized comparison of radial and femoral approaches. Am Heart J 2012; 164:449-454.e1. [PMID: 23067900 DOI: 10.1016/j.ahj.2012.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 01/21/2012] [Accepted: 04/10/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Single center studies using serial cerebral diffusion-weighted magnetic resonance imaging in patients having cardiac catheterization have suggested that cerebral microembolism might be responsible for silent cerebral infarct (SCI) as high as 15% to 22%. We evaluated in a multicenter trial the incidence of SCIs after cardiac catheterization and whether or not the choice of the arterial access site might impact this phenomenon. METHODS AND RESULTS Patients were randomized to have cardiac catheterization either by Radial (n = 83) or Femoral (n = 77) arterial approaches by experimented operators. The main outcome measure was the occurrence of new cerebral infarct on serial diffusion-weighted magnetic resonance imaging. Patient and catheterization characteristics, including duration of catheterization, were similar in both groups. The risk of SCI did not differ significantly between the Femoral and Radial groups (incidence of 11.7% versus 17.5%; OR, 0.85; 95% CI, 0.62-1.16; P = .31). At multivariable analysis, the independent predictors of SCI were the patient's higher height and lower transvalvular gradient. CONCLUSIONS The high rate of SCI after cardiac catheterization of patients with aortic stenosis was confirmed, but its occurrence was not affected by the selection of Radial and Femoral access.
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Siminiak T, Wu JC, Haude M, Hoppe UC, Sadowski J, Lipiecki J, Fajadet J, Shah AM, Feldman T, Kaye DM, Goldberg SL, Levy WC, Solomon SD, Reuter DG. Treatment of functional mitral regurgitation by percutaneous annuloplasty: results of the TITAN Trial. Eur J Heart Fail 2012; 14:931-8. [PMID: 22613584 PMCID: PMC3403476 DOI: 10.1093/eurjhf/hfs076] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims Functional mitral regurgitation (FMR) contributes to morbidity and mortality in heart failure (HF) patients. The aim of this study was to determine whether percutaneous mitral annuloplasty could safely and effectively reduce FMR and yield durable long-term clinical benefit. Methods and results The impact of mitral annuloplasty (Carillon Mitral Contour System) was evaluated in HF patients with at least moderate FMR. Patients in whom the device was placed then acutely recaptured for clinical reasons served as a comparator group. Quantitative measures of FMR, left ventricular (LV) dimensions, New York Heart Association (NYHA) class, 6 min walk distance (6MWD), and quality of life were assessed in both groups up to 12 months. Safety and key functional data were assessed in the implanted cohort up to 24 months. Thirty-six patients received a permanent implant; 17 had the device recaptured. The 30-day major adverse event rate was 1.9%. In contrast to the comparison group, the implanted cohort demonstrated significant reductions in FMR as represented by regurgitant volume [baseline 34.5 ±11.5 mL to 17.4 ±12.4 mL at 12 months (P < 0.001)]. There was a corresponding reduction in LV diastolic volume [baseline 208.5 ±62.0 mL to 178.9 ±48.0 mL at 12 months (P =0.015)] and systolic volume [baseline 151.8 ±57.1 mL to 120.7 ±43.2 mL at 12 months (P =0.015)], compared with progressive LV dilation in the comparator. The 6MWD markedly improved for the implanted patients by 102.5 ±164 m at 12 months (P =0.014) and 131.9 ±80 m at 24 months (P < 0.001). Conclusion Percutaneous reduction of FMR using a coronary sinus approach is associated with reverse LV remodelling. Significant clinical improvements persisted up to 24 months.
