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Rexhaj E, Bär S, Soria R, Ueki Y, Häner JD, Otsuka T, Kavaliauskaite R, Siontis GC, Stortecky S, Shibutani H, Spirk D, Engstrøm T, Lang I, Morf L, Ambühl M, Windecker S, Losdat S, Koskinas KC, Räber L. Effects of alirocumab on endothelial function and coronary atherosclerosis in myocardial infarction: A PACMAN-AMI randomized clinical trial substudy. Atherosclerosis 2024; 392:117504. [PMID: 38513436 DOI: 10.1016/j.atherosclerosis.2024.117504] [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: 12/01/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS The effects of protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on endothelial function as assessed by flow-mediated dilation (FMD) in patients with acute myocardial infarction (AMI) are unknown. Therefore, we aimed to investigate the effects of the PCSK9 inhibitor alirocumab added to high-intensity statin on FMD, and its association with coronary atherosclerosis in non-infarct related arteries using intracoronary intravascular ultrasound (IVUS), near-infrared spectroscopy (NIRS), and optical coherence tomography (OCT). METHODS This was a pre-specified substudy among patients recruited at Bern University Hospital, Switzerland, for the randomized-controlled, double-blind, PACMAN-AMI trial, which compared the effects of biweekly alirocumab 150 mg vs. placebo added to rosuvastatin. Brachial artery FMD was measured at 4 and 52 weeks, and intracoronary imaging at baseline and 52 weeks. RESULTS 139/173 patients completed the substudy. There was no difference in FMD at 52 weeks in the alirocumab (n = 68, 5.44 ± 2.24%) versus placebo (n = 71, 5.45 ± 2.19%) group (difference = -0.21%, 95% CI -0.77 to 0.35, p = 0.47). FMD improved throughout 52 weeks in both groups similarly (p < 0.001). There was a significant association between 4 weeks FMD and baseline plaque burden (IVUS) (n = 139, slope = -1.00, p = 0.006), but not with lipid pool (NIRS) (n = 139, slope = -7.36, p = 0.32), or fibrous cap thickness (OCT) (n = 81, slope = -1.57, p = 0.62). CONCLUSIONS Among patients with AMI, the addition of alirocumab did not result in further improvement of FMD as compared to 52 weeks secondary preventative medical therapy including high-intensity statin therapy. FMD was significantly associated with coronary plaque burden at baseline, but not with lipid pool or fibrous cap thickness.
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Affiliation(s)
- Emrush Rexhaj
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Rodrigo Soria
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Raminta Kavaliauskaite
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - George Cm Siontis
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Hiroki Shibutani
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - David Spirk
- Institute of Pharmacology, Bern University Hospital and University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland; Sanofi, Suurstofi 2, 6343, Risch-Rotkreuz, Switzerland
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 20100, Copenhagen, Denmark
| | - Irene Lang
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Laura Morf
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Maria Ambühl
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Sylvain Losdat
- CTU Bern, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Konstantinos C Koskinas
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Numao Y, Otsuka T, Nuki T, Ohta H. Successful treatment with ivabradine for haemodynamically unstable junctional ectopic tachycardia occurring early after ST-elevation myocardial infarction. BMJ Case Rep 2024; 17:e258901. [PMID: 38262712 PMCID: PMC10826492 DOI: 10.1136/bcr-2023-258901] [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] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 01/25/2024] Open
Abstract
Junctional ectopic tachycardia (JET) is a relatively uncommon arrhythmia predominantly observed in infancy, often occurring after congenital heart surgery. Although JET is rare in adults, it can occur in the presence of myocardial ischaemia. We describe a woman in her early 70s who presented with multivessel ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention on left anterior descending artery and right coronary artery. She developed JET on the second day, resulting in haemodynamic compromise. Despite initial treatment attempts including amiodarone and beta-blocking agents proving insufficient in controlling JET, we successfully managed by administering ivabradine. Subsequently, she was discharged with recovered cardiac function without recurrence of JET. JET often proves refractory to multiple antiarrhythmic agents and can lead to unfavourable outcomes. Several case reports have demonstrated the effectiveness of ivabradine in treating JET during infancy, which can also be an effective therapeutic option for adult without adversely affecting haemodynamics.
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Affiliation(s)
- Yoshimi Numao
- Cardiology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Tatsuhiko Otsuka
- Cardiology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Toshiaki Nuki
- Cardiology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Hiroshi Ohta
- Cardiology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
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3
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Rohla M, Ye SX, Shibutani H, Bruno J, Otsuka T, Häner JD, Bär S, Temperli F, Kavaliauskaite R, Lanz J, Stortecky S, Praz F, Hunziker L, Pilgrim T, Siontis GC, Losdat S, Windecker S, Räber L. Pretreatment With P2Y 12 Inhibitors in ST-Segment Elevation Myocardial Infarction: Insights From the Bern-PCI Registry. JACC Cardiovasc Interv 2024; 17:17-28. [PMID: 38199749 DOI: 10.1016/j.jcin.2023.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Evidence to support immediate P2Y12 inhibitor loading in ST-segment elevation myocardial infarction (STEMI) is limited. OBJECTIVES This study sought to compare outcomes of STEMI patients receiving immediate or delayed P2Y12 inhibitor treatment. METHODS Using data from the prospective Bern-PCI registry between 2016 and 2020, we stratified STEMI patients undergoing percutaneous coronary intervention according to time periods with different institutional recommendations regarding P2Y12 inhibitor pretreatment. In cohort 1 (October 2016-September 2018), immediate P2Y12 inhibitor treatment was recommended. In cohort 2 (October 2018-September 2020), P2Y12 inhibitor treatment was recommended after coronary anatomy was confirmed. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events (MACCEs) defined as all-cause death, recurrent myocardial infarction, stroke, or definite stent thrombosis at 30 days. Sensitivity analysis included only patients in whom these recommendations were followed. RESULTS Cohort 1 included 1,116 patients; pretreatment was actually given in 708 (63.4%). Cohort 2 included 847 patients; pretreatment was withheld in 798 (94.2%). The mean age was 65 ± 13 years, and 24% were female. Baseline characteristics were well-balanced between groups. The median difference for P2Y12 loading to angiography was 52 minutes between cohort 1 and 2 and 100 minutes between patients receiving vs not receiving pretreatment. Rates of MACCEs were similar between cohort 1 and cohort 2 (10.1% vs 8.1%; adjusted HR: 0.91; 95% CI: 0.65-1.28; P = 0.59) and between patients receiving vs not receiving pretreatment (7.1% vs 8.4%; adjusted HR: 1.17; 95% CI: 0.78-1.74; P = 0.45). CONCLUSIONS In this cohort study of patients with STEMI undergoing primary percutaneous coronary intervention, P2Y12 inhibitor pretreatment was not associated with improved MACCEs.
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Affiliation(s)
- Miklos Rohla
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Shirley Xinyu Ye
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Hiroki Shibutani
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Jolie Bruno
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabrice Temperli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Raminta Kavaliauskaite
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - George Cm Siontis
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Sylvain Losdat
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
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4
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Bär S, Kavaliauskaite R, Otsuka T, Ueki Y, Häner J, Lanz J, Fürholz M, Praz F, Hunziker L, Siontis GCM, Pilgrim T, Stortecky S, Losdat S, Windecker S, Räber L. Quantitative Flow Ratio to Predict Non-Target-Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome. J Am Heart Assoc 2024; 13:e031847. [PMID: 38156592 PMCID: PMC10863833 DOI: 10.1161/jaha.123.031847] [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: 07/19/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The optimal time point of staged percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remains a matter of debate. Quantitative flow ratio (QFR) is a novel noninvasive method to assess the hemodynamic significance of coronary stenoses. We aimed to investigate whether QFR could refine the timing of staged PCI of non-target vessels (non-TVs) on top of clinical judgment for patients with ACS. METHODS AND RESULTS For this cohort study, patients with ACS from Bern University Hospital, Switzerland, scheduled to undergo out-of-hospital non-TV staged PCI were eligible. The primary end point was the composite of non-TV myocardial infarction and urgent unplanned non-TV PCI before planned staged PCI. The association between lowest QFR per patient measured in the non-TV (from index angiogram) and the primary end point was assessed using multivariable adjusted Cox proportional hazards regressions with QFR included as linear or penalized spline (nonlinear) term. QFR was measured in 1093 of 1432 patients with ACS scheduled to undergo non-TV staged PCI. Median time to staged PCI was 28 days. The primary end point occurred in 5% of the patients. In multivariable analysis (1018 patients), there was no independent association between non-TV QFR and the primary end point (hazard ratio, 0.87 [95% CI, 0.69-1.05] per 0.1 increase; P=0.125; nonlinear P=0.648). CONCLUSIONS In selected patients with ACS scheduled to undergo staged PCI at a median of 4 weeks after index PCI, QFR did not emerge as an independent predictor of non-TV events before planned staged PCI. Thus, this study does not provide conceptual evidence that QFR is helpful to refine the timing of staged PCI on top of clinical judgment. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.
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Affiliation(s)
- Sarah Bär
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Raminta Kavaliauskaite
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Tatsuhiko Otsuka
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
- Department of CardiologyItabashi Chuo Medical CenterTokyoJapan
| | - Yasushi Ueki
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
- Department of Cardiovascular MedicineShinshu University School of MedicineNaganoJapan
| | - Jonas Häner
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Jonas Lanz
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Monika Fürholz
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Fabien Praz
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Lukas Hunziker
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - George CM Siontis
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Thomas Pilgrim
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Stefan Stortecky
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | | | - Stephan Windecker
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
| | - Lorenz Räber
- Department of CardiologyBern University Hospital, Inselspital, University of BernSwitzerland
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5
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Kondo Y, Achouri NL, Falou HA, Atar L, Aumann T, Baba H, Boretzky K, Caesar C, Calvet D, Chae H, Chiga N, Corsi A, Delaunay F, Delbart A, Deshayes Q, Dombrádi Z, Douma CA, Ekström A, Elekes Z, Forssén C, Gašparić I, Gheller JM, Gibelin J, Gillibert A, Hagen G, Harakeh MN, Hirayama A, Hoffman CR, Holl M, Horvat A, Horváth Á, Hwang JW, Isobe T, Jiang WG, Kahlbow J, Kalantar-Nayestanaki N, Kawase S, Kim S, Kisamori K, Kobayashi T, Körper D, Koyama S, Kuti I, Lapoux V, Lindberg S, Marqués FM, Masuoka S, Mayer J, Miki K, Murakami T, Najafi M, Nakamura T, Nakano K, Nakatsuka N, Nilsson T, Obertelli A, Ogata K, de Oliveira Santos F, Orr NA, Otsu H, Otsuka T, Ozaki T, Panin V, Papenbrock T, Paschalis S, Revel A, Rossi D, Saito AT, Saito TY, Sasano M, Sato H, Satou Y, Scheit H, Schindler F, Schrock P, Shikata M, Shimizu N, Shimizu Y, Simon H, Sohler D, Sorlin O, Stuhl L, Sun ZH, Takeuchi S, Tanaka M, Thoennessen M, Törnqvist H, Togano Y, Tomai T, Tscheuschner J, Tsubota J, Tsunoda N, Uesaka T, Utsuno Y, Vernon I, Wang H, Yang Z, Yasuda M, Yoneda K, Yoshida S. Publisher Correction: First observation of 28O. Nature 2023; 623:E13. [PMID: 37935927 PMCID: PMC10665181 DOI: 10.1038/s41586-023-06815-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Affiliation(s)
- Y Kondo
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan.
- RIKEN Nishina Center, Saitama, Japan.
| | - N L Achouri
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - H Al Falou
- Lebanese University, Beirut, Lebanon
- Lebanese-French University of Technology and Applied Sciences, Deddeh, Lebanon
| | - L Atar
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - T Aumann
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz Research Academy Hesse for FAIR, Darmstadt, Germany
| | - H Baba
- RIKEN Nishina Center, Saitama, Japan
| | - K Boretzky
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - C Caesar
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - D Calvet
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - H Chae
- Institute for Basic Science, Daejeon, Republic of Korea
| | - N Chiga
- RIKEN Nishina Center, Saitama, Japan
| | - A Corsi
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - F Delaunay
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - A Delbart
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Q Deshayes
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | | | - C A Douma
- ESRIG, University of Groningen, Groningen, The Netherlands
| | - A Ekström
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | | | - C Forssén
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | - I Gašparić
- RIKEN Nishina Center, Saitama, Japan
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- Ruđer Bošković Institute, Zagreb, Croatia
| | - J-M Gheller
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - J Gibelin
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - A Gillibert
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - G Hagen
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, TN, USA
| | - M N Harakeh
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- ESRIG, University of Groningen, Groningen, The Netherlands
| | - A Hirayama
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - C R Hoffman
- Physics Division, Argonne National Laboratory, Argonne, IL, USA
| | - M Holl
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - A Horvat
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Á Horváth
- Eötvös Loránd University, Budapest, Hungary
| | - J W Hwang
- Center for Exotic Nuclear Studies, Institute for Basic Science, Daejeon, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul, Republic of Korea
| | - T Isobe
- RIKEN Nishina Center, Saitama, Japan
| | - W G Jiang
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | - J Kahlbow
- RIKEN Nishina Center, Saitama, Japan
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | | | - S Kawase
- Department of Advanced Energy Engineering Science, Kyushu University, Fukuoka, Japan
| | - S Kim
- Center for Exotic Nuclear Studies, Institute for Basic Science, Daejeon, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul, Republic of Korea
| | | | - T Kobayashi
- Department of Physics, Tohoku University, Miyagi, Japan
| | - D Körper
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - S Koyama
- Department of Physics, The University of Tokyo, Tokyo, Japan
| | - I Kuti
- Atomki, Debrecen, Hungary
| | - V Lapoux
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - S Lindberg
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | - F M Marqués
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - S Masuoka
- Center for Nuclear Study, The University of Tokyo, Saitama, Japan
| | - J Mayer
- Institut für Kernphysik, Universität zu Köln, Köln, Germany
| | - K Miki
- Department of Physics, Tohoku University, Miyagi, Japan
| | - T Murakami
- Department of Physics, Kyoto University, Kyoto, Japan
| | - M Najafi
- ESRIG, University of Groningen, Groningen, The Netherlands
| | - T Nakamura
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
- RIKEN Nishina Center, Saitama, Japan
| | - K Nakano
- Department of Advanced Energy Engineering Science, Kyushu University, Fukuoka, Japan
| | - N Nakatsuka
- Department of Physics, Kyoto University, Kyoto, Japan
| | - T Nilsson
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | - A Obertelli
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - K Ogata
- Department of Physics, Kyushu University, Fukuoka, Japan
- Research Center for Nuclear Physics, Osaka University, Osaka, Japan
- Department of Physics, Osaka City University, Osaka, Japan
| | - F de Oliveira Santos
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DRF-CNRS/IN2P3, Caen, France
| | - N A Orr
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - H Otsu
- RIKEN Nishina Center, Saitama, Japan
| | - T Otsuka
- RIKEN Nishina Center, Saitama, Japan
- Department of Physics, The University of Tokyo, Tokyo, Japan
| | - T Ozaki
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - V Panin
- RIKEN Nishina Center, Saitama, Japan
| | - T Papenbrock
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, TN, USA
| | - S Paschalis
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - A Revel
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DRF-CNRS/IN2P3, Caen, France
| | - D Rossi
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - A T Saito
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - T Y Saito
- Department of Physics, The University of Tokyo, Tokyo, Japan
| | - M Sasano
- RIKEN Nishina Center, Saitama, Japan
| | - H Sato
- RIKEN Nishina Center, Saitama, Japan
| | - Y Satou
- Department of Physics and Astronomy, Seoul National University, Seoul, Republic of Korea
| | - H Scheit
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - F Schindler
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - P Schrock
- Center for Nuclear Study, The University of Tokyo, Saitama, Japan
| | - M Shikata
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - N Shimizu
- Center for Computational Sciences, University of Tsukuba, Ibaraki, Japan
| | - Y Shimizu
- RIKEN Nishina Center, Saitama, Japan
| | - H Simon
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - O Sorlin
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DRF-CNRS/IN2P3, Caen, France
| | - L Stuhl
- RIKEN Nishina Center, Saitama, Japan
- Center for Exotic Nuclear Studies, Institute for Basic Science, Daejeon, Republic of Korea
| | - Z H Sun
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, TN, USA
| | - S Takeuchi
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - M Tanaka
- Department of Physics, Osaka University, Osaka, Japan
| | - M Thoennessen
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, MI, USA
| | - H Törnqvist
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Y Togano
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
- Department of Physics, Rikkyo University, Tokyo, Japan
| | - T Tomai
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - J Tscheuschner
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - J Tsubota
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - N Tsunoda
- Center for Nuclear Study, The University of Tokyo, Saitama, Japan
| | - T Uesaka
- RIKEN Nishina Center, Saitama, Japan
| | - Y Utsuno
- Advanced Science Research Center, Japan Atomic Energy Agency, Ibaraki, Japan
| | - I Vernon
- Department of Mathematical Sciences, Durham University, Durham, UK
| | - H Wang
- RIKEN Nishina Center, Saitama, Japan
| | - Z Yang
- RIKEN Nishina Center, Saitama, Japan
| | - M Yasuda
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - K Yoneda
- RIKEN Nishina Center, Saitama, Japan
| | - S Yoshida
- Liberal and General Education Center, Institute for Promotion of Higher Academic Education, Utsunomiya University, Tochigi, Japan
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6
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Biccirè FG, Häner J, Losdat S, Ueki Y, Shibutani H, Otsuka T, Kakizaki R, Hofbauer TM, van Geuns RJ, Stortecky S, Siontis GCM, Bär S, Lønborg J, Heg D, Kaiser C, Spirk D, Daemen J, Iglesias JF, Windecker S, Engstrøm T, Lang I, Koskinas KC, Räber L. Concomitant Coronary Atheroma Regression and Stabilization in Response to Lipid-Lowering Therapy. J Am Coll Cardiol 2023; 82:1737-1747. [PMID: 37640248 DOI: 10.1016/j.jacc.2023.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 06/26/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The frequency, characteristics, and outcomes of patients treated with high-intensity lipid-lowering therapy and showing concomitant atheroma volume reduction, lipid content reduction, and increase in fibrous cap thickness (ie, triple regression) are unknown. OBJECTIVES This study was designed to investigate rates, determinants, and prognostic implications of triple regression in patients presenting with acute myocardial infarction and treated with high-intensity lipid-lowering therapy. METHODS The PACMAN-AMI (Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction) trial used serial intravascular ultrasound, near-infrared spectroscopy, and optical coherence tomography to compare the effects of alirocumab vs placebo in patients receiving high-intensity statin therapy. Triple regression was defined by the combined presence of percentage of atheroma volume reduction, maximum lipid core burden index within 4 mm reduction, and minimal fibrous cap thickness increase. Clinical outcomes at 1-year follow-up were assessed. RESULTS Overall, 84 patients (31.7%) showed triple regression (40.8% in the alirocumab group vs 23.0% in the placebo group; P = 0.002). On-treatment low-density lipoprotein cholesterol levels were lower in patients with vs without triple regression (between-group difference: -27.1 mg/dL; 95% CI: -37.7 to -16.6 mg/dL; P < 0.001). Triple regression was independently predicted by alirocumab treatment (OR: 2.83; 95% CI: 1.57-5.16; P = 0.001) and a higher baseline maximum lipid core burden index within 4 mm (OR: 1.03; 95% CI: 1.01-1.06; P = 0.013). The composite clinical endpoint of death, myocardial infarction, and ischemia-driven revascularization occurred less frequently in patients with vs without triple regression (8.3% vs 18.2%; P = 0.04). CONCLUSIONS Triple regression occurred in one-third of patients with acute myocardial infarction who were receiving high-intensity lipid-lowering therapy and was associated with alirocumab treatment, higher baseline lipid content, and reduced cardiovascular events. (Vascular Effects of Alirocumab in Acute MI-Patients [PACMAN-AMI]; NCT03067844).
