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Delabays C, Correia P, Eeckhout E, Delabays A, Michel P. Comparison of atrial septal defect and patent foramen ovale in cryptogenic strokes. J Stroke Cerebrovasc Dis 2024; 33:107664. [PMID: 38428550 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107664] [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] [Received: 08/13/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES Paradoxical embolism from right-to-left shunt through atrial septal defect (ASD) and patent foramen ovale (PFO) is a well-accepted cause of "cryptogenic" strokes (CS). To better understand the pathogenic role of ASD, we compared ASD patients with CS having a high and low likelihood of being PFO-related. METHODS In the Acute Stroke Registry and Analysis of Lausanne, we calculated prevalence of PFO and ASD in CS patients undergoing echocardiography, and calculated odds ratios (OR) when compared to non-CS. Using the Risk of Paradoxical Embolism (RoPE) score, we divided CS PFO patients in high (HL-PFO, RoPE 8-10) and low-likelihood (LL-PFO, RoPE 0-4) PFO-related stroke. We then performed univariate comparison of epidemiological, clinical and radiological variables of ASD patients with both PFO groups. RESULTS Among all CS, prevalence of ASD and PFO were 1.3% and 36.8% respectively. When compared to non-CS, ASD and PFO were associated with CS (OR of 5.2, CI= 1.6-16.6, and 2.8, CI= 2.1-3.8). Compared with HL-PFO, ASD patients were older, more often female, had more cardiovascular risk factors and silent strokes. Compared with LL-PFO, ASD patients were younger, more often female, and had less risk factors. No differences were found for clinical and radiological characteristics and clinical outcome. CONCLUSION ASD is a rare stroke risk factor for CS. Since characteristics of such patients lie in-between high and low-likelihood paradoxical PFO-strokes, a thorough work-up for other stroke mechanisms is warranted. Individual evaluation of the likelihood of the ASD being causative for stroke may be preferable over routine ASD closure.
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Affiliation(s)
- Constant Delabays
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, of the Lausanne University Hospital, Lausanne, Switzerland.
| | - Pamela Correia
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, of the Lausanne University Hospital, Lausanne, Switzerland.
| | - Eric Eeckhout
- Cardiology Service, Department Heart-Vessel of the Lausanne University Hospital, Lausanne, Switzerland.
| | - Alain Delabays
- Cardiology Service, Department Heart-Vessel of the Lausanne University Hospital, Lausanne, Switzerland.
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, of the Lausanne University Hospital, Lausanne, Switzerland.
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2
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Luangphiphat W, Prombutara P, Muangsillapasart V, Sukitpunyaroj D, Eeckhout E, Taweechotipatr M. Exploring of gut microbiota features in dyslipidemia and chronic coronary syndrome patients undergoing coronary angiography. Front Microbiol 2024; 15:1384146. [PMID: 38646625 PMCID: PMC11026706 DOI: 10.3389/fmicb.2024.1384146] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Chronic coronary syndrome (CCS) has a high mortality rate, and dyslipidemia is a major risk factor. Atherosclerosis, a cause of CCS, is influenced by gut microbiota dysbiosis and its metabolites. The objective of this study was to study the diversity and composition of gut microbiota and related clinical parameters among CCS patients undergoing coronary angiography and dyslipidemia patients in comparison to healthy volunteers in Thailand. CCS patients had more risk factors and higher inflammatory markers, high-sensitivity C-reactive protein (hs-CRP) than others. The alpha diversity was lower in dyslipidemia and CCS patients than in the healthy group. A significant difference in the composition of gut microbiota was observed among the three groups. The relative abundance of Proteobacteria, Fusobacteria, Enterobacteriaceae, Prevotella, and Streptococcus was significantly increased while Roseburia, Ruminococcus, and Faecalibacterium were lower in CCS patients. In CCS patients, Lachnospiraceae, Peptostreptococcaceae, and Pediococcus were positively correlated with hs-CRP. In dyslipidemia patients, Megasphaera was strongly positively correlated with triglyceride (TG) level and negatively correlated with high-density lipoprotein cholesterol (HDL-C). The modification of gut microbiota was associated with changes in clinical parameters involved in the development of coronary artery disease (CAD) in CCS patients.
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Affiliation(s)
- Wongsakorn Luangphiphat
- Innovative Anatomy Program, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
- Division of Cardiology, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Pinidphon Prombutara
- Omics Sciences and Bioinformatics Center, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
- Mod Gut Co., Ltd., Bangkok, Thailand
| | - Viroj Muangsillapasart
- Division of Cardiology, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Damrong Sukitpunyaroj
- Division of Cardiology, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Malai Taweechotipatr
- Center of Excellence in Probiotics, Srinakharinwirot University, Bangkok, Thailand
- Department of Microbiology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
- Clinical Research Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
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Rutz T, Aubert JD, Beghetti M, Eeckhout E, Muller O, Bouchardy J, Yerly P. Atrial Septal Defect, Pulmonary Arterial Hypertension, and Diastolic Left Heart Failure: When 3 Players Come into the Game. Circ Heart Fail 2024:e010545. [PMID: 38511310 DOI: 10.1161/circheartfailure.123.010545] [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] [Indexed: 03/22/2024]
Affiliation(s)
- Tobias Rutz
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.)
| | - John-David Aubert
- Division of Pulmonology, Lausanne University Hospital and University of Lausanne, Switzerland. (J.-D.A.)
| | - Maurice Beghetti
- Pediatric Cardiology Unit and Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Children's University Hospitals, Lausanne and Geneva, Switzerland (M.B.)
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.)
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.)
| | - Judith Bouchardy
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.)
| | - Patrick Yerly
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.)
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4
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Bergamaschi L, Landi A, Maurizi N, Pizzi C, Leo LA, Arangalage D, Iglesias JF, Eeckhout E, Schwitter J, Valgimigli M, Pavon AG. Acute Response of the Noninfarcted Myocardium and Surrounding Tissue Assessed by T2 Mapping After STEMI. JACC Cardiovasc Imaging 2024:S1936-878X(23)00540-5. [PMID: 38276932 DOI: 10.1016/j.jcmg.2023.11.014] [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: 05/16/2023] [Revised: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is associated with a systemic and local inflammatory response with edema. However, their role at the tissue level is poorly characterized. OBJECTIVES This study aims to characterize T2 values of the noninfarcted myocardium (NIM) and surrounding tissue and to investigate prognostic relevance of higher NIM T2 values after STEMI. METHODS A total of 171 consecutive patients with STEMI without prior cardiovascular events who underwent cardiac magnetic resonance after primary percutaneous coronary intervention were analyzed in terms of standard infarct characteristics. Edema of the NIM, liver, spleen, and pectoralis muscle was assessed based on T2 mapping. Follow-up was available for 130 patients. The primary endpoint was major adverse cardiac events (MACE), defined as cardiovascular death, myocardial infarction, unplanned coronary revascularization or rehospitalization for heart failure. The median time from primary percutaneous coronary intervention to cardiac magnetic resonance was 3 days (IQR: 2-5 days). RESULTS Higher (above the median value of 45 ms) T2 values in the NIM area were associated with larger infarct size, microvascular obstruction, and left ventricular dysfunction and did not correlate with C-reactive protein, white blood cells, or T2 values of the pectoralis muscle, liver, and spleen. At a median follow-up of 17 months, patients with higher (>45 ms) NIM T2 values had increased risk of MACE (P < 0.001) compared with subjects with NIM T2 values ≤45 ms, mainly caused by a higher rate of myocardial reinfarction (26.3% vs 1.4%; P < 0.001). At multivariable analysis, higher NIM T2 values independently predicted MACE (HR: 2.824 [95% CI: 1.254-6.361]; P = 0.012). CONCLUSIONS Higher NIM T2 values after STEMI are independently associated with worse cardiovascular outcomes, mainly because of higher risk of myocardial infarction.
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Affiliation(s)
- Luca Bergamaschi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Niccolò Maurizi
- Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland; Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Dimitri Arangalage
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland; University of Lausanne (Unil), Lausanne, Switzerland
| | - Juerg Schwitter
- Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland; Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland; University of Lausanne (Unil), Lausanne, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland.
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5
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Abellan C, Antiochos P, Fournier S, Skali H, Shah P, Maurizi N, Eeckhout E, Roguelov C, Monney P, Tzimas G, Kirsch M, Muller O, Lu H. Extrathoracic Against Intrathoracic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review With Meta-Analysis. Am J Cardiol 2023; 203:473-483. [PMID: 37633682 DOI: 10.1016/j.amjcard.2023.07.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/14/2023] [Indexed: 08/28/2023]
Abstract
Alternative vascular accesses to transfemoral access for transcatheter aortic valve replacement (TAVR) can be divided into intrathoracic (IT)-transapical and transaortic- and extrathoracic (ET)-transcarotid, transsubclavian, and transaxillary. This study aimed to compare the outcomes and safety of IT and ET accesses for TAVR as alternatives to transfemoral access. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all studies comparing IT-TAVR with ET-TAVR published until April 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM), 1-year ACM, postoperative and 30-day complications. A total of 18 studies with 6,800 IT-TAVR patients and 5,032 ET-TAVR patients were included. IT accesses were associated with a significantly higher risk of in-hospital or 30-day ACM (relative risk 1.99, 95% confidence interval 1.67 to 2.36, p <0.001), and 1-year ACM (relative risk 1.31, 95% confidence interval 1.21 to 1.42, p <0.001). IT-TAVR patients presented more often with postoperative life-threatening bleeding, 30-day new-onset atrial fibrillation or flutter, and 30-day acute kidney injury needing renal replacement therapy. The risks of postoperative permanent pacemaker implantation and significant paravalvular leak were lower with IT-TAVR. ET-TAVR patients were more likely to be directly discharged home. There was no statistically significant difference regarding the 30-day risk of stroke. Compared with ET-TAVR, IT-TAVR was associated with higher risks of in-hospital or 30-day ACM, 1-year ACM and higher risks for some critical postprocedural and 30-day complications. Our results suggest that ET-TAVR could be considered as the first-choice alternative approach when transfemoral access is contraindicated.
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Affiliation(s)
- Christophe Abellan
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Panagiotis Antiochos
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pinak Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Niccolo Maurizi
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christan Roguelov
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgios Tzimas
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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6
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Salihu A, Roguelov C, Fournier S, Coucke P, Eeckhout E. Intracoronary Brachytherapy for Restenosis: 20 Years of Follow-Up. Cardiovasc Revasc Med 2023; 54:1-4. [PMID: 37087307 DOI: 10.1016/j.carrev.2023.04.009] [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] [Received: 01/24/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND/PURPOSE Intracoronary brachytherapy (ICB) has mainly been used to treat in-stent restenosis following percutaneous coronary intervention and was virtually abandoned about 20 years ago. However, patients treated with this strategy are still alive and some teams continue to perform this therapy. We aimed to investigate the very long-term clinical outcome of patients treated with ICB. METHODS/MATERIALS A total of 173 consecutive patients who had been treated with ICB at a large tertiary referral centre between 1998 and 2003 were included. The primary endpoint of the study was all-cause mortality. The secondary endpoints were as follows: occurrence of major adverse cardiac events (MACE, defined as all-cause death, non-fatal myocardial infarction, or target vessel revascularization), cardiac death, and presence of angina at the end of follow-up. RESULTS Patients' mean age at the time of ICB was 64 ± 10 years and 77 % were male. Restenosis (bare metal stent vs. balloon angioplasty) was the only indication for ICB. Unstable angina was present in 34 % of the patients. Follow-up was available for 166 patients. After a mean follow-up of 20 ± 1.3 years, 66 % of the patients had died (including 74 patients (67 %) with cardiac death). Cumulative MACE rate at 20 years was 96 %. CONCLUSIONS Very long-term follow-up of patients with in-stent restenosis treated with ICB confirmed a high all-cause mortality rate mainly due to cardiac causes and MACEs.