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Reuter DG, Haude M, Siminiak T, Sadowski J, Lipiecki J, Fajadet J, Hoppe UC. Treatment of Functional Mitral Regurgitation by Percutaneous Annuloplasty Results in Durable Clinical Efficacy through 18 Months. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.146] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lipiecki J, Dupuy P, Slama M, Teiger E, Wittenberg O, Hanssen M. 032 Differences in clinical presentation and 6-month outcomes in different age classes of elderly patients (75-80, 81-85, and >85 years). Data from prospective, nationwide, French PAPI registry. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70034-3] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dupouy P, Hanssen M, Teiger E, Slama M, Wittenberg O, Lipiecki J. 063 Is it Safe to use Drug Eluting Stents in Older patients? Lessons from the PAPI registry. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70065-3] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lipiecki J, Durel N, Ernande L, Monzy S, Muliez A, Ponsonnaille J. Different patterns of left ventricular enlargement and long-term prognosis after reperfused acute myocardial infarction. Arch Cardiovasc Dis 2009; 102:599-605. [PMID: 19786263 DOI: 10.1016/j.acvd.2009.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 01/28/2009] [Revised: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dilation of end-systolic and end-diastolic volumes (ESV, EDV) has been used to define left ventricular remodelling after acute myocardial infarction (MI), but the prognostic significance of different enlargement patterns has not been evaluated fully. AIM To analyse the evolution of left ventricular volumes and parameters of global and regional contractility and their correlations with long-term prognosis in patients treated by angioplasty in the acute phase of MI. METHODS Seventy-four patients (mean age 56+/-13 years; 77% men), treated successfully by angioplasty in the acute phase of MI, were included prospectively. Significant enlargement of left ventricular volumes was defined as a greater than 20% increase between acute phase and 6-month control, assessed by contrast ventriculography. Clinical follow-up was obtained for all patients at 82+/-19 months. RESULTS Four groups were identified based on volume evolution: Group I (n=29, 39%; no volume enlargement); Group II (n=8, 11%; isolated EDV enlargement); Group III (n=10, 14%; isolated ESV enlargement); Group IV (n=27, 36%; ESV plus EDV enlargement). Global left ventricular ejection fraction increased in Groups I (p=0.001) and II (p=0.037), but decreased in Groups III (p=0.0002) and IV (p=0.019). The 6-year event-free survival rate was significantly (p=0.0039) better in Groups I and II (100%) than in Groups III and IV (80 and 78%, respectively). CONCLUSION ESV enlargement in patients with reperfused acute MI impacts negatively on long-term prognosis, while isolated EDV enlargement does not.
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Affiliation(s)
- Janusz Lipiecki
- Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand, rue Montalembert, 63003 Clermont-Ferrand, France.
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Cluzel P, Chabrot P, Citron B, Gazuy N, Cassagnes L, Boyer L, Lipiecki J, Bonniol C. [Aortocoronary bypass, haemodialysis and internal mammary artery steal]. Nephrol Ther 2009; 5:648-51. [PMID: 19617020 DOI: 10.1016/j.nephro.2009.06.002] [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] [Received: 06/03/2008] [Revised: 06/06/2009] [Accepted: 06/07/2009] [Indexed: 11/17/2022]
Abstract
The dramatic occurrence, during haemodialysis sessions, of hemodynamic and cerebral symptoms in a 53-year-old haemodialysed woman with a history of aortocoronary bypass leads to discovery and treatment by percutaneous angioplasty and stenting of a significant stenosis of proximal subclavian artery, ipsilateral to the arteriovenous fistula, with retrograde flow in internal mammary artery graft and vertebral artery. All symptoms resume after interventional radiology. Analysis of literature confirms possibility of coronary artery steal induced by use of the arteriovenous fistula in haemodialysed patients with ipsilateral internal mammary bypass, especially if there is concomitant subclavian artery stenosis, and leading us to discuss the diagnostic and therapeutic implications.
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Affiliation(s)
- Pascal Cluzel
- Service d'hémodialyse, Aura Auvergne, CHU de Clermont-Ferrand, Chamalières, France.
