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2. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management
- Author
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Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, Filippo, Galiuto, Leonarda, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Lüscher, Tf, Templin, C, Crea F (ORCID:0000-0001-9404-8846), Galiuto L (ORCID:0000-0002-6831-479X), Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, Filippo, Galiuto, Leonarda, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Lüscher, Tf, Templin, C, Crea F (ORCID:0000-0001-9404-8846), and Galiuto L (ORCID:0000-0002-6831-479X)
- Abstract
The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians.
- Published
- 2018
3. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology
- Author
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Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, Filippo, Galiuto, Leonarda, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Lüscher, Tf, Templin, C, Crea F (ORCID:0000-0001-9404-8846), Galiuto L (ORCID:0000-0002-6831-479X), Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, Filippo, Galiuto, Leonarda, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Lüscher, Tf, Templin, C, Crea F (ORCID:0000-0001-9404-8846), and Galiuto L (ORCID:0000-0002-6831-479X)
- Abstract
Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy.
- Published
- 2018
4. Use of platelet glycoprotein IIb/IIIa inhibitors in diabetics undergoing PCI for non-ST-segment elevation acute coronary syndromes: impact of clinical status and procedural characteristics
- Author
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Bauer, T, Mollmann, H, Weidinger, F, Zeymer, U, Seabra-Gomes, R, Eberli, F, Serruys, PWJC (Patrick), Vahanian, A, Silber, S, Wijns, W (William), Hochadel, M, Nef, HM, Hamm, CW, Marco, J, Gitt, AK, Bauer, T, Mollmann, H, Weidinger, F, Zeymer, U, Seabra-Gomes, R, Eberli, F, Serruys, PWJC (Patrick), Vahanian, A, Silber, S, Wijns, W (William), Hochadel, M, Nef, HM, Hamm, CW, Marco, J, and Gitt, AK
- Abstract
The most recent ESC guidelines for percutaneous coronary intervention (PCI) recommend the use of glycoprotein IIb/IIIa inhibitors (GPI) in high risk patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), particularly in diabetics. Little is known about the adherence to these guidelines within Europe. Between May 2005 and April 2008 a total of 47,407 consecutive patients undergoing PCI were prospectively enrolled into the PCI-Registry of the Euro Heart Survey Programme. In the present analysis we examined the use of GPI in 2,922 diabetics who underwent PCI for NSTE-ACS. In this high risk population only 22.2% received a GPI; 8.9% upstream and 13.4% during PCI. The strategy of the individual institution had a major impact on the usage of GPI. In the multiple regression analysis clinical instability and complex lesion characteristics were strong independent determinants for the use of GPI, whereas renal insufficiency was negatively associated with its use. After adjustment for confounding variables no significant differences in hospital mortality could be observed between the cohorts, but a significantly higher rate of non-fatal postprocedural myocardial infarction was observed among patients receiving GPI upstream. Despite the recommendation for its use in the current ESC guidelines, only a minority of the diabetics in Europe undergoing PCI for NSTE-ACS received a GPI. The use of GPI was mainly triggered by high-risk interventional scenarios.
- Published
- 2010
5. Increase of Neutrophil gelatinase-associated Lipocalin and Cystatin C after cardiac surgery – new options for detecting acute kidney injury
- Author
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Baumgarten, H, primary, Liebetrau, C, additional, Van Linden, A, additional, Njezic, B, additional, Walther, T, additional, Nef, HM, additional, and Hamm, C, additional
- Published
- 2012
- Full Text
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6. Effects of 2-Deoxy-d-Glucose on Proliferation of Vascular Smooth Muscle Cells and Endothelial Cells
- Author
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Nef, HM, primary, Möllmann, H, additional, Joseph, A, additional, Troidl, C, additional, Voss, S, additional, Vogt, A, additional, Weber, M, additional, Hamm, CW, additional, and Elsässer, A, additional
- Published
- 2008
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7. Negative Inotropic Effect of Rapamycin on Isolated Human Cardiomyocytes
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Möllmann, H, primary, Nef, HM, additional, Kahlert, P, additional, Kostin, S, additional, Möllmann, S, additional, Weber, M, additional, Troidl, C, additional, Hamm, CW, additional, Holubarsch, CJF, additional, and Elsässer, A, additional
- Published
- 2008
- Full Text
- View/download PDF
8. Multi-detector computed tomography is equivalent to trans-oesophageal echocardiography for the assessment of the aortic annulus before transcatheter aortic valve implantation.
- Author
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Rixe J, Schuhbaeck A, Liebetrau C, Moellmann H, Nef HM, Szardien S, Brandt R, Schmitt J, Neumann T, Schneider C, Krombach G, Hamm CW, Achenbach S, Rolf A, Rixe, Johannes, Schuhbaeck, Annika, Liebetrau, Christoph, Moellmann, Helge, Nef, Holger M, and Szardien, Sebastian
- Abstract
Objectives: In transcatheter aortic valve implantation (TAVI), assessment of the aortic annulus is mandatory. We sought to investigate the correlation between trans-oesophageal echocardiography (TEE) and multi-detector computed tomography (MDCT) for annulus diameter assessment before TAVI.Methods: A total of 122 patients (67 male, mean age 84 ± 6 years) underwent MDCT and TEE for TAVI planning. In TEE annulus diameters were obtained in a long-axis view at diastole. MDCT data were evaluated using MPR images, and corresponding projections were adjusted for MDCT and TEE. Patients were classified by the predominant localisation of aortic valve calcifications, and annulus diameters between TEE and MDCT were correlated. Additionally, the eccentricity of the aortic annulus was calculated.Results: Mean eccentricity of the aortic annulus determined by MDCT was 0.34 ± 0.17, with no difference according to valve calcification. Regarding the aortic annulus diameter, the mean values measured were 24.3 ± 2.1 mm in MDCT and 24.0 ± 2.5 mm in TEE (P < 0.0001 for agreement).Conclusions: Independent of the pattern of aortic valve calcification, close correlation is found between CT and TEE measurements of the aortic annulus diameter. In addition, CT demonstrates the non-circular shape of the aortic annulus.Key Points: Accurate assessment of aortic annulus before transcatheter aortic valve implantation is crucial. Trans-oesophageal echocardiography has been the preferred method for aortic annulus assessment. We demonstrated a strong correlation between TEE and CT for annulus dimensions. CT reliably demonstrates the non-circular shape of the aortic annulus. CT could therefore be generally used for aortic annulus assessment before TAVI. [ABSTRACT FROM AUTHOR]- Published
- 2012
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9. Image quality on dual-source computed-tomographic coronary angiography.
- Author
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Rixe J, Rolf A, Conradi G, Elsaesser A, Moellmann H, Nef HM, Bachmann G, Hamm CW, Dill T, Rixe, Johannes, Rolf, Andreas, Conradi, Guido, Elsaesser, Albrecht, Moellmann, Helge, Nef, Holger M, Bachmann, Georg, Hamm, Christian W, and Dill, Thorsten
- Abstract
Multi-detector CT reliably permits visualization of coronary arteries, but due to the occurrence of motion artefacts at heart rates >65 bpm caused by a temporal resolution of 165 ms, its utilisation has so far been limited to patients with a preferably low heart rate. We investigated the assessment of image quality on computed tomography of coronary arteries in a large series of patients without additional heart rate control using dual-source computed tomography (DSCT). DSCT (Siemens Somatom Definition, 83-ms temporal resolution) was performed in 165 consecutive patients (mean age 64 +/- 11.4 years) after injection of 60-80 ml of contrast. Data sets were reconstructed in 5% intervals of the cardiac cycle and evaluated by two readers in consensus concerning evaluability of the coronary arteries and presence of motion and beam-hardening artefacts using the AHA 16-segment coronary model. Mean heart rate during CT was 65 +/- 10.5 bpm; visualisation without artefacts was possible in 98.7% of 2,541 coronary segments. Only two segments were considered unevaluable due to cardiac motion; 30 segments were unassessable due to poor signal-to-noise ratio or coronary calcifications (both n = 15). Data reconstruction at 65-70% of the cardiac cycle provided for the best image quality. For heart rates >85 bpm, a systolic reconstruction at 45% revealed satisfactory results. Compared with earlier CT generations, DSCT provides for non-invasive coronary angiography with diagnostic image quality even at heart rates >65 bpm and thus may broaden the spectrum of patients that can be investigated non-invasively. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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10. Calcium and C-reactive protein hot enough to predict the future?
- Author
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Hamm CW, Nef HM, Rolf A, Möllmann H, Hamm, Christian W, Nef, Holger M, Rolf, Andreas, and Möllmann, Helge
- Published
- 2011
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11. Images in cardiovascular medicine. Natural tissue engineering inside a ventricular septum defect occluder.