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Affiliation(s)
- Adil Salihu
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Christan Roguelov
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Eric Eeckhout
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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7
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Häner JD, Rohla M, Losdat S, Iglesias JF, Muller O, Eeckhout E, Kurz D, Weilenmann D, Kaiser C, Tapponnier M, Roffi M, Heg D, Windecker S, Pilgrim T. Ultrathin-strut vs thin-strut drug-eluting stents for multi and single-stent lesions: A lesion-level subgroup analysis of 2 randomized trials. Am Heart J 2023; 263:73-84. [PMID: 37192697 DOI: 10.1016/j.ahj.2023.05.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Whether ultrathin-strut stents are particularly beneficial for lesions requiring implantation of more than 1 stent is unknown. METHODS In a post-hoc lesion-level analysis of 2 randomized trials comparing ultrathin-strut biodegradable polymer Sirolimus-eluting stents (BP-SES) vs thin-strut durable polymer Everolimus-eluting stents (DP-EES), lesions were stratified into multistent lesions (MSL) vs single-stent lesions (SSL). The primary endpoint was target lesion failure (TLF), a composite of lesion-related unclear/cardiac death, myocardial infarction (MI), or revascularization, at 24 months. RESULTS Among 5328 lesions in 3397 patients, 1492 (28%) were MSL (722 with BP-SES, 770 with DP-EES). At 2 years, TLF occurred in 63 lesions (8.9%) treated with BP-SES and 60 lesions (7.9%) treated with DP-EES in the MSL-group (subdistibution hazard ratio [SHR], 1.13; 95% CI, 0.77-1.64; P = .53), and in 121 (6.4%) and 136 (7.4%) lesions treated with BP-SES and DP-EES respectively (SHR, 0.86; 95% CI, 0.62-1.18; P = .35) in the SSL-group (P for interaction = .241). While the rates of lesion-related MI or revascularization were significantly lower in SSL treated with BP-SES as compared to DP-EES (3.5% vs 5.2%; SHR, 0.67; 95% CI 0.46-0.97; P = .036), no significant difference was observed in MSL (7.1% vs 5.4%; SHR, 1.31; 95% CI 0.85-2.03; P = .216) with significant interaction between groups (P for interaction = .014). CONCLUSIONS Rates of TLF are similar between ultrathin-strut BP-SES and thin-strut DP-EES in MSL and SSL. The use of ultrathin-strut BP-SES vs thin-strut DP-EES did not prove to be particularly beneficial for the treatment of multistent lesions. TRIAL REGISTRATION Post-hoc analysis from the BIOSCIENCE (NCT01443104) and BIOSTEMI (NCT02579031) trials.
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Affiliation(s)
- Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Miklos Rohla
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Kurz
- Department of Cardiology, Triemli Hospital, Zurich, Switzerland
| | | | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel; Switzerland
| | | | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, 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
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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Vella A, Roux O, Antiochos P, Monney P, Maurizi N, Skalidis I, Fournier S, Eeckhout E, Roguelov C, Oestreicher S, Kirsch M, Muller O, Lu H. Meta-Analysis of the Prognostic Significance of Carotid Artery Stenosis in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 200:225-231. [PMID: 37355356 DOI: 10.1016/j.amjcard.2023.04.031] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 06/26/2023]
Abstract
Stroke is a known complication of both transcatheter aortic valve implantation (TAVI) and carotid artery stenosis (CAS). Whether CAS is a predictor of worse prognosis after TAVI is unclear. We performed a meta-analysis to assess the impact of CAS on the incidence of neurovascular complications and mortality after TAVI. We searched PubMed/MEDLINE and EMBASE databases from inception to January 2023. CAS was defined by ≥50% stenosis of at least 1 carotid artery. Studies comparing CAS versus non-CAS TAVI populations were included. Patients' baseline characteristics and 30-day clinical outcomes were extracted. End points included the 30-day incidence of neurovascular complications (stroke or transient ischemic attack) and 30-day all-cause mortality. We identified six studies, totaling 6,763 patients in the CAS group and 23,861 patients in the non-CAS group. Patients with CAS had a higher prevalence of hypertension, diabetes mellitus, dyslipidemia, previous myocardial infarction, coronary artery bypass graft, peripheral artery disease, previous neurovascular disease, and chronic kidney disease. There was no significant difference in the rates of 30-day neurovascular complications between CAS and non-CAS groups (relative risk 1.23, 95% confidence interval 0.63 to 2.40, p = 0.54). CAS was associated with a higher risk of 30-day all-cause mortality (relative risk 1.28, 95% confidence interval 1.12 to 1.47, p <0.001), not found in a sensitivity analysis. In conclusion, patients with CAS presented with a significantly higher co-morbidity burden. CAS was not associated with an increased risk of 30-day neurovascular complications. 30-day mortality was higher in the CAS group but that may be a surrogate of the heavy co-morbidity burden of patients with CAS.
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Affiliation(s)
- Agnese Vella
- Service of Cardiology, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Olivier Roux
- HerzHirslanden Group, Herzzentrum im Park AG, Zurich, Switzerland
| | - Panagiotis Antiochos
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niccolo Maurizi
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ioannis Skalidis
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christan Roguelov
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Simon Oestreicher
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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9
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Dietz M, Kamani CH, Allenbach G, Rubimbura V, Fournier S, Dunet V, Treglia G, Nicod Lalonde M, Schaefer N, Eeckhout E, Muller O, Prior JO. Comparison of the prognostic value of impaired stress myocardial blood flow, myocardial flow reserve, and myocardial flow capacity on low-dose Rubidium-82 SiPM PET/CT. J Nucl Cardiol 2023; 30:1385-1395. [PMID: 36574175 PMCID: PMC10371877 DOI: 10.1007/s12350-022-03155-6] [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: 07/22/2022] [Accepted: 10/26/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The most reliable quantitative variable on Rubidium-82 (82Rb) cardiac PET/CT for predicting major adverse cardiovascular events (MACE) has not been characterized with low-dose silicon photomultipliers (SiPM) technology, which allows halving injected activity and radiation dose delivering less than 1.0 mSv in a 70-kg individual. METHODS AND RESULTS We prospectively enrolled 234 consecutive participants with suspected myocardial ischemia. Participants underwent 82Rb cardiac SiPM PET/CT (5 MBq/kg) and were followed up for MACE over 652 days (interquartile range 559-751 days). For each participant, global stress myocardial blood flow (stress MBF), global myocardial flow reserve (MFR), and regional severely reduced myocardial flow capacity (MFCsevere) were measured. The Youden index was used to select optimal thresholds. In multivariate analysis after adjustments for clinical risk factors, reduced global stress MBF < 1.94 ml/min/g, reduced global MFR < 1.98, and regional MFCsevere > 3.2% of left ventricle emerged all as independent predictors of MACE (HR 4.5, 3.1, and 3.67, respectively, p < 0.001). However, only reduced global stress MBF remained an independent prognostic factor for MACE after adjusting for clinical risk factors and the combined use of global stress MBF, global MFR, and regional MFCsevere impairments (HR 2.81, p = 0.027). CONCLUSION Using the latest SiPM PET technology with low-dose 82Rb halving the standard activity to deliver < 1 mSv for a 70-kg patient, impaired global stress MBF, global MFR, and regional MFC were powerful predictors of cardiovascular events, outperforming traditional cardiovascular risk factors. However, only reduced global stress MBF independently predicted MACE, being superior to global MFR and regional MFC impairments.
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Affiliation(s)
- Matthieu Dietz
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- INSERM U1060, CarMeN Laboratory, University of Lyon, Lyon, France
| | - Christel H Kamani
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Gilles Allenbach
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Nuclear Medicine Department, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Vladimir Rubimbura
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- University of Lausanne, Lausanne, Switzerland
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Giorgio Treglia
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Università Della Svizzera Italiana, Lugano, Switzerland
| | - Marie Nicod Lalonde
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
- University of Lausanne, Lausanne, Switzerland.
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10
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Pitta Gros B, Roux O, Eeckhout E, Kirsch M. Case report: Stenosis turned leak … and turned stenosis-complications of paravalvular prosthetic leak closure with a plug device. Front Cardiovasc Med 2023; 10:1132063. [PMID: 37378399 PMCID: PMC10292925 DOI: 10.3389/fcvm.2023.1132063] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Background Paravalvular leak is one of the most common complications and is among the most important prognostic factors of short- and long-term mortality after transcatheter aortic valve implantation (TAVI). Percutaneous valvular leak repair constitutes a first-line treatment for paravalvular leaks and is associated with high success rates and few serious complications nowadays. To the best of our knowledge, this is the first case where placement of the device through the stenting of the bioprosthesis resulted in creating a new symptomatic stenosis that required surgery. Case summary We present a case of a patient with low-flow, low-gradient aortic stenosis treated with transfemoral implantation of a biological aortic prosthesis. One month after the procedure, the patient presented with acute pulmonary oedema and a paravalvular leak was discovered, which was corrected by percutaneous repair with a plug device. Five weeks after the valvular leak repair, the patient was readmitted for heart failure. At this time, a new aortic stenosis and paravalvular leak were diagnosed and the patient was referred for surgery. The new aortic mixed diseased was caused by the positioning of the plug device through the valve's metal stenting, which resulted in a paravalvular leak and pressed against the valve's leaflets, causing valvular stenosis. The patient was referred for surgical replacement and evolved well afterward. Conclusion This case illustrates a rare complication of a complex procedure, and it highlights the need for multidisciplinary decisions and good cooperation between the cardiology and cardiac surgery teams to develop better criteria in the selection of the appropriate technique for managing paravalvular leaks after TAVI.
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Affiliation(s)
- Barbara Pitta Gros
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Olivier Roux
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- University of Lausanne, Lausanne, Switzerland
- Department of Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
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11
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Oestreicher S, Vella A, Muller O, Kirsch M, Eeckhout E, Fournier S, Monney P, Roux O, Roguelov C, Zhang P, Abraham P, Ferlay C, Antiochos P, Lu H. Neurovascular Outcomes in Relation With Carotid Artery Stenosis in Patients Undergoing Transcatheter Aortic Valve Implantation. J Invasive Cardiol 2023; 35:E136-E142. [PMID: 36705606] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Data regarding the prevalence of carotid artery stenosis (CAS) in patients undergoing transcatheter aortic valve implantation (TAVI) are scarce. Whether CAS, especially severe or bilateral, is a predictor of worse prognosis after TAVI is unknown. We aimed to address these questions. METHODS We included all patients who underwent TAVI between 2018 and 2021. Using pre-TAVI carotid Doppler ultrasound, atherosclerosis of the right and left carotid internal arteries was assessed. CAS was defined as moderate (50%-69% stenosis, peak systolic velocity of 125-230 cm/sec) or severe (≥70% stenosis, peak systolic velocity of >230 cm/sec). When both carotid arteries presented with ≥50% stenosis, CAS was defined as bilateral. Endpoints included the 30-day incidence of stroke or transient ischemic attack (TIA), 30-day all-cause mortality, and periprocedural complications. RESULTS Among 448 patients, 56 (12.5%) had CAS, of which 15 had bilateral and 15 had severe CAS. Patients with CAS were more often men and had higher rates of peripheral artery disease, coronary artery disease, and previous percutaneous coronary intervention. There was no association between CAS and 30-day stroke or TIA (adjusted hazard ratio [aHR], 2.55; 95% confidence interval [CI], 0.73-8.91; P=.14), even when considering severe CAS only. However, a significant association was found between bilateral CAS and 30-day stroke or TIA (aHR, 8.399; 95% CI, 1.603-44.000; P=.01). No association between CAS and 30-day mortality or periprocedural complications was found. CONCLUSIONS CAS is common among TAVI patients. While CAS as a whole was not a predictor of neurovascular complications, the subgroup of bilateral CAS was associated with an increased risk of stroke.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Henri Lu
- Service of Cardiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1010 Lausanne, CH.