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Affiliation(s)
- Flavio G Biccirè
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. https://twitter.com/FBiccire
| | - Jonas Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sylvain Losdat
- Clinical Trials Unit of the University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hiroki Shibutani
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ryota Kakizaki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas M Hofbauer
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dik Heg
- Clinical Trials Unit of the University of Bern, Bern, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | - David Spirk
- Institute of Pharmacology, Bern University Hospital, University of Bern, Bern, Switzerland; Sanofi, Vernier, Switzerland
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Juan F Iglesias
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Irene Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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7
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Ueki Y, Häner JD, Losdat S, Gargiulo G, Shibutani H, Bär S, Otsuka T, Kavaliauskaite R, Mitter VR, Temperli F, Spirk D, Stortecky S, Siontis GCM, Valgimigli M, Windecker S, Gutmann C, Koskinas KC, Mayr M, Räber L. Effect of Alirocumab Added to High-Intensity Statin on Platelet Reactivity and Noncoding RNAs in Patients with AMI: A Substudy of the PACMAN-AMI Trial. Thromb Haemost 2023. [PMID: 37595625 DOI: 10.1055/a-2156-7872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
OBJECTIVE The effect of the PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor alirocumab on platelet aggregation among patients with acute myocardial infarction (AMI) remains unknown. We aimed to explore the effect of alirocumab added to high-intensity statin therapy on P2Y12 reaction unit (PRU) among AMI patients receiving dual antiplatelet therapy (DAPT) with a potent P2Y12 inhibitor (ticagrelor or prasugrel). In addition, we assessed circulating platelet-derived noncoding RNAs (microRNAs and YRNAs). METHODS This was a prespecified, powered, pharmacodynamic substudy of the PACMAN trial, a randomized, double-blind trial comparing biweekly alirocumab (150 mg) versus placebo in AMI patients undergoing percutaneous coronary intervention. Patients recruited at Bern University Hospital, receiving DAPT with a potent P2Y12 inhibitor, and adherent to the study drug (alirocumab or placebo) were analyzed for the current study. The primary endpoint was PRU at 4 weeks after study drug initiation as assessed by VerifyNow P2Y12 point-of-care assays. RESULTS Among 139 randomized patients, the majority of patients received ticagrelor DAPT at 4 weeks (57 [86.4%] in the alirocumab group vs. 69 [94.5%] in the placebo group, p = 0.14). There were no significant differences in the primary endpoint PRU at 4 weeks between groups (12.5 [interquartile range, IQR: 27.0] vs. 19.0 [IQR: 30.0], p = 0.26). Consistent results were observed in 126 patients treated with ticagrelor (13.0 [IQR: 20.0] vs. 18.0 [IQR: 27.0], p = 0.28). Similarly, platelet-derived noncoding RNAs did not significantly differ between groups. CONCLUSION Among AMI patients receiving DAPT with a potent P2Y12 inhibitor, alirocumab had no significant effect on platelet reactivity as assessed by PRU and platelet-derived noncoding RNAs.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Hiroki Shibutani
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raminta Kavaliauskaite
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vera R Mitter
- Institute of Hospital Pharmacy, Bern University Hospital, Bern, Switzerland
| | - Fabrice Temperli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Spirk
- Department of Pharmacology, Bern University, Bern and Sanofi, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Cardiocentro Ticino, Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Clemens Gutmann
- King's British Heart Foundation Centre, King's College London, London, United Kingdom
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Manuel Mayr
- Cardiocentro Ticino, Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
- King's British Heart Foundation Centre, King's College London, London, United Kingdom
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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8
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Kondo Y, Achouri NL, Falou HA, Atar L, Aumann T, Baba H, Boretzky K, Caesar C, Calvet D, Chae H, Chiga N, Corsi A, Delaunay F, Delbart A, Deshayes Q, Dombrádi Z, Douma CA, Ekström A, Elekes Z, Forssén C, Gašparić I, Gheller JM, Gibelin J, Gillibert A, Hagen G, Harakeh MN, Hirayama A, Hoffman CR, Holl M, Horvat A, Horváth Á, Hwang JW, Isobe T, Jiang WG, Kahlbow J, Kalantar-Nayestanaki N, Kawase S, Kim S, Kisamori K, Kobayashi T, Körper D, Koyama S, Kuti I, Lapoux V, Lindberg S, Marqués FM, Masuoka S, Mayer J, Miki K, Murakami T, Najafi M, Nakamura T, Nakano K, Nakatsuka N, Nilsson T, Obertelli A, Ogata K, de Oliveira Santos F, Orr NA, Otsu H, Otsuka T, Ozaki T, Panin V, Papenbrock T, Paschalis S, Revel A, Rossi D, Saito AT, Saito TY, Sasano M, Sato H, Satou Y, Scheit H, Schindler F, Schrock P, Shikata M, Shimizu N, Shimizu Y, Simon H, Sohler D, Sorlin O, Stuhl L, Sun ZH, Takeuchi S, Tanaka M, Thoennessen M, Törnqvist H, Togano Y, Tomai T, Tscheuschner J, Tsubota J, Tsunoda N, Uesaka T, Utsuno Y, Vernon I, Wang H, Yang Z, Yasuda M, Yoneda K, Yoshida S. First observation of 28O. Nature 2023; 620:965-970. [PMID: 37648757 PMCID: PMC10630140 DOI: 10.1038/s41586-023-06352-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/21/2023] [Indexed: 09/01/2023]
Abstract
Subjecting a physical system to extreme conditions is one of the means often used to obtain a better understanding and deeper insight into its organization and structure. In the case of the atomic nucleus, one such approach is to investigate isotopes that have very different neutron-to-proton (N/Z) ratios than in stable nuclei. Light, neutron-rich isotopes exhibit the most asymmetric N/Z ratios and those lying beyond the limits of binding, which undergo spontaneous neutron emission and exist only as very short-lived resonances (about 10-21 s), provide the most stringent tests of modern nuclear-structure theories. Here we report on the first observation of 28O and 27O through their decay into 24O and four and three neutrons, respectively. The 28O nucleus is of particular interest as, with the Z = 8 and N = 20 magic numbers1,2, it is expected in the standard shell-model picture of nuclear structure to be one of a relatively small number of so-called 'doubly magic' nuclei. Both 27O and 28O were found to exist as narrow, low-lying resonances and their decay energies are compared here to the results of sophisticated theoretical modelling, including a large-scale shell-model calculation and a newly developed statistical approach. In both cases, the underlying nuclear interactions were derived from effective field theories of quantum chromodynamics. Finally, it is shown that the cross-section for the production of 28O from a 29F beam is consistent with it not exhibiting a closed N = 20 shell structure.
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Affiliation(s)
- Y Kondo
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan.
- RIKEN Nishina Center, Saitama, Japan.
| | - N L Achouri
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - H Al Falou
- Lebanese University, Beirut, Lebanon
- Lebanese-French University of Technology and Applied Sciences, Deddeh, Lebanon
| | - L Atar
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - T Aumann
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz Research Academy Hesse for FAIR, Darmstadt, Germany
| | - H Baba
- RIKEN Nishina Center, Saitama, Japan
| | - K Boretzky
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - C Caesar
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - D Calvet
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - H Chae
- Institute for Basic Science, Daejeon, Republic of Korea
| | - N Chiga
- RIKEN Nishina Center, Saitama, Japan
| | - A Corsi
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - F Delaunay
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - A Delbart
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Q Deshayes
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | | | - C A Douma
- ESRIG, University of Groningen, Groningen, The Netherlands
| | - A Ekström
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | | | - C Forssén
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | - I Gašparić
- RIKEN Nishina Center, Saitama, Japan
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- Ruđer Bošković Institute, Zagreb, Croatia
| | - J-M Gheller
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - J Gibelin
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - A Gillibert
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - G Hagen
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, TN, USA
| | - M N Harakeh
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- ESRIG, University of Groningen, Groningen, The Netherlands
| | - A Hirayama
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - C R Hoffman
- Physics Division, Argonne National Laboratory, Argonne, IL, USA
| | - M Holl
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - A Horvat
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Á Horváth
- Eötvös Loránd University, Budapest, Hungary
| | - J W Hwang
- Center for Exotic Nuclear Studies, Institute for Basic Science, Daejeon, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul, Republic of Korea
| | - T Isobe
- RIKEN Nishina Center, Saitama, Japan
| | - W G Jiang
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | - J Kahlbow
- RIKEN Nishina Center, Saitama, Japan
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | | | - S Kawase
- Department of Advanced Energy Engineering Science, Kyushu University, Fukuoka, Japan
| | - S Kim
- Center for Exotic Nuclear Studies, Institute for Basic Science, Daejeon, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul, Republic of Korea
| | | | - T Kobayashi
- Department of Physics, Tohoku University, Miyagi, Japan
| | - D Körper
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - S Koyama
- Department of Physics, The University of Tokyo, Tokyo, Japan
| | - I Kuti
- Atomki, Debrecen, Hungary
| | - V Lapoux
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - S Lindberg
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | - F M Marqués
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - S Masuoka
- Center for Nuclear Study, The University of Tokyo, Saitama, Japan
| | - J Mayer
- Institut für Kernphysik, Universität zu Köln, Köln, Germany
| | - K Miki
- Department of Physics, Tohoku University, Miyagi, Japan
| | - T Murakami
- Department of Physics, Kyoto University, Kyoto, Japan
| | - M Najafi
- ESRIG, University of Groningen, Groningen, The Netherlands
| | - T Nakamura
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
- RIKEN Nishina Center, Saitama, Japan
| | - K Nakano
- Department of Advanced Energy Engineering Science, Kyushu University, Fukuoka, Japan
| | - N Nakatsuka
- Department of Physics, Kyoto University, Kyoto, Japan
| | - T Nilsson
- Institutionen för Fysik, Chalmers Tekniska Högskola, Göteborg, Sweden
| | - A Obertelli
- Irfu, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - K Ogata
- Department of Physics, Kyushu University, Fukuoka, Japan
- Research Center for Nuclear Physics, Osaka University, Osaka, Japan
- Department of Physics, Osaka City University, Osaka, Japan
| | - F de Oliveira Santos
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DRF-CNRS/IN2P3, Caen, France
| | - N A Orr
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
| | - H Otsu
- RIKEN Nishina Center, Saitama, Japan
| | - T Otsuka
- RIKEN Nishina Center, Saitama, Japan
- Department of Physics, The University of Tokyo, Tokyo, Japan
| | - T Ozaki
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - V Panin
- RIKEN Nishina Center, Saitama, Japan
| | - T Papenbrock
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, TN, USA
| | - S Paschalis
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - A Revel
- LPC Caen UMR6534, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, Caen, France
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DRF-CNRS/IN2P3, Caen, France
| | - D Rossi
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - A T Saito
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - T Y Saito
- Department of Physics, The University of Tokyo, Tokyo, Japan
| | - M Sasano
- RIKEN Nishina Center, Saitama, Japan
| | - H Sato
- RIKEN Nishina Center, Saitama, Japan
| | - Y Satou
- Department of Physics and Astronomy, Seoul National University, Seoul, Republic of Korea
| | - H Scheit
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - F Schindler
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - P Schrock
- Center for Nuclear Study, The University of Tokyo, Saitama, Japan
| | - M Shikata
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - N Shimizu
- Center for Computational Sciences, University of Tsukuba, Ibaraki, Japan
| | - Y Shimizu
- RIKEN Nishina Center, Saitama, Japan
| | - H Simon
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - O Sorlin
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DRF-CNRS/IN2P3, Caen, France
| | - L Stuhl
- RIKEN Nishina Center, Saitama, Japan
- Center for Exotic Nuclear Studies, Institute for Basic Science, Daejeon, Republic of Korea
| | - Z H Sun
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, TN, USA
| | - S Takeuchi
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - M Tanaka
- Department of Physics, Osaka University, Osaka, Japan
| | - M Thoennessen
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, MI, USA
| | - H Törnqvist
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Y Togano
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
- Department of Physics, Rikkyo University, Tokyo, Japan
| | - T Tomai
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - J Tscheuschner
- Institut für Kernphysik, Technische Universität Darmstadt, Darmstadt, Germany
| | - J Tsubota
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - N Tsunoda
- Center for Nuclear Study, The University of Tokyo, Saitama, Japan
| | - T Uesaka
- RIKEN Nishina Center, Saitama, Japan
| | - Y Utsuno
- Advanced Science Research Center, Japan Atomic Energy Agency, Ibaraki, Japan
| | - I Vernon
- Department of Mathematical Sciences, Durham University, Durham, UK
| | - H Wang
- RIKEN Nishina Center, Saitama, Japan
| | - Z Yang
- RIKEN Nishina Center, Saitama, Japan
| | - M Yasuda
- Department of Physics, Tokyo Institute of Technology, Tokyo, Japan
| | - K Yoneda
- RIKEN Nishina Center, Saitama, Japan
| | - S Yoshida
- Liberal and General Education Center, Institute for Promotion of Higher Academic Education, Utsunomiya University, Tochigi, Japan
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9
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Čulo M, Licciardello S, Ishida K, Mukasa K, Ayres J, Buhot J, Hsu YT, Imajo S, Qiu MW, Saito M, Uezono Y, Otsuka T, Watanabe T, Kindo K, Shibauchi T, Kasahara S, Matsuda Y, Hussey NE. Expanded quantum vortex liquid regimes in the electron nematic superconductors FeSe 1-xS x and FeSe 1-xTe x. Nat Commun 2023; 14:4150. [PMID: 37438333 DOI: 10.1038/s41467-023-39730-9] [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: 04/20/2022] [Accepted: 06/21/2023] [Indexed: 07/14/2023] Open
Abstract
The quantum vortex liquid (QVL) is an intriguing state of type-II superconductors in which intense quantum fluctuations of the superconducting (SC) order parameter destroy the Abrikosov lattice even at very low temperatures. Such a state has only rarely been observed, however, and remains poorly understood. One of the key questions is the precise origin of such intense quantum fluctuations and the role of nearby non-SC phases or quantum critical points in amplifying these effects. Here we report a high-field magnetotransport study of FeSe1-xSx and FeSe1-xTex which show a broad QVL regime both within and beyond their respective electron nematic phases. A clear correlation is found between the extent of the QVL and the strength of the superconductivity. This comparative study enables us to identify the essential elements that promote the QVL regime in unconventional superconductors and to demonstrate that the QVL regime itself is most extended wherever superconductivity is weakest.