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Ernande L, Cachin F, Chabrot P, Durel N, Morand D, Boyer L, Maublant J, Lipiecki J. Rest and low-dose dobutamine Tc-99m-mibi gated-SPECT for early prediction of left ventricular remodeling after a first reperfused myocardial infarction. J Nucl Cardiol 2009; 16:597-604. [PMID: 19479315 DOI: 10.1007/s12350-009-9098-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 12/03/2008] [Revised: 04/29/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Left ventricular (LV) remodeling after myocardial infarction (MI) occurs frequently despite successful percutaneaous coronary intervention (PCI) but cannot be predicted by simple clinical parameters. METHODS AND RESULTS This prospective study tested the value of rest and low-dose dobutamine (LDD) Tc-99m-mibi gated-SPECT for early prediction of LV remodeling in patients treated by PCI in the acute phase of a first MI. Infarct size, infarct severity, regional wall motion abnormality (RWMA), and wall thickening score (WTs) were assessed at rest and on LDD by SPECT 6 +/- 2 days after MI in 40 patients. LV remodeling was defined as 20% increase at 6 months in LV end-diastolic volume assessed by MRI. Infarct severity at rest showed the best predictive values for left remodeling (PPV: 86%, NPV: 88%, accuracy: 88%; AUC: 0.750). Functional parameters at neither rest nor LDD study further improved predictive values of the SPECT imaging. CONCLUSIONS Infarct severity assessed by Tc-99m-sestamibi gated-SPECT performed in the subacute phase of a first STEMI predicts LV remodeling with high accuracy without incremental value nor of functional parameters nor of LDD. Therefore, our results suggest that LDD should not be used in this setting.
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Affiliation(s)
- Laura Ernande
- Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
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Affiliation(s)
- Angelos Sourgounis
- From the Department of Cardiology, University Hospital of Caen, Normandy (A.S., T.S.L., M.H.); Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand (J.L.); and INSERM U744, Institute Pasteur de Lille (M.H.), Lille, France
| | - Janusz Lipiecki
- From the Department of Cardiology, University Hospital of Caen, Normandy (A.S., T.S.L., M.H.); Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand (J.L.); and INSERM U744, Institute Pasteur de Lille (M.H.), Lille, France
| | - Ted S. Lo
- From the Department of Cardiology, University Hospital of Caen, Normandy (A.S., T.S.L., M.H.); Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand (J.L.); and INSERM U744, Institute Pasteur de Lille (M.H.), Lille, France
| | - Martial Hamon
- From the Department of Cardiology, University Hospital of Caen, Normandy (A.S., T.S.L., M.H.); Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand (J.L.); and INSERM U744, Institute Pasteur de Lille (M.H.), Lille, France
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Lipiecki J, Monzy S, Durel N, Cachin F, Chabrot P, Muliez A, Morand D, Maublant J, Ponsonnaille J. Effect of thrombus aspiration on infarct size and left ventricular function in high-risk patients with acute myocardial infarction treated by percutaneous coronary intervention. Results of a prospective controlled pilot study. Am Heart J 2009; 157:583.e1-7. [PMID: 19249433 DOI: 10.1016/j.ahj.2008.11.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 11/26/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Thrombus aspiration devices have been shown to improve reperfusion criteria and to reduce distal embolization in patients treated by percutaneous coronary interventions (PCI) in the acute phase of ST-elevation myocardial infarction (STEMI). There are, however, little data about their efficacy in the reduction of infarct size. METHODS We sought to assess in a prospective randomized trial the impact of thrombus aspiration on infarct size and severity and on left ventricular function in high-risk patients with a first STEMI. The primary end point was scintigraphic infarct size, and secondary end points were infarct severity and regional and global left ventricular function. Forty-four patients with completely occluded (Thrombolysis in Myocardial Infarction flow 0-1) proximal segments of infarct-related artery were randomly assigned to thrombus aspiration group with the Export catheter (n = 20) (Medtronic, Inc, Minneapolis, MN) or PCI-only group. A rest Tc-99-mibi gated single-photon emission computed tomographic and contrast-enhanced magnetic resonance imaging were performed 6 +/- 2 days later. RESULTS Infarct size was comparable in patients in the thrombus aspiration group and PCI-only group (30.6% +/- 15.8% vs 28.5% +/- 17.9% of the left ventricle, P = .7) as was infarct severity in infarct-related artery territory (55% +/- 12% vs 55% +/- 14%, P = .9). Transmurality score as assessed by magnetic resonance imaging was similar in both groups (2.03 +/- 1.05 vs 2.16 +/- 1.21, P = .7). There was no impact of thrombus aspiration on other secondary end points. CONCLUSION In our study, thrombus aspiration with the Export catheter performed as adjunctive therapy in high-risk patients with total occlusion of the proximal part of major coronary arteries does not decrease infarct size or severity and has no effect on left ventricular regional and global function.