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12
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Skalidis I, Lu H, Antiochos P, Pitta Gros B, Auberson D, Domenichini G, Carroz P, Teres C, Messaoudi Y, Fournier S, Rutz T, Bouchardy J, Pascale P, Monney P, Hullin R, Eeckhout E, Schwitter J, Pruvot É, Muller O. [Cardiology: what's new in 2022]. Rev Med Suisse 2023; 19:16-24. [PMID: 36660831 DOI: 10.53738/revmed.2023.19.809-10.16] [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] [Indexed: 06/17/2023]
Abstract
The year of 2022 was marked by many novelties in the fields of interventional cardiology, heart failure, electrophysiology, cardiac imaging, and congenital heart disease. These advances will certainly change our daily practice, on top of improving the diagnosis and treatment of many heart conditions. In addition, the European Society of Cardiology has updated its guidelines on pulmonary hypertension, ventricular arrhythmias and sudden death, cardiovascular assessment of patients undergoing non-cardiac surgery. The members of the Cardiology division of Lausanne University Hospital (CHUV) here present the publications which they considered to be the most important of the past year.
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Affiliation(s)
- Ioannis Skalidis
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Henri Lu
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Panagiotis Antiochos
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Barbara Pitta Gros
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Denise Auberson
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Giulia Domenichini
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Patrice Carroz
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Cheryl Teres
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Yosra Messaoudi
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Stéphane Fournier
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Tobias Rutz
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Judith Bouchardy
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Patrizio Pascale
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Pierre Monney
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Roger Hullin
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Eric Eeckhout
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Jurg Schwitter
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Étienne Pruvot
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Olivier Muller
- Service de cardiologie, Département cœur et vaisseaux, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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13
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Stalder G, Chatte A, De Rossi N, Yerly P, Alberio L, Eeckhout E. Caplacizumab for treating subacute intra-stent thrombus occurring despite efficacious double anti-platelet treatment and anticoagulation: a case report. Eur Heart J Case Rep 2023; 7:ytac497. [PMID: 36793934 PMCID: PMC9924497 DOI: 10.1093/ehjcr/ytac497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/02/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
Background Acute and subacute stent thromboses are a rare complication associated with high mortality and morbidity occurring in ∼1.5% of patients treated with primary percutaneous intervention for ST-elevation myocardial infarction (STEMI). Recent publications describe a potential role of the von Willebrand factor (VWF) in thrombus formation at sites of critical coronary stenosis in STEMI. Case summary We describe a 58-year-old woman with STEMI at initial presentation, who suffered subacute stent thrombosis despite good stent expansion, efficacious dual antiplatelet therapy, and therapeutic anticoagulation. Because of very high VWF values, we administered N-acetylcysteine in order to depolymerize VWF, but the drug was not well tolerated. Since the patient was still symptomatic, we used caplacizumab in order to prevent VWF from interacting with platelets. Under this treatment, the clinical and angiographic course was favourable. Discussion Considering a modern view of intracoronary thrombus pathophysiology, we describe an innovative treatment approach, which eventually ended in a favourable outcome.
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Affiliation(s)
| | | | - Noemy De Rossi
- Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Patrick Yerly
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Lorenzo Alberio
- Corresponding author. Tel: +41 21 314 34 32, Fax: +41 21 314 43 23,
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14
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Skalidis I, Meier D, De Bruyne B, Collet C, Sonck J, Mahendiran T, Rotzinger D, Qanadli SD, Eeckhout E, Muller O, Fournier S. Diagnostic performance of angiography-derived fractional flow reserve in patients with NSTEMI. Catheter Cardiovasc Interv 2022; 101:308-315. [PMID: 36579415 DOI: 10.1002/ccd.30526] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/26/2022] [Accepted: 12/04/2022] [Indexed: 12/30/2022]
Abstract
Noninvasive methods of estimating invasively measured fractional flow reserve (FFRinvasive ) are actively being explored, aiming to avoid the use of an invasive pressure wire and the administration of hyperemia-inducing drugs. Coronary angiography-derived FFR (FFRangio ) has already demonstrated its diagnostic performance in the context of stable coronary artery disease. However, its applicability in the context of non-ST-segment elevation myocardial infarction (NSTEMI) has yet to be established. We sought to determine the diagnostic performance of FFRangio exclusively in patients presenting with NSTEMI. We performed a prospective, single-center, single-arm, double-blinded study comparing FFR calculated by FFRangio to FFRinvasive in NSTEMI patients. FFRinvasive was measured in all angiographically intermediate lesions (30%-70% stenosis) and was then compared to FFRangio which was calculated at the same position, by a blinded operator. The primary endpoints were the sensitivity and specificity of FFRangio for predicting FFRinvasive using a cut-off value of ≤0.80. Among 100 NSTEMI patients who were screened, 46 patients with 60 vessels in total underwent FFRinvasive and were included in the study. The mean value of FFRinvasive was 0.83 ± 0.3 with 22 (36%) being ≤0.80 while the mean FFRangio was 0.82 ± 0.1 with 22 (36%) being ≤0.80. FFRangio exhibited a sensitivity of 95.5%, a specificity of 97.4%, and a diagnostic accuracy of 96.7%. FFRangio can precisely and noninvasively estimate FFRinvasive in acute coronary syndromes and may have a role in guiding treatment decisions related to angiographically intermediate coronary lesions in this context. WHAT IS KNOWN FFRangio has demonstrated its diagnostic performance in validation studies, as a noninvasive and cost-effective method in the context of stable coronary artery disease but its performance has never been exclusively evaluated in NSTEMI patients. WHAT IS NEW The present prospective single-center study demonstrates the excellent diagnostic performance of FFRangio in detecting functionally significant coronary artery stenosis in the setting of NSTEMI, providing more confidence in utilizing FFRangio in this population, avoiding the risk of an invasive pressure wire and the administration of hyperemia-inducing drugs. WHAT IS NEXT Future randomized trials evaluating FFRangio -guided treatment of coronary artery disease (stable or ACS) are now needed to definitively establish the role of FFRangio in the physiological assessment of coronary lesions.
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Affiliation(s)
- Ioannis Skalidis
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- School of Medicine, University of Crete, Iraklio, Greece
| | - David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard De Bruyne
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Cardiovascular Center Aalst, Aalst, Belgium
| | | | | | - Thabo Mahendiran
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Rotzinger
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Salah Dine Qanadli
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
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15
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Pagnoni M, Meier D, Luca A, Fournier S, Aminfar F, Gentil P, Haddad C, Domenichini G, Le Bloa M, Herrera-Siklody C, Cook S, Goy JJ, Roguelov C, Girod G, Rubimbura V, Dupré M, Eeckhout E, Pruvot E, Muller O, Pascale P. Corrigendum: Yield of the electrophysiological study in patients with new-onset left bundle branch block after transcathether aortic valve replacement: The PR interval matters. Front Cardiovasc Med 2022; 9:1065221. [PMID: 36330011 PMCID: PMC9623285 DOI: 10.3389/fcvm.2022.1065221] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mattia Pagnoni
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Adrian Luca
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Farhang Aminfar
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascale Gentil
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Christelle Haddad
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Arrhythmias Unit, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
| | - Giulia Domenichini
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Mathieu Le Bloa
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Stephane Cook
- Department of Cardiology, Clinique Cecil Hirslanden Group, Lausanne, Switzerland
- Department of Cardiology, University Hospital Fribourg, Fribourg, Switzerland
| | - Jean-Jacques Goy
- Department of Cardiology, Clinique Cecil Hirslanden Group, Lausanne, Switzerland
- Department of Cardiology, University Hospital Fribourg, Fribourg, Switzerland
| | - Christan Roguelov
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Grégoire Girod
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marion Dupré
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrizio Pascale
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- *Correspondence: Patrizio Pascale
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16
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Pagnoni M, Meier D, Luca A, Fournier S, Aminfar F, Gentil P, Haddad C, Domenichini G, Le Bloa M, Herrera-Siklody C, Cook S, Goy JJ, Roguelov C, Girod G, Rubimbura V, Dupré M, Eeckhout E, Pruvot E, Muller O, Pascale P. Yield of the electrophysiological study in patients with new-onset left bundle branch block after transcathether aortic valve replacement: The PR interval matters. Front Cardiovasc Med 2022; 9:910693. [PMID: 36148076 PMCID: PMC9485718 DOI: 10.3389/fcvm.2022.910693] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Studies suggest that performing an electrophysiological study (EPS) may be useful to identify patients with new-onset left bundle branch block (LBBB) post-TAVR at risk of atrioventricular block. However, tools to optimize the yield of such strategy are needed. We therefore aimed to investigate whether 12-lead ECG changes post-TAVR may help identify patients with abnormal EPS findings. Materials and methods Consecutive patients with new-onset LBBB post-TAVR who underwent EPS were included. PR and QRS intervals were measured on 12-lead ECG pre-TAVR and during EPS. Abnormal EPS was defined as an HV interval > 55 ms. Results Among 61 patients, 28 (46%) had an HV interval > 55 ms after TAVR. Post-TAVR PR interval and ΔPR (PR-post–pre-TAVR) were significantly longer in patients with prolonged HV (PR: 188 ± 38 vs. 228 ± 34 ms, p < 0.001, ΔPR: 10 ± 30 vs. 34 ± 23 ms, p = 0.001), while no difference was found in QRS duration. PR and ΔPR intervals both effectively discriminated patients with HV > 55 ms (AUC = 0.804 and 0.769, respectively; p < 0.001). A PR > 200 ms identified patients with abnormal EPS results with a sensitivity of 89% and a negative predictive value (NPV) of 88%. ΔPR ≥ 20 ms alone provided a somewhat lower sensitivity (64%) but combining both criteria (i.e., PR > 200 ms or ΔPR ≥ 20 ms) identified almost every patients with abnormal HV (sensitivity = 96%, NPV = 95%). Selecting EPS candidate based on both criteria would avoid 1/3 of exams. Conclusion PR interval assessment may be useful to select patients with new-onset LBBB after TAVR who may benefit most from an EPS. In patients with PR ≤ 200 ms and ΔPR < 20 ms the likelihood of abnormal EPS is very low independently of QRS changes.
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Affiliation(s)
- Mattia Pagnoni
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Adrian Luca
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Farhang Aminfar
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascale Gentil
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Christelle Haddad
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Arrhythmias Unit, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
| | - Giulia Domenichini
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Mathieu Le Bloa
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Stephane Cook
- Department of Cardiology, Clinique Cecil Hirslanden Group, Lausanne, Switzerland
- Department of Cardiology, University Hospital Fribourg, Fribourg, Switzerland
| | - Jean-Jacques Goy
- Department of Cardiology, Clinique Cecil Hirslanden Group, Lausanne, Switzerland
- Department of Cardiology, University Hospital Fribourg, Fribourg, Switzerland
| | - Christan Roguelov
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Grégoire Girod
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marion Dupré
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrizio Pascale
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- *Correspondence: Patrizio Pascale,
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17
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Skalidis I, Roux O, Rotzinger DC, Fournier S, Rosner L, Eeckhout E, Deglise S, Muller O, Roguelov C. Endovascular Stent Grafting for Descending Thoracic Aortic Rupture During TAVR. JACC Cardiovasc Interv 2022; 15:1880-1882. [DOI: 10.1016/j.jcin.2022.07.016] [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] [Received: 06/23/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
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18
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Rubimbura V, Johnson N, Van't Veer M, Adjedj J, Fournier S, Dupré M, De Bruyne B, Eeckhout E, Muller O. Reliability and Safety of a Side-Branch Jailed Second-Generation Optical-Pressure Guidewire in a Physiology-Guided Bifurcation-PCI In Vitro Model. J Invasive Cardiol 2022; 34:E594-E600. [PMID: 35830360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The treatment of a coronary bifurcation with a single stent (the provisional stenting technique) is associated with a good outcome in most cases. In the majority of cases, after provisional stenting technique, a residual significant angiographic stenosis is associated with the absence of ischemia when fractional flow reserve (FFR) is measured. Jailing an optical pressure guidewire in the side branch (SB) could potentially reduce unnecessary SB interventions after provisional stenting technique. The aim of this study was to compare distal pressure to aortic pressure ratio (Pd/Pa) measurements between 2 second-generation optical pressure guidewires in bifurcation treatment-a jailed wire (JW) and a second free-floating wire (FW) advanced into the SB after stenting. METHODS In an in vitro bifurcation hydrodynamic model with pressure sensors, a JW was advanced into the SB and the FW into the main branch. Bifurcation stenting is performed with the proximal optimization technique (POT)-side-POT technique using a 3.0 x 22-mm stent, a 4.0 x 12-mm noncompliant balloon for the POT, and a 2.5 x 12-mm semicompliant balloon for the SB opening. The same steps were performed in a second model where a surgical clamp was placed in the main vessel to lower overall absolute values pressures. RESULTS A strong correlation was found between JW and FW values (Pearson's coefficient, r=0.91). All wires could be safely retrieved. CONCLUSION In bifurcation stenting, the Pd/Pa value of a second-generation optical pressure guidewire jailed in the SB is reliable compared with a FW inserted after stent implantation.