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Affiliation(s)
- M Čulo
- High Field Magnet Laboratory (HFML-EMFL) and Institute for Molecules and Materials, Radboud University, Toernooiveld 7, 6525, ED, Nijmegen, Netherlands.
- Institut za fiziku, Bijenička cesta 46, HR-10000, Zagreb, Croatia.
| | - S Licciardello
- High Field Magnet Laboratory (HFML-EMFL) and Institute for Molecules and Materials, Radboud University, Toernooiveld 7, 6525, ED, Nijmegen, Netherlands
| | - K Ishida
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - K Mukasa
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - J Ayres
- H. H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol, BS8 1TL, UK
| | - J Buhot
- H. H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol, BS8 1TL, UK
| | - Y-T Hsu
- High Field Magnet Laboratory (HFML-EMFL) and Institute for Molecules and Materials, Radboud University, Toernooiveld 7, 6525, ED, Nijmegen, Netherlands
- Center for Theory and Computation, National Tsing Hua University, No. 101, Section. 2, Kuang-Fu Road, Hsinchu, 30013, Taiwan
| | - S Imajo
- Institute for Solid State Physics, University of Tokyo, Kashiwa, Chiba, 277-8581, Japan
| | - M W Qiu
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - M Saito
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - Y Uezono
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Aomori, 036-8561, Japan
| | - T Otsuka
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Aomori, 036-8561, Japan
| | - T Watanabe
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Aomori, 036-8561, Japan
| | - K Kindo
- Institute for Solid State Physics, University of Tokyo, Kashiwa, Chiba, 277-8581, Japan
| | - T Shibauchi
- Department of Advanced Materials Science, University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - S Kasahara
- Research Institute for Interdisciplinary Science, Okayama University, 3-1-1 Tsushimanaka, Kita-Ku, Okayama, 700-8530, Japan
| | - Y Matsuda
- Department of Physics, Kyoto University, Sakyo-Ku, Kyoto, 606-8502, Japan
| | - N E Hussey
- High Field Magnet Laboratory (HFML-EMFL) and Institute for Molecules and Materials, Radboud University, Toernooiveld 7, 6525, ED, Nijmegen, Netherlands.
- H. H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol, BS8 1TL, UK.
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10
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Bär S, Kavaliauskaite R, Otsuka T, Ueki Y, Häner JD, Siontis GCM, Stortecky S, Shibutani H, Temperli F, Kaiser C, Iglesias J, Jan van Geuns R, Daemen J, Spirk D, Engstrøm T, Lang I, Windecker S, Koskinas KC, Losdat S, Räber L. Impact of alirocumab on plaque regression and haemodynamics of non-culprit arteries in patients with acute myocardial infarction: a prespecified substudy of the PACMAN-AMI trial. EUROINTERVENTION 2023:EIJ-D-23-00201. [PMID: 37341586 DOI: 10.4244/eij-d-23-00201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND Treatment with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on top of statins leads to plaque regression and stabilisation. The effects of PCSK9 inhibitors on coronary physiology and angiographic diameter stenosis (DS%) are unknown. AIMS This study aimed to investigate the effects of the PCSK9 inhibitor alirocumab on coronary haemodynamics as assessed by quantitative flow ratio (QFR) and DS% by three-dimensional quantitative coronary angiography (3D-QCA) in non-infarct-related arteries (non-IRA) among acute myocardial infarction (AMI) patients. METHODS This was a prespecified substudy of the randomised controlled PACMAN-AMI trial, comparing alirocumab versus placebo on top of rosuvastatin. QFR and 3D-QCA were assessed at baseline and 1 year in any non-IRA ≥2.0 mm and 3D-QCA DS% >25%. The prespecified primary endpoint was the number of patients with a mean QFR increase at 1 year, and the secondary endpoint was the change in 3D-QCA DS%. RESULTS Of 300 enrolled patients, 265 had serial follow-up, of which 193 underwent serial QFR/3D-QCA analysis in 282 non-IRA. At 1 year, QFR increased in 50/94 (53.2%) patients with alirocumab versus 40/99 (40.4%) with placebo (Δ12.8%; odds ratio 1.7, 95% confidence interval [CI]: 0.9 to 3.0; p=0.076). DS% decreased by 1.03±7.28% with alirocumab and increased by 1.70±8.27% with placebo (Δ-2.50%, 95% CI: -4.43 to -0.57; p=0.011). CONCLUSIONS Treatment of AMI patients with alirocumab versus placebo for 1 year resulted in a significant regression in angiographic DS%, whereas no overall improvement of coronary haemodynamics was observed. CLINICALTRIALS gov: NCT03067844.
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Affiliation(s)
- Sarah Bär
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | | | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
- Department of Cardiology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - Hiroki Shibutani
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Fabrice Temperli
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - Christoph Kaiser
- Division of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Juan Iglesias
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | | | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David Spirk
- Department of Pharmacology, Bern University Hospital, Bern, Switzerland
- Sanofi, Vernier, Switzerland
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Irene Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | | | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
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11
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Iimura S, Rosenbusch M, Takamine A, Tsunoda Y, Wada M, Chen S, Hou DS, Xian W, Ishiyama H, Yan S, Schury P, Crawford H, Doornenbal P, Hirayama Y, Ito Y, Kimura S, Koiwai T, Kojima TM, Koura H, Lee J, Liu J, Michimasa S, Miyatake H, Moon JY, Naimi S, Nishimura S, Niwase T, Odahara A, Otsuka T, Paschalis S, Petri M, Shimizu N, Sonoda T, Suzuki D, Watanabe YX, Wimmer K, Wollnik H. Study of the N=32 and N=34 Shell Gap for Ti and V by the First High-Precision Multireflection Time-of-Flight Mass Measurements at BigRIPS-SLOWRI. Phys Rev Lett 2023; 130:012501. [PMID: 36669221 DOI: 10.1103/physrevlett.130.012501] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The atomic masses of ^{55}Sc, ^{56,58}Ti, and ^{56-59}V have been determined using the high-precision multireflection time-of-flight technique. The radioisotopes have been produced at RIKEN's Radioactive Isotope Beam Factory (RIBF) and delivered to the novel designed gas cell and multireflection system, which has been recently commissioned downstream of the ZeroDegree spectrometer following the BigRIPS separator. For ^{56,58}Ti and ^{56-59}V, the mass uncertainties have been reduced down to the order of 10 keV, shedding new light on the N=34 shell effect in Ti and V isotopes by the first high-precision mass measurements of the critical species ^{58}Ti and ^{59}V. With the new precision achieved, we reveal the nonexistence of the N=34 empirical two-neutron shell gaps for Ti and V, and the enhanced energy gap above the occupied νp_{3/2} orbit is identified as a feature unique to Ca. We perform new Monte Carlo shell model calculations including the νd_{5/2} and νg_{9/2} orbits and compare the results with conventional shell model calculations, which exclude the νg_{9/2} and the νd_{5/2} orbits. The comparison indicates that the shell gap reduction in Ti is related to a partial occupation of the higher orbitals for the outer two valence neutrons at N=34.
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Affiliation(s)
- S Iimura
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Department of Physics, Graduate School of Science, Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka 560-0043, Japan
- Wako Nuclear Science Center (WNSC), Institute of Particle and Nuclear Studies (IPNS), High Energy Accelerator Research Organization (KEK), Wako, Saitama 351-0198, Japan
- Department of Physics, College of Science, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Tokyo 171-8501, Japan
| | - M Rosenbusch
- Wako Nuclear Science Center (WNSC), Institute of Particle and Nuclear Studies (IPNS), High Energy Accelerator Research Organization (KEK), Wako, Saitama 351-0198, Japan
| | - A Takamine
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - Y Tsunoda
- Center for Computational Sciences, University of Tsukuba, Tsukuba 305-8577, Japan
| | - M Wada
- Wako Nuclear Science Center (WNSC), Institute of Particle and Nuclear Studies (IPNS), High Energy Accelerator Research Organization (KEK), Wako, Saitama 351-0198, Japan
| | - S Chen
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - D S Hou
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- University of Chinese Academy of Sciences, Beijing 100049, China
- School of Nuclear Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - W Xian
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - H Ishiyama
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - S Yan
- Institute of Mass Spectrometry and Atmospheric Environment, Jinan University, Guangzhou 510632, China
| | - P Schury
- Wako Nuclear Science Center (WNSC), Institute of Particle and Nuclear Studies (IPNS), High Energy Accelerator Research Organization (KEK), Wako, Saitama 351-0198, Japan
| | - H Crawford
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94523, USA
| | - P Doornenbal
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - Y Hirayama
- Wako Nuclear Science Center (WNSC), Institute of Particle and Nuclear Studies (IPNS), High Energy Accelerator Research Organization (KEK), Wako, Saitama 351-0198, Japan
| | - Y Ito
- Advanced Science Research Center, Japan Atomic Energy Agency, Ibaraki 319-1195, Japan
| | - S Kimura
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - T Koiwai
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Department of Physics, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - T M Kojima
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - H Koura
- Advanced Science Research Center, Japan Atomic Energy Agency, Ibaraki 319-1195, Japan
| | - J Lee
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - J Liu
- Department of Physics, The University of Hong Kong, Pokfulam, Hong Kong, China
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - S Michimasa
- Center of Nuclear Study (CNS), The University of Tokyo, Bunkyo 113-0033, Japan
| | - H Miyatake
- Wako Nuclear Science Center (WNSC), Institute of Particle and Nuclear Studies (IPNS), High Energy Accelerator Research Organization (KEK), Wako, Saitama 351-0198, Japan
| | - J Y Moon
- Institute for Basic Science, 70, Yuseong-daero 1689-gil, Yusung-gu, Daejeon 305-811, Korea
| | - S Naimi
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - S Nishimura
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - T Niwase
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Wako Nuclear Science Center (WNSC), Institute of Particle and Nuclear Studies (IPNS), High Energy Accelerator Research Organization (KEK), Wako, Saitama 351-0198, Japan
- Kyushu University, Hakozaki, Higashi-ku, Fukuoka 812-8581, Japan
| | - A Odahara
- Department of Physics, Graduate School of Science, Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka 560-0043, Japan
| | - T Otsuka
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Advanced Science Research Center, Japan Atomic Energy Agency, Ibaraki 319-1195, Japan
- Department of Physics, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - S Paschalis
- School of Physics, Engineering, and Technology, University of York, York YO10 5DD, United Kingdom
| | - M Petri
- School of Physics, Engineering, and Technology, University of York, York YO10 5DD, United Kingdom
| | - N Shimizu
- Center for Computational Sciences, University of Tsukuba, Tsukuba 305-8577, Japan
| | - T Sonoda
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - D Suzuki
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
| | - Y X Watanabe
- Wako Nuclear Science Center (WNSC), Institute of Particle and Nuclear Studies (IPNS), High Energy Accelerator Research Organization (KEK), Wako, Saitama 351-0198, Japan
| | - K Wimmer
- RIKEN Nishina Center for Accelerator-Based Science, Wako, Saitama 351-0198, Japan
- Department of Physics, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
- GSI Helmholtzzentrum für Schwerionenforschung, 64291 Darmstadt, Germany
| | - H Wollnik
- New Mexico State University, Las Cruces, New Mexico 88001, USA
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12
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Hirota N, Suzuki S, Arita T, Yagi N, Otsuka T, Yamashita T. Prediction of recurrence after catheter ablation for atrial fibrillation using left atrial morphology on preprocedural computed tomography: application of radiomics. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Radiomics is a comprehensive analysis methodology of medical image and involves the extraction of numerous features from standard imaging. Its usefulness has been reported mainly in the field of cancer for diagnosis and prediction of prognosis. In the territory of cardiac imaging, several reports have investigated the utility of radiomics for classifying the risk of prognosis in coronary artery disease, and few practical applications have been reported for patients with atrial fibrillation (AF) who underwent pulmonary vein isolation (PVI). Although the left atrial morphology can affect the clinical course after the PVI procedure, it is unclear whether the radiomics feature values of the left atrial morphology on cardiac computed tomography (CT) is useful for predicting the AF recurrence after PVI.
Purpose
To predict the recurrence of AF after PVI using the radiomics feature values of the left atrial morphology on cardiac computed tomography (CT).
Methods
We analyzed 525 consecutive three-dimensional cardiac CT in patients with atrial fibrillation who underwent PVI from 2018 to 2019 in our institute. After marking the region of interest on left atrium (including the root of pulmonary veins) semiautomatically, 107 radiomics feature values were obtained by Python program. After excluding the parameters having collinearity or with low predictive capability for the recurrence of AF after PVI, 42 parameters were applied to the final prediction model. Two prediction models were constructed by multivariate Cox regression analysis and machine learning model by support vector machine algorithm.
Results
The area under the curve (AUC) for predicting the recurrence of AF was 0.815 for the multivariate Cox regression model and 0.826 for the machine learning model by support vector machine.