- Author
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Möllmann H, Nef HM, Kostin S, Skwara W, Schaper J, Hamm CW, and Elsässer A
- Published
- 2006
12. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology
- Author
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Ilan S. Wittstein, Abhishek Deshmukh, Takashi Ueyama, Keigo Dote, G. Tarantini, Patrick Meimoun, David E. Winchester, Jelena-Rima Ghadri, Elmir Omerovic, Leonarda Galiuto, Roberto Manfredini, Scott W. Sharkey, Thomas F. Lüscher, Federico Migliore, Abhiram Prasad, Charanjit S. Rihal, Tetsuro Yoshida, Masami Kosuge, Eduardo Bossone, Filippo Crea, Holger Nef, Hiroaki Shimokawa, Yoshihiro J. Akashi, Christian Templin, Domenico Corrado, John D. Horowitz, Satoshi Kurisu, Walter Desmet, Jeroen J. Bax, Amir Lerman, Shams Y. Hassan, Frank Ruschitzka, Rodolfo Citro, Victoria L. Cammann, Ingo Eitel, Alexander R. Lyon, Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, F, Galiuto, L, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Luescher, Tf, and Templin, C
- Subjects
Benign condition ,Cardiac & Cardiovascular Systems ,TAKO-TSUBO CARDIOMYOPATHY ,Heart disease ,030204 cardiovascular system & hematology ,EMOTIONAL-STRESS ,Coronary artery disease ,Takotsubo definition ,0302 clinical medicine ,ST-SEGMENT ELEVATION ,APICAL BALLOONING SYNDROME ,Broken heart syndrome ,F-18 FDG PET ,InterTAK Diagnostic Criteria ,Takotsubo syndrome, Broken heart syndrome, Takotsubo definition, Acute heart failure, Consensus statement, InterTAK Diagnostic Criteria ,WALL-MOTION ,OF-THE-LITERATURE ,DESCENDING CORONARY-ARTERY ,Consensus statement ,Acute heart failure ,Takotsubo syndrome ,Cardiology and Cardiovascular Medicine ,CORONARY-ARTERY-DISEASE ,MENTAL STRESS ,Life Sciences & Biomedicine ,ACUTE MYOCARDIAL-INFARCTION ,medicine.medical_specialty ,MEDLINE ,Socio-culturale ,1102 Cardiovascular Medicine And Haematology ,ADRENERGIC-RECEPTOR POLYMORPHISMS ,03 medical and health sciences ,LEFT-VENTRICULAR DYSFUNCTION ,Consensus Paper ,STRESS-INDUCED CARDIOMYOPATHY ,medicine ,Intensive care medicine ,Science & Technology ,STRESS CARDIOMYOPATHY ,business.industry ,TERTIARY CARDIOVASCULAR CENTERS ,Expert consensus ,medicine.disease ,Editor's Choice ,Cardiovascular System & Hematology ,Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Cardiovascular System & Cardiology ,Etiology ,business ,030217 neurology & neurosurgery - Abstract
Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy. ispartof: EUROPEAN HEART JOURNAL vol:39 issue:22 pages:2032-2046 ispartof: location:England status: published
- Published
- 2018
- Full Text
- View/download PDF
13. Use and Outcomes of Multivessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the EHS-PCI Registry)
- Author
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Bauer T, Zeymer U, Hochadel M, Möllmann H, Weidinger F, Zahn R, Nef HM, Hamm CW, Marco J, and Gitt AK
- Published
- 2012
14. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management
- Author
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Domenico Corrado, Ilan S. Wittstein, Charanjit S. Rihal, Victoria L. Cammann, Satoshi Kurisu, John D. Horowitz, Abhiram Prasad, Alexander R. Lyon, Patrick Meimoun, Federico Migliore, Tetsuro Yoshida, Rodolfo Citro, Walter Desmet, Filippo Crea, Masami Kosuge, David E. Winchester, Holger Nef, Eduardo Bossone, Jeroen J. Bax, Amir Lerman, Shams Y. Hassan, Hiroaki Shimokawa, Thomas F. Lüscher, Yoshihiro J. Akashi, Abhishek Deshmukh, Jelena-Rima Ghadri, Leonarda Galiuto, Ingo Eitel, Christian Templin, Scott W. Sharkey, Elmir Omerovic, Roberto Manfredini, Takashi Ueyama, Keigo Dote, G. Tarantini, Frank Ruschitzka, Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, F, Galiuto, L, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Hassan, Sy, Migliore, F, Horowitz, Jd, Shimokawa, H, Luscher, Tf, and Templin, C
- Subjects
Cardiac & Cardiovascular Systems ,TAKO-TSUBO CARDIOMYOPATHY ,Computed Tomography Angiography ,RIGHT-VENTRICULAR INVOLVEMENT ,Diagnostic algorithm ,030204 cardiovascular system & hematology ,Coronary Angiography ,ACUTE CORONARY SYNDROME ,Outcome (game theory) ,Electrocardiography ,0302 clinical medicine ,Recurrence ,IN-HOSPITAL MORTALITY ,APICAL BALLOONING SYNDROME ,ST-SEGMENT ELEVATION ,030212 general & internal medicine ,Disease management (health) ,Broken heart syndrome ,Acute heart failure ,Consensus statement ,Takotsubo syndrome ,Cardiology and Cardiovascular Medicine ,LATE GADOLINIUM ENHANCEMENT ,Myocardial Perfusion Imaging ,Disease Management ,Magnetic Resonance Imaging ,Treatment Outcome ,Echocardiography ,CARDIOVASCULAR MAGNETIC-RESONANCE ,Risk stratification ,LIFE-THREATENING ARRHYTHMIAS ,Medical emergency ,Life Sciences & Biomedicine ,Algorithms ,ACUTE MYOCARDIAL-INFARCTION ,OUTFLOW TRACT OBSTRUCTION ,MEDLINE ,Socio-culturale ,takotsubo syndrome ,broken heart syndrome ,acute heart failure ,consensus statement ,diagnostic algorithm ,1102 Cardiovascular Medicine And Haematology ,Timely diagnosis ,03 medical and health sciences ,LEFT-VENTRICULAR DYSFUNCTION ,Takotsubo Cardiomyopathy ,Consensus Paper ,medicine ,Humans ,ANTERIOR MYOCARDIAL-INFARCTION ,Science & Technology ,business.industry ,Expert consensus ,Arrhythmias, Cardiac ,medicine.disease ,Clinical trial ,Editor's Choice ,Cardiovascular System & Hematology ,Takotsubo syndrome, Broken heart syndrome, Acute heart failure, Consensus statement, Diagnostic algorithm ,Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Cardiovascular System & Cardiology ,business - Abstract
The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians. ispartof: EUROPEAN HEART JOURNAL vol:39 issue:22 pages:2047-2062 ispartof: location:England status: published
- Published
- 2018
15. Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients
- Author
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Patompong Ungprasert, Olivier Morel, Francesco Pelliccia, Rodolfo Citro, Luca Cacciotti, Tetsuro Yoshida, Olivier Lairez, David Antoniucci, Orlando Santana, Eduardo Bossone, Costin N. Ionescu, Juan Carlos Kaski, Guido Parodi, Christos G. Mihos, Jae Kwan Song, Federico Guerra, Nicolas Mansencal, Carlo Gaudio, Andrew W. Teh, Giuseppe Marazzi, Alessandro Capucci, Alberto Valbusa, Maiteder Larrauri-Reyes, Bong Gun Song, Clément Delmas, Franziska Schneck, Holger Nef, Roman Brenner, Andreas Wahl, Pil Hyung Lee, Andres M. Pineda, Cesare Greco, Iván J. Núñez Gil, Giuseppe M.C. Rosano, Ilaria Passaseo, Laboratoire de Biophotonique et Pharmacologie - UMR 7213 (LBP), Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA)), Pelliccia, F, Parodi, G, Greco, C, Antoniucci, D, Brenner, R, Bossone, E, Cacciotti, L, Capucci, A, Citro, R, Delmas, C, Guerra, F, Ionescu, Cn, Lairez, O, Larrauri-Reyes, M, Lee, Ph, Mansencal, N, Marazzi, G, Mihos, Cg, Morel, O, Nef, Hm, Gil, Ijn, Passaseo, I, Pineda, Am, Rosano, G, Santana, O, Schneck, F, Song, Bg, Song, Jk, Teh, Aw, Ungprasert, P, Valbusa, A, Wahl, A, Yoshida, T, Gaudio, C, Kaski, Jc, and Barthel, Ingrid
- Subjects
medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Cardiovascular risk factors ,Cardiomyopathy ,Global Health ,apical ballooning syndrome ,Catecholamines ,Risk Factors ,Stress, Physiological ,Takotsubo Cardiomyopathy ,Diabetes mellitus ,Internal medicine ,medicine ,takotsubo syndrome ,Humans ,medicine (all) ,ComputingMilieux_MISCELLANEOUS ,Acute left ventricular dysfunction ,cardiomyopathy ,takotsubo cardiomyopathy ,Takotsubo syndrome ,business.industry ,Mean age ,General Medicine ,medicine.disease ,Obesity ,3. Good health ,[SDV] Life Sciences [q-bio] ,Physical therapy ,business ,Dyslipidemia ,Kidney disease - Abstract
Background To identify predisposing factors that can result in the onset of takotsubo syndrome, we performed an international, collaborative systematic review focusing on clinical characteristics and comorbidities of patients with takotsubo syndrome. Methods We searched and reviewed cited references up to August 2013 to identify relevant studies. Corresponding authors of selected studies were contacted and asked to provide additional quantitative details. Data from each study were extracted by 2 independent reviewers. The cumulative prevalence of presenting features and comorbidities was assessed. Nineteen studies whose authors sent the requested information were included in the systematic review, with a total of 1109 patients (951 women; mean age, 59-76 years). Evaluation of risk factors showed that obesity was present in 17% of patients (range, 2%-48%), hypertension in 54% (range, 27%-83%), dyslipidemia in 32% (range, 7%-59%), diabetes in 17% (range, 4%-34%), and smoking in 22% (range, 6%-49%). Emotional stressors preceded takotsubo syndrome in 39% of patients and physical stressors in 35%. The most common comorbidities were psychological disorders (24%; range, 0-49%), pulmonary diseases (15%; range, 0-22%), and malignancies (10%; range, 4%-29%). Other common associated disorders were neurologic diseases (7%; range, 0-22%), chronic kidney disease (7%; range, 2%-27%), and thyroid diseases (6%; range, 0-37%). Conclusions Patients with takotsubo syndrome have a relevant prevalence of cardiovascular risk factors and associated comorbidities. Such of associations needs to be evaluated in further studies.