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Abstract
The coronary venous system is routinely targeted during electrophysiological measurements or cardiac resynchronization therapy. However, several novel interventional techniques require coronary venous catheterization and visualization as well as transvenous delivery of devices and/or therapeutic agents. Recent reports suggest the possibility of a transvenous approach for the interventional treatment of refractory angina and mitral valve regurgitation. In addition, the coronary venous system has been used as a route for the delivery of stem cells in patients with left ventricular dysfunction due to ischemic heart disease. We review the potential value of using a coronary venous approach in association with recent therapeutic developments in the interventional treatment of structural and ischemic heart disease. We will also discuss techniques related to coronary venous catheterization.
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Affiliation(s)
- Tomasz Siminiak
- From the Department of Cardiology, Poznan Medical University (T.S.), Cardiac and Rehabilitation Hospital Kowanówko, Poland; and University Hospital Clermont-Ferrand (J.L.), France
| | - Janusz Lipiecki
- From the Department of Cardiology, Poznan Medical University (T.S.), Cardiac and Rehabilitation Hospital Kowanówko, Poland; and University Hospital Clermont-Ferrand (J.L.), France
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Bolewski A, Lipiecki J, Plewa R, Burchardt P, Siminiak T. The effect of atorvastatin treatment on lipid profile and adhesion molecule levels in hypercholesterolemic patients: relation to low-density lipoprotein receptor gene polymorphism. Cardiology 2008; 111:140-6. [PMID: 18376126 DOI: 10.1159/000119702] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 04/30/2007] [Accepted: 11/30/2007] [Indexed: 11/19/2022]
Abstract
Inflammation has been indicated to play a major role in the development of atherosclerosis. The beneficial effect of statins has been suggested to be related to their anti-inflammatory properties. We have studied plasma levels of soluble adhesion molecules in patients with hypercholesterolemia before and after 3 months of treatment with atorvastatin and evaluated possible relations to the mutations in low-density lipoprotein receptor (LDLR) gene. In patients with no LDLR gene polymorphism (group A), lower baseline levels of total cholesterol and LDL cholesterol were found than in patients with LDLR gene polymorphism (group B). The soluble adhesion molecules sICAM-1, sE-selectin and sP-selectin, but not sVCAM-1 and sL-selectin, were higher in group B than in group A. sICAM-1 levels decreased in group A by 7% (p = 0.007) and in group B by 21% (p = 0.039), whereas levels of sVCAM-1 decreased in group A by 12% (p = 0.001) and in group B patients by 19% (p = 0.039). Atorvastatin did not change sE-selectin nor sP-selectin levels in group A. However, in group B, the treatment reduced E-selectin and sP-selectin levels by 39% (p = 0.007) and 24% (p = 0.007), respectively. Atorvastatin attenuates the inflammatory reaction in hypercholesterolemic patients, but in patients with LDLR gene polymorphism, this effect is more profound.