Conclusion
The radiomics feature values on preprocedural cardiac CT could be helpful for predicting the recurrence of AF after PVI. Since radiomics feature analysis yields a huge number of numerical values representing the left atrial morphology in a reproducible manner, it would provide a new direction to construct a good prediction model using machine learning including artificial intelligence out of a routine cardiac CT scan.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Hirota
- Cardiovascular Institute Hospital , Tokyo , Japan
| | - S Suzuki
- Cardiovascular Institute Hospital , Tokyo , Japan
| | - T Arita
- Cardiovascular Institute Hospital , Tokyo , Japan
| | - N Yagi
- Cardiovascular Institute Hospital , Tokyo , Japan
| | - T Otsuka
- Cardiovascular Institute Hospital , Tokyo , Japan
| | - T Yamashita
- Cardiovascular Institute Hospital , Tokyo , Japan
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13
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Koskinas KC, Losdat S, Shibutani H, Ueki Y, Otsuka T, Haener J, Fahrni G, Iglesias JF, Spirk D, Van Geuns RJ, Daemen J, Windecker S, Engstrom T, Lang I, Raber L. Interrelation between baseline plaque characteristics and changes in coronary atherosclerosis with the PCSK9-inhibitor alirocumab: insights from the PACMAN-AMI randomized trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with acute myocardial infarction (AMI) frequently experience recurrent atherothrombotic events, largely attributable to non-culprit lesions with high-risk characteristics. Statins can halt the progression of coronary atherosclerosis, and addition of protein convertase subtilisin/kexin type 9-inhibitors (PCSK9i) results in incremental low-density lipoprotein cholesterol (LDL-C) lowering and atheroma regression.
Purpose
We sought to examine the interrelation between baseline imaging characteristics, on-treatment LDL-C levels, and changes in coronary atherosclerosis as assessed by serial, multi-modality intracoronary imaging in patients with AMI.
Methods
This is a post hoc analysis from the PACMAN-AMI randomized trial. Patients were randomly allocated to biweekly alirocumab 150 mg vs. placebo on top of high-intensity statin initiated within 24h of presentation with AMI, and underwent serial imaging of the two non-infarct-related arteries at baseline and after 52 weeks. The primary endpoint was percent atheroma volume (PAV) by intravascular ultrasound (IVUS). Powered secondary endpoints were maximal lipid core burden index (maxLCBI4mm) by near-infrared spectroscopy (NIRS) and minimum fibrous cap thickness (FCTmin) by optical coherence tomography (OCT).
Results
Of 300 randomized patients (mean age 58.5±9.8 years, 18.7% women, baseline LDL-C 3.94±0.87 mmol/L), IVUS was serially performed in 265 patients (537 arteries). LDL-C levels decreased to 1.92±0.79 mmol/L with placebo and 0.61±0.61 mmol/L with alirocumab (p<0.001). Compared with placebo (statin alone), alirocumab added to statin resulted in greater PAV reduction (−2.13% vs. −0.92%; p<0.001), greater maxLCBI4mm reduction (−79.42 vs. −37.60; p=0.006), and greater increase in FCTmin (62.67 vs. 33.19 μm; p=0.001). Changes in PAV and maxLCBI4mm were inversely related to on-treatment LDL-C levels, and change in FCTmin was positively related to on-treatment LDL-C levels (Figure 1). Across all patients, we found significant, inverse relationships between change in PAV and baseline PAV [slope: −0.072 (95% CI −0.101 to −0.042); p<0.001], between change in maxLCBI4mm and baseline maxLCBI4mm [slope: −0.437 (95% CI −0.505 to −0.369); p<0.001], and between change in FCTmin and baseline FCTmin [slope: −0.436 (95% CI −0.541 to −0.332); p<0.001]; these findings indicate greater PAV and maxLCBI4mm regression in lesions with greater PAV and LCBI4mm at baseline, and greater fibrous cap thickening in lesions with thinner fibrous caps at baseline.
Conclusion
In this study of intensive LDL-C lowering treatment initiated in the acute AMI setting, more favorable plaque changes were observed in patients with lower on-treatment LDL-C levels and in lesions with more adverse baseline plaque characteristics. Whether AMI patients with high-risk plaque features might derive greater clinical benefit from early initiation of intensive LDL-C-lowering therapies requires further investigation.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Sanofi, Regeneron
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Affiliation(s)
- K C Koskinas
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - S Losdat
- CTU Bern, University of Bern , Bern , Switzerland
| | - H Shibutani
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - Y Ueki
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - T Otsuka
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - J Haener
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - G Fahrni
- University Hospital Basel , Basel , Switzerland
| | - J F Iglesias
- Geneva University Hospitals, Cardiology , Geneva , Switzerland
| | - D Spirk
- University of Bern , Bern , Switzerland
| | - R J Van Geuns
- Radboud University Medical Centre , Nijmegen , The Netherlands
| | - J Daemen
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - S Windecker
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - T Engstrom
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - I Lang
- Medical University of Vienna , Vienna , Austria
| | - L Raber
- Bern University Hospital, Inselspital , Bern , Switzerland
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14
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Ueki Y, Haner J, Losdat S, Gargiulo G, Bar S, Otsuka T, Kavaliauskaite R, Mitter V, Temperli F, Shibutani H, Siontis G, Valgimigli M, Windecker S, Koskinas K, Raber L. Impact of alirocumab added to high-intensity statin therapy on platelet function in AMI patients: a pre-specified substudy of the randomized, placebo-controlled PACMAN-AMI trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous small observational studies have suggested a potential association of proprotein convertase subtilisin kexin type 9 (PCSK9) and platelet reactivity. However, the role of the PCSK9 inhibitor alirocumab on platelet aggregation among patients with acute myocardial infarction (AMI) remains unknown.
Purpose
We investigated the effect of alirocumab on P2Y12 reaction unit (PRU) on top of high-intensity statin therapy among AMI patients receiving dual antiplatelet therapy (DAPT) with a potent P2Y12 inhibitor (ticagrelor or prasugrel).
Methods
This was a pre-specified, powered, pharmacodynamic substudy nested within the PACMAN (effects of the PSCK9 antibody AliroCuMab on coronary Atherosclerosis in patieNts with Acute Myocardial Infarction) trial, a randomized, double-blind trial comparing biweekly alirocumab (150mg) versus placebo in AMI patients undergoing percutaneous coronary intervention (PCI). Patients recruited at Bern University Hospital, receiving DAPT with either ticagrelor or prasugrel at 4 weeks and adherent to the study drug (alirocumab or placebo) were analyzed for the current study. The VerifyNow P2Y12 point-of-care assays were used to measure PRU at baseline (i.e. before first study drug administration), 4 weeks, and 52 weeks after study drug administration (higher PRU levels indicating greater platelet aggregation). The primary endpoint was PRU at 4 weeks.
Results
Among 139 randomized patients (mean age 58.2 years [SD, 9.5], 21 [15.0%] women, mean LDL-C level 150.6mg/dL [SD, 30.9]), baseline characteristics were well balanced between groups including baseline PRU (50.0 [IQR, 120.0] in the alirocumab group vs. 62.0 [IQR, 122.0] in the placebo group, P=0.75). At 4 weeks, mean LDL-C was significantly lower in the alirocumab group (23.5 [SD, 23.7] mg/dL vs. 74.4 [SD, 30.5] mg/dL, P<0.001). The majority of patients received ticagrelor DAPT at 4 weeks (57 [86.4%] vs. 69 [94.5%], P=0.14). There were no significant differences in PRU at 4 weeks (12.5 [IQR, 27.0] vs. 19.0 [IQR, 30.0], P=0.26) and at 52 weeks (25.0 [IQR, 37.0] vs. 34.0 [IQR, 59.0], P=0.07) (Figure). Consistent results were observed in 126 patients treated with ticagrelor (i.e. after excluding 13 patients treated with prasugrel) at 4 weeks (13.0 [IQR, 20.0] vs. 18.0 [IQR, 27.0], P=0.28).
Conclusion
Among AMI patients receiving DAPT with potent P2Y12 inhibitors, alirocumab had no significant effect on platelet function as assessed by PRU.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Bern University Hospital
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Affiliation(s)
- Y Ueki
- University Hospital , Bern , Switzerland
| | - J Haner
- University Hospital , Bern , Switzerland
| | - S Losdat
- University of Bern , Bern , Switzerland
| | - G Gargiulo
- Federico II University Hospital , Naples , Italy
| | - S Bar
- University Hospital , Bern , Switzerland
| | - T Otsuka
- University Hospital , Bern , Switzerland
| | | | - V Mitter
- University of Bern , Bern , Switzerland
| | - F Temperli
- University Hospital , Bern , Switzerland
| | | | - G Siontis
- University Hospital , Bern , Switzerland
| | | | | | - K Koskinas
- University Hospital , Bern , Switzerland
| | - L Raber
- University Hospital , Bern , Switzerland
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15
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Kaur S, Kanungo R, Horiuchi W, Hagen G, Holt JD, Hu BS, Miyagi T, Suzuki T, Ameil F, Atkinson J, Ayyad Y, Bagchi S, Cortina-Gil D, Dillmann I, Estradé A, Evdokimov A, Farinon F, Geissel H, Guastalla G, Janik R, Knöbel R, Kurcewicz J, Litvinov YA, Marta M, Mostazo M, Mukha I, Nociforo C, Ong HJ, Otsuka T, Pietri S, Prochazka A, Scheidenberger C, Sitar B, Strmen P, Takechi M, Tanaka J, Tanihata I, Terashima S, Vargas J, Weick H, Winfield JS. Proton Distribution Radii of ^{16-24}O: Signatures of New Shell Closures and Neutron Skin. Phys Rev Lett 2022; 129:142502. [PMID: 36240396 DOI: 10.1103/physrevlett.129.142502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/31/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
The root mean square radii of the proton density distribution in ^{16-24}O derived from measurements of charge changing cross sections with a carbon target at ∼900A MeV together with the matter radii portray thick neutron skin for ^{22-24}O despite ^{22,24}O being doubly magic. Imprints of the shell closures at N=14 and 16 are reflected in local minima of their proton radii that provide evidence for the tensor interaction causing them. The radii agree with ab initio calculations employing the chiral NNLO_{sat} interaction, though skin thickness predictions are challenged. Shell model predictions agree well with the data.
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Affiliation(s)
- S Kaur
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - R Kanungo
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
- TRIUMF, Vancouver, British Columbia V6T 4A3, Canada
| | - W Horiuchi
- Department of Physics, Osaka Metropolitan University, Osaka 558-8585, Japan
- Nambu Yoichiro Institute of Theoretical and Experimental Physics (NITEP), Osaka Metropolitan University, Osaka 558-8585, Japan
- Department of Physics, Hokkaido University, Sapporo 060-0810, Japan
| | - G Hagen
- TRIUMF, Vancouver, British Columbia V6T 4A3, Canada
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - J D Holt
- TRIUMF, Vancouver, British Columbia V6T 4A3, Canada
| | - B S Hu
- TRIUMF, Vancouver, British Columbia V6T 4A3, Canada
| | - T Miyagi
- Technische Universität Darmstadt, Department of Physics, 64289 Darmstadt, Germany
- ExtreMe Matter Institute EMMI, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - T Suzuki
- Department of Physics, Nihon University, Setagaya-ku, Tokyo 156-8550, Japan
| | - F Ameil
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - J Atkinson
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
| | - Y Ayyad
- Universidad de Santiago de Compostela, E-15706 Santiago de Compostella, Spain
| | - S Bagchi
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - D Cortina-Gil
- Universidad de Santiago de Compostela, E-15706 Santiago de Compostella, Spain
| | - I Dillmann
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
- Justus-Liebig University, 35392 Giessen, Germany
| | - A Estradé
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - A Evdokimov
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - F Farinon
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - H Geissel
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
- Justus-Liebig University, 35392 Giessen, Germany
| | - G Guastalla
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - R Janik
- Faculty of Mathematics and Physics, Comenius University, 84215 Bratislava, Slovakia
| | - R Knöbel
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - J Kurcewicz
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - Yu A Litvinov
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - M Marta
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - M Mostazo
- Universidad de Santiago de Compostela, E-15706 Santiago de Compostella, Spain
| | - I Mukha
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - C Nociforo
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - H J Ong
- RCNP, Osaka University, Mihogaoka, Ibaraki, Osaka 567 0047, Japan
| | - T Otsuka
- Department of Physics, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - S Pietri
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - A Prochazka
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - C Scheidenberger
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
- Justus-Liebig University, 35392 Giessen, Germany
| | - B Sitar
- Faculty of Mathematics and Physics, Comenius University, 84215 Bratislava, Slovakia
| | - P Strmen
- Faculty of Mathematics and Physics, Comenius University, 84215 Bratislava, Slovakia
| | - M Takechi
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - J Tanaka
- RCNP, Osaka University, Mihogaoka, Ibaraki, Osaka 567 0047, Japan
| | - I Tanihata
- RCNP, Osaka University, Mihogaoka, Ibaraki, Osaka 567 0047, Japan
- School of Physics and Nuclear Energy Engineering and IRCNPC, Beihang University, Beijing 100191, China
| | - S Terashima
- School of Physics and Nuclear Energy Engineering and IRCNPC, Beihang University, Beijing 100191, China
| | - J Vargas
- Universidad de Santiago de Compostela, E-15706 Santiago de Compostella, Spain
| | - H Weick
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - J S Winfield
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
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Bass R, Garcia-Garcia HM, Sanz-Sanchez J, Ziemer PG, Bulant CA, Kuku KO, Kahsay YA, Beyene S, Melaku G, Otsuka T, Choi J, Fernandez-Peregrina E, Erdogan E, Gonzalo N, Bourantas CV, Blanco PJ, Raber L. Human vs. Machine vs. Core Lab in Lumen and Vessel Contour Segmentation With Intravascular Ultrasound. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.154] [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: 11/03/2022]
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17
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Imajima T, Shirakawa T, Shimokawa M, Otsuka T, Shibuki T, Nakazawa J, Arima S, Miwa K, Okabe Y, Koga F, Kubotsu Y, Ueda Y, Hosokawa A, Takeshita S, Shimokawa H, Komori A, Kawahira M, Oda H, Sakai K, Arita S, Mizuta T, Mitsugi K. P-113 A multicenter observational study of liposomal irinotecan and fluorouracil/leucovorin in patients with unresectable or recurrent pancreatic cancer (NAPOLEON-2): Retrospective part. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.203] [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: 11/01/2022] Open
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18
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Shibutani H, Otsuka T, Häner J, Räber L. Stent-Based Treatment of Refractory Coronary Vasospasm. JACC Cardiovasc Interv 2022; 15:e123-e124. [PMID: 35490125 DOI: 10.1016/j.jcin.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Hiroki Shibutani
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jonas Häner
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
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Räber L, Ueki Y, Otsuka T, Losdat S, Häner JD, Lonborg J, Fahrni G, Iglesias JF, van Geuns RJ, Ondracek AS, Radu Juul Jensen MD, Zanchin C, Stortecky S, Spirk D, Siontis GCM, Saleh L, Matter CM, Daemen J, Mach F, Heg D, Windecker S, Engstrøm T, Lang IM, Koskinas KC. Effect of Alirocumab Added to High-Intensity Statin Therapy on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction: The PACMAN-AMI Randomized Clinical Trial. JAMA 2022; 327:1771-1781. [PMID: 35368058 PMCID: PMC8978048 DOI: 10.1001/jama.2022.5218] [Citation(s) in RCA: 165] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Coronary plaques that are prone to rupture and cause adverse cardiac events are characterized by large plaque burden, large lipid content, and thin fibrous caps. Statins can halt the progression of coronary atherosclerosis; however, the effect of the proprotein convertase subtilisin kexin type 9 inhibitor alirocumab added to statin therapy on plaque burden and composition remains largely unknown. OBJECTIVE To determine the effects of alirocumab on coronary atherosclerosis using serial multimodality intracoronary imaging in patients with acute myocardial infarction. DESIGN, SETTING, AND PARTICIPANTS The PACMAN-AMI double-blind, placebo-controlled, randomized clinical trial (enrollment: May 9, 2017, through October 7, 2020; final follow-up: October 13, 2021) enrolled 300 patients undergoing percutaneous coronary intervention for acute myocardial infarction at 9 academic European hospitals. INTERVENTIONS Patients were randomized to receive biweekly subcutaneous alirocumab (150 mg; n = 148) or placebo (n = 152), initiated less than 24 hours after urgent percutaneous coronary intervention of the culprit lesion, for 52 weeks in addition to high-intensity statin therapy (rosuvastatin, 20 mg). MAIN OUTCOMES AND MEASURES Intravascular ultrasonography (IVUS), near-infrared spectroscopy, and optical coherence tomography were serially performed in the 2 non-infarct-related coronary arteries at baseline and after 52 weeks. The primary efficacy end point was the change in IVUS-derived percent atheroma volume from baseline to week 52. Two powered secondary end points were changes in near-infrared spectroscopy-derived maximum lipid core burden index within 4 mm (higher values indicating greater lipid content) and optical coherence tomography-derived minimal fibrous cap thickness (smaller values indicating thin-capped, vulnerable plaques) from baseline to week 52. RESULTS Among 300 randomized patients (mean [SD] age, 58.5 [9.7] years; 56 [18.7%] women; mean [SD] low-density lipoprotein cholesterol level, 152.4 [33.8] mg/dL), 265 (88.3%) underwent serial IVUS imaging in 537 arteries. At 52 weeks, mean change in percent atheroma volume was -2.13% with alirocumab vs -0.92% with placebo (difference, -1.21% [95% CI, -1.78% to -0.65%], P < .001). Mean change in maximum lipid core burden index within 4 mm was -79.42 with alirocumab vs -37.60 with placebo (difference, -41.24 [95% CI, -70.71 to -11.77]; P = .006). Mean change in minimal fibrous cap thickness was 62.67 μm with alirocumab vs 33.19 μm with placebo (difference, 29.65 μm [95% CI, 11.75-47.55]; P = .001). Adverse events occurred in 70.7% of patients treated with alirocumab vs 72.8% of patients receiving placebo. CONCLUSIONS AND RELEVANCE Among patients with acute myocardial infarction, the addition of subcutaneous biweekly alirocumab, compared with placebo, to high-intensity statin therapy resulted in significantly greater coronary plaque regression in non-infarct-related arteries after 52 weeks. Further research is needed to understand whether alirocumab improves clinical outcomes in this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03067844.