- Published
- 2014
16. Prognostic utility of mid-regional pro-adrenomedullin and growth differentiation factor 15 in patients undergoing transfemoral transcatheter aortic valve implantation.
- Author
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Piayda K, Keranov S, Schulz L, Arsalan M, Liebetrau C, Kim WK, Hofmann FJ, Bauer P, Voss S, Troidl C, Sossalla ST, Hamm CW, Nef HM, and Dörr O
- Abstract
Background: Risk prediction in patients with severe, symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) remains an unsolved issue. In addition to classical risk scoring systems, novel circulating biomarkers like mid-regional pro-adrenomedullin (MR-proADM) and growth differentiation factor 15 (GDF-15) may be of value in assessing risk., Methods: Consecutive patients undergoing elective transfemoral TAVI were included in this prospective observational study. Baseline information, imaging findings, blood samples, and clinical outcomes were collected. Blood levels of the classical biomarkers interleukin-6 (IL-6) and high-sensitivity C-reactive peptide (hsCRP) and of the novel biomarkers MR-proADM and GDF-15 were measured and their predictive utility for mortality assessed., Results: The study cohort consisted of 92 patients undergoing TAVI. The median age was 80.7 years [IQR 77.2;83.3], and 48 (52.2%) were male. Analysis of the area under the curve (AUC) of the receiver-operating characteristics showed that the hsCRP levels discriminated poorly (AUC 0.66, 95% CI [0.52;0.8], p = 0.027), whereas all other biomarkers reached a higher level of discrimination (IL-6: AUC 0.76, 95% CI [0.66;0.86], p < 0.001; MR-proADM: AUC 0.73, 95% CI [0.61;0.85], p = 0.002; GDF-15: AUC 0.73, 95% CI [0.61;0.85], p = 0.002). Kaplan-Meier analysis in conjunction with Youden J-statistics yielded the optimal cutoff points for each biomarker to predict survival: IL-6 4.65 pg/mL, hsCRP 12.9 mg/L, MR-proADM 1.02 nmol/L, and GDF-15 2400.1 pg/mL., Conclusion: Novel circulating biomarkers like MR-proADM and GDF-15 may provide additional value in predicting survival after TAVI., (© 2024. The Author(s).)
- Published
- 2024
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17. Epicardial adipose tissue and muscle distribution affect outcomes in very old patients after transcatheter aortic valve replacement.
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Rohrbach S, Uluocak O, Junge M, Knapp F, Schulz R, Böning A, Nef HM, Krombach GA, and Niemann B
- Abstract
Aims: To analyse the relevance of body composition and blood markers for long-term outcomes in very old patients after transcatheter aortic valve replacement (TAVR)., Methods and Results: A total of 403 very old patients were characterized with regard to subcutaneous, visceral, and epicardial fat, psoas muscle area, plasma growth differentiation factor 15 (GDF-15), and leptin. Cohorts grouped by body mass index (BMI) were analysed for long-term outcomes. Patients underwent transapical and transfemoral TAVR (similar 30-day/1-year survival). Body mass index >35 kg/m
2 showed increased 2- and 3-year mortality compared with BMI 25-34.9 kg/m2 but not compared with BMI <25 kg/m2 . Fat areas correlated positively to BMI (epicardial: R2 = 0.05, P < 0.01; visceral: R2 = 0.20, P < 0.001; subcutaneous: R2 = 0.13, P < 0.001). Increased epicardial or visceral but not subcutaneous fat area resulted in higher long-term mortality. Patients with high BMI (1781.3 mm2 ± 75.8, P < 0.05) and lean patients (1729.4 ± 52.8, P < 0.01) showed lower psoas muscle area compared with those with mildly elevated BMI (2055.2 ± 91.7). Reduced psoas muscle area and increased visceral fat and epicardial fat areas were independent predictors of long-term mortality. The levels of serum GDF-15 were the highest in BMI >40 kg/m2 (2793.5 pg/mL ± 123.2) vs. BMI <25 kg/m2 (2017.6 pg/mL ±130.8), BMI 25-30 kg/m2 (1881.8 pg/mL ±127.4), or BMI 30-35 kg/m2 (2054.2 pg/mL ±124.1, all P < 0.05). Increased GDF-15 level predicted mortality (2587 pg/mL, area under the receiver operating characteristic curve 0.94). Serum leptin level increased with BMI without predictive value for long-term mortality., Conclusion: Morbidly visceral and epicardial fat accumulation, reduction in muscle area, and GDF-15 increase are strong predictors of adverse outcomes in very old patients post-TAVR., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)- Published
- 2024
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18. Mitral Valve Edge-to-Edge Repair Through an Atrial Septal Shunt Device.
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Hofmann FJ, Dörr O, Abt B, Rastan AJ, and Nef HM
- Abstract
Atrial shunt devices are being implanted with increasing frequency, and there are potential concerns for subsequent procedures using transseptal access. A 79-year-old woman presented with progressive dyspnea of multifactorial etiology with already implanted atrial shunt device. Due to comorbidities, successful mitral-valve edge-to-edge repair was performed transseptally through the shunt device., Competing Interests: Dr Nef has received speaker honorarium from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)
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- 2024
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19. The role of Matrix Metalloproteinase-2 and Galectin-3 as predictive biomarkers for all-cause mortality in patients undergoing transfemoral transcatheter aortic valve implantation.
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Piayda K, Heilemann JT, Keranov S, Schulz L, Arsalan M, Liebetrau C, Kim WK, Hofmann FJ, Bauer P, Voss S, Troidl C, Sossalla ST, Hamm CW, Nef HM, and Dörr O
- Subjects
- Humans, Male, Female, Aged, 80 and over, Aged, Prognosis, Galectins, Blood Proteins analysis, Blood Proteins metabolism, Matrix Metalloproteinase 2 blood, Transcatheter Aortic Valve Replacement mortality, Biomarkers blood, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, Aortic Valve Stenosis blood, Galectin 3 blood
- Abstract
Background: Currently available risk scores fail to accurately predict morbidity and mortality in patients with severe symptomatic aortic stenosis who undergo transcatheter aortic valve implantation (TAVI). In this context, biomarkers like matrix metalloproteinase-2 (MMP-2) and Galectin-3 (Gal-3) may provide additional prognostic information., Methods: Patients with severe aortic stenosis undergoing consecutive, elective, transfemoral TAVI were included. Baseline demographic data, functional status, echocardiographic findings, clinical outcomes and biomarker levels were collected and analysed., Results: The study cohort consisted of 89 patients (age 80.4 ± 5.1 years, EuroScore II 7.1 ± 5.8%). During a median follow-up period of 526 d, 28 patients (31.4%) died. Among those who died, median baseline MMP-2 (alive: 221.6 [170.4; 263] pg/mL vs. deceased: 272.1 [225; 308.8] pg/mL, p < 0.001) and Gal-3 levels (alive: 19.1 [13.5; 24.6] pg/mL vs . deceased: 25 [17.6; 29.5] pg/mL, p = 0.006) were higher than in survivors. In ROC analysis, MMP-2 reached an acceptable level of discrimination to predict mortality (AUC 0.733, 95% CI [0.62; 0.83], p < 0.001), but the predictive value of Gal-3 was poor (AUC 0.677, 95% CI [0.56; 0.79], p = 0.002). Kaplan-Meier and Cox regression analyses showed that patients with MMP-2 and Gal-3 concentrations above the median at baseline had significantly impaired long-term survival ( p = 0.004 and p = 0.02, respectively)., Conclusions: In patients with severe aortic stenosis undergoing transfemoral TAVI, MMP-2 and to a lesser extent Gal-3, seem to have additive value in optimizing risk prediction and streamlining decision-making.