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Affiliation(s)
- Andrzej Bolewski
- Poznań Medical University, Cardiac and Rehabilitation Hospital Kowanowko, Poznań, Poland
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Lipiecki J, Durel N, Ponsonnaille J. Which patients with ischaemic heart disease could benefit from cell replacement therapy? Eur Heart J Suppl 2006. [DOI: 10.1093/eurheartj/sul062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lipiecki J, Durel N, Decalf V, Soubeyrand P, Moisa A, Citron B, Ponsonnaille J. [Transient left ventricular apical ballooning or the tako-tsubo syndrome]. Arch Mal Coeur Vaiss 2005; 98:275-80. [PMID: 15881841] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Recently, Japanese authors have described a new clinical entity associating apical akidyskinesia and basal hyperkinesias without significant coronary artery disease under the name of the tako-tsubo syndrome. This syndrome is usually observed in elderly women and the clinical presentation is usually that of an acute coronary syndrome. The authors report 10 cases of patients investigated between June 2003 and August 2004. All patients were women with an average age of 66 +/- 15 years. Seven patients had chest pain on admission with, in three cases, signs of cardiac failure. In 8 patients, a causal factor was identified: emotional stress in 7 cases and anaphylactic shock in one case. All patients underwent coronary angiography and ventriculography which showed typical changes in left ventricular contractility without significant coronary disease. The peak CPK and troponin values were 222 +/- 115 UI/l and 3.32 +/- 1.50 microg/l, respectively. One patient died in cardiogenic shock. In the other cases, normalisation of wall motion was observed in the month following the onset of symptoms. One patient developed 3rd degree atrioventricular block and required implantation of a pacemaker. This clinical entity must be taken into consideration in elderly women with acute coronary syndromes.
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Affiliation(s)
- J Lipiecki
- Service de cardiologie, center hospitalier universitarie, rue Montalembert, 63003 Clermont-Ferrand 1.
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Lipiecki J, Cachin F, Durel N, de Tauriac O, Ponsonnaille J, Maublant J. Influence of infarct-zone viability detected by rest Tc-99m sestamibi gated SPECT on left ventricular remodeling after acute myocardial infarction treated by percutaneous transluminal coronary angioplasty in the acute phase. J Nucl Cardiol 2004; 11:673-81. [PMID: 15592190 DOI: 10.1016/j.nuclcard.2004.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to assess the value of technetium 99m sestamibi gated single photon emission computed tomography (SPECT) in predicting the evolution of left ventricular volumes in patients treated successfully in the acute phase of a myocardial infarction (MI). METHODS AND RESULTS Twenty-nine patients with acute MI and early percutaneous transluminal coronary angioplasty (PTCA) were included in this study. A rest Tc-99m sestamibi electrocardiography (ECG)-gated SPECT study was performed 21 +/- 5 days after PTCA. The myocardial perfusion index was calculated by use of a semiautomatic sectorial analysis. All patients had contrast ventriculography performed during the acute phase and 6 months later. The patients were separated into two groups according to the absence (group I, n = 21) or presence (group II, n = 8) of end-systolic enlargement. The perfusion index in the infarct sectors was -2.29 +/- 2.90 SD in group I and -6.40 +/- 2.85 SD in group II ( P < .01). With a cutoff value of -2.46 SD, the sensitivity and specificity of Tc-99m sestamibi SPECT for the prediction of end-systolic volume enlargement were 100% and 62%, respectively. When the functional data from ECG-gated acquisitions were added, specificity increased to 86%. CONCLUSIONS Despite successful PTCA in the acute phase of MI, an increase in end-systolic volume was observed at 6 months in 28% of patients. Tc-99m sestamibi ECG-gated SPECT performed 3 weeks after the acute phase could predict this enlargement with a high accuracy.
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Affiliation(s)
- Janusz Lipiecki
- Department of Cardiology, University Hospital, Jean Perrin Cancer Center, Rue Montalembert, 63000 Clermont-Ferrand, France.