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Affiliation(s)
- Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Jonas D. Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacob Lonborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gregor Fahrni
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Juan F. Iglesias
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | | | - Anna S. Ondracek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Christian Zanchin
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Spirk
- Department of Pharmacology, Bern University Hospital, Bern, Switzerland, and Sanofi, Switzerland
| | - George C. M. Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lanja Saleh
- Institute of Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
| | | | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - François Mach
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Irene M. Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
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20
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Rai H, Harzer F, Otsuka T, Abdelwahed YS, Antuña P, Blachutzik F, Koppara T, Räber L, Leistner DM, Alfonso F, Nef H, Seguchi M, Aytekin A, Xhepa E, Kufner S, Cassese S, Laugwitz KL, Byrne RA, Kastrati A, Joner M. Stent Optimization Using Optical Coherence Tomography and Its Prognostic Implications After Percutaneous Coronary Intervention. J Am Heart Assoc 2022; 11:e023493. [PMID: 35470682 PMCID: PMC9238610 DOI: 10.1161/jaha.121.023493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Stent underexpansion has been known to be associated with worse outcomes. We sought to define optical coherence tomography assessed optimal stent expansion index (SEI), which associates with lower incidence of follow-up major adverse cardiac events (MACEs). Methods and Results A total of 315 patients (involving 370 lesions) who underwent optical coherence tomography-aided coronary stenting were retrospectively included. SEI was calculated separately for equal halves of each stented segment using minimum stent area/mean reference lumen area ([proximal reference area+distal reference area]/2). The smaller of the 2 was considered to be the SEI of that case. Follow-up MACE was defined as a composite of all-cause death, myocardial infarction, stent thrombosis, and target lesion revascularization. Average minimum stent area was 6.02 (interquartile range, 4.65-7.92) mm2, while SEI was 0.79 (interquartile range, 0.71-0.86). Forty-seven (12.7%) incidences of MACE were recorded for 370 included lesions during a median follow-up duration of 557 (interquartile range, 323-1103) days. Receiver operating characteristic curve analysis identified 0.85 as the best SEI cutoff (<0.85) to predict follow-up MACE (area under the curve, 0.60; sensitivity, 0.85; specificity, 0.34). MACE was observed in 40 of 260 (15.4%) lesions with SEI <0.85 and in 7 of 110 (6.4%) lesions with SEI ≥0.85 (P=0.02). Least absolute shrinkage and selection operator regression identified SEI <0.85 (odds ratio, 3.55; 95% CI, 1.40-9.05; P<0.01) and coronary calcification (odds ratio, 2.47; 95% CI, 1.00-6.10; P=0.05) as independent predictors of follow-up MACE. Conclusions The present study identified SEI <0.85, associated with increased incidence of MACE, as the optimal cutoff in daily practice. Along with suboptimal SEI (<0.85), coronary calcification was also found to be a significant predictor of follow-up MACE.
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Affiliation(s)
- Himanshu Rai
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,Cardiovascular Research Institute DublinMater Private Network Dublin Ireland.,School of Pharmacy and Biomolecular Sciences RCSI University of Medicine and Health Sciences Dublin Ireland
| | - Fiona Harzer
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany
| | - Tatsuhiko Otsuka
- Universitätsklinik für KardiologieInselspital Bern Bern Switzerland
| | - Youssef S Abdelwahed
- Charité - Universitätsmedizin Berlin Berlin Germany.,DZHK (German Centre for Cardiovascular Research)partner site Berlin Bern Germany
| | - Paula Antuña
- Hospital Universitario de La Princesa and Universidad Autónoma de MadridCIBERCV Madrid Spain
| | | | | | - Lorenz Räber
- Universitätsklinik für KardiologieInselspital Bern Bern Switzerland
| | - David M Leistner
- Charité - Universitätsmedizin Berlin Berlin Germany.,DZHK (German Centre for Cardiovascular Research)partner site Berlin Bern Germany
| | - Fernando Alfonso
- Hospital Universitario de La Princesa and Universidad Autónoma de MadridCIBERCV Madrid Spain
| | - Holger Nef
- Universitätsklinikum Gießen und Marburg Giessen Germany
| | - Masaru Seguchi
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany
| | - Alp Aytekin
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany
| | - Erion Xhepa
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany
| | - Sebastian Kufner
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany
| | - Salvatore Cassese
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany
| | | | - Robert A Byrne
- Cardiovascular Research Institute DublinMater Private Network Dublin Ireland.,School of Pharmacy and Biomolecular Sciences RCSI University of Medicine and Health Sciences Dublin Ireland
| | - Adnan Kastrati
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research) partner site Munich Heart Alliance Munich Germany
| | - Michael Joner
- Klinik für Herz- und KreislauferkrankungenDeutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research) partner site Munich Heart Alliance Munich Germany
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21
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Spicher B, Fischer K, Zimmerli ZA, Yamaji K, Ueki Y, Bertschinger CN, Jung B, Otsuka T, Bigler MR, Gräni C, von Tengg-Kobligk H, Räber L, Eberle B, Guensch DP. Combined Analysis of Myocardial Deformation and Oxygenation Detects Inducible Ischemia Unmasked by Breathing Maneuvers in Chronic Coronary Syndrome. Front Cardiovasc Med 2022; 9:800720. [PMID: 35282374 PMCID: PMC8907543 DOI: 10.3389/fcvm.2022.800720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/23/2021] [Accepted: 01/31/2022] [Indexed: 12/20/2022] Open
Abstract
Introduction In patients with chronic coronary syndromes, hyperventilation followed by apnea has been shown to unmask myocardium susceptible to inducible deoxygenation. The aim of this study was to assess whether such a provoked response is co-localized with myocardial dysfunction. Methods A group of twenty-six CAD patients with a defined stenosis (quantitative coronary angiography > 50%) underwent a cardiovascular magnetic resonance (CMR) exam prior to revascularization. Healthy volunteers older than 50 years served as controls (n = 12). Participants hyperventilated for 60s followed by brief apnea. Oxygenation-sensitive images were analyzed for changes in myocardial oxygenation and strain. Results In healthy subjects, hyperventilation resulted in global myocardial deoxygenation (-10.2 ± 8.2%, p < 0.001) and augmented peak circumferential systolic strain (-3.3 ± 1.6%, p < 0.001). At the end of apnea, myocardial signal intensity had increased (+9.1 ± 5.3%, p < 0.001) and strain had normalized to baseline. CAD patients had a similar global oxygenation response to hyperventilation (−5.8 ± 9.6%, p = 0.085) but showed no change in peak strain from their resting state (-1.3 ± 1.6%), which was significantly attenuated in comparison the strain response observed in controls (p = 0.008). With apnea, the CAD patients showed an attenuated global oxygenation response to apnea compared to controls (+2.7 ± 6.2%, p < 0.001). This was accompanied by a significant depression of peak strain (3.0 ± 1.7%, p < 0.001), which also differed from the control response (p = 0.025). Regional analysis demonstrated that post-stenotic myocardium was most susceptible to de-oxygenation and systolic strain abnormalities during respiratory maneuvers. CMR measures at rest were unable to discriminate post-stenotic territory (p > 0.05), yet this was significant for both myocardial oxygenation [area under the curve (AUC): 0.88, p > 0.001] and peak strain (AUC: 0.73, p = 0.023) measured with apnea. A combined analysis of myocardial oxygenation and peak strain resulted in an incrementally higher AUC of 0.91, p < 0.001 than strain alone. Conclusion In myocardium of patients with chronic coronary syndromes and primarily intermediate coronary stenoses, cine oxygenation-sensitive CMR can identify an impaired vascular and functional response to a vasoactive breathing maneuver stimulus indicative of inducible ischemia.
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Affiliation(s)
- Barbara Spicher
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Zoe A. Zimmerli
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Kyohei Yamaji
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Carina N. Bertschinger
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Marius R. Bigler
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dominik P. Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- *Correspondence: Dominik P. Guensch
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22
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Ueki Y, Zanchin T, Losdat S, Karagiannis A, Otsuka T, Siontis GCM, Häner J, Stortecky S, Pilgrim T, Valgimigli M, Windecker S, Räber L. Self-reported non-adherence to P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: Application of the medication non-adherence academic research consortium classification. PLoS One 2022; 17:e0263180. [PMID: 35171913 PMCID: PMC8849552 DOI: 10.1371/journal.pone.0263180] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
Aims The Non-adherence Academic Research Consortium (NARC) has recently developed a consensus-based standardized classification for medication non-adherence in cardiovascular clinical trials. We aimed to assess the prevalence of NARC-defined self-reported non-adherence to P2Y12 inhibitors and its impact on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Methods and results Using a standardized questionnaire administered at 1 year after PCI, we assessed the 4 NARC-defined non-adherence levels including type, decision-maker, reasons, and timing within the Bern PCI registry. The primary endpoint was the patient-oriented composite endpoint (POCE) defined as a composite of death, myocardial infarction, stroke, and any revascularization at 1 year. The recommended P2Y12 inhibitor duration was 12 months. Among 3,896 patients, P2Y12 inhibitor non-adherence was observed in 647 (17%) patients. Discontinuation was permanent in the majority of patients (84%). The decision was mainly driven by a physician (94%), and rarely by patients (6%). The most frequent reason was risk profile change (43%), followed by unlisted reasons (25%), surgery (17%), and adverse events (14%). Non-adherence occurred early (<30 days) in 21%, late (30–180 days) in 45%, and very late (>180 days) in 33%. The majority of POCE events (n = 421/502, 84%) occurred during adherence to the prescribed P2Y12 inhibitor. Permanent discontinuation, doctor-driven non-adherence, and risk profile change emerged as independent predictors for POCE. Conclusions In real-world PCI population treated with 1-year DAPT, non-adherence was observed in nearly one-fifth of patients. Non-adherence to P2Y12 inhibitors was associated with worse clinical outcomes, while the risk was related to underlying contexts. ClinicalTrials.gov identifier NCT02241291.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Zanchin
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Jonas Häner
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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23
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Ueki Y, Otsuka T, Bär S, Koskinas KC, Heg D, Häner J, Siontis GCM, Praz F, Hunziker L, Lanz J, Stortecky S, Pilgrim T, Losdat S, Windecker S, Räber L. Frequency and Outcomes of Periprocedural MI in Patients With Chronic Coronary Syndromes Undergoing PCI. J Am Coll Cardiol 2022; 79:513-526. [PMID: 35144742 DOI: 10.1016/j.jacc.2021.11.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 08/23/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Definitions of periprocedural myocardial infarction (MI) differ with respect to biomarker threshold as well as ancillary criteria for myocardial ischemia and are limited in terms of validation. OBJECTIVES This study evaluated the frequency and impact of periprocedural MI by using various MI definitions among patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI). METHODS Between 2010 and 2018, periprocedural MIs were assessed according to the third and fourth Universal Definition of Myocardial Infarction (UDMI), Academic Research Consortium-2 (ARC-2), and Society for Cardiovascular Angiography and Interventions (SCAI) criteria based on high-sensitivity troponin in patients with CCS undergoing PCI enrolled into the Bern PCI registry. The primary endpoint was cardiac death at 1 year. RESULTS Among 4,404 patients with CCS, periprocedural MI defined by the third UDMI, fourth UDMI, ARC-2, and SCAI were observed in 18.0%, 14.9%, 2.0%, and 2.0% of patients, respectively. Among patients with periprocedural MI defined by the third UDMI, fourth UDMI, ARC-2, and SCAI, cardiac mortality at 1 year was 2.9%, 3.0%, 5.8%, and 10.0%. The ARC-2 (HR: 3.90; 95% CI: 1.54-9.93) and SCAI (HR: 7.66; 95% CI: 3.64-16.11) were more relevant compared with the third UDMI (HR: 1.76; 95% CI: 1.04-3.00) and fourth UDMI (HR: 1.93; 95% CI: 1.11-3.37) for cardiac death at 1 year. CONCLUSIONS Among patients with CCS undergoing PCI, periprocedural MI defined according to the ARC-2 and SCAI criteria was 7 to 9 times less frequent compared with the third and fourth UDMI. Periprocedural MI defined by using the ARC-2 and SCAI were more prognostic for cardiac death at 1 year compared with the third and fourth UDMI. (CARDIOBASE Bern PCI Registry; NCT02241291).
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kostantinos C Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Jonas Häner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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24
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Zanchin C, Ledwoch S, Bär S, Ueki Y, Otsuka T, Häner JD, Zanchin T, Praz F, Hunziker L, Stortecky S, Pilgrim T, Losdat S, Windecker S, Räber L, Siontis GCM. Acute coronary syndromes in young patients: Phenotypes, causes and clinical outcomes following percutaneous coronary interventions. Int J Cardiol 2022; 350:1-8. [PMID: 35033577 DOI: 10.1016/j.ijcard.2022.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/15/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of acute coronary syndromes (ACS) among young individuals is increasing, but the phenotypic characteristics, causes and clinical outcomes in this group have not been well described. METHODS Between 2009 and 2017, 8712 ACS patients underwent percutaneous coronary intervention (PCI) and were prospectively enrolled. We defined a young patient as female <50 years and male <45 years. The causes of ACS were defined by an adjudication committee. The primary endpoint was the patient-oriented composite endpoint (POCE) of all-cause mortality, myocardial infarction or any revascularization at 12 months. RESULTS Among 8712 ACS patients, 472 (5.4%) patients were young (26% female). The main cause of ACS in young patients was atherosclerosis (86.5%), followed by coronary artery embolism (9%), and spontaneous coronary artery dissection (SCAD) (4.5%). POCE occurred less frequently in young compared to old patients (8.5% vs. 16.7%, hazard ratio 0.48 (95% confidence interval 0.35-0.66), p < 0.001). The rates of the individual components of the POCE were lower in young including all-cause mortality (3.2% versus 9.5%, 0.32 (0.19-0.54), p < 0.001), myocardial infarction (1.9% versus 3.7%, 0.49 (0.25-0.95), p = 0.035) and any revascularization (5.1% versus 7.4%, 0.65 (0.43-0.97), p = 0.037). Young patients with SCAD had a higher rate of death as compared to those with atherosclerosis, mainly attributed to cardiac deaths. CONCLUSIONS One out of 20 ACS patients undergoing PCI was young and the principal cause was atherosclerosis. Young carry a lower risk for future events compared to older ACS patients. The underlying cause leading to ACS should be considered in appropriate risk stratification of young patients. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov. NCT02241291.