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- 2024
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20. Technology viewpoint: Evolution in PCI: The next major advance in implant technology to restore vessel function.
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Kereiakes DJ, Saito S, Nef HM, Webster M, Verheye S, and Colombo A
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- Humans, Stents, Treatment Outcome, Percutaneous Coronary Intervention adverse effects, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery
- Abstract
Competing Interests: Declaration of competing interest Authors report the following disclosures of conflicts of interest.
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- 2024
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21. One-Year Outcomes According to Mitral Regurgitation Etiology Following Transcatheter Edge-to-Edge Repair With the PASCAL System: Results From a Multicenter Registry.
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von Stein P, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Friedrichs K, Öztürk C, Baldus S, Guthoff H, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Horn P, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, Pfister R, and Mauri V
- Subjects
- Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Treatment Outcome, Registries, Cardiac Catheterization adverse effects, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency epidemiology, Mitral Valve Insufficiency etiology, Cardiac Surgical Procedures, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods
- Abstract
Background: We previously reported procedural and 30-day outcomes of a German early multicenter experience with the PASCAL system for severe mitral regurgitation (MR). This study reports 1-year outcomes of mitral valve transcatheter edge-to-edge repair with the PASCAL system according to MR etiology in a large all-comer cohort., Methods and Results: Clinical and echocardiographic outcomes up to 1-year were investigated according to MR etiology (degenerative [DMR], functional [FMR], or mixed [MMR]) in the first 282 patients with symptomatic MR 3+/4+ treated with the PASCAL implant at 9 centers in 2019. A total of 282 patients were included (33% DMR, 50% FMR, 17% MMR). At discharge, MR reduction to ≤1+/2+ was achieved in 58%/87% of DMR, in 75%/97% of FMR, and in 78%/98% of patients with MMR ( P =0.004). MR reduction to ≤1+/2+ was sustained at 30 days (50%/83% DMR, 67%/97% FMR, 74%/100% MMR) and at 1 year (53%/78% DMR, 75%/97% FMR, 67%/91% MMR) with significant differences between etiologies. DMR patients with residual MR 3+/4+ at 1-year had at least complex valve morphology in 91.7%. Valve-related reintervention was performed in 7.4% DMR, 0.7% FMR, and 0.0% MMR ( P =0.010). At 1-year, New York Heart Association Functional Class was significantly improved irrespective of MR etiology ( P <0.001)., Conclusions: In this large all-comer cohort, mitral valve transcatheter edge-to-edge repair with the PASCAL system was associated with an acute and sustained MR reduction at 1-year in all causes. However, in patients with DMR, MR reduction was less pronounced, reflecting the high incidence of complex or very complex anatomies being referred for mitral valve transcatheter edge-to-edge repair.
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- 2023
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22. Cardiovascular Risk Factors and Culprit Plaque Characteristics in Women With Acute Coronary Syndromes.
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Seegers LM, Yeh DD, Wood MJ, Yonetsu T, Minami Y, Araki M, Nakajima A, Yuki H, Ako J, Soeda T, Kurihara O, Higuma T, Kimura S, Adriaenssens T, Nef HM, Lee H, McNulty I, Sugiyama T, Kakuta T, and Jang IK
- Subjects
- Female, Humans, Coronary Angiography, Coronary Vessels pathology, Heart Disease Risk Factors, Lipids, Risk Factors, Tomography, Optical Coherence methods, Middle Aged, Acute Coronary Syndrome etiology, Cardiovascular Diseases complications, Coronary Artery Disease epidemiology, Diabetes Mellitus, Plaque, Atherosclerotic diagnostic imaging, Plaque, Atherosclerotic epidemiology, Plaque, Atherosclerotic complications
- Abstract
Outcomes after myocardial infarction in women remain poor. The number of cardiovascular risk factors in women increase with age, however the relation between risk factors and culprit plaque characteristics in this population is poorly understood. The aim of the study was to investigate the relation between risk factors and culprit plaque characteristics in women with acute coronary syndrome (ACS). A total of 382 women who presented with ACS and underwent pre-intervention optical coherence tomography imaging of the culprit lesion were included in this analysis. The culprit plaques were categorized as plaque rupture, plaque erosion or calcified plaque, and then stratified by age and risk factors. The predominant pathology of ACS was plaque erosion in young patients (<60 years), which decreased with age (p <0.001). Current smokers had a high prevalence of plaque rupture (60%) and lipid plaque (79%). Women with diabetes tended to have more lipid plaque (70%) even at a young age. In women with hyperlipidemia, the prevalence of lipid plaques was modest in younger ages, but rose gradually with age (p <0.001). An increasing age trend for lipid plaque was also observed in women with hypertension (p = 0.03) and current smokers (p = 0.01). In conclusion, early treatment of risk factors such as diabetes in young women might be important before accelerated progression of atherosclerosis begins as age advances. Clinical trial registration: http://www.clinicaltrials.gov, NCT01110538, NCT03479723 and NCT02041650., Competing Interests: Declaration of Competing Interest Dr. Jang received educational grants from Abbott Vascular and consulting fees from Svelte Medical Systems, Inc. The authors have no competing interests to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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23. First randomised controlled trial comparing the sirolimus-eluting bioadaptor with the zotarolimus-eluting drug-eluting stent in patients with de novo coronary artery lesions: 12-month clinical and imaging data from the multi-centre, international, BIODAPTOR-RCT.
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Saito S, Bennett J, Nef HM, Webster M, Namiki A, Takahashi A, Kakuta T, Yamazaki S, Shibata Y, Scott D, Vrolix M, Menon M, Möllmann H, Werner N, Neylon A, Mehmedbegovic Z, Smits PC, Morice MC, and Verheye S
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Background: The DynamX™ bioadaptor is the first coronary implant technology with a unique mechanism of unlocking the bioadaptor frame after polymer resorption over 6 months, uncaging the vessel while maintaining a dynamic support to the vessel. It aims to achieve the acute performance of drug-eluting stents (DES) with the advantages of restoration of vessel function., Methods: This international, single blinded, randomised controlled (1:1) trial compared a sirolimus-eluting bioadaptor with a contemporary zotarolimus-eluting stent (DES) in 34 hospitals in Europe, Japan and New Zealand. Patients with de novo coronary lesions and absence of acute myocardial infarction were enrolled from January 2021 to Feburary 2022. The implantation of the bioadaptor followed the standards of DES. An imaging subset of 100 patients had angiographic and intravascular ultrasound assessments, and 20 patients additionally optical coherence tomography. Data collection will continue through 5 years, we herein report 12-month data based on an intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT04192747)., Findings: 445 patients were randomised between January 2021 and February 2022. Device, lesion and procedural success rates, and acute gain were similar amongst the groups. The primary endpoint, 12-month target lesion failure, was 1.8% [95% CI: 0.5; 4.6] (n = 4) versus 2.8% [95% CI: 1.0; 6.0] (n = 6), p
non-inferiority < 0.001 for the bioadaptor and the DES, respectively (Δ-1.0% [95% CI: -3.3; 1.4]). One definite or probable device thrombosis occurred in each group. The 12-month imaging endpoints showed superior effectiveness of the bioadaptor such as in-device late lumen loss (0.09 mm [SD 0.34] versus 0.25 mm [SD 0.39], p = 0.04), and restored compliance and cyclic pulsatility (%mid in-device lumen area change of 7.5% versus 2.7%, p < 0.001)., Interpretation: This is the first randomised controlled trial comparing the novel bioadaptor technology against a contemporary DES. The bioadaptor demonstrated similar acute performance and 12-month clinical outcomes, and superior imaging endpoints including restoration of vessel function., Funding: The study was funded by Elixir Medical., Competing Interests: Shigeru Saito reports consulting fees from Elixir Medical which are paid to the NPO International TRI network, Johan Bennett reports consulting fees from Biotronik AG, Boston Scientific, Abbott Vascular and Elixir, Holger Nef reports honoraria, payments for expert testimony, and support for attending meetings from Elixir Medical, Helge Möllmann reports grants/contracts and support for attending meetings from Abbott, Boston Scientific and Medtronic and payment/honoraria from Abbott, Boston Scientific, Edwards Lifesciences and Medtronic, Nikos Werner reports speakers honorarium and research grants from Abiomed, Boston Scientific, Edwards Lifesciences, Medtronic, and Shockwave, and is an advisory board member for ElixirMedical, Antoinette Neylon is a shareholder of CERC, Zlatko Mehmedbegovic is an independent core laboratory specialist at CERC, Pieter C. Smits reports institutional research grants from Abbott Vascular, SMT, Microport and Daiichy Sankyo, consulting fees of Abbott Vascular, Astra Zeneca, Terumo and Microport, and payments/honoraria from Abiomed, Terumo and Microport, participates in the DSMBs of the Protector, Legacy and ASET Japan trials, in the global advisory board of Abbott, and the European advisory board of Terumo (the latter paid to its institution), and is a minor shareholder of CERC. Marie-Claude Morice is a minor shareholder of Electroducer and Basecamps, and a shareholder and CEO of CERC, Stefan Verheye reports consulting fees and payment/honoraria from Elixir and Neovasc. The other authors report no conflict of interest., (© 2023 The Author(s).)- Published
- 2023
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24. DynamX sirolimus-eluting Bioadaptor versus the zotarolimus-eluting Resolute Onyx stent in patients with de novo coronary artery lesions: Design and rationale of the multi-center, international, randomized BIODAPTOR-RCT.