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Affiliation(s)
- Vladimir Rubimbura
- Cardiology Department, Lausanne University- Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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19
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Lu H, Rotzinger D, Monney P, Muller O, Egea M, Grange M, Eeckhout E, Kirsch M, Qanadli SD. Prevalence and Prognostic Value of Mesenteric Artery Stenosis in Patients Undergoing Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2022; 9:750634. [PMID: 35198609 PMCID: PMC8858964 DOI: 10.3389/fcvm.2022.750634] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/17/2022] [Indexed: 01/16/2023] Open
Abstract
IntroductionData regarding the prevalence of mesenteric artery stenosis in patients undergoing transcatheter aortic valve implantation (TAVI) are scarce. Whether patients with high-risk features for acute mesenteric ischemia (AMesI) have a worse prognosis compared with those without high-risk features is unknown. We aimed to address these questions.MethodsWe included 361 patients who underwent TAVI between 2015 and 2019. Using pre-TAVI computed tomography exams, the number of stenosed arteries in each patient and the degree of stenosis for the coeliac trunk (CTr), SMA and inferior mesenteric artery (IMA) were analyzed. High-risk features for AMesI were defined as the presence of ≥2 arteries presenting with ≥50% stenosis. Patient demographic and echocardiographic data were collected. Endpoints included 30-day all-cause mortality, mortality and morbidity related to mesenteric ischemia.Results22.7% of patients had no arterial stenosis, while 59.3% had 1 or 2 stenosed arteries, and 18.0% presented stenoses in 3 arteries. Prevalence of significant stenosis (≥50%) in CTr, SMA, and IMA were respectively 11.9, 5.5, 10.8%. Twenty patients at high-risk for AMesI were identified: they had significantly higher all-cause mortality (15.0 vs. 1.2%, p < 0.001) and higher mortality related to AMesI (5.0 vs. 0.3%, p = 0.004), compared with non-high-risk patients.ConclusionsPatients at high-risk for AMesI presented with significantly higher 30-day all-cause mortality and mortality related to AMesI following TAVI. Mesenteric revascularization before TAVI interventions may be beneficial in these patients. Prospective studies are needed to clarify these questions.
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Affiliation(s)
- Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Henri Lu
| | - David Rotzinger
- Cardiothoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michael Egea
- Cardiothoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthieu Grange
- Department of Medical Imaging, Neuchâtel Cantonal Hospital, Neuchâtel, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Cardiothoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
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20
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De Boulle M, Vandeloo B, Eeckhout E, Lochy S. Endovascular treatment of a giant infected ascending aortic pseudoaneurysm with occlusion device and coil embolization. J Vasc Surg Cases Innov Tech 2021; 7:706-709. [PMID: 34746535 PMCID: PMC8556492 DOI: 10.1016/j.jvscit.2021.09.006] [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] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/22/2021] [Indexed: 10/27/2022]
Abstract
A patient with recurrent sepsis caused by an infected ascending aortic pseudoaneurysm was deemed unsuitable for surgery after the heart team evaluation. He successfully underwent percutaneous treatment with a combination of a septal occlusion device and coil embolization and remained free of sepsis 24 months after implantation.
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Affiliation(s)
- Matthias De Boulle
- Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bert Vandeloo
- Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Eric Eeckhout
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Stijn Lochy
- Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
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21
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Pilgrim T, Muller O, Heg D, Roffi M, Kurz DJ, Moarof I, Weilenmann D, Kaiser C, Tapponnier M, Losdat S, Eeckhout E, Valgimigli M, Jüni P, Windecker S, Iglesias JF. Biodegradable- Versus Durable-Polymer Drug-Eluting Stents for STEMI: Final 2-Year Outcomes of the BIOSTEMI Trial. JACC Cardiovasc Interv 2021; 14:639-648. [PMID: 33727005 DOI: 10.1016/j.jcin.2020.12.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 09/28/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the safety and efficacy of biodegradable-polymer sirolimus-eluting stents (BP-SES) compared with durable-polymer everolimus-eluting stents (DP-EES) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND Primary percutaneous coronary intervention (PCI) is an effective treatment for patients with STEMI, and long-term outcomes are determined by the safety and efficacy profile of the newest generation drug-eluting stents. METHODS BIOSTEMI (A Comparison of an Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent With a Durable Polymer Everolimus-Eluting Stent for Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention) was an investigator-initiated, multicenter, assessor-blind, randomized superiority trial using Bayesian methods. Patients with STEMI undergoing primary PCI within 24 h of symptom onset were randomized in a 1:1 ratio to receive BP-SES (n = 649) or DP-EES (n = 651). The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial reinfarction, and clinically indicated target lesion revascularization (TLR) at 2 years. RESULTS Between April 2016 and March 2018, 1,300 patients were included. Baseline characteristics were comparable between the 2 treatment groups. Follow-up through 2 years was complete in 1,221 patients (94%). At 2 years, TLF occurred in 33 patients (5.1%) treated with BP-SES and in 53 patients (8.1%) treated with DP-EES (rate ratio: 0.58; 95% Bayesian credible interval: 0.40 to 0.84; posterior probability of superiority = 0.998). The difference was driven by a lower incidence of clinically indicated TLR in patients treated with BP-SES compared with DP-EES (2.5% vs. 5.1%; rate ratio: 0.52; 95% Bayesian credible interval: 0.30 to 0.87; posterior probability of superiority = 0.993). There were no significant differences in rates of cardiac death, target vessel myocardial reinfarction, and definite stent thrombosis between the 2 treatment arms. CONCLUSIONS In patients with STEMI undergoing primary PCI, BP-SES were superior to DP-EES with respect to TLF at 2 years. The difference was driven by lower rates of ischemia-driven TLR. (A Comparison of an Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent With a Durable Polymer Everolimus-Eluting Stent for Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention [BIOSTEMI]; NCT02579031).
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Affiliation(s)
- Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Marco Roffi
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - David J Kurz
- Department of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - Igal Moarof
- Department of Cardiology, Kantonsspital, Aarau, Switzerland
| | | | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | | | | | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juan F Iglesias
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
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22
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Haude M, Toelg R, Lemos PA, Christiansen EH, Abizaid A, von Birgelen C, Neumann FJ, Wijns W, Ince H, Kaiser C, Lim ST, Escaned J, Eeckhout E, Garcia-Garcia HM, Waksman R. Sustained safety and performance of a second-generation sirolimus-eluting absorbable metal scaffold: Long-term data of the BIOSOLVE-II first-in-man trial at 5 years. Cardiovasc Revasc Med 2021; 38:106-110. [PMID: 34364807 DOI: 10.1016/j.carrev.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Permanent drug-eluting stents are associated with a steady increase of late complications attributed to persistent inflammation and poor vessel remodelling. Bioresorbable scaffolds have been developed to overcome such long-term limitations by providing temporary vessel support and disappearing thereafter. We aimed to assess the long-term outcomes of an absorbable metallic scaffold at 5 years. METHODS BIOSOLVE-II is an international, multi-centre, first-in-human study assessing the safety and performance of the sirolimus-eluting absorbable metal scaffold DREAMS 2G (commercial name Magmaris) in patients with a maximum of two de novo lesions. After 3 years, follow-up was extended to 5 years with the endpoints target lesion failure and rate of definite or probable stent thrombosis. RESULTS 123 patients with 123 lesions were enrolled. Lesions were 12.6 ± 4.5 mm long and 2.7 ± 0.4 mm in diameter, 43.4% were class B2/C lesions, and calcification was moderate to severe in 10.6%. At 5 years, 5.4% of patients had stable angina and 94.6% had no symptoms or ischemia. Target lesion failure rate was 8.0% [95% CI:4.2;14.9], reflecting 2 cardiac deaths, 2 target-vessel myocardial infarction, and 6 clinically-driven target lesion revascularizations. Only one target lesion failure occurred beyond 3 years; a target-vessel myocardial infarction with clinically-driven TLR on post-procedure day 1157. One additional non-cardiac death beyond 3 years due to renal failure was reported on day 1777. No definite or probable scaffold thrombosis was observed. CONCLUSION The Magmaris scaffold showed favourable long-term safety and clinical performance with low target lesion failure rates and absence of definite or probable scaffold thrombosis throughout 5 years. ANNOTATED TABLE OF CONTENTS BIOSOLVE-II is a prospective, multi-centre, first-in-man trial enrolling 123 patients with de novo coronary artery lesions. Target lesion failure rate at 5 years was low (8.0%), including 2 cardiac deaths, 2 target-vessel myocardial infarction and 6 clinically-driven target lesion revascularizations. No definite or probable scaffold thrombosis was observed.
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Affiliation(s)
- Michael Haude
- Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany.
| | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Pedro Alves Lemos
- Instituto do Coração - HCFMUSP, University of Sao Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | - Franz-Josef Neumann
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | - William Wijns
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Christoph Kaiser
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Eric Eeckhout
- CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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23
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Lu H, Fournier S, Namasivayam J, Roguelov C, Ferrari E, Eeckhout E, Monney P, Tozzi P, Marcucci C, Muller O, Kirsch M. Transapical approach versus transcervical approach for transcatheter aortic valve replacement: a retrospective monocentric study. Interact Cardiovasc Thorac Surg 2021; 31:781-788. [PMID: 33051655 DOI: 10.1093/icvts/ivaa202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/20/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Transfemoral approach is the standard access-route for transcatheter aortic valve replacement (TAVR). However, alternative approaches are needed in a number of patients and accesses such as transapical (TA) TAVR or transcervical (TC) are used. We aimed to compare clinical and echocardiographic outcomes after TA-TAVR or TC-TAVR. METHODS All patients who underwent TA- and TC-TAVR for severe aortic stenosis in our institution between 2008 and 2020 were retrospectively included. End points included 30-day all-cause mortality, procedural complications (according to the Valve Academic Research Consortium-2 criteria), procedure duration, intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as difference in year of intervention. RESULTS TAVR was performed in 176 patients, using a TA approach (n = 127) or a TC approach (n = 49). Baseline clinical and echocardiographic characteristics were comparable between the 2 groups, except age and peripheral artery disease. All-cause 30-day mortality rates were not significantly different (8.5% in the TA group vs 2.3% in the TC group, P = 0.124). TC approach was associated with significantly shorter procedure duration {71.0 [interquartile range (IQR) 52.5-101.0] vs 93 [IQR 80.0-120.0] min, P < 0.001}, shorter ICU LOS [0.0 (IQR 0.0-0.0) vs 1.0 (IQR 1.0-3.0) days, P < 0.001] and shorter hospital LOS [7.0 (IQR 5.0-9.5) vs 14.0 (IQR 10.0-22.0) days, P < 0.001]. CONCLUSIONS The TC approach may be a good first-choice alternative in case of contraindications to transfemoral-TAVR.
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Affiliation(s)
- Henri Lu
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Christian Roguelov
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Enrico Ferrari
- Department of Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiovascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlo Marcucci
- Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
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24
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Lu H, Monney P, Hullin R, Fournier S, Roguelov C, Eeckhout E, Rubimbura V, Faroux L, Barrier A, Muller O, Kirsch M. Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:687168. [PMID: 34124210 PMCID: PMC8190826 DOI: 10.3389/fcvm.2021.687168] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10–15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR. Methods: We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted. Results: We identified 9 studies, among which 2 used propensity-score matching, including 1,374 TC patients and 3,706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0 ± 6.7 vs. 6.3 ± 5.4, p = 0.002 and 20.8 ± 14.2% vs. 20.0 ± 13.4%, p = 0.04), a higher prevalence of peripheral artery disease (52.6 vs. 32.8%, p = 0.001), previous cardiac surgery (26.3 vs. 22.4%, p = 0.008) and coronary artery disease (64.6 vs. 60.5%, p = 0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02–1.96, p = 0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25–0.92, p = 0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02–2.55, p = 0.040). Conclusion: Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount.