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Leandri M, Lipiecki J, Lipiecka E, Hamzaoui A, Amonchot A, Mansour M, Albuisson E, Citron B, Ponsonnaille J, Boyer L. Prévalence des sténoses des artères rénales dépistées au cours de coronarographies diagnostiques : dans quels cas doit-on réaliser une aortographie abdominale ? ACTA ACUST UNITED AC 2004; 85:627-33. [PMID: 15205654 DOI: 10.1016/s0221-0363(04)97639-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To define a subgroup of patients at increased risk of renal artery stenosis (RAS) in a population of patients undergoing cardiac catheterization. MATERIALS AND METHODS A total of 467 patients (mean age of 64 Years +/-11) underwent cardiac catheterization and aortography Results were evaluated to detect correlations between the presence or absence of RAS and clinical and biological parameters. RESULTS A total of 42 (9%) patients had a renal artery stenosis. Univariate analysis defined parameters correlated with the presence of RAS: systolic blood pressure (p=0.03), pulse pressure (p=0.005), age (p<0.0001), creatinine clearance (p<0.0001), 2-vessel (p=0.028) and 3-vessel (p=0.037) coronary artery diseases. Multivariate analysis showed that the presence of RAS correlated to creatinine clearance (p=0.02) and 2-vessel coronary artery disease. A creatinine clearance between 30 and 60 ml/min and multi-vessel coronary artery disease defined a subgroup at increased risk of RAS with sensitivity, specificity, positive and negative predictive values of: 47.6, 90.1, 32.3 and 94.6%. The prevalence of renal artery stenosis was 5.2% when both parameters were absent. CONCLUSION Patients with mild renal insufficiency and multi-vessel coronary artery disease defined a subgroup of patients at increased risk of RAS (32.5%) that may benefit from abdominal aortography performed at the time of cardiac catheterization.
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Boulet V, Lipiecki J, Philippot F, Durel N, De Tauriac O, Amonchot A, Citron B, Ponsonnaille J. Transluminal angioplasty in a patient with a single coronary artery during the acute phase of a myocardial infarction. J Interv Cardiol 2003; 16:371-4. [PMID: 14603792 DOI: 10.1046/j.1540-8183.2003.01001.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence of coronary artery abnormalities, in particular the single vessel form, is low among the general population. We report a case of a transluminal angioplasty of the left anterior descending artery arising from the right coronary artery during the acute phase of myocardial infarction.
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Affiliation(s)
- Vincent Boulet
- Department of Cardiology, University Hospital, rue Montalembert, 63000 Clermont-Ferrand, France.
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Cachin F, Lipiecki J, Mestas D, Amonchot A, Geissler B, Thouly C, Ponsonnaille J, Maublant J. Preliminary evaluation of a fuzzy logic-based automatic quantitative analysis in myocardial SPECT. J Nucl Med 2003; 44:1625-32. [PMID: 14530477] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
UNLABELLED This study validates a new quantitative myocardial perfusion SPECT software. METHODS The processing starts with the extraction of the morphologic skeleton of the left ventricular myocardium from reconstructed transverse sections. Fuzzy logic is used to decide whether a pixel belongs to the myocardium and any perfusion defect is filled according to a truncated bullet model. The resulting image is partitioned in 18 isovolumetric sectors. Sex-matched normal limits, criteria of abnormality for rest (201)Tl and (99m)Tc-labeled perfusion tracers, reproducibility studies, and detection of coronary artery disease were developed and validated in an overall population of 343 patients. The sex- and tracer-matched means and SDs of a normal response were calculated in 93 male and 93 female patients with a <5% likelihood of coronary artery disease. Reproducibility measurements and assignment of different sectors of the myocardium to a specific coronary were performed from data collected in 49 and 60 patients, respectively. The accuracy of the detection of a coronary artery occlusion was assessed in 48 patients who also underwent coronary angiography. RESULTS The intra- and interoperator reproducibility of the sectorial activity was high with a linear regression coefficient of 0.97 and a SD of the difference measurement at 4.4% and 3.8%, respectively. Overall sensitivity and specificity for the detection of occluded coronary artery were 90% and 80%, respectively. For the detection of left anterior descending, left circumflex, and right artery coronary occlusion, sensitivity was 92%, 75%, and 92.5%, respectively, and specificity was 75%, 78%, and 90%, respectively. CONCLUSION The new quantitative myocardial perfusion SPECT software appears to be a very helpful program for the objective analysis of perfusion tracer distribution in myocardial SPECT and a very accurate tool in the detection and localization of coronary artery occlusion.
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Affiliation(s)
- Florent Cachin
- Division of Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France
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