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Saito S, Nef HM, Webster M, and Verheye S
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- Humans, Coronary Angiography, Treatment Outcome, Sirolimus adverse effects, Prosthesis Design, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Drug-Eluting Stents, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: Conventional drug-eluting stents achieve good safety and performance outcomes, but the stents permanently cage the vessel, leading to a non-plateauing rate of clinical events. The DynamX Bioadaptor is designed to reduce these long-term events through unique design features that permit restoring vessel function and physiology through the disengagement of uncaging elements after the resorption of a biodegradable polymer over six months. Promising initial results have been obtained in the DynamX mechanistic study, with excellent safety and effectiveness, positive arterial remodeling, improved vasomotion, compliance, and cyclic pulsatility. We now aim to confirm these findings randomizing the DynamX Bioadaptor against the Resolute Onyx stent., Methods: This multi-center, international, randomized single-blinded study is conducted in 34 sites across Europe, Japan, and New Zealand and is divided into the European/New Zealand cohort and the Japanese cohort (which includes an imaging subset). It is designed to randomly assign 444 patients (222 per region) in a 1:1 ratio to either the DynamX Bioadaptor or the Resolute Onyx stent. Furthermore, a pharmacokinetic substudy is conducted in 9 patients enrolled in Japan to assess the pharmacokinetics of sirolimus after implantation of the DynamX Bioadaptor. Study follow-up is scheduled at one, six, and 12 months, and annually thereafter for five years; imaging follow-up includes angiographic, intravascular ultrasound, and optical coherence tomography assessments at 12 months in a subset of patients. The primary endpoint is 12-month target lesion failure., Conclusions: This trial will provide valuable insights into the safety and efficacy of this novel bioadaptor when compared to a contemporary drug-eluting stent., Condensed Abstract: The DynamX Sirolimus-Eluting Bioadaptor has unique design features aiming to reduce long-term events after percutaneous coronary intervention by permitting the restoration of vessel function through the freeing of uncaging elements. Promising initial results have been obtained in the DynamX mechanistic study. This trial aims to confirm these findings in a randomized setting. The European/ New Zealand and Japanese cohorts were designed to randomly assign 444 subjects in a 1:1 ratio to either the DynamX Bioadaptor or the Resolute Onyx stent. Furthermore, a pharmacokinetic substudy is conducted in 9 patients enrolled in Japan to assess the pharmacokinetics of sirolimus., Competing Interests: Declaration of competing interest Shigeru Saito receives consulting fees from Elixir Medical which are paid to the NPO International TRI network, Holger Nef reports honoraria, payments for expert testimony, and support for attending meeting from Elixir Medical, Mark Webster reports research support from Elixir Medical to its institution, Stefan Verheye reports research support from Elixir Medical to its institution, consulting fees from Elixir and Neovasc, and honoraria for lecturers etc. from Elixir and Neovasc., (Copyright © 2023. Published by Elsevier Inc.)
- Published
- 2023
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25. Interventional Treatment of Recurrent Ventricular Septal Defect Planed by 3D-Printed Reconstruction of the Heart.
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Hofmann FJ, Dörr O, Abt B, Jung TN, Luduena M, Rolf A, Sohrabi K, Staszewicz P, Rastan AJ, and Nef HM
- Abstract
We report a complex case of a 53-year-old male patient with recurrent ischemic ventricular septal defect that had been occluded by a surgical patch. Treatment was accomplished utilizing a 3-dimensional-printed model for preprocedural planning. In the future, printing of 3-dimensional models could offer new therapeutic strategies on an individual level. ( Level of Difficulty: Intermediate. )., Competing Interests: Drs Dörr and Nef have received speaker honoraria from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2023 The Authors.)
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- 2023
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26. Second-generation robotic angioplasty system use for the treatment of ST-elevation myocardial infarction: a first-in-man proof of concept case report.
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Hofmann FJ, Dörr O, Blachutzik F, Elsässer A, Möllmann H, Köhne AJ, and Nef HM
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Background: Robotically assisted remote-controlled PCI (rPCI) was introduced in the past decade as one of the latest enhancements in this rapidly evolving field. The use of a second-generation rPCI system in ST-elevation myocardial infarction (STEMI) is an effort to couple immediate revascularization with the accuracy of newer robotic assistance and software support., Case Summary: Here we report on the safety and efficacy of rPCI applied to a 74-year-old female STEMI patient with persistent acute chest pain as well as regional wall motion abnormalities in the echocardiogram. The first medical contact-to-device time was 76 min, and door-to-balloon time was 33 min. The impatient course was uneventful, so the patient was discharged from hospital after 5 days. To the best of our knowledge, this is the first report of the successful application of second-generation rPCI in STEMI., Discussion: In the case presented, rPCI was feasible and safe even in acute coronary syndrome based on a single-centre experience. rPCI is a revolutionary new technique that may be applied to various types of clinical presentations., Competing Interests: Conflict of interest: H.M.N. and H.M.: speaker honoraria Shockwave Medical and Siemens Healthineers., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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27. Early Outcomes of 2 Mitral Valve Transcatheter Leaflet Approximation Devices: A Propensity Score-Matched Multicenter Comparison.
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Mauri V, Sugiura A, Spieker M, Iliadis C, Horn P, Öztürk C, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Mues C, Boeder N, Kreidel F, Friedrichs K, Westenfeld R, Braun D, Baldus S, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, and Pfister R
- Subjects
- Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Stroke Volume, Propensity Score, Ventricular Function, Left, Treatment Outcome, Cardiac Catheterization adverse effects, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency etiology, Heart Valve Prosthesis Implantation adverse effects
- Abstract
Background: In addition to the edge-to-edge MitraClip repair system, the edge-to-spacer PASCAL repair system was approved for percutaneous treatment of severe mitral regurgitation (MR). Comparative data are lacking., Objectives: The aim of this study was to compare procedural and short-term safety and efficacy of 2 leaflet-based transcatheter mitral valve repair systems., Methods: Procedural and 30-day outcomes were investigated in a propensity score-matched cohort of 307 PASCAL and 307 MitraClip patients at 10 sites. Matching criteria included sex, age, left ventricular ejection fraction, New York Heart Association functional class, MR etiology, left ventricular end-diastolic diameter, left atrial volume index, and vena contracta width. The primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE)., Results: Technical success was 97.0% in the PASCAL group and 98.0% in the MitraClip group (P = 0.624). MR ≤2+ at discharge was comparable in both groups (PASCAL: 93.8% vs MitraClip: 92.4%; P = 0.527), with more patients exhibiting MR ≤1+ in the PASCAL group (70.5% vs 56.6%; P < 0.001). The postprocedural mean gradient was significantly higher in the MitraClip group (3.3 ± 1.5 mm Hg vs 3.9 ± 1.7 mm Hg; P < 0.001). At 30 days, all-cause mortality and MAE rates were similar (mortality: 1.7% vs 3.3%; P = 0.299; MAE: 3.9% vs 5.2%; P = 0.562)., Conclusions: In this first large propensity score-matched comparison, procedural success rates and MAE did not differ significantly between patients treated with the PASCAL or MitraClip valve repair system. Procedural results with less than moderate MR and no elevated transmitral gradient were more common in the PASCAL group, which might have an impact on long-term outcome., Competing Interests: Funding Support and Author Disclosures Dr Iliadis has received travel support from Abbott; and has received consultant honoraria from Abbott and Edwards Lifesciences. Dr Hausleiter has received research grants and speaker honoraria from Abbott Cardiovascular and Edwards Lifesciences. Dr Lurz has received institutional fees and research grants from Abbott Cardiovascular, Edwards Lifesciences, and Medtronic. Dr Möllmann has received speaker honoraria from Abbott Cardiovascular and Edwards Lifesciences. Dr Rudolph has received research grants and consulting honoraria from Edwards Lifesciences. Dr von Bardeleben has received consulting and lecture honoraria from Abbott Cardiovascular, Boehringer Ingelheim, Edwards Lifesciences, NeoChord, and Medtronic. Dr Nef has received speaker and consulting honoraria from Abbott Vascular and Edwards Lifesciences. Dr Luedike has received consulting and lecture honoraria from Edwards Lifesciences. Drs Pfister and Baldus have received consulting honoraria from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2022
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28. First case report of fully robotically assisted lithotripsy in heavily calcified left main stenosis.