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Affiliation(s)
- Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Roger Hullin
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christian Roguelov
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Adelin Barrier
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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25
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Meier D, Fournier S, Masci PG, Eeckhout E, Antiochos P, Tzimas G, Stoyanov N, Muenkaew M, Monney P, Schwitter J, Muller O, Harbaoui B. Impact of manual thrombectomy on microvascular obstruction in STEMI patients. Catheter Cardiovasc Interv 2021; 97:1141-1148. [PMID: 32277793 DOI: 10.1002/ccd.28907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/27/2019] [Revised: 02/27/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the effect of manual thrombectomy (MT) on microvascular obstruction (MVO) using cardiac magnetic resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS Three hundred and eighty-three patients admitted for STEMI and undergoing CMR fulfilled the inclusion criteria and were categorized into two groups (did or did not undergo MT). The two primary endpoints were the occurrence and extent of MVO, analyzed as a categorical variable and as a semicontinuous variable. Among the 383 patients, 49.1% exhibited MVO. Both the incidence of MVO and the median number of segments presenting with MVO were significantly higher in the MT group than in the no-MT group, (59.5 vs. 38.9%, p < .001) and (1.5 [0;4] vs. 0 [0;2], p < .001). Analysis stratified on coronary thrombus grade showed similar results, only in patients with a high thrombus burden (60.7 vs. 43.5%, p = .004, and 2 [0;4] vs. 0 [0;3], p = .001. When adjusting for baseline differences, MT remained a determinant of MVO occurrence and extent (odds ratio, OR 1.802 [95% confidence interval, CI 1.080-3.009], p = .024) and β = .137, p = .024) in patients with a high thrombus grade. CONCLUSION In STEMI patients, MT was associated with the occurrence and extent of MVO, on CMR, especially in patients with a high thrombus burden.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Pier G Masci
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Nikolay Stoyanov
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Muenpetch Muenkaew
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Brahim Harbaoui
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Department of Cardiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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26
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Pagnoni M, Meier D, Candreva A, Maillard L, Adjedj J, Collet C, Mahendiran T, Cook S, Mujcinovic A, Dupré M, Rubimbura V, Roguelov C, Eeckhout E, De Bruyne B, Muller O, Fournier S. Future culprit detection based on angiography-derived FFR. Catheter Cardiovasc Interv 2021; 98:E388-E394. [PMID: 33913606 DOI: 10.1002/ccd.29736] [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: 02/10/2021] [Revised: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We sought to characterize the hemodynamic impact of mild coronary artery disease (CAD) using quantitative flow ratio (QFR, an angiography-derived fractional flow reserve [FFR]) in a population of patients with only non-significant CAD at baseline that subsequently experienced a myocardial infarction (MI). BACKGROUND The discriminatory value of FFR in patients with mild CAD remains imperfect. METHODS We retrospectively included patients who underwent invasive coronary angiography for an MI, in whom another angiogram had been performed within the previous 5 years. Three-dimensional quantitative coronary angiography, QFR, and lesion length analysis were conducted on lesions responsible for the MI (future culprit lesions, [FCL]) as well as on control lesions (non-culprit lesions, [NCL]). RESULTS Eighty-three FCL and 117 NCL were analyzed in 83 patients: FCL were more severe (median % diameter of stenosis [DS] 39.1% [29.8; 45.7] vs. 29.8% [25.0; 37.2], p < .001), had lower QFR values (0.94 [0.86; 0.98] vs. 0.98 [0.96; 1.00], p < .001) and tended to be longer (15.2 mm [10.0; 27.3] vs. 12.7 mm [9.3; 22.4], p = .070) than NCL. In lesions with an interval < 2 years between baseline angiography and MI, the difference in QFR was more pronounced compared to the lesions with a longer interval (FCL: 0.92 [0.85; 0.97] vs. NCL: 0.98 [0.94; 1.00], p < .001 and FCL: 0.96 [0.88; 1.00] vs. NCL: 0.98 [0.96;1.00], p = .006 respectively) CONCLUSION: Mild coronary stenoses that are subsequently responsible for an MI (FCL) exhibit a higher DS and lower QFR years before the event. Furthermore, FCL with a lower QFR at baseline appear to lead earlier to MI.
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Affiliation(s)
- Mattia Pagnoni
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Luc Maillard
- Department of Cardiology, GCS ES Axium Rambot, Aix en Provence, France
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzank Institute, Saint Laurent Du Var, France
| | - Carlos Collet
- Cardiovascular Center, OLV Ziekenhuis, Aalst, Belgium
| | - Thabo Mahendiran
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Cook
- Department of Cardiology, HFR Fribourg, Fribourg, Switzerland
| | - Alma Mujcinovic
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marion Dupré
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Christan Roguelov
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard De Bruyne
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiovascular Center, OLV Ziekenhuis, Aalst, Belgium
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Abstract
Purpose: We carried out this study to evaluate the predictive value of atherosclerosis burden score (ABS) to predict coronary artery disease (CAD) among asymptomatic patients without known cardiovascular disease (CVD), as compared to other imaging or functional techniques, namely coronary artery calcium (CAC) score, carotid intima-media thickness (C-IMT), and ankle brachial index (ABI). Patients and methods: This prospective study included 198 asymptomatic consecutive patients referred for evaluation of their cardiovascular (CV) risk and for therapeutic advice. Traditional CV risk factors, ABS, CAC score, C-IMT, ABI and an ECG-synchronized coronary CT-angiography (CCTA) were performed for each patient. We compared the predictive values of these atherosclerosis markers to detect CAD defined as coronary stenosis ≥30% objectivated by CCTA. Results: Among the whole sample, the area under the receiver-operating characteristic curve (ROC-AUC) was significantly higher for CAC score (0.81, p=0.015) than for ABS, the reference (0.70) but these values were lower for C-IMT (0.60, p=0.16) and particularly for ABI (0.56, p=0.0015). However, among patients at intermediate risk of coronary heart disease (CHD), according to Framingham risk score (FRS), the differences between the ROC-AUC values for ABS (0.70) and CAC score (0.76, p=0.36) were less pronounced. Again, as compared to ABS, the ROC-AUC values were lower for C-IMT (0.60, p=0.21) and ABI (0.57, p=0.06). Conclusions: ABS, an ultrasonographic score based on the assessment of carotid and femoral plaque burden, predicts more accurately CAD than other non-radiation tools analyzed here, and has a similar performance to CAC in patients at intermediate CHD risk. Thus, ABS could be an appropriate non-invasive and safe method to improve the detection of high-risk patients who will benefit from a more intensive therapy for the primary prevention of CVD.
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Affiliation(s)
| | - Roger Darioli
- Lipid and Cardiovascular Prevention Unit, University Hospital CHUV, Lausanne, Switzerland
| | - Salah Dine Qanadli
- Diagnostic and Interventional Radiology, University Hospital CHUV, Lausanne, Switzerland
| | - Eugène Katz
- Cardiology, University Hospital CHUV, Lausanne, Switzerland
| | - Eric Eeckhout
- Cardiology, University Hospital CHUV, Lausanne, Switzerland
| | - Lucia Mazzolai
- Angiology, University Hospital CHUV, Lausanne, Switzerland
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Meier D, Depierre A, Topolsky A, Roguelov C, Dupré M, Rubimbura V, Eeckhout E, Qanadli SD, Muller O, Mahendiran T, Rotzinger D, Fournier S. Computed Tomography Angiography for the Diagnosis of Coronary Artery Disease Among Patients Undergoing Transcatheter Aortic Valve Implantation. J Cardiovasc Transl Res 2021; 14:894-901. [PMID: 33543417 PMCID: PMC8575747 DOI: 10.1007/s12265-021-10099-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/05/2021] [Indexed: 11/05/2022]
Abstract
Background Computed tomography angiography (CTA) is used to plan TAVI procedures. We investigated the performance of pre-TAVI CTA for excluding coronary artery disease (CAD). Methods In total 127 patients were included. CTA images were analyzed for the presence of ≥ 50% (significant CAD) and ≥ 70% (severe CAD) diameter stenoses in proximal coronary arteries. Results were compared with invasive coronary angiography (ICA) at vessel and patient levels. Primary endpoint was the negative predictive value (NPV) of CTA for the presence of CAD. Results A total of 342 vessels were analyzable. NPV of CTA was 97.5% for significant CAD and 96.3% for severe CAD. Positive predictive value and accuracy were 44.8% and 87.1% for significant CAD and 56.3% and 94.4% for severe CAD. At patient level, NPV for significant CAD was 88.6%. Conclusion Pre-TAVI CTA shows good performance for ruling out CAD and could be used as a gatekeeper for ICA in selected patients. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s12265-021-10099-8.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Arnaud Depierre
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Antoine Topolsky
- Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christan Roguelov
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Marion Dupré
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Salah Dine Qanadli
- Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Thabo Mahendiran
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - David Rotzinger
- Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland. .,Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland. .,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
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Kilani N, Haddad C, Lu H, Ghanbari F, Domenichini G, Pavon AG, Tzimas G, Fournier S, Hullin R, Pascale P, Eeckhout E, Schwitter J, Pruvot E, Bouchardy J, Monney P, Muller O, Rutz T. [Cardiology]. Rev Med Suisse 2021; 17:172-180. [PMID: 33507655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In 2020, new guidelines have been published by the European Society of Cardiology including those on non-ST-segment elevation acute coronary syndromes, atrial fibrillation and adult congenital heart disease. Regarding interventional cardiology, POPular TAVI opens the possibility of anti-platelet monotherapy after transcutaneous aortic valve replacement. EMPEROR-Reduced confirms the importance of SGLT2 inhibitors in the treatment of heart failure with reduced ejection fraction. Within the field of imaging, stress MRI has now become the first-line technique for the screening of coronary artery disease, demonstrating an excellent cost-benefit ratio. Finally, renin-angiotensin-aldosterone inhibitors do not appear to increase the risk of an infection by COVID-19.
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Affiliation(s)
- Nadia Kilani
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | | | - Henri Lu
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Fahime Ghanbari
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | | | | | - Georgios Tzimas
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | | | - Roger Hullin
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Patrizio Pascale
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Eric Eeckhout
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Juerg Schwitter
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Etienne Pruvot
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Judith Bouchardy
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Pierre Monney
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Olivier Muller
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
| | - Tobias Rutz
- Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne
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Lu H, Monney P, Fournier S, Pavon AG, Roguelov C, Eeckhout E, Muller O, Kirsch M. Transcervical approach versus transfemoral approach for transcatheter aortic valve replacement. Int J Cardiol 2020; 327:58-62. [PMID: 33242507 DOI: 10.1016/j.ijcard.2020.11.026] [Citation(s) in RCA: 13] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The transfemoral (TF) approach is the gold-standard access route for transcatheter aortic valve replacement (TAVR). Alternative approaches, among which the transcervical (TC) approach, are needed in some patients. We aimed to compare TC-TAVR with TF-TAVR. METHODS All patients who underwent TAVR in our institution between 2016 and 2020, using Edwards SAPIEN family balloon-expandable transcatheter heart valves, were retrospectively included. Endpoints included 30-day all-cause mortality, procedural complications (according to the VARC-2 criteria), procedure duration, hospital length of stay (LOS) and echocardiographic outcomes. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as anesthesia modality. RESULTS TAVR was performed in 306 patients, using a TF approach (n = 255) or a TC approach (n = 51). TC-TAVR was associated with significantly higher STS scores (4.06 [IQR (interquartile range), 2.05, 5.56] vs. 2.97 [IQR, 2.08, 4.88], p < 0.001) and higher prevalence of peripheral artery disease, history of stroke, previous cardiovascular surgery. 30-day mortality (hazard ratio, 0.87 [0.77, 9.77], p = 0.909) and stroke rates (2.0% vs. 1.6%, p = 0.840) were similar, as well as procedural duration (74.0 [53.0, 99.5] vs. 77.0 [58.0, 98.0] minutes, p = 0.370), LOS (6.0 [IQR, 3.0, 8.0] vs. 6.0 [IQR, 4.0, 9.0] days, p = 0.175) and postprocedural mean transvalvular gradient (10.00 [IQR, 8.00, 13.00] vs. 10.00 [IQR, 8.00, 12.00] mmHg, p = 0.724). CONCLUSION Despite a higher cardiovascular disease burden in TC patients, TC-TAVR and TF-TAVR yielded similar outcomes. TC-TAVR may be a safe alternative when TF-TAVR is contraindicated.