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Affiliation(s)
- Christian Zanchin
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Ledwoch
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Zanchin
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sylvain Losdat
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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25
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Otsuka T, Bär S, Losdat S, Kavaliauskaite R, Ueki Y, Zanchin C, Lanz J, Praz F, Häner J, Siontis GCM, Zanchin T, Stortecky S, Pilgrim T, Windecker S, Räber L. Effect of Timing of Staged Percutaneous Coronary Intervention on Clinical Outcomes in Patients With Acute Coronary Syndromes. J Am Heart Assoc 2021; 10:e023129. [PMID: 34816730 PMCID: PMC9075355 DOI: 10.1161/jaha.121.023129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Complete revascularization reduces cardiovascular events in patients with acute coronary syndromes (ACSs) and multivessel disease. The optimal time point of non–target‐vessel percutaneous coronary intervention (PCI) remains a matter of debate. The aim of this study was to investigate the impact of early (<4 weeks) versus late (≥4 weeks) staged PCI of non–target‐vessels in patients with ACS scheduled for staged PCI after hospital discharge. Methods and Results All patients with ACS undergoing planned staged PCI from 2009 to 2017 at Bern University Hospital, Switzerland, were analyzed. Patients with cardiogenic shock, in‐hospital staged PCI, staged cardiac surgery, and multiple staged PCIs were excluded. The primary end point was all‐cause death, recurrent myocardial infarction and urgent premature non–target‐vessel PCI. Of 8657 patients with ACS, staged revascularization was planned in 1764 patients, of whom 1432 patients fulfilled the eligibility criteria. At 1 year, there were no significant differences in the crude or adjusted rates of the primary end point (7.8% early versus 10.8% late, hazard ratio [HR], 0.72 [95% CI, 0.47–1.10], P=0.129; adjusted HR, 0.80 [95% CI, 0.50–1.28], P=0.346) and its individual components (all‐cause death: 1.5% versus 2.9%, HR, 0.52 [95% CI, 0.20–1.33], P=0.170; adjusted HR, 0.62 [95% CI, 0.23–1.67], P=0.343; recurrent myocardial infarction: 4.2% versus 4.4%, HR, 0.97 [95% CI, 0.475–1.10], P=0.924; adjusted HR, 1.03 [95% CI, 0.53–2.01], P=0.935; non–target‐vessel PCI, 3.9% versus 5.7%, HR, 0.97 [95% CI, 0.53–1.80], P=0.928; adjusted HR, 1.19 [95% CI, 0.61–2.34], P=0.609). Conclusions In this single‐center cohort study of patients with ACS scheduled to undergo staged PCI after hospital discharge, early (<4 weeks) versus late (≥4 weeks) staged PCI was associated with a similar rate of major adverse cardiac events at 1 year follow‐up. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.
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Affiliation(s)
- Tatsuhiko Otsuka
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Sarah Bär
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | | | | | - Yasushi Ueki
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Christian Zanchin
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Jonas Lanz
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Fabien Praz
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Jonas Häner
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - George C M Siontis
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Thomas Zanchin
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Stefan Stortecky
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Thomas Pilgrim
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
| | - Lorenz Räber
- Department of Cardiology Bern University HospitalUniversity of Bern Bern Switzerland
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26
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Ueki Y, Otsuka T, Bar S, Koskinas K, Losdat S, Heg D, Zanchin T, Siontis G, Praz F, Haner J, Susuri N, Stortecky S, Pilgrim T, Windecker S, Raber L. Frequency and prognostic impact of periprocedural myocardial infarction determined by various MI definitions in patients with chronic coronary syndromes undergoing percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Several definitions of peri-procedural myocardial infarction (MI) requiring different biomarker thresholds with or without ancillary criteria for myocardial ischemia are currently recommended without being fully validated in real-world patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI).
Objectives
We aimed to evaluate the prevalence and prognostic value of high-sensitivity cardiac troponin-based peri-procedural MI according to contemporary MI definitions using a large real-world PCI cohort.
Methods
In CCS patients undergoing elective PCI enrolled to the Bern PCI registry (NCT02241291) between 2010 and 2018, peri-procedural myocardial injury and infarction were assessed according to the 4th and 3rd universal definition of MI (UDMI), academic research consortium (ARC)-2, and Society for Cardiovascular Angiography and Interventions (SCAI) criteria. The primary endpoint was cardiac death at 1 year.
Results
Among 4404 CCS patients, peri-procedural MI defined by the 4th UDMI, 3rd UDMI, ARC-2, and SCAI were observed in 14.9%, 18.0%, 2.0%, and 2.0% of patients, respectively. Cardiac mortality at 1 year in patients with peri-procedural MI defined by 4th UDMI, 3rd UDMI, ARC-2, and SCAI were 3.0%, 2.9%, 5.8%, and 10.0%, respectively. After multivariate adjustments, peri-procedural MI defined by the ARC-2 and SCAI were independently associated with cardiac death at 1 year, while those defined by the 4th and 3rd UDMI were not.
Conclusion
Among CCS patients undergoing PCI, periprocedural MIs defined by theARC-2 and SCAI occurred 7 to 9 times less frequently as compared with the 4th and 3rd UDMI, and were the only definitions significantly associated with cardiac mortality.
Funding Acknowledgement
Type of funding sources: None. Cardiac death at 1 year
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Affiliation(s)
- Y Ueki
- University Hospital, Bern, Switzerland
| | - T Otsuka
- University Hospital, Bern, Switzerland
| | - S Bar
- University Hospital, Bern, Switzerland
| | | | - S Losdat
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - D Heg
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Zanchin
- University Hospital, Bern, Switzerland
| | - G Siontis
- University Hospital, Bern, Switzerland
| | - F Praz
- University Hospital, Bern, Switzerland
| | - J Haner
- University Hospital, Bern, Switzerland
| | - N Susuri
- University Hospital, Bern, Switzerland
| | - S Stortecky
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Pilgrim
- University Hospital, Bern, Switzerland
| | | | - L Raber
- University Hospital, Bern, Switzerland
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27
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Bigler MR, Spano G, Boscolo Berto M, Ueki Y, Otsuka T, Huber AT, Raeber L, Graeni C. Comprehensive non-invasive and invasive functional assessment of anomalous coronary arteries with anatomical high-risk features. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital disease associated with an increased risk of myocardial ischemia. In AAOCA, the occurrence of ischemia is based on the extent of a fixed and a dynamic component, each attributed to different anatomical high-risk features (i.e., acute take-off angle, slit-like ostium, proximal narrowing, elliptic vessel shape and intramural course). Coronary computed tomography angiography (CCTA) is the primary non-invasive imaging method to depict the presence and quantitatively assess anatomical high-risk features while invasive physiologic evaluation under maximal dobutamine-volume challenge is the gold standard to unravel the hemodynamic relevance of AAOCA.
Methods
We included all consecutive AAOCA patients with anatomical high-risk features from our prospective, open-label registry. The objective is to quantify anatomical high-risk features in the CCTA and to measure hemodynamic relevance using invasive fractional flow reserve with maximal dobutamine-volume challenge (gradually increasing dose of dobutamine max. 40 μg/kg per body weight/min, max. 3000 mL ringer lactate and max. 1mg atropine). Pathological invasive FFR was defined as FFR Dobutamine<0.80. Additionally, CCTA-data were processed to assess computational fluid dynamics (CT FFR) and intravascular ultrasound (IVUS) was used to determine minimal lumen area (MLA) during baseline and maximal stress conditions.
Results
A total of 11 patients were included between 05/19 and 11/2020. Mean age was 59±13 years (range: 40–79), 10 patients showed a right-AAOCA and one patient showed a single right coronary artery. All patients had either one (i.e., in 1 patient) or more than one anatomical-high risk features (i.e., in 10 patients). Mean invasive FFR Dobutamine was 0.88±0.07 with n=2 (18%) being pathological. Mean non-invasive CT FFR was 0.89±0.04 (FFR<0.80; n=0), mean invasive FFR Adenosine was 0.92±0.06 (FFR<0.80; n=1; 9%). There was a significant decrease in IVUS MLA between rest (7.93±2.79mm2) and under dobutamine-volume challenge (6.57±3.20mm2, p=0.008). Mean percentage of MLA reduction was 19±18%.
Conclusion
Our preliminary results provide evidence that relevant myocardial ischemia seems to be often absent in a middle-aged population with AAOCA and anatomical high-risk features. However, in a minority of cases hemodynamic relevance could be depicted, especially when stressing with dobutamine-volume challenge. The presence of a dynamic component in AAOCA is represented by the reduced minimal lumen area under stress conditions. Comprehensive diagnostic evaluation should be performed to prevent unnecessary guideline recommended open-heart surgery in a middle-aged population with AAOCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M R Bigler
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - G Spano
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - Y Ueki
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - T Otsuka
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A T Huber
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - C Graeni
- Bern University Hospital, Inselspital, Bern, Switzerland
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28
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Suzuki S, Motogi J, Matsuzawa W, Takayanagi T, Umemoto T, Hirota N, Nakai H, Hyodo A, Satoh K, Otsuka T, Arita T, Yagi N, Yajima J, Yamashita T. Identifying patients with atrial fibrillation during sinus rhythm on ECG: confirming the utility of artificial intelligence algorithm in a small-scale cohort without structural heart diseases. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Detection of atrial fibrillation (AF) out of electrocardiograph (ECG) on sinus rhythm (SR) using artificial intelligence (AI) algorithm has been widely studied within recent couple of years. Generally, it is believed that a huge number of ECGs are necessary for developing an AI-enabled ECG to be adequate to correspond to a lot of minor variations of ECGs. For example, structural heart diseases have typical ECG characteristics, but they could be a noise for the purpose of detecting the small signs of electrocardiographic signature of AF. We hypothesized that when patients with structural heart diseases are excluded, AI-enabled ECG for identifying patients with AF can be developed with a small number of ECGs.
Methods
We developed an AI-enabled ECG using a convolutional neural network to detect the electrocardiographic signature of AF present during normal sinus rhythm (NSR) using a digital, standard 10-second, 12-lead ECGs. We included all patients who newly visited the Cardiovascular Institute with at least one NSR ECG between Feb 1, 2010, and March 31, 2018. We classified patients with at least one ECG with a rhythm of AF as positive for AF (AF label) and others as negative for AF (SR label). We allocated ECGs to the training, internal validation, and testing datasets in a 7:1:2 ratio. We calculated the area under the curve (AUC) of the receiver operating characteristic curve for the internal validation dataset to select a probability threshold, which we applied to the testing dataset. We evaluated model performance on the testing dataset by calculating the AUC and the sensitivity, specificity, F1 score, and accuracy with two-sided 95% confidence intervals (CIs).
Results
We totally included 19170 patients with 12-lead ECG. After excluding patients with structural heart diseases, 12825 patients with NSR ECGs at the initial visit were identified (1262 were clinically diagnosed as AF anytime during the time course and 11563 were never diagnosed as AF). Of 11563 non-AF patients, 1818 patients who were followed over 1095 days were selected for the analysis with the SR label, to secure the robustness for maintaining SR. Of 1262 AF patients, 251 patients were selected for the analysis with the AF label, of whom a NSR ECG within 31 days before or after the index AF ECG (the first AF ECG during the time course) could be obtained. In the patients with AF label, the NSR ECG of which the date was the nearest to the index AF ECG was selected for the analysis. The AI-enabled ECG showed an AUC of 0.88 (0.84–0.92) with sensitivity 81% (72–88), specificity 80% (77–83), F1 score 50% (43–57), and overall accuracy 80% (78–83).
Conclusion
An AI-enabled ECG acquired during NSR allowed identification of patients with AF in a small population without structural heart diseases.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Suzuki
- Cardiovascular Institute, Department of cardiovascular medicine, Tokyo, Japan
| | - J Motogi
- Nihon Kohden Corporation, Tokyo, Japan
| | | | | | - T Umemoto
- Nihon Kohden Corporation, Tokyo, Japan
| | - N Hirota
- Cardiovascular Institute, Department of cardiovascular medicine, Tokyo, Japan
| | - H Nakai
- Cardiovascular Institute, Department of cardiovascular medicine, Tokyo, Japan
| | - A Hyodo
- Nihon Kohden Corporation, Tokyo, Japan
| | - K Satoh
- Nihon Kohden Corporation, Tokyo, Japan
| | - T Otsuka
- Cardiovascular Institute, Department of cardiovascular medicine, Tokyo, Japan
| | - T Arita
- Cardiovascular Institute, Department of cardiovascular medicine, Tokyo, Japan
| | - N Yagi
- Cardiovascular Institute, Department of cardiovascular medicine, Tokyo, Japan
| | - J Yajima
- Cardiovascular Institute, Department of cardiovascular medicine, Tokyo, Japan
| | - T Yamashita
- Cardiovascular Institute, Department of cardiovascular medicine, Tokyo, Japan
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29
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Otsuka T, Ueki Y, Losdat S, Baer S, Raeber L. Derivation and validation of myocardial bridge characteristics by optical coherence tomography: a prospective multimodality imaging study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Optical coherence tomography (OCT) findings of myocardial bridge (MB) have not been established.
Purpose
We aimed to establish the OCT appearance of MB compared with the half-moon sign derived by intravascular ultrasound (IVUS) and to assess the prevalence among patients undergoing coronary angiography and OCT in clinical practice.
Methods
For derivation of the OCT appearance of MB, imaging data obtained from 122 patients undergoing OCT and IVUS for the left anterior descending artery (LAD) enrolled in two prospective imaging studies were analyzed. To assess the prevalence of OCT-derived MB, 470 patients undergoing OCT for LAD in clinical routine were analyzed.
Results
We found a homogeneous band with intermediate light intensity surrounding the vessel wall as assessed by OCT corresponding to half-moon sign derived by IVUS. Mean length, angle, and thickness of OCT-MB were 21.2±10.8mm, 205.7±56.5°, and 0.39±0.06mm, respectively. Mean length of IVUS-MB was significantly longer as compared with OCT-MB (23.7±11.9, P=0.010), while there were no significant differences in angle and thickness. MB angle was >180° in approximately 50% of frames with MB. There was a strong/moderate correlation between OCT-MB and half-moon sign (MB length: r=0.81, P=0.001, MB angle: r=0.58, P=0.001). In the derivation cohort, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of OCT-MB for the milking effect by angiography were 96.3%, 62.1%, 41.9%, 98.3%, and 69.7%, respectively, and much comparable with the IVUS half-moon sign. In the validation cohort, OCT-detected MB was observed in 139 (29.6%) patients, of whom 57.6% (n=80) did not have angiographic evidence of milking effect.
Conclusion
OCT is able to identify IVUS-defined MB as homogenous band with intermediate light intensity surrounding the vessel wall. There was a high concordance in terms of MB angle and thickness between OCT and IVUS. In clinically-indicated OCT cases of the LAD, more than half of OCT-MBs were angiographically silent. OCT assessment of MB may facilitate the accurate diagnosis of MB and thus provide useful information in determining the subsequent treatment strategy for the patients with MB.