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Hofmann FJ, Dörr O, Blachutzik F, Boeder NF, Elsässer A, Möllmann H, and Nef HM
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Background: Percutaneous coronary intervention (PCI) is the standard-of-care treatment for left main stenosis as an alternative to bypass surgery. In addition, severe coronary lesion calcification can be modified by intravascular lithotripsy (IVL). However, with PCI and debulking treatment options, there are inherent limitations. PCI poses an increased health burden for the treating physician that is associated with wearing a heavy, lead-lined apron and being exposed to radiation. To overcome these issues, a robotically assisted angioplasty system (rPCI) was established that enables the operator to perform PCI remotely in routine clinical procedures. Furthermore, IVL have not been used remotely., Case Summary: Here, we report the use of this technique for treating a heavily calcified left main stenosis in an 82-year-old male with previously diagnosed two-vessel coronary artery disease, progressive symptoms of dyspnoea at high cardio-vascular risk profile. The decision of the local heart team declined surgery. To the best of our knowledge, this is the first report of successful rPCI combined with IVL., Discussion: In the case presented, rPCI was feasible and safe even in a complex lesion of the left main coronary artery requiring IVL. rPCI is a revolutionary new technique that may be applied to various types of coronary artery lesions., Competing Interests: Conflict of interest: H.M.N., H.M.: Speaker honoraria Shockwave Medical and Siemens Healthineers., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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29. No Difference in 30-Day Outcome and Quality of Life in Transradial Versus Transfemoral Access - Results From the German Austrian ABSORB Registry (GABI-R).
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Wein B, Zaczkiewicz M, Graf M, Zimmermann O, Gori T, Nef HM, Kastner J, Mehilli J, Richardt G, Wöhrle J, Achenbach S, Riemer T, Hamm C, and Torzewski J
- Subjects
- Austria, Femoral Artery, Hemorrhage etiology, Humans, Quality of Life, Radial Artery, Registries, Treatment Outcome, Myocardial Infarction etiology, Percutaneous Coronary Intervention adverse effects, Stroke diagnosis, Stroke etiology
- Abstract
Background: Radial (RA) instead of femoral access (FA) for coronary interventions has become a European Society of Cardiology Class-IA guideline recommendation. But when the decision on the access site is left to the discretion of the operator, differences in adverse event rates mitigate., Methods: We compared the 30-day outcome for RA and FA in all patients recruited for the observational German Austrian ABSORB Registry (GABI-R) in regard to all-cause mortality, stroke, myocardial infarction (MI), TIMI major bleedings (TMB) and quality of life (QoL). All patients were treated with a bioresorbable vascular scaffold. Access site was left to the discretion of the operator., Results: In total, 3137 patients included by 92 centers received percutaneous coronary interventions (PCI) for acute MI in 51.5% and non-acute settings in 48.5%. RA was performed in 47.8% and had a higher median radiation exposure (3896 vs. 3082 cGycm
2 , p < 0.001). There was no difference in the amount of contrast used. There was also no difference in all-cause mortality (0.53% vs. 0.49%, p = 0.86), the combination of death, MI and stroke (1.87% vs. 1.83%, p = 0.94), but a trend towards more TMB (0.47% vs. 1.04%, p = 0.07) with FA. These outcomes were consistent across the subgroups of patients with ST-elevation MI, non-ST-elevation-ACS and stable coronary artery disease. Finally, QoL did not differ between RA and FA., Conclusions: In this contemporary GABI-R cohort, in which access site was left to the discretion of the operator, both access routes were safe and equal concerning QoL (ClinicalTrials.gov; NCT02066623)., Competing Interests: Declaration of competing interest, (Copyright © 2021 Elsevier Inc. All rights reserved.)- Published
- 2022
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30. Sex Differences in Culprit Plaque Characteristics Among Different Age Groups in Patients With Acute Coronary Syndromes.
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Seegers LM, Araki M, Nakajima A, Yonetsu T, Minami Y, Ako J, Soeda T, Kurihara O, Higuma T, Kimura S, Adriaenssens T, Nef HM, Lee H, McNulty I, Sugiyama T, Kakuta T, and Jang IK
- Subjects
- Aged, Coronary Angiography, Coronary Vessels diagnostic imaging, Coronary Vessels pathology, Female, Humans, Male, Sex Characteristics, Tomography, Optical Coherence methods, Treatment Outcome, Acute Coronary Syndrome diagnostic imaging, Calcinosis, Coronary Artery Disease pathology, Plaque, Atherosclerotic pathology
- Abstract
Background: Despite the significant decline in cardiovascular mortality in women over the past several decades, sex differences in the underlying pathology of acute coronary syndromes remain poorly understood. Previous postmortem studies have demonstrated sex differences in coronary plaque morphology with a higher prevalence of plaque erosion in young women and more plaque rupture in older women after menopause, whereas men showed no increase in prevalence of plaque rupture with age. However, in vivo data are limited., Methods: This study included patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging of the culprit lesion. The culprit plaque was categorized as plaque rupture, plaque erosion or culprit plaque with calcification, and stratified by age. Features of plaque vulnerability at culprit lesion were also analyzed., Results: In 1368 patients (women=286), women and men had a similar distribution of culprit plaque morphology (plaque rupture versus plaque erosion). However, significant sex differences were found in the underlying mechanisms of acute coronary syndrome among different age groups: women showed a significant ascending trend with age in plaque rupture ( P <0.001) and the features of plaque vulnerability such as lipid plaque ( P <0.001), thin-cap fibroatheroma ( P =0.005), and microstructures including macrophages, cholesterol crystals, and calcification ( P =0.026). No trend was observed in men., Conclusions: Age related sex differences in culprit plaque morphology and vulnerability were identified in patients with acute coronary syndrome: prevalence of plaque rupture and vulnerability increased with age in women but not in men., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT01110538 and NCT03479723.
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- 2022
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31. Early Clinical Experience With the TRICENTO Bicaval Valved Stent for Treatment of Symptomatic Severe Tricuspid Regurgitation: A Multicenter Registry.