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Affiliation(s)
- Henri Lu
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anna Giulia Pavon
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christan Roguelov
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Birkemeyer R, Olivecrona GK, Hellig F, Wöhrle J, Rottbauer W, Witkowski A, Kuliczkowski W, Bernhardt P, Bettels N, Schrage B, von Zur Mühlen C, Cook S, Miljak T, Eggbrecht H, Eeckhout E, Westermann D, Monsegu J, Dumonteil N. Sealing of Coronary Perforations With a Second-Generation Covered Stent Graft - Results From the PAST-PERF Registry. Cardiovasc Revasc Med 2020; 25:20-26. [PMID: 33132086 DOI: 10.1016/j.carrev.2020.10.012] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The PAST-PERF registry was initiated to collect data on the PK Papyrus covered stent, a second-generation device for the treatment of coronary artery perforations with enhanced mechanical properties, but with limited available data. METHODS Patients treated for coronary artery perforations with the PK Papyrus stent at 14 international centers were retrospectively identified. The primary effectiveness outcome was successful sealing of the perforation. The primary safety outcome was a composite of all-cause mortality, definite or probable stent thrombosis, myocardial infarction and target lesion revascularization. RESULTS Among the 94 included patients, 72.3% (68/94) had Ellis type III and cavity spilling perforations. Complete sealing was achieved in 93.6% (n = 88), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). Pericardiocentesis was required in 25.0% (n = 23), emergency cardiac surgery was needed in 7.6% (n = 7), acute stent thrombosis was observed in 1.1% (n = 1), and in-hospital mortality occurred in 11.7% (n = 11). The median follow-up duration was 283 (IQR:40;670) days. At 6 and 12 months, the incidence of the primary safety endpoint was 26.6% [95%CI:18.6;37.1] and 32.0% [95%CI:22.8;43.4], mortality 15.0% [95%CI:9.0;24.6] and 19.0% [95%CI:11.3;30.0], and target lesion revascularization 5.5% [95%CI:2.0;14.6] and 7.7% [95%CI:3.1;18.2]. Two definite stent thrombosis occurred, one during the procedure and one on post-procedure day 233. CONCLUSIONS The registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. ANNOTATED TABLE OF CONTENT The PAST-PERF registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. Specifically, complete sealing was achieved in 93.6% of patients (n = 88/94), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). The 12-month mortality was 19.0% [95%CI:11.3;30.0], the rate of target lesion revascularization was 7.7% [95%CI:3.1;18.2], and two definite stent thromboses occurred (one during procedure and one on post-procedure day 233).
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Affiliation(s)
| | | | | | - Jochen Wöhrle
- University Hospital Ulm, Ulm, Germany; Medical Campus Lake Constance, Friedrichshafen, Germany
| | | | | | | | | | | | | | | | | | | | | | - Eric Eeckhout
- CHUV (Centre Hospitalier Universitaire Vaudoise), Lausanne, Switzerland
| | | | - Jaques Monsegu
- Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
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Pavon AG, Georgiopoulos G, Vincenti G, Muller O, Monney P, Berchier G, Cirillo C, Eeckhout E, Schwitter J, Masci PG. Head-to-head comparison of multiple cardiovascular magnetic resonance techniques for the detection and quantification of intramyocardial haemorrhage in patients with ST-elevation myocardial infarction. Eur Radiol 2020; 31:1245-1256. [PMID: 32929640 PMCID: PMC7880961 DOI: 10.1007/s00330-020-07254-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
Objectives T2*-weighted (T2*w) is deemed as a reference standard for post-infarction intramyocardial haemorrhage (IMH). However, high proportion of T2* images is affected by off-resonance artefacts hampering image interpretation. Diagnostic accuracy and precision of alternative techniques for IMH diagnosis and quantification have been seldomly investigated. Methods and results Between April 2016 and May 2017, 50 ST-segment elevation myocardial infarction patients (66% male, 57 ± 17 years) and 15 healthy controls (60% male, 58 ± 13) were consecutively enrolled. Subjects underwent head-to-head comparison of single mid-infarct slice acquired on black-blood T2-weighted short-TI-inversion recovery (T2w-STIR), bright-blood T2prep-steady-state-free precession (T2prep-SSFP), and T2/T1 maps for IMH diagnosis and quantification against T2*w. All images were graded for quality (grade 1: very poor; grade 4: excellent) and diagnostic confidence (Likert scale, 1: very unsure and 5: highly confident). Reduced relaxation time/hypointense region (hypocore) embedded in infarct-related oedema on T2 map, T1 map, and T2w-STIR had the best overall diagnostic accuracy (per-subject: 91%, 86%, and 86%, respectively; per segment: 95%, 93%, and 93%, respectively). By mixed-effects analysis, image quality, and diagnostic confidence were higher for T2 map and T1 maps than T2*w (p < 0.05 for both scores). For IMH quantification, hypocore on T2 map and T1 map strongly correlated (Spearman’s r > 0.7, p < 0.001 for both) with IMH extent on T2*w and presented an overall excellent agreement on Bland-Altman analysis. By linear mixed model analysis, absolute hypocore size did not differ among T1-, T2 map, and T2*w. T2/T1 maps had the best intra- and inter-observer reproducibility among CMR techniques. Conclusion Hypocore on T2/T1 map is the best alternative technique to T2*w for diagnosing and quantifying IMH in post-STEMI patients. Key Point • Mapping techniques are the best alternatives for diagnosing post-infarction intramyocardial haemorrhage. • Mapping techniques are valuable tools for imaging intramyocardial haemorrhage. Electronic supplementary material The online version of this article (10.1007/s00330-020-07254-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Giulia Pavon
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Gabriella Vincenti
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
- Faculty Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Gregoire Berchier
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Chiara Cirillo
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Eric Eeckhout
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
- Faculty Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Pier Giorgio Masci
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Lu H, Muller O, Eeckhout E, Monney P, Roguelov C, Marcucci C, Meziani A, Kirsch M. TAVI : une revue de la littérature des voies alternatives à l’accès trans-fémoral. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.lpmfor.2020.04.016] [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: 12/13/2022]
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Rubimbura V, Rotzinger D, Eeckhout E, Rutz T. Multimodality imaging for percutaneous closure of a post-surgical paravalvular aortic fistula. Eur Heart J 2020; 41:4211. [DOI: 10.1093/eurheartj/ehaa287] [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] [Received: 03/29/2020] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vladimir Rubimbura
- Service of Cardiology, Department of Heart Vessels, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - David Rotzinger
- Department of Radiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Department of Heart Vessels, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Tobias Rutz
- Service of Cardiology, Department of Heart Vessels, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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35
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Meier D, Skalidis I, De Bruyne B, Qanadli SD, Rotzinger D, Eeckhout E, Collet C, Muller O, Fournier S. Ability of FFR-CT to detect the absence of hemodynamically significant lesions in patients with high-risk NSTE-ACS admitted in the emergency department with chest pain, study design and rationale. Int J Cardiol Heart Vasc 2020; 27:100496. [PMID: 32181323 PMCID: PMC7063126 DOI: 10.1016/j.ijcha.2020.100496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/27/2020] [Indexed: 11/02/2022]
Abstract
Background In the era of High-sensitive troponin (hs-Tn), up to 50% of patients with a mild increase of hs-Tn will finally have a normal invasive coronary angiogram. Fractional Flow Reserve (FFR) derived from coronary computed tomographic angiography (FFR-CT) has never been used as a non-invasive tool for the diagnosis of coronary artery disease in patients with high-risk acute coronary syndrome without ST segment elevation (NSTE-ACS). Aims The study aims to determine the role of coronary CT angiography and FFR-CT in the setting of high-risk NSTE-ACS. Methodology We will conduct a prospective trial, enrolling 250 patients admitted with high-risk NSTE-ACS who will rapidly undergo a coronary CT angiography and then a coronary angiography with FFR measurements. Results of coronary CT, FFR-CT and coronary angiography (± FFR) will be compared. Potential significance In conclusion, non-invasive identification of patients with high-risk NSTE-ACS who could avoid coronary angiography would reduce procedure related risks and medical costs.
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Key Words
- ACS, Acute coronary syndrome
- AE, Adverse Event
- Acute coronary syndrome
- CMRI, Cardiac Magnetic resonance imaging
- CT, Computed tomography
- Coronary computed tomography
- ECG, Electrocardiogram
- ED, Emergency department
- FFR, Fractional Flow Reserve
- FFR-CT
- FFR-CT, FFR derived from coronary CT
- Fractional Flow Reserve
- Hs-Tn, High-sensitive troponins
- MACE, Major adverse cardiac events
- MI, Myocardial infraction
- NSTE-ACS, Acute coronary syndromes without ST-segment elevation
- NSTEMI, Non-ST-elevation myocardial infarction
- PCI, Percutaneous Coronary Intervention
- STEMI, ST-elevation myocardial infarction
- URL, Upper Range Limit
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ioannis Skalidis
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard De Bruyne
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiovascular Center Aalst, Aalst, Belgium
| | - Salah Dine Qanadli
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Rotzinger
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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Chichareon P, Modolo R, Kogame N, Takahashi K, Chang CC, Tomaniak M, Botelho R, Eeckhout E, Hofma S, Trendafilova-Lazarova D, Kőszegi Z, Iñiguez A, Wykrzykowska JJ, Piek JJ, Garg S, Hamm C, Steg PG, Jüni P, Vranckx P, Valgimigli M, Windecker S, Onuma Y, Serruys PW. Association of diabetes with outcomes in patients undergoing contemporary percutaneous coronary intervention: Pre-specified subgroup analysis from the randomized GLOBAL LEADERS study. Atherosclerosis 2020; 295:45-53. [DOI: 10.1016/j.atherosclerosis.2020.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/25/2019] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
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37
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Haude M, Ince H, Toelg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Neumann FJ, Eeckhout E, Garcia-Garcia HM, Waksman R. Safety and performance of the second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) in patients with de novo coronary lesions: three-year clinical results and angiographic findings of the BIOSOLVE-II first-in-man trial. EUROINTERVENTION 2020; 15:e1375-e1382. [DOI: 10.4244/eij-d-18-01000] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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38
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Rubimbura V, Guillon B, Fournier S, Amabile N, Chi Pan C, Combaret N, Eeckhout E, Kibler M, Silvain J, Wijns W, Schiele F, Muller O, Meneveau N, Adjedj J. Quantitative flow ratio virtual stenting and post stenting correlations to post stenting fractional flow reserve measurements from the DOCTORS (Does Optical Coherence Tomography Optimize Results of Stenting) study population. Catheter Cardiovasc Interv 2019; 96:1145-1153. [DOI: 10.1002/ccd.28615] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/12/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Benoit Guillon
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | | | | | - Chan Chi Pan
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | | | - Eric Eeckhout
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Marion Kibler
- Departement de cardiologie, Nouvel Hôpital Civil Centre Hospitalier Universitaire Strasbourg France
| | - Johanne Silvain
- Université Paris 6, ACTION Study Group, Institut de Cardiologie (AP‐HP) Centre Hospitalier Universitaire Pitié‐Salpêtrière, INSERM UMRS Paris France
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam National University of Ireland Galway Ireland
| | - Francois Schiele
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | - Olivier Muller
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Nicolas Meneveau
- Department of Cardiology, EA3920 University Hospital Jean Minjoz Besançon France
| | - Julien Adjedj
- Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
- Department of Cardiology Arnault Tzanck Institute Saint Laurent du Var France
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39
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Meier D, Antiochos P, Herrera-Siklody C, Eeckhout E, Delabays A, Tzimas G, Fournier S, Pascale P, Muller O, Monney P. Interatrial septum dissection and atrial wall hematoma following transseptal puncture: A systematic review of the literature. Catheter Cardiovasc Interv 2019; 96:424-431. [PMID: 31642609 DOI: 10.1002/ccd.28554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/18/2019] [Accepted: 10/08/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Interatrial septum (IAS) dissection due to transseptal puncture (TSP) is a rare, underreported complication of the procedure. Data on the mechanism, diagnosis, and management of this complication are lacking. METHODS We conducted a systematic review of all reported cases of IAS dissection with or without associated LA hematoma due to TSP, by thoroughly searching MEDLINE and EMBASE through May 2019. RESULTS After screening of n = 882 studies, eight studies with a total of 19 patients addressed the complication of IAS dissection and/or LA hematoma secondary to TSP. Median age was 63 years with a 1:1 male to female ratio. Ablation of atrial fibrillation was the most frequently reported procedure (84%). Diagnosis was established using fluoroscopy with contrast injection (58%), TEE (32%) or intracardiac echocardiography (5%). The mechanism identified involved puncture of the septum secundum portion of the IAS, leading to transient needle passage into the extracardiac space. In the majority of patients, the hematoma remained localized in the IAS and management was conservative with progressive resolution of the hematoma during follow-up (95%). Two patients (11%) required further intervention by either pericardiocentesis or surgical drainage due to hemodynamic instability. CONCLUSIONS IAS dissection with or without hematoma after TSP remains an underdiagnosed entity. The main mechanism involves lesion to the septum secundum portion of the IAS, resulting in needle passage into the extracardiac space and local bleeding. Although conservative management may be sufficient in the majority of cases, interventional cardiologists should be familiar with this complication and its diagnosis.