Funding Acknowledgement
Type of funding sources: None. Representative imaging of MBCase of OCT-MB without milking effect
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Affiliation(s)
- T Otsuka
- Swiss Cardiovascular Center, Bern, Switzerland
| | - Y Ueki
- Shinshu University Hospital, Cardiology, Matsumoto, Japan
| | - S Losdat
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - S Baer
- Swiss Cardiovascular Center, Bern, Switzerland
| | - L Raeber
- Swiss Cardiovascular Center, Bern, Switzerland
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Otsuka T, Adachi S, Hattori M, Sakurai Y, Tajima O. Material survey for a millimeter-wave absorber using a 3D-printed mold. Appl Opt 2021; 60:7678-7685. [PMID: 34613254 DOI: 10.1364/ao.433254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
Radio absorptive materials (RAMs) are key elements for receivers in the millimeter-wave range. We previously established a method for production of RAM by using a 3D-printed mold. An advantage of this method is a wide range of choices for absorptive materials to be used. To take advantage of this flexibility, we added a range of absorptive materials to a base epoxy resin, STYCAST-2850FT, and examined the optical performance of the resultant RAM across a wide frequency range under cryogenic conditions. We found that adding a particular type of carbon fiber produced the best performance with a reflectance at 77 K estimated as 0.01%-3% over a frequency range of 20-300 GHz.
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Häner J, Lanz J, Otsuka T, Räber L. Periprocedural stent thrombosis after percutaneous coronary intervention for a bifurcation lipid-rich plaque. EUROINTERVENTION 2021; 17:e439-e440. [PMID: 32808930 PMCID: PMC9724898 DOI: 10.4244/eij-d-20-00731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jonas Häner
- Bern University Hospital, University of Bern, Inselspital, 3010 Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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Zanchin C, Ueki Y, Losdat S, Fahrni G, Daemen J, Ondracek AS, Häner JD, Stortecky S, Otsuka T, Siontis GCM, Rigamonti F, Radu M, Spirk D, Kaiser C, Engstrom T, Lang I, Koskinas KC, Räber L. In vivo relationship between near-infrared spectroscopy-detected lipid-rich plaques and morphological plaque characteristics by optical coherence tomography and intravascular ultrasound: a multimodality intravascular imaging study. Eur Heart J Cardiovasc Imaging 2021; 22:824-834. [PMID: 31990323 DOI: 10.1093/ehjci/jez318] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/09/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS We assessed morphological features of near-infrared spectroscopy (NIRS)-detected lipid-rich plaques (LRPs) by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS). METHODS AND RESULTS IVUS-NIRS and OCT were performed in the two non-infarct-related arteries (non-IRAs) in patients undergoing percutaneous coronary intervention for treatment of an acute coronary syndrome. A lesion was defined as the 4 mm segment with the maximum amount of lipid core burden index (maxLCBI4mm) of each LRP detected by NIRS. We divided the lesions into three groups based on the maxLCBI4mm value: <250, 250-399, and ≥400. OCT analysis and IVUS analysis were performed blinded for NIRS. We measured fibrous cap thickness (FCT) by using a semi-automated method. A total of 104 patients underwent multimodality imaging of 209 non-IRAs. NIRS detected 299 LRPs. Of those, 41% showed a maxLCBI4mm <250, 39% a maxLCBI4mm 251-399, and 19% a maxLCBI4mm ≥400. LRPs with a maxLCBI4mm ≥400, as compared with LRPs with a maxLCBI4mm 250-399 and <250, were more frequently thin-cap fibroatheroma (TCFA) (42.1% vs. 5.1% and 0.8%; P < 0.001) with a smaller minimum FCT (80 μm vs. 110 μm and 120 μm; P < 0.001); a higher IVUS-derived percent atheroma volume (53% vs. 53% and 44%; P < 0.001) and a higher remodelling index (1.08 vs. 1.02 and 1.01; P < 0.001). MaxLCBI4mm correlated with OCT-derived FCT (r = 0.404; P < 0.001) and was the best predictor for TCFA with an optimal cut-off value of 401 (area under the curve = 0.882; P < 0.001). CONCLUSION LRPs with increasing maxLCBI4mm exhibit OCT and IVUS features of presumed plaque vulnerability including TCFA morphology, increased plaque burden, and positive remodelling.
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Affiliation(s)
- Christian Zanchin
- Cardiology Department, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Yasushi Ueki
- Cardiology Department, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Sylvain Losdat
- Department of Social and Preventive Medicine, Clinical Trials Unit, Institute of Social and Preventive Medicine, Bern University Hospital, 3012 Bern, Switzerland
| | - Gregor Fahrni
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Joost Daemen
- Department of Cardiology, Erasmus Medical Center, 3015 Rotterdam, the Netherlands
| | - Anna S Ondracek
- Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Jonas D Häner
- Cardiology Department, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Stefan Stortecky
- Cardiology Department, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Tatsuhiko Otsuka
- Cardiology Department, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - George C M Siontis
- Cardiology Department, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Fabio Rigamonti
- Department of Cardiology, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Maria Radu
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - David Spirk
- Department of Pharmacology, Institute of Pharmacology, University of Bern, 3012 Bern, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Thomas Engstrom
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Irene Lang
- Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Lorenz Räber
- Cardiology Department, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
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Zanchin C, Koskinas KC, Ueki Y, Losdat S, Häner JD, Bär S, Otsuka T, Inderkum A, Jensen MRJ, Lonborg J, Fahrni G, Ondracek AS, Daemen J, van Geuns RJ, Iglesias JF, Matter CM, Spirk D, Juni P, Mach F, Heg D, Engstrom T, Lang I, Windecker S, Räber L. Effects of the PCSK9 antibody alirocumab on coronary atherosclerosis in patients with acute myocardial infarction: a serial, multivessel, intravascular ultrasound, near-infrared spectroscopy and optical coherence tomography imaging study-Rationale and design of the PACMAN-AMI trial. Am Heart J 2021; 238:33-44. [PMID: 33951415 DOI: 10.1016/j.ahj.2021.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/26/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The risk for cardiovascular adverse events after acute myocardial infarction (AMI) remains high despite potent medical treatment including low-density lipoprotein cholesterol (LDL-C) lowering with statins. Proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies substantially reduce LDL-C when added to statin. Alirocumab, a monoclonal antibody to PCSK9, reduces major adverse cardiovascular events after AMI. The effects of alirocumab on coronary atherosclerosis including plaque burden, plaque composition and fibrous cap thickness in patients presenting with AMI remains unknown. AIMS To determine the effect of LDL-C lowering with alirocumab on top of high-intensity statin therapy on intravascular ultrasound (IVUS)-derived percent atheroma volume (PAV), near-infrared spectroscopy (NIRS)-derived maximum lipid core burden index within 4 mm (maxLCBI4 mm) and optical coherence tomography (OCT)-derived fibrous cap thickness (FCT) in patients with AMI. METHODS In this multicenter, double-blind, placebo-controlled trial, 300 patients with AMI (ST-elevation or non-ST-elevation myocardial infarction) were randomly assigned to receive either biweekly subcutaneous alirocumab (150 mg) or placebo beginning <24 hours after the acute event as add-on therapy to rosuvastatin 20 mg. Patients undergo serial IVUS, NIRS and OCT in the two non-infarct related arteries at baseline (at the time of treatment of the culprit lesion) and at 52 weeks. The primary endpoint, change in IVUS-derived PAV, and the powered secondary endpoints, change in NIRS-derived maxLCBI4 mm, and OCT-derived minimal FCT, will be assessed 52 weeks post randomization. SUMMARY The PACMAN-AMI trial will determine the effect of alirocumab on top of high-intensity statin therapy on high-risk coronary plaque characteristics as assessed by serial, multimodality intracoronary imaging in patients presenting with AMI. CLINICAL TRIAL REGISTRATION NCT03067844.
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Affiliation(s)
- Christian Zanchin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Konstantinos C Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Inderkum
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Radu Juul Jensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Lonborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gregor Fahrni
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Anna S Ondracek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Joost Daemen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - David Spirk
- Department of Pharmacology, Bern University Hospital, Bern, Switzerland and Sanofi, Switzerland
| | - Peter Juni
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Francois Mach
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Thomas Engstrom
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Irene Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Otsuka T, Ueki Y, Kavaliauskaite R, Zanchin T, Bär S, Stortecky S, Pilgrim T, Valgimigli M, Meier B, Heg D, Windecker S, Räber L. Single antiplatelet therapy with use of prasugrel in patients undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 98:E213-E221. [PMID: 33754441 DOI: 10.1002/ccd.29650] [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: 12/26/2020] [Revised: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to assess the ischemic and bleeding risks of single antiplatelet therapy (SAPT) with prasugrel compared with standard dual antiplatelet therapy (DAPT) (aspirin plus clopidogrel for 1 year) in patients with chronic coronary syndrome (CCS) treated with new generation drug-eluting stents (DES). BACKGROUND To date, data on SAPT with potent P2Y12 inhibitors in the absence of aspirin immediately after PCI are limited. METHODS Between January 2009 and November 2019, all CCS patients undergoing percutaneous coronary intervention (PCI) enrolled to the Bern PCI registry were considered for analysis. We performed propensity score matching in a 1:4 fashion to compare patients who received SAPT with prasugrel versus standard DAPT. The primary ischemic endpoint was a composite of cardiovascular death, myocardial infarction, and stroke and the primary bleeding endpoint was BARC 3 or 5 bleeding, both assessed at 1 year. RESULTS After propensity score matching, the final study population consisted of 225 patients with SAPT and 889 with DAPT. There was no significant difference in rates of the primary ischemic (5.2% vs. 4.2%, p = .50) or the primary bleeding (1.5% vs. 2.0%, p = .60) endpoints between groups. SAPT was not associated with an increased risk of definite stent thrombosis (0.9% vs. 0.8%, p = .83). CONCLUSIONS Among selected CCS patients undergoing PCI with DES, SAPT with prasugrel was not associated with an excess of ischemic events compared with standard DAPT. No difference in bleeding was observed either. The results may serve as the basis for larger trials assessing the potential benefits and risks of SAPT.
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Affiliation(s)
- Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raminta Kavaliauskaite
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Zanchin
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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Häner JD, Duband B, Ueki Y, Otsuka T, Combaret N, Siontis GCM, Bär S, Stortecky S, Motreff P, Losdat S, Windecker S, Souteyrand G, Räber L. Impact of intracoronary optical coherence tomography in routine clinical practice: A contemporary cohort study. Cardiovasc Revasc Med 2021; 38:96-103. [PMID: 34340915 DOI: 10.1016/j.carrev.2021.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/PURPOSE Guidelines recommend intracoronary optical coherence tomography (OCT) to assess stent failure and guide percutaneous coronary intervention (PCI) but OCT may be useful for other indications in routine clinical practice. METHODS/MATERIALS We conducted an international registry of OCT cases at two large tertiary care centers to assess clinical indications and the potential impact on decision making of OCT in clinical routine. Clinical indications, OCT findings, and their impact on interventional or medical treatment strategy were retrospectively assessed. RESULTS OCT was performed in 810 coronary angiography cases (1928 OCT-pullbacks). OCT was used for diagnostic purposes in 67% (N = 542) and OCT-guided percutaneous coronary intervention in 50% (N = 404, 136 cases with prior diagnostic indication). Most frequent indications for diagnostic OCT were culprit lesion identification in suspected ACS (29%) and stent failure assessment (28%). OCT findings in the diagnostic setting influenced patient management in 74%. OCT-guided PCIs concerned ACS patients in 45%. Among the 55% with chronic coronary syndrome, long lesions >28 mm (19%), left main PCI (16%), and bifurcation PCI with side-branch-stenting (5%) were the leading indications for PCI-guidance. Post-procedural OCT findings led to corrective measures in 52% (26% malapposition, 14% underexpansion, 6% edge dissection, 3% intrastent mass, 3% geographic plaque miss). CONCLUSIONS OCT was most frequently performed to identify culprit lesions in suspected ACS, for stent failure assessment, and PCI-guidance. OCT may impact subsequent treatment strategies in two out of three patients.
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Affiliation(s)
- Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin Duband
- Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - Sylvain Losdat
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Institut Pascal UMR 6602 CNRS SIGMA UCA, Clermont-Ferrand, France
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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Ueki Y, Yamaji K, Losdat S, Karagiannis A, Taniwaki M, Roffi M, Otsuka T, Koskinas KC, Holmvang L, Maldonado R, Pedrazzini G, Radu MD, Dijkstra J, Windecker S, Garcia-Garcia HM, Räber L. Discordance in the diagnostic assessment of vulnerable plaques between radiofrequency intravascular ultrasound versus optical coherence tomography among patients with acute myocardial infarction: insights from the IBIS-4 study. Int J Cardiovasc Imaging 2021; 37:2839-2847. [PMID: 34236570 PMCID: PMC8494667 DOI: 10.1007/s10554-021-02272-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022]
Abstract
We aimed to evaluate the diagnostic agreement between radiofrequency (RF) intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for thin-cap fibroatheroma (TCFA) in non-infarct-related coronary arteries (non-IRA) in patients with ST-segment elevation myocardial infarction (STEMI). In the Integrated Biomarker Imaging Study (IBIS-4), 103 STEMI patients underwent OCT and RF-IVUS imaging of non-IRA after successful primary percutaneous coronary intervention and at 13-month follow-up. A coronary lesion was defined as a segment with ≥ 3 consecutive frames (≈1.2 mm) with plaque burden ≥ 40% as assessed by grayscale IVUS. RF-IVUS-derived TCFA was defined as a lesion with > 10% confluent necrotic core abutting to the lumen in > 10% of the circumference. OCT-TCFA was defined by a minimum cap thickness < 65 μm. The two modalities were matched based on anatomical landmarks using a dedicated matching software. Using grayscale IVUS, we identified 276 lesions at baseline (N = 146) and follow-up (N = 130). Using RF-IVUS, 208 lesions (75.4%) were classified as TCFA. Among them, OCT identified 14 (6.7%) TCFA, 60 (28.8%) thick-cap fibroatheroma (ThCFA), and 134 (64.4%) non-fibroatheroma. All OCT-TCFA (n = 14) were confirmed as RF-TCFA. The concordance rate between RF-IVUS and OCT for TCFA diagnosis was 29.7%. The reasons for discordance were: OCT-ThCFA (25.8%); OCT-fibrous plaque (34.0%); attenuation due to calcium (23.2%); attenuation due to macrophage (10.3%); no significant attenuation (6.7%). There was a notable discordance in the diagnostic assessment of TCFA between RF-IVUS and OCT. The majority of RF-derived TCFA were not categorized as fibroatheroma using OCT, while all OCT-TCFA were classified as TCFA by RF-IVUS. ClinicalTrials.gov Identifier NCT00962416.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | | | - Masanori Taniwaki
- Department of Cardiology, Tokorozawa Heart Center, Tokorozawa, Japan
| | - Marco Roffi
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Konstantinos C Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Lene Holmvang
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rafaela Maldonado
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | | | - Maria D Radu
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jouke Dijkstra
- Leiden University Medical Center, Leiden, the Netherlands
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Hector M Garcia-Garcia
- MedStar Cardiovacular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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Kavaliauskaite R, Otsuka T, Ueki Y, Räber L. Coronary embolism due to possible thrombosis of prosthetic aortic valve - the role of optical coherence tomography: case report. Eur Heart J Case Rep 2021; 5:ytab115. [PMID: 34377894 PMCID: PMC8343470 DOI: 10.1093/ehjcr/ytab115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/11/2020] [Accepted: 03/04/2021] [Indexed: 12/04/2022]
Abstract
Background Coronary embolism is an important non-atherosclerotic cause of acute myocardial infarction (AMI) that requires an individualized diagnostic and therapeutic approach. Although certain angiographic criteria exist that render an embolic origin likely, uncertainty remains. Optical coherence tomography (OCT) is a high-resolution intracoronary imaging technology that enables visualization of thrombus and the underlying coronary vessel wall, which may be helpful to distinguish between an atherosclerotic and non-atherosclerotic origin of AMI. Case summary A 50-year-old male was admitted with ongoing chest pain. Eleven years ago, he underwent implantation of a mechanical aortic valve prosthesis due to degenerated bicuspid valve with normal coronaries on preoperative angiography. The electrocardiogram showed anterior ST-segment elevation. Emergent angiography revealed total occlusion of the proximal left anterior descending artery (LAD). Thrombus was aspirated along with administration of intravenous glycoprotein IIbIIIa inhibitor. Except the apical part of the LAD showing distal embolization, coronary flow was completely re-established with no evidence of significant atherosclerosis. Stents were not implanted on the basis of the OCT finding, which demonstrated at the site of occlusion a normal vessel wall without atherosclerosis that could explain an erosion or plaque rupture event. Transoesophageal echocardiography confirmed a floating structure in the left ventricular outflow tract, suggesting that an embolus originating from the prosthetic aortic valve obstructed the LAD. The international normalized ratio 2 days prior to presentation measured 1.9. Discussion This case illustrates the utility of OCT to rule out the atherosclerotic aetiology of myocardial infarction and to avoid unnecessary stenting.
