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Cholesterol crystals (CCs) are frequently found in high-risk plaques, such as thin-capped fibroatheromas. The purpose of this study was to investigate the associations of CCs, plaque morphologies, and post-stent optical frequency domain imaging (OFDI) findings with periprocedural cardiac troponin (cTn) elevation in patients treated with percutaneous coronary intervention (PCI). This study consists of 119 patients with stable coronary artery disease (CAD) with normal cTn levels who underwent OFDI-guided PCI. Periprocedural cTn elevation was defined as an elevation of cTn ≥ × 5 times the upper reference limit after PCI. Pre- and post-stent OFDI findings, including fibrous cap thickness (FCT), presence of CCs, and parameters for lipid and calcification were analyzed. A total of 37 (31%) patients were classified into the periprocedural cTn elevation group. Compared with lesions without CCs, lesions exhibiting CCs had thinner FCT, larger lipid arc, and longer lipid length, and were more likely to have irregular protrusion and in-stent thrombus (all p

Recently, an aortic valve area (AVA) index (AVAI)0.6 cm(2)/m(2) was proposed as an indicator of severe aortic stenosis. The purpose of the present study was to clarify the prognostic value of the AVAI. We identified 103 consecutive asymptomatic patients (mean age 72 ± 11 years) with severe aortic stenosis, defined by an AVA of1.0 cm(2), who had not undergone aortic valve replacement on initial evaluation. During follow-up (median 36 ± 27 months), 31 aortic valve replacements and 20 cardiac deaths occurred. Multivariate analysis revealed that an AVAI0.6 cm(2)/m(2) (hazard ratio 2.6, 95% confidence interval 1.1 to 6.3; p = 0.03) and peak aortic jet velocity (Vp)4.0 m/s (hazard ratio 2.6, 95% confidence interval 1.2 to 5.8; p = 0.02) were associated with cardiac events but that an AVA0.75 cm(2) was not. The event-free survival of patients with an AVAI of ≥0.6 cm(2)/m(2) was better than that for those with an AVAI0.6 cm(2)/m(2) (86% vs 41% at 3 years, p0.01). Furthermore, patients with an AVAI of ≥0.6 cm(2)/m(2) and Vp of ≤4.0 m/s showed an excellent prognosis, but those without these findings had poorer outcomes. In conclusion, AVAI is a powerful predictor of adverse events in asymptomatic patients with severe aortic stenosis. Furthermore, the combination of AVAI and Vp provides additional prognostic information. Watchful observations are required for timely aortic valve replacement in patients with an AVAI of0.6 cm(2)/m(2) or a Vp4.0 m/s.

Introduction: Contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) is associated with adverse short- and long-term cardiovascular outcomes in patients with acute coronary syndrome (ACS). However, the association between the reduction in glomerular filtration rate (GFR) at baseline, CI-AKI, and their prognostic significance on cardiovascular outcomes has not been established. Hypothesis: We hypothesized that the decreased GFR on admission would be associated with cardiovascular outcomes in patients with ACS independent of CI-AKI. Methods: This study consists of consecutive 283 ACS patients (67±12 years old, 207 men) underwent primary-PCI. Decreased admission GFR was defined as less than 60 ml/min per 1.73m2. CI-AKI was defined as an increase of serum creatinine more than 25% within 72 hours after PCI. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death and non-fatal myocardial infarction. Results: Of the 283 ACS patients, 59 (21%) had CI-AKI. During median follow-up of 2-year, MACE was occurred in 36 (12%, 5.3% per year) patients. Multivariate Cox proportional hazard analysis demonstrated that higher age (hazard ratio [HR], 1.06, 95% confidence interval [CI], 1.02-1.11; p=0.002), decreased admission GFR (HR, 3.3, 95% CI; 1.45-8.02; p=0.004), and CI-AKI (HR, 2.5, CI, 1.10-5.65; p=0.03) were associated with MACE. Kaplan-Meier analysis demonstrated that patients with decreased admission GFR and CI-AKI presented worse outcomes compared with those without decreased admission GFR and CI-AKI (P Conclusions: Decreased admission GFR and CI-AKI were independent robust predictors of future MACE in ACS patients underwent primary-PCI.

Bicuspid aortic valve (BAV) is associated with an increased risk of aortic valve (AV) dysfunction, aortic dissection, and infective endocarditis. Therefore, its accurate diagnosis is critical. The morphological features of AVs are generally evaluated by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE), however, the difference in the diagnostic capability of these imaging modalities for detecting BAV remains unclear. Here, we compared these 2 methods to determine their accuracy, and to clarify each role in the diagnosis of BAV.This blind study evaluated 126 patients (age, 70.3 +/- 7.8 years) who subsequently underwent AV replacement. The number of AV cusps of each patient was estimated by TTE and TEE and compared to the number of AV written in the operative record. Patients with poor echocardiographic images were not excluded.Surgical findings showed 97 tricuspid AVs and 29 BAVs. The sensitivity, specificity, and accuracy for the diagnosis of BAV were 61%, 81%, and 77%, respectively, for TTE and 86%, 90%, and 89%, respectively, for TEE. The accuracy of TEE was significantly higher than that of TTE (p = 0.016). In non-calcified AVs, the accuracy of TTE was similar to that of TEE (96%, each) whereas in calcified AVs, TTE had a lower accuracy than TEE (72% vs 87%, p = 0.011). The feasibility was significantly higher for TEE than for TTE (98% vs 90%, p = 0.003).TEE provides higher accuracy and feasibility than TTE in the diagnosis of BAV, and it should therefore be indicated when morphological features of AVs cannot be evaluated by TTE.