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Affiliation(s)
- David Meier
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Panagiotis Antiochos
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | | | - Eric Eeckhout
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Alain Delabays
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Georgios Tzimas
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Stephane Fournier
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Patrizio Pascale
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Olivier Muller
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Pierre Monney
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
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40
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Tzimas G, Antiochos P, Monney P, Eeckhout E, Meier D, Fournier S, Harbaoui B, Muller O, Schläpfer J. Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention. Am J Cardiol 2019; 124:1305-1314. [PMID: 31455501 DOI: 10.1016/j.amjcard.2019.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/18/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022]
Abstract
Early initiation of reperfusion therapy remains the cornerstone of successful management for ST-elevation myocardial infarction (STEMI). Rapid restoration of coronary blood flow relies on prompt recognition of the typical ST-segment elevation on a 12-lead electrocardiogram (ECG)-a surrogate for coronary occlusion or critical stenosis-allowing timely activation of the STEMI protocol cascade, with a major positive impact in mortality and clinical outcomes. However, atypical, very high risk ECG patterns-known as "STEMI equivalents"-are present in 10% to 25% of patients with ongoing myocardial ischemia in need of urgent primary percutaneous coronary intervention. Though briefly mentioned in the current recommendations, structured clinical data on those specific ECG presentations are lacking. By thoroughly searching MEDLINE and EMBASE we conducted a structured review of non-STEMI, albeit very high risk, ECG patterns of acute coronary syndrome, often associated with coronary occlusion or critical stenosis. After screening 997 studies, we identified the following distinct "STEMI equivalent" ECG patterns: Wellens' syndrome, de Winter sign, hyperacute T waves, left bundle branch block-including paced rhythm-and right bundle branch block. For each pattern, a brief summary of the existing evidence, together with the sensitivity, specificity, and positive predictive value-whenever available-are presented. In conclusion, prompt recognition of "STEMI equivalent" ECG patterns is crucial for every physician or paramedic dealing with acute coronary syndrome patients in the emergency department or the prehospital setting, as misinterpretation of those high risk presentations can lead to reperfusion delays and worse outcomes.
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Affiliation(s)
- Georgios Tzimas
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Panagiotis Antiochos
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - David Meier
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Brahim Harbaoui
- University Hospital la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jürg Schläpfer
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
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41
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Iglesias JF, Muller O, Heg D, Roffi M, Kurz DJ, Moarof I, Weilenmann D, Kaiser C, Tapponnier M, Stortecky S, Losdat S, Eeckhout E, Valgimigli M, Odutayo A, Zwahlen M, Jüni P, Windecker S, Pilgrim T. Biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents in patients with ST-segment elevation myocardial infarction (BIOSTEMI): a single-blind, prospective, randomised superiority trial. Lancet 2019; 394:1243-1253. [PMID: 31488372 DOI: 10.1016/s0140-6736(19)31877-x] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Newer-generation drug-eluting stents that combine ultrathin strut metallic platforms with biodegradable polymers might facilitate vascular healing and improve clinical outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI) compared with contemporary thin strut second-generation drug-eluting stents. We did a randomised clinical trial to investigate the safety and efficacy of ultrathin strut biodegradable polymer sirolimus-eluting stents versus thin strut durable polymer everolimus-eluting stents in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. METHODS The BIOSTEMI trial was an investigator-initiated, multicentre, prospective, single-blind, randomised superiority trial at ten hospitals in Switzerland. Patients aged 18 years or older with acute STEMI who were referred for primary PCI were eligible to participate. Patients were randomly allocated (1:1) to either biodegradable polymer sirolimus-eluting stents or durable polymer everolimus-eluting stents. Central randomisation was done based on a computer-generated allocation sequence with variable block sizes of 2, 4, and 6, which was stratified by centre, diabetes status, and presence or absence of multivessel coronary artery disease, and concealed using a secure web-based system. Patients and treating physicians were aware of group allocations, whereas outcome assessors were masked to the allocated stent. The experimental stent (Orsiro; Biotronik; Bülach, Switzerland) consisted of an ultrathin strut cobalt-chromium metallic stent platform releasing sirolimus from a biodegradable polymer. The control stent (Xience Xpedition/Alpine; Abbott Vascular, Abbott Park, IL, USA) consisted of a thin strut cobalt-chromium stent platform that releases everolimus from a durable polymer. The primary endpoint was target lesion failure, a composite of cardiac death, target vessel myocardial reinfarction (Q-wave and non-Q-wave), and clinically-indicated target lesion revascularisation, within 12 months of the index procedure. All analyses were done with the individual participant as the unit of analysis and according to the intention-to-treat principle. The trial was registered with ClinicalTrials.gov, number NCT02579031. FINDINGS Between April 26, 2016, and March 9, 2018, we randomly assigned 1300 patients (1623 lesions) with acute myocardial infarction to treatment with biodegradable polymer sirolimus-eluting stents (649 patients and 816 lesions) or durable polymer everolimus-eluting stents (651 patients and 806 lesions). At 12 months, follow-up data were available for 614 (95%) patients treated with biodegradable polymer sirolimus-eluting stents and 626 (96%) patients treated with durable polymer everolimus-eluting stents. The primary composite endpoint of target lesion failure occurred in 25 (4%) of 649 patients treated with biodegradable polymer sirolimus-eluting stents and 36 (6%) of 651 patients treated with durable polymer everolimus-eluting stents (difference -1·6 percentage points; rate ratio 0·59, 95% Bayesian credibility interval 0·37-0·94; posterior probability of superiority 0·986). Cardiac death, target vessel myocardial reinfarction, clinically-indicated target lesion revascularisation, and definite stent thrombosis were similar between the two treatment groups in the 12 months of follow-up. INTERPRETATION In patients with acute STEMI undergoing primary PCI, biodegradable polymer sirolimus-eluting stents were superior to durable polymer everolimus-eluting stents with respect to target lesion failure at 1 year. This difference was driven by reduced ischaemia-driven target lesion revascularisation in patients treated with biodegradable polymer sirolimus-eluting stents compared with durable polymer everolimus-eluting stents. FUNDING Biotronik.
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Affiliation(s)
- Juan F Iglesias
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Dik Heg
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Marco Roffi
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - David J Kurz
- Department of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - Igal Moarof
- Department of Cardiology, Kantonsspital, Aarau, Switzerland
| | | | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sylvain Losdat
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ayodele Odutayo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
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42
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Haude M, Ince H, Kische S, Abizaid A, Toelg R, Lemos PA, Van Mieghem N, Verheye S, von Birgelen C, Christiansen E, Neumann FJ, Witzenbichler B, Kaiser C, Eeckhout E, Escaned J, Garcia-Garcia H, Waksman R. TCT-188 Safety and Clinical Performance of the Drug-Eluting Absorbable Metal Scaffold in the Treatment of Subjects With de Novo Lesions in Native Coronary Arteries at 36-Month Follow-Up: BIOSOLVE-II and BIOSOLVE-III. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Meier D, Fournier S, Eeckhout E, Masci PG, Schwitter J, Muller O, Harbaoui B. P3631Impact of manual thrombectomy on microvascular obstruction among STEMI patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0489] [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
Manual thrombectomy (MT) in ST segment elevation myocardial infarction (STEMI) is not associated with improved outcome and may even be harmful. Microvascular obstruction (MVO) assessed with cardiac magnetic resonance (CMR) imaging is among the strongest outcome predictors after STEMI.
Purpose
We aimed to investigate the impact of MT on MVO occurrence and extent.
Method
Between December 2010 and June 2017, 401 consecutive STEMI patients admitted for primary PCI, and still hospitalized in our tertiary care hospital at day 3 or later, (i.e. not transferred to another hospital) underwent a CMR during the index hospitalization (routine care at our institution during this period). Among them, 383 patients fulfilled the inclusion criteria and were classified into 2 categories (with or without MT) while 18 patients were excluded because of incomplete CMR data. The 2 co-primary endpoints were the occurrence and the extent of MVO, with these latter being analyzed either as a categorical variable (MVO vs. No-MVO) or as a semi-continuous variable (numbers of segments with MVO), respectively.
Results
In total, 188 (49.1%) patients experienced MVO. Both the incidence of MVO and the median number of segments with MVO were significantly higher in the MT group as compared to the no-MT group (59.5% vs 38.9%, respectively p<0.001, Figure 1A) and (0 [0; 2] vs 1.5 [0; 4]; respectively, p<0.001). When stratifying the analysis on coronary thrombus grade (Figures 1B and 1C), similar results were found only in patients with high thrombus burden (43.5% vs 60.7%, respectively, p=0.004). When adjusting for baseline differences between the 2 groups, MT remained a determinant of MVO (OR 1.90 (CI 95% 1.08 to 3.34); p=0.026) in patients with high thrombus grade.
Figure 1
Conclusion
In STEMI patients undergoing primary PCI, MT is associated with the occurrence and the extent of MVO assessed by CMR, especially in patients with a high thrombus grade. This suggests thrombus fragmentation with distal embolization as a potential mechanistic explanation.