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Wild MG, Lubos E, Cruz-Gonzalez I, Amat-Santos I, Ancona M, Andreas M, Boeder NF, Butter C, Carrasco-Chinchilla F, Estevez-Loureiro R, Kempfert J, Köll B, Montorfano M, Nef HM, Toggweiler S, Unbehaun A, Werner P, Windecker S, and Praz F
- Subjects
- Aged, Aged, 80 and over, Cardiac Catheterization, Female, Humans, Male, Registries, Retrospective Studies, Severity of Illness Index, Stents, Time Factors, Treatment Outcome, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Heart Valve Prosthesis Implantation, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency surgery
- Abstract
Background: Patients with severe tricuspid regurgitation present late and are often ineligible for surgery or transcatheter repair systems. Transfemoral venous implantation of a bicaval valved stent has been proposed as therapeutic option in selected patients. The aim of this study was to summarize the early procedural and clinical outcomes of the novel TRICENTO system for the treatment of patients with symptomatic severe tricuspid regurgitation., Methods: All consecutive patients treated with the custom-made TRICENTO implant at the participating centers were included in this retrospective multicentre registry., Results: A total of 21 high-risk patients (mean age 76±7 years; 67% female) with severe or higher grade tricuspid regurgitation were analyzed. The majority of the patients were in New York Heart Association class III/IV (95%), had peripheral edema (95%), and previous hospitalization for right heart failure (67%). Technical success was 100%, and there was no case of in-hospital mortality. During follow-up (median 61 days), symptomatic improvement was observed (65% in New York Heart Association class I/II; P <0.001). Computed tomography revealed asymptomatic fractures of the TRICENTO prosthesis in 3 patients. Cardiac magnetic resonance imaging obtained in 7 patients showed a significant decrease (252±65 mm
3 at baseline versus 216±58 mm3 at follow-up, P =0.006) of right ventricular end-diastolic volume. The overall-survival rate was 76% at 1 year., Conclusions: The present data indicate the feasibility of transfemoral bicaval valved stent implantation for the treatment of severe tricuspid regurgitation. Functional improvement and signs of right ventricular reverse remodeling were observed. Stent fractures did not impair valve function, but require refinement of prosthesis design and careful assessment of eligibility criteria.- Published
- 2022
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32. Outcomes of 10,312 patients treated with everolimus-eluting bioresorbable scaffolds during daily clinical practice - results from the European Absorb Consortium.
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Wiebe J, Hofmann FJ, West N, Baumbach A, Carrie D, Bermudez EP, Cayla G, Hernandez FH, de la Torre Hernandez JM, Koning R, Loi B, Moscarella E, Tarantini G, Zaman A, Lober C, Riemer T, Achenbach S, Hamm CW, and Nef HM
- Subjects
- Absorbable Implants, Aged, Everolimus adverse effects, Humans, Middle Aged, Prosthesis Design, Tissue Scaffolds, Treatment Outcome, Coronary Artery Disease chemically induced, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Drug-Eluting Stents, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: To asses mid-term clinical outcomes of bioresorbable vascular scaffolds (BVS) for the treatment of coronary artery disease in a large-scale all-comers population., Background: Several clinical settings are underrepresented in randomized studies investigating BVS against drug-eluting stents. Whether their results can be translated into the heterogeny patient population seen during daily routine requires further investigation., Methods: The European ABSORB Consortium comprises the following European registries: GABI-R, ABSORB UK Registry, ABSORB France, BVS RAI Registry, and REPARA BVS Registry, which all prospectively collected patient-level data regarding outcomes following unrestricted BVS implantation. The primary endpoint of target lesion failure (TLF) includes cardiac death, target-vessel myocardial infarction (TVMI) and target-lesion revascularisation (TLR) at 12 months. The incidence of scaffold thrombosis (ST) according to ARC criteria was also assessed. Multivariable analysis was used to adjust for differences in patient and lesion characteristics., Results: A total of 10,312 patients (mean age 58.4 ± 11.4 y) underwent BVS implantation during routine practice. The 12-month follow-up was complete in 95.5% of patients. At 12 months, the primary endpoint of TLF occurred in 3.6%; its components cardiac death, TVMI and TLR were documented in 1.2%, 1.8%, and 2.6%, respectively. The definite/probable ST rate was 1.7%. Absence of predilatation, discontinuation of DAPT and scaffold diameter below 3 mm were independent predictors of ST., Conclusions: The EAC demonstrates reasonable real-world clinical outcome data after BVS implantation. However, the rate of scaffold thrombosis remains high., (© 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
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- 2022
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33. Coronary plaque and clinical characteristics of South Asian (Indian) patients with acute coronary syndromes: An optical coherence tomography study.
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Nakajima A, Subban V, Russo M, Bryniarski KL, Kurihara O, Araki M, Minami Y, Soeda T, Yonetsu T, Crea F, Takano M, Higuma T, Kakuta T, Adriaenssens T, Boeder NF, Nef HM, Raffel OC, McNulty I, Lee H, Nakamura S, Abdullakutty J, Mathew R, Sankardas MA, and Jang IK
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- Asian People, Coronary Angiography, Coronary Vessels diagnostic imaging, Humans, Tomography, Optical Coherence, Acute Coronary Syndrome diagnostic imaging, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic diagnostic imaging
- Abstract
Background: South Asians, and Indians in particular, are known to have a higher incidence of premature atherosclerosis and acute coronary syndromes (ACS) with worse clinical outcomes, compared to populations with different ethnic backgrounds. However, the underlying pathobiology accounting for these differences has not been fully elucidated., Methods: ACS patients who had culprit lesion optical coherence tomography (OCT) imaging were enrolled. Culprit plaque characteristics were evaluated using OCT., Results: Among 1315 patients, 100 were South Asian, 1009 were East Asian, and 206 were White. South Asian patients were younger (South Asians vs. East Asians vs. Whites: 51.6 ± 13.4 vs. 65.4 ± 11.9 vs. 62.7 ± 11.7; p < 0.001) and more frequently presented with ST-segment elevation myocardial infarction (STEMI) (77.0% vs. 56.4% vs. 35.4%; p < 0.001). On OCT analysis after propensity group matching, plaque erosion was more frequent (57.0% vs. 38.0% vs. 50.0%; p = 0.003), the lipid index was significantly greater (2281.6 [1570.8-3160.6] vs. 1624.3 [940.9-2352.4] vs. 1303.8 [1090.0-1757.7]; p < 0.001), and the prevalence of layered plaque was significantly higher in the South Asian group than in the other two groups (52.0% vs. 30.0% vs. 34.0%; p = 0.003)., Conclusions: Compared to East Asians and Whites, South Asians with ACS were younger and more frequently presented with STEMI. Plaque erosion was the predominant pathology for ACS in South Asians and their culprit lesions had more features of plaque vulnerability., Clinical Trial Registration: http://www.clinicaltrials.gov, NCT03479723., (Copyright © 2021 Elsevier B.V. All rights reserved.)
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- 2021
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34. Fusion imaging guided implantation of a Tricento transcatheter heart valve for severe tricuspid regurgitation.
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Boeder NF, Bayer M, Dörr O, and Nef HM
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- Cardiac Catheterization, Female, Humans, Middle Aged, Prosthesis Design, Treatment Outcome, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency surgery
- Abstract
We report the case of a 64-year-old patient with history of chronic kidney disease on dialysis who was repeatedly hospitalized due to hydropic decompensation. Right heart failure with secondary severe tricuspid regurgitation was diagnosed. An interventional approach was recommended due to the heavy calcification of the sinus venosus and the perioperative risk (EuroScore II 3.2%) and taking into account the explicit request of the patient. After analysis of a full-cycle computed tomography, the patient was eligible for the implantation of the Tricento transcatheter heart valve. The custom-made prosthesis was implanted successfully using periprocedural transoesophageal guidance supported by fusion imaging that integrates live co-registration. After implantation of the valve prosthesis, the primary result was excellent. The patient was discharged without further complications shortly after the procedure and her status is being closely monitored., (© 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
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- 2021
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35. Age and Phenotype of Patients With Plaque Erosion.
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Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, Higuma T, Kimura S, Takano M, Yan BP, Adriaenssens T, Boeder NF, Nef HM, Kim CJ, McNulty I, Crea F, Kakuta T, and Jang IK
- Subjects
- Aged, Constriction, Pathologic, Coronary Angiography, Coronary Vessels, Humans, Male, Middle Aged, Phenotype, Tomography, Optical Coherence, Acute Coronary Syndrome, Calcinosis, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Plaque, Atherosclerotic
- Abstract
Background A recent study reported that the outcome of patients with plaque erosion treated with stenting is poor when the underlying plaque is lipid rich. However, the detailed phenotype of patients with plaque erosion, particularly as related to different age groups, has not been systematically studied. Methods and Results Patients with acute coronary syndromes caused by plaque erosion were selected from 2 data sets. Demographic, clinical, angiographic, and optical coherence tomography findings of the culprit lesion were compared between 5 age groups. Among 579 erosion patients, male sex and current smoking were less frequent, and hypertension, diabetes, and chronic kidney disease were more frequent in older patients. ST-segment-elevation myocardial infarction was more frequent in younger patients. Percentage of diameter stenosis on angiogram was greater in older patients. The prevalence of lipid-rich plaque (27.3% in age <45 years and 49.4% in age ≥75 years, P <0.001), cholesterol crystal (3.9% in age <45 years and 21.8% in age ≥75 years, P =0.027), and calcification (5.5% in age <45 years and 54.0% in age ≥75 years, P <0.001) increased with age. After adjusting risk factors, younger patients were associated with the presence of thrombus, and older patients were associated with greater percentage of diameter stenosis and the presence of lipid-rich plaque and calcification. Conclusions The demographic, clinical, angiographic, and plaque phenotypes of patients with plaque erosion distinctly vary depending on age. This may affect the clinical outcome in these patients. Registration URL: https://www.clinicaltrials.gov. Unique identifiers: NCT03479723, NCT02041650.