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Affiliation(s)
- Raminta Kavaliauskaite
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
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Bigler M, Spano G, Boscolo Berto M, Ueki Y, Otsuka T, Huber A, Räber L, Gräni C. Non-invasive And Invasive Functional Assessment Of Anomalous Coronary Arteries With Anatomical High-risk Features In A Middle-aged Population. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.185] [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: 11/15/2022]
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Yajima M, Masuzaki S, Yoshida N, Tokitani M, Otsuka T, Oya Y, Torikai Y, Motojima G. Investigation on tritium retention and surface properties on the first wall in the large helical Device. Nuclear Materials and Energy 2021. [DOI: 10.1016/j.nme.2021.100906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Bär S, Kavaliauskaite R, Ueki Y, Otsuka T, Kelbæk H, Engstrøm T, Baumbach A, Roffi M, von Birgelen C, Ostojic M, Pedrazzini G, Kornowski R, Tüller D, Vukcevic V, Magro M, Losdat S, Windecker S, Räber L. Quantitative Flow Ratio to Predict Nontarget Vessel-Related Events at 5 Years in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Angiography-Guided Revascularization. J Am Heart Assoc 2021; 10:e019052. [PMID: 33899509 PMCID: PMC8200733 DOI: 10.1161/jaha.120.019052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Indexed: 12/31/2022]
Abstract
Background In ST-segment-elevation myocardial infarction, angiography-based complete revascularization is superior to culprit-lesion-only percutaneous coronary intervention. Quantitative flow ratio (QFR) is a novel, noninvasive, vasodilator-free method used to assess the hemodynamic significance of coronary stenoses. We aimed to investigate the incremental value of QFR over angiography in nonculprit lesions in patients with ST-segment-elevation myocardial infarction undergoing angiography-guided complete revascularization. Methods and Results This was a retrospective post hoc QFR analysis of untreated nontarget vessels (any degree of diameter stenosis [DS]) from the randomized multicenter COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trial by assessors blinded for clinical outcomes. The primary end point was cardiac death, spontaneous nontarget vessel myocardial infarction, and clinically indicated nontarget vessel revascularization (ie, ≥70% DS by 2-dimensional quantitative coronary angiography or ≥50% DS and ischemia) at 5 years. Of 1161 patients with ST-segment-elevation myocardial infarction, 946 vessels in 617 patients were analyzable by QFR. At 5 years, the rate of the primary end point was significantly higher in patients with QFR ≤0.80 (n=35 patients, n=36 vessels) versus QFR >0.80 (n=582 patients, n=910 vessels) (62.9% versus 12.5%, respectively; hazard ratio [HR], 7.33 [95% CI, 4.54-11.83], P<0.001), driven by higher rates of nontarget vessel myocardial infarction (12.8% versus 3.1%, respectively; HR, 4.38 [95% CI, 1.47-13.02], P=0.008) and nontarget vessel revascularization (58.6% versus 7.7%, respectively; HR, 10.99 [95% CI, 6.39-18.91], P<0.001) with no significant differences for cardiac death. Multivariable analysis identified QFR ≤0.80 but not ≥50% DS by 3-dimensional quantitative coronary angiography as an independent predictor of the primary end point. Results were consistent, including only >30% DS by 3-dimensional quantitative coronary angiography. Conclusions Our study suggests incremental value of QFR over angiography-guided percutaneous coronary intervention for nonculprit lesions among patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
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Affiliation(s)
- Sarah Bär
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
| | | | - Yasushi Ueki
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
| | - Henning Kelbæk
- Department of Cardiology Zealand University Hospital Roskilde Denmark
| | - Thomas Engstrøm
- Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices William Harvey Research InstituteQueen Mary University of London and Barts Heart Centre London United Kingdom
| | - Marco Roffi
- Division of Cardiology University Hospital Geneva Geneva Switzerland
| | - Clemens von Birgelen
- Department of Cardiology Thoraxcentrum Medisch Spectrum Twente Enschede the Netherlands.,Department of Health Technology and Services Research Technical Medical Centre University of Twente Enschede the Netherlands
| | | | | | - Ran Kornowski
- Cardiology Department Rabin Medical Center Tel Aviv University Petah Tikwa Israel
| | - David Tüller
- Cardiology Department Triemlispital Zurich Switzerland
| | | | | | - Sylvain Losdat
- Clinical Trials Unit (CTU) Bern University of Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
| | - Lorenz Räber
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
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Sepah Y, Nguyen Q, Yamaguchi Y, Otsuka T, Majikawa Y, Reusch M, Akizawa T. POS-292 OPHTHALMOLOGICAL EFFECTS OF ROXADUSTAT IN THE TREATMENT OF ANEMIA IN DIALYSIS-DEPENDENT AND NON–DIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE PATIENTS: FINDINGS FROM TWO PHASE 3 STUDIES. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.307] [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: 10/21/2022] Open
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Akizawa T, Iwasaki M, Otsuka T, Yamaguchi Y, Reusch M. POS-244 A PHASE 3, MULTICENTER, RANDOMIZED, OPEN-LABEL, ACTIVE COMPARATOR CONVERSION STUDY OF ROXADUSTAT IN NON–DIALYSIS-DEPENDENT (NDD) PATIENTS WITH ANEMIA IN CHRONIC KIDNEY DISEASE (CKD). Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.259] [Citation(s) in RCA: 1] [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: 10/21/2022] Open
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NAGASAWA H, Kobayashi T, Otsuka T, Kaifu K, Matsusita S, Amano A, Ueda S, Suzuki Y. POS-679 Safety and efficacy of using cereal food (Frugra®) to improve blood pressure and bowel health in patients undergoing chronic hemodialysis: A pilot study. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.710] [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: 10/21/2022] Open
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Lee S, Hatano Y, Tokitani M, Masuzaki S, Oya Y, Otsuka T, Ashikawa N, Torikai Y, Asakura N, Nakamura H, Isobe K, Kurotaki H, Hamaguchi D, Hayashi T, Widdowson A, Jachmich S, Likonen J, Rubel M. Global distribution of tritium in JET with the ITER-like wall. Nuclear Materials and Energy 2021. [DOI: 10.1016/j.nme.2021.100930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Masuzaki S, Yajima M, Ogawa K, Motojima G, Tanaka M, Tokitani M, Isobe M, Otsuka T. Investigation of the distribution of remaining tritium in divertor in LHD. Nuclear Materials and Energy 2021. [DOI: 10.1016/j.nme.2020.100884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bär S, Ueki Y, Otsuka T, Kavaliauskaite R, Räber L. [Intracoronary imaging - an essential tool on the way to an individualized therapy of coronary artery disease?]. Ther Umsch 2021; 78:11-15. [PMID: 33538632 DOI: 10.1024/0040-5930/a001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intracoronary imaging - an essential tool on the way to an individualized therapy of coronary artery disease? Abstract. Since decades, coronary angiography is the standard method to assess coronary anatomy and guide percutaneous coronary intervention. However, coronary angiography is limited to the lumen and a resolution of 200 - 300 micrometers. Thus, anything beyond is not detectable. Intracoronary imaging methods by means of intravascular ultrasound (IVUS) and particularly optical coherence tomography (OCT), provide incremental effects on coronary diagnostics and therapeutic decisions. Plaque burden and -composition (lipid, fibrous, calcific tissue, intramural hematoma), small intraluminal structures (thrombus), and implanted stents are uniquely detectable by intracoronary imaging. The use of these techniques inevitably leads to improved precision in coronary diagnostics and optimization of stent implantation.
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Affiliation(s)
- Sarah Bär
- Klinik für Kardiologie, Universitätsspital Inselspital Bern
| | - Yasushi Ueki
- Klinik für Kardiologie, Universitätsspital Inselspital Bern
| | | | | | - Lorenz Räber
- Klinik für Kardiologie, Universitätsspital Inselspital Bern
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Hirota N, Suzuki S, Arita T, Yagi N, Otsuka T, Semba H, Kano H, Matsuno S, Kato Y, Uejima T, Oikawa Y, Yajima J, Yamashita T. Prediction of atrial fibrillation by 12-lead electrocardiogram parameters in patients without structural heart disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recently, the analysis of electrocardiogram (ECG) waveform by artificial intelligence has been reported to pick out those who have atrial fibrillation (AF) or have a high potential of developing AF, which, however, cannot explain the mechanisms or algorisms for the prediction from its nature.
Purpose
The purpose of this study is to conduct a comprehensive analysis to investigate the difference of weighting in predicting capability for AF among hundreds of automatically-measured ECG parameters using a single ECG at sinus rhythm.
Methods and results
Out of Shinken Database 2010–2017 (n=19170), 12825 patients were extracted, where those with ECG showing AF rhythm at the initial visit (including all persistent/permanent AF and a part of paroxysmal AF) and those with structural heart diseases were excluded. Out of 639 automatically-measured ECG parameters in MUSE data management system (GE Healthcare, USA), 438 were used. [Analysis 1] A predicting model for paroxysmal AF were determined by logistic regression analysis (Total, n=12825; paroxysmal AF, n=1138), showing a high predictive capability (AUC = 0.780, p<0.001). In this model, the relative contribution of ECG parameters (by coefficient of determination) according to the time phase were P:72.4%, QRS:32.7%, and ST-T:13.7%, respectively (Figure A). [Analysis 2] Excluding AF at baseline, a predicting model for new-developed AF were determined by Cox regression analysis (Total, n=11687; new-developed AF, n=87), showing a high predictive capability (AUC = 0.887, p<0.001). In this model, the relative contribution of parameters (by log likelihood) according to the time phase were P:40.8%, QRS:42.5%, and ST-T:24.9%, respectively (Figure B).
Conclusions
We determined ECG parameters that potentially contribute to picking up existing AF or predicting future development of AF, where the measurement of P wave strongly contributed in the former whereas all time phases were similarly important in the latter.
Weighting of parameters to predict AF
Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Self funding of the institute
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Affiliation(s)
- N Hirota
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - S Suzuki
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - T Arita
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - N Yagi
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - T Otsuka
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - H Semba
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - H Kano
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - S Matsuno
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - Y Kato
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - T Uejima
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - Y Oikawa
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - J Yajima
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - T Yamashita
- Cardiovascular Institute Hospital, Tokyo, Japan
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Nio K, Iguchi H, Shimokawa M, Shirakawa T, Koga F, Ueda Y, Nakazawa J, Komori A, Arima S, Fukahori M, Makiyama A, Taguchi H, Honda T, Shibuki T, Ide Y, Ureshino N, Mizuta T, Mitsugi K, Otsuka T. 192P A multicenter crossover analysis of first and second-line FOLFIRINOX or gemcitabine plus nab-paclitaxel administered to pancreatic cancer patients: Results from the NAPOLEON study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.456] [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] Open
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Kato Y, Itahashi N, Uejima T, Semba H, Arita T, Yagi N, Suzuki S, Otsuka T, Kishi M, Kanou H, Matsuno S, Oikawa Y, Yajima J, Yamashita T. Heart rate recovery after exercise as a prognostic predictor in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A delayed heart rate recovery (HRR) after exercise is related to mortality in sinus rhythm. This study aimed to investigate this concept can be applied to patients with atrial fibrillation (AF).
Methods
We analyzed 483 patients with AF (mean 65 years, male 74%). HRR integral was calculated by integrating the difference in HR in every 3 second between the end of exercise and the specified time after the exercise (30, 60, 120 and 180 seconds). After evaluating the prognostic power of each HRR integral, we selected HRR integral of 180 seconds (180HRR-integral).
Results
We divided the patients into two groups using median value of 180HRR-integral. All-cause mortality, the incidence of cardiovascular events and heart failure events were higher in the poor 180HRR-integral. After adjustment for covariates, the impact of the high 180HRR-integral for all-cause mortality was 3.15 (p=0.057), 1.77 for cardiovascular events (p=0.067) and 1.28 for heart failure events (p=0.519).
Conclusion
Poor HRR was associated with worse prognosis in patients with AF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Kato
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - N Itahashi
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - T Uejima
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - H Semba
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - T Arita
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - N Yagi
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - S Suzuki
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - T Otsuka
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - M Kishi
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - H Kanou
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - S Matsuno
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - Y Oikawa
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - J Yajima
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
| | - T Yamashita
- The Cardiovascular Institute, Cardiology, Tokyo, Japan
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Baer S, Kavaliauskaite R, Ueki Y, Otsuka T, Engstrom T, Baumbach A, Roffi M, Von Birgelen C, Vukcevic V, Pedrazzini G, Kornowski R, Tueller D, Losdat S, Windecker S, Raeber L. Quantitative flow ratio to predict non-target-vessel-related events at 5 years in STEMI patients undergoing angiography-guided revascularization. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with ST-segment-elevation myocardial infarction (STEMI), angiography-based complete revascularization is associated with superior outcomes compared with culprit-lesion-only percutaneous coronary intervention (PCI). Quantitative Flow Ratio (QFR) is a novel, non-invasive, vasodilator-free method to assess the hemodynamic significance of coronary stenoses.
Purpose
To investigate the incremental value of QFR over angiography alone in the assessment of non-culprit lesions (NCL) in STEMI patients undergoing primary PCI.
Methods
In the randomized, multicenter COMFORTABLE AMI trial, STEMI patients underwent angiography-guided complete revascularization. QFR was determined in untreated non-target vessels by assessors blinded for clinical outcomes.
Results
Out of 1161 STEMI patients, 946 vessels in 617 patients could be analyzed by QFR. At 5-year follow-up, the rate of the primary endpoint cardiac death, non-target vessel myocardial infarction (non-TV-MI) and clinically indicated, non-target vessel revascularization (non-TVR) was significantly higher in patients with QFR ≤0.80 compared with QFR >0.80 (62.9% vs. 12.7%, HR 7.20, 95% CI 4.46–11.62, p<0.001), driven by higher rates of non-TV-MI (15.4% vs. 3.6%, HR 4.59, 95% CI 1.72–12.23, p=0.002) and non-TVR (58.6% vs. 7.7%, HR 10.99, 95% CI 6.39–18.91, p<0.001). No significant differences for cardiac death were observed. Multivariate analysis identified QFR ≤0.80, MI SYNTAX score and left ventricular function as independent predictors of the primary endpoint. QFR ≤0.80 showed an accuracy of 86.1%, sensitivity of 23.2%, specificity of 97.5%, positive predictive value of 62.9% and negative predictive value of 87.5% for the prediction of the primary endpoint.
Conclusions
Our study results suggest incremental value of QFR over angiography-guided PCI for NCL among STEMI patients undergoing primary PCI.
Kaplan-Meier curves of primary endpoint
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Baer
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - R Kavaliauskaite
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - Y Ueki
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - T Otsuka
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - T Engstrom
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - A Baumbach
- Barts Heart Centre, Department of Cardiology, London, United Kingdom
| | - M Roffi
- Geneva University Hospitals, Division of Cardiology, Geneva, Switzerland
| | - C Von Birgelen
- Thorax Centre in Medisch Spectrum Twente (MST), Department of Cardiology, Enschede, Netherlands (The)
| | - V Vukcevic
- Clinical center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - G Pedrazzini
- Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - R Kornowski
- Clalit Health Services- Rabin Medical Center, Department of Cardiology, Tel Aviv, Israel
| | - D Tueller
- Triemli Hospital, Department of Cardiology, Zurich, Switzerland
| | - S Losdat
- University of Bern, Clinical Trials Unit, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
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