Acknowledgement/Funding
None
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Affiliation(s)
- D Meier
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - S Fournier
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - E Eeckhout
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - P G Masci
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - J Schwitter
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - B Harbaoui
- Civils Hospices of Lyon, Cardiology, Lyon, France
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44
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Colombier S, Girod G, Niclauss L, Danzer D, Eeckhout E, Qanadli SD, Delay D. Total Endovascular Repair of Post-Trauma Ascending Aortic Pseudoaneurysm and Secondary Superior Vena Cava Syndrome. Ann Vasc Surg 2019; 61:468.e13-468.e17. [PMID: 31376549 DOI: 10.1016/j.avsg.2019.04.043] [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: 12/03/2018] [Revised: 04/28/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Clavicular fracture or sternoclavicular luxation is observed in 10% of all polytrauma patients and is frequently associated with concomitant intrathoracic life-threatening injuries. Posterior sternoclavicular luxation is well known to induce underlying great vessels damage. The gold standard treatment usually is a combined orthopedic and cardiovascular surgical procedure associating vascular repair, clavicular open reduction, and internal fixation. METHODS A 59-year-old wheelchair ridden, institutionalized woman, known for psychiatric disorder, severe scoliosis, malnutrition, and chronic obstructive pulmonary disease was admitted in our hospital for chronic chest pain 3 months after a stairway wheelchair downfall. A thoracic computed tomography (CT) scan revealed a voluminous ascending aortic pseudoaneurysm (63 × 58 mm, orifice 5 mm) consecutive to perforation following posterior sternoclavicular luxation. The patient refused all therapies and was lost to follow-up. Six months later, she was readmitted for a symptomatic superior vena cava syndrome. Thoracic CT scan revealed pseudoaneurysm growth with innominate vein thrombosis and superior vena cava subocclusion. Pseudoaneurysm orifice was stable. In the presence of symptoms with massive facial edema and inability to open her eyelids, the patient accepted an endovascular treatment. RESULTS The procedure was performed under general anesthesia using both fluoroscopic and transesophageal echocardiographic guidance. Through a femoral arterial access, a 10-mm atrial septal defect occluder device was used to seal successfully the pseudoaneurysm orifice. The superior vena cava was then opened with a 26-mm nitinol high radial force stent through a femoral venous access. Postoperative course was uneventful. At 3-month follow-up, the patient remains symptom free and a CT scan confirmed pseudoaneurysm thrombosis and superior vena cava permeability. CONCLUSION Post-traumatic sternoclavicular posterior luxation is a cause of great vessels and ascending aorta injuries. Minimally invasive endovascular approaches can be considered to treat vascular injuries and their consequences, especially in elderly patients and those at high risk for surgery.
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Affiliation(s)
- Sébastien Colombier
- Department of Cardiac Surgery, Hôpital du Valais, Sion, Switzerland; Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Grégoire Girod
- Department of Cardiology, Hôpital du Valais, Sion, Switzerland
| | - Lars Niclauss
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Daniel Danzer
- Department of Vascular Surgery, Hôpital du Valais, Sion, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Salah Dine Qanadli
- Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Dominique Delay
- Department of Cardiac Surgery, Hôpital du Valais, Sion, Switzerland
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45
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Pavon A, Masci PG, Bermano A, Vaxman A, Gotsman C, Lauriers N, Rodrigues D, Monney P, Rutz T, Eeckhout E, Muller O, Schwitter J. P158The role of left atrium in patient with myocardial infarction with ST-segment elevation (STEMI). Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.021] [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: 11/12/2022] Open
Affiliation(s)
- A Pavon
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P G Masci
- Kings College London, School of Bioengineer and Medical Sciences, Life Sciences, King’s College, London, United Kingdom of Great Britain & Northern Ireland
| | - A Bermano
- University of Zurich, Computer Graphics lab, Zurich, Switzerland
| | - A Vaxman
- Geometric Modeling and Industrial Geometry group, Vienna University of Technology, wien, Austria
| | - C Gotsman
- Jacobs Technion-Cornell Institute at Cornell Tech, new york, United States of America
| | - N Lauriers
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - D Rodrigues
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P Monney
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - T Rutz
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - E Eeckhout
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - J Schwitter
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
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Hideo-Kajita A, Garcia-Garcia HM, Haude M, Joner M, Koolen J, Ince H, Abizaid A, Toelg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Neumann FJ, Kaiser C, Eeckhout E, Teik LS, Escaned J, Azizi V, Kuku KO, Ozaki Y, Dan K, Waksman R. First Report of Edge Vascular Response at 12 Months of Magmaris, A Second-Generation Drug-Eluting Resorbable Magnesium Scaffold, Assessed by Grayscale Intravascular Ultrasound, Virtual Histology, and Optical Coherence Tomography. A Biosolve-II Trial Sub-Study. Cardiovasc Revasc Med 2019; 20:392-398. [PMID: 31079817 DOI: 10.1016/j.carrev.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/11/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND OBJECTIVE The edge vascular response (EVR) remains unknown in second generation drug-eluting Resorbable Magnesium Scaffold (RMS), such as Magmaris. The aim of the study was to evaluate tissue modifications in the RMS edges over time, assessed by different invasive imaging modalities. METHODS The patients treated with the device were assessed by optical coherence tomography (OCT), grayscale intravascular ultrasound (IVUS), and virtual histology IVUS at baseline and 12 months. The EVR study performed a segment- and frame-level analysis of the 5 mm segments proximal and distal of the actual RMS. RESULTS The segment-level grayscale IVUS (n = 10), virtual histology IVUS (n = 10), and OCT (n = 18) analysis did not show any significant changes after 12 months, except for a fibrous plaque area (FPA) reduction of 0.5mm2 (p = 0.017) in the proximal segment compared to baseline. In the frame-level analysis, IVUS evaluation revealed a vessel area decreased 2.80 ± 1.43 mm2 (p = 0.012) and 2.49 ± 1.53 mm2 (p = 0.022) in 2 proximal frames. This was accompanied by plaque area reduction of 0.88 ± 0.70 mm2 (p = 0.048) and a FPA decreased by 0.63 ± 0.48 mm2 (p = 0.004) in one proximal frame. In 1 distal frame, there was a dense calcium area reduction of 0.10 ± 0.12 mm2 (p = 0.045), FPA and fibrous fatty plaque increased 0.54 ± 0.53 mm2 (p = 0.023) and 0.17 ± 0.16 mm2 (p = 0.016), respectively. By OCT, there was a lumen area decrease of 0.76 ± 1.51 mm2 (p = 0.045) in a distal frame. CONCLUSION At 12 months, Magmaris EVR assessment does not show overall significant changes, except for a fibrous plaque area reduction in the proximal segment. This could be translated as a benign healing process at the edges of the RMS. SUMMARY The edge vascular response (EVR) remains unknown in second generation drug-eluting absorbable metal scaffolds (RMS), such as Magmaris. Patients treated with the device were assessed by multi invasive imaging modalities [i.e. optical coherence tomography (OCT), grayscale intravascular ultrasound (IVUS), and virtual histology IVUS] evaluating the tissue changes over time in the segment- and frame-level analysis of the 5 mm segments proximal and distal of the actual RMS. As a result, after 12 months, Magmaris EVR assessment does not show overall significant changes, except for a fibrous plaque area reduction in the proximal segment, translating a benign healing process at the edges of the RMS.
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Affiliation(s)
- Alexandre Hideo-Kajita
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Michael Joner
- Deutsches Herzzentrum Muenchen und Deutsches Zentrum fuer Herz-Kreislaufforschung e.V., Munich, Germany
| | - Jacques Koolen
- Cardiologie, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Hüseyin Ince
- Vivantes Klinikum im Friedrichshain and Am Urban, Department of Cardiology, University of Rostock, Berlin, Germany
| | | | - Ralph Toelg
- Herzzentrum Segeberger Kliniken, Henstedt-Ulzburg, Germany
| | - Pedro A Lemos
- Instituto do Coração - HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | | | - William Wijns
- Cardiology Department, Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium
| | - Franz-Josef Neumann
- Klinik fur Kardiologie und Angiologie II, Universitats-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Christoph Kaiser
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Lim Soo Teik
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Viana Azizi
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kayode O Kuku
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Yuichi Ozaki
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kazuhiro Dan
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Interventional Cardiology Department, MedStar Washington Hospital Center, Washington, DC, USA
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Fournier S, Monney P, Roguelov C, Ferrari E, Eeckhout E, Muller O, Durko A, Van Mieghem NM, Kappetein AP, Margey R. How should I treat an Edwards SAPIEN 3 aortic valve embolisation during a transaortic transcatheter aortic valve implantation? EUROINTERVENTION 2018; 13:495-498. [PMID: 28735254 DOI: 10.4244/eij-d-16-00592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
- Stephane Fournier
- Department of Cardiology, University Hospital Center Vaudois (CHUV), Lausanne, Switzerland
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Harbaoui B, Nanchen D, Lantelme P, Gencer B, Heg D, Klingenberg R, Räber L, Carballo D, Matter CM, Windecker S, Mach F, Rodondi N, Eeckhout E, Monney P, Antiochos P, Schwitter J, Pascale P, Fournier S, Courand PY, Lüscher TF, Muller O. Prognostic value of pulse pressure after an acute coronary syndrome. Atherosclerosis 2018; 277:219-226. [DOI: 10.1016/j.atherosclerosis.2018.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/24/2018] [Accepted: 07/10/2018] [Indexed: 01/03/2023]
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Iglesias JF, Muller O, Zaugg S, Roffi M, Kurz DJ, Vuilliomenet A, Weilenmann D, Kaiser C, Tapponnier M, Heg D, Valgimigli M, Eeckhout E, Jüni P, Windecker S, Pilgrim T. A comparison of an ultrathin-strut biodegradable polymer sirolimus-eluting stent with a durable polymer everolimus-eluting stent for patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: rationale and design of the BIOSTEMI trial. EUROINTERVENTION 2018; 14:692-699. [DOI: 10.4244/eij-d-17-00734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Masci PG, Pavon AG, Muller O, Iglesias JF, Vincenti G, Monney P, Harbaoui B, Eeckhout E, Schwitter J. Relationship between CMR-derived parameters of ischemia/reperfusion injury and the timing of CMR after reperfused ST-segment elevation myocardial infarction. J Cardiovasc Magn Reson 2018; 20:50. [PMID: 30037343 PMCID: PMC6055335 DOI: 10.1186/s12968-018-0474-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/26/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To investigate the influence of cardiovascular magnetic resonance (CMR) timing after reperfusion on CMR-derived parameters of ischemia/reperfusion (I/R) injury in patients with ST-segment elevation myocardial infarction (STEMI). METHODS The study included 163 reperfused STEMI patients undergoing CMR during the index hospitalization. Patients were divided according to the time between revascularization and CMR (Trevasc-CMR: Tertile-1 ≤ 43; 43 < Tertile-2 ≤ 93; Tertile-3 > 93 h). T2-mapping derived area-at-risk (AAR) and intramyocardial-hemorrhage (IMH), and late gadolinium enhancement (LGE)-derived infarct size (IS) and microvascular obstruction (MVO) were quantified. T1-mapping was performed before and > 15 min after Gd-based contrast-agent administration yielding extracellular volume (ECV) of infarct. RESULTS Main factors influencing I/R injury were homogenously balanced across Trevasc-CMR tertiles. T2 values of infarct and remote regions increased with increasing Trevasc-CMR tertiles (infarct: 60.0 ± 4.9 vs 63.5 ± 5.6 vs 64.8 ± 7.5 ms; P < 0.001; remote: 44.3 ± 2.8 vs 46.1 ± 2.8 vs ± 46.1 ± 3.0; P = 0.001). However, T2 value of infarct largely and significantly exceeded that of remote myocardium in each tertile yielding comparable T2-mapping-derived AAR extent throughout Trevasc-CMR tertiles (17 ± 9% vs 19 ± 9% vs 18 ± 8% of LV, respectively, P = 0.385). Similarly, T2-mapping-based IMH detection and quantification were independent of Trevasc-CMR. LGE-derived IS and MVO were not influenced by Trevasc-CMR (IS: 12 ± 9% vs 12 ± 9% vs 14 ± 9% of LV, respectively, P = 0.646). In 68 patients without MVO, T1-mapping based ECV of infarct region was comparable across Trevasc-CMR tertiles (P = 0.470). CONCLUSION In STEMI patients, T2 values of infarct and remote myocardium increase with increasing CMR time after revascularization. However, these changes do not give rise to substantial variation of T2-mapping-derived AAR size nor of other CMR-based parameters of I/R. TRIAL REGISTRATION ISRCTN03522116 . Registered 30.4.2018 (retrospectively registered).
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Affiliation(s)
- Pier-Giorgio Masci
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Anna Giulia Pavon
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardio-Thoracic-Vascular Department, San Raffaele’s Scientific Institute, Milan, Italy
| | - Olivier Muller
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Juan-Fernando Iglesias
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Gabriella Vincenti
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Pierre Monney
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Brahim Harbaoui
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Eric Eeckhout
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Juerg Schwitter
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
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