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- 2021
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36. Everolimus eluting bioresorbable vascular scaffolds in patients with acute coronary syndromes: Two-year results from the German-Austrian ABSORB registry.
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Tröbs M, Achenbach S, Nef HM, Gori T, Naber C, Neumann T, Richardt G, Schmermund A, Wöhrle J, Zahn R, and Hamm CW
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- Absorbable Implants, Austria, Everolimus adverse effects, Humans, Prospective Studies, Prosthesis Design, Registries, Time Factors, Treatment Outcome, Acute Coronary Syndrome diagnostic imaging, Acute Coronary Syndrome surgery, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: To identify potential differences in 2-year outcome between patients who underwent coronary revascularization using bioresorbable vascular scafffolds (BVS) in stable coronary artery disease (CAD) and acute coronary syndromes (ACS)., Background: Data from randomized trials suggest a significantly higher event rate following coronary revascularization using everolimus-eluting BVS as compared to new generation drug eluting stents. Whether particular patient subgroups are at increased risk for scaffold thrombosis and target lesion failure (TLF) has not clearly been demonstrated., Methods: German-Austrian ABSORB RegIstRy is a prospective all-comer multi-center observational study of consecutive patients who were considered for coronary revascularization with BVS. We compared 1499 patients with stable CAD to 1594 patients with ACS. Endpoints were major adverse cardiac events (MACE), TLF, and scaffold thrombosis., Results: While single vessel disease was more prevalent in ACS (46% vs. 37%, p < 0.0001), lesion complexity (B2/C stenosis 37% vs. 36%, bifurcation 2.4% vs. 3.4%, p < 0.05), number of implanted scaffolds/patient (1.34 vs. 1.43), scaffold length (18 vs. 18 mm) or the rate of high pressure postdilatation (68% vs. 70%) did not differ between ACS and stable CAD. Two-year MACE rates were 11.6% in ACS and 11.4% in stable CAD, TLF occurred in 7.0% versus 7.4% and target vessel revascularization in 8.8 versus 10.2% (n.s. for all). Definite scaffold thrombosis rates were not significantly different (ACS 1.9% vs. stable CAD 2.1%)., Conclusion: Real-world 2-year event rates after coronary revascularization with BVS are not significantly different between individuals with ACS as compared to stable CAD., (© 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
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- 2021
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37. Predictors of scaffold failure and impact of optimized scaffold implantation technique on outcome: Results from the German-Austrian ABSORB RegIstRy.
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Boeder NF, Kastner J, Mehilli J, Münzel T, Naber C, Neumann T, Richardt G, Schmermund A, Wöhrle J, Zahn R, Riemer T, Achenbach S, Hamm CW, and Nef HM
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- Absorbable Implants, Austria, Humans, Prospective Studies, Prosthesis Design, Registries, Time Factors, Treatment Outcome, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Percutaneous Coronary Intervention adverse effects
- Abstract
Aims: We aimed to investigate predictors of scaffold failure and the potential impact of an optimized scaffold implantation technique by means of a learning curve on long-term clinical outcome after bioresorbable scaffold (BRS) implantation and to evaluate predictors of scaffold failure., Methods and Results: A total of 3326 patients were included in this prospective, observational, multi-center study (ClinicalTrials.gov NCT02066623) of consecutive patients undergoing BRS implantation between November 2013 and January 2016. The 3144 patients completed follow-up after 24 months, 3265 patients were eligible for time-to-event-analysis. Clinical endpoints were major adverse cardiac events-a composite endpoint of death, target vessel revascularization and myocardial infarction, and scaffold thrombosis (ScT). Patients were grouped according to treatment before or since 2015. During follow-up MACE rate improved from 2.52% after 30 days, 5.45% after 6 months and 12.67% after 24 months to 1.52%, 3.44%, and 10.52%, respectively. A total of 75 ScT occurred. In multiple regression analysis, treatment of bifurcations, long lesions, and procedures performed earlier than 2014 were identified as predictors for the occurrence of ScT., Conclusion: Treatment of bifurcation lesions is the strongest predictor of ScT following BRS implantation. A significantly lower incidence of ScT and 24-month target lesion revascularization in patients recruited after 2014 into our observational registry suggests the influence of a learning curve., (© 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
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- 2021
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38. Clinical presentation does not affect acute mechanical performance of the Novolimus-eluting bioresorbable vascular scaffold as assessed by optical coherence tomography.
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Boeder NF, Dörr O, Gaderer R, Blachutzik F, Achenbach S, Elsässer A, Hamm C, and Nef HM
- Abstract
Introduction: Initial trials of bioresorbable vascular scaffolds (BVS) have mostly excluded patients presenting with acute coronary syndrome (ACS). However, these patients might benefit from a BVS platform, in particular as they are often younger and have been less frequently treated than patients with chronic disease., Aim: To compare the acute performance of a Novolimus eluting BVS in ACS and non-ACS patients using optical coherence tomography (OCT) in patients presenting with acute or chronic coronary syndrome., Material and Methods: The final OCT pullback of 79 patients (34 with ACS, 45 non-ACS) was analysed at 1-mm intervals. The following indices were calculated: mean and minimal area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection., Results: OCT showed a minimum lumen area (non-ACS vs. ACS) of 6.2 ±2.1 vs. 5.6 ±1.5 mm
2 ( p = 0.21). Mean residual area stenosis was 14.5% vs. 19.5% ( p = 0.39). The mean eccentricity index did not differ significantly (0.78 ±0.13 vs. 0.78 ±0.06; p = 0.42). There was a non-significant tendency for more fractures in the non-ACS group (22.2% vs. 5.9%; p = 0.07). Prolapse area was comparable (4.4 ±7.4 mm2 vs. 5.2 ±10.9 mm2 ; p = 0.62)., Conclusions: This is the first study to investigate the acute mechanical performance of a Novolimus-eluting BVS in patients with different clinical presentations using OCT. We found that clinical presentation did not determine acute mechanical performance as assessed by the final OCT pullback. There was evidence of more mechanical complications in terms of fractures and a higher percentage of incomplete strut apposition in the group of patients with chronic coronary syndrome., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2021 Termedia Sp. z o. o.)- Published
- 2021
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39. Acute Mechanical Performance of Magmaris vs. DESolve Bioresorbable Scaffolds in a Real-World Scenario.
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Boeder NF, Dörr O, Koepp T, Blachutzik F, Achenbach S, Elsässer A, Hamm CW, and Nef HM
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Background: After the bioresorbable PLLA-based vascular scaffold (Absorb BVS) was taken from the market due to its high adverse event rates, a magnesium-based scaffold (Magmaris) was introduced. Objective: To compare the acute performance of the sirolimus-eluting magnesium alloy Magmaris scaffold with that of the novolimus-eluting PLLA-based DESolve scaffold in terms of appropriate scaffold deployment using optical coherence tomography (OCT). Methods and Results: Data from the final OCT pullback of 98 patients were included (19 Magmaris, 79 DESolve) and analyzed at 1-mm intervals. The following indices were calculated: mean and minimal area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection. OCT showed a minimum lumen area for Magmaris vs. DESolve of 6.6 ± 1.6 vs. 6.0 ± 1.9 ( p = 0.06). Scaffolds with residual area stenosis >20% were predominantly seen in the DESolve group (15.8 vs. 46.8%; p = 0.01). The mean eccentricity index did differ significantly (0.74 ± 0.06 vs. 0.63 ± 0.09; p < 0.001). No fractures were observed for Magmaris scaffolds, but 15.2% were documented for DESolve BRS ( p < 0.001). Incomplete scaffold apposition area was significantly higher in the DESolve group (0.01 ± 0.02 vs. 1.05 ± 2.32 mm
2 ; p < 0.001). Conclusion: This is the first study to compare the acute mechanical performance between Magmaris and DESolve in a real-world setting. The acute mechanical performance of Magmaris BRS seems to be superior to that of DESolve BRS, whereas OCT showed a good acute mechanical performance for both BRS in terms of generally accepted imaging criteria., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Boeder, Dörr, Koepp, Blachutzik, Achenbach, Elsässer, Hamm and Nef.)- Published
- 2021
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40. Latest Developments in Robotic Percutaneous Coronary Intervention.
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Hofmann FJ, Dörr O, Blachutzik F, Boeder N, Elsässer A, Keranov S, Köhne A, Hofmann S, Möllmann H, Hamm C, and Nef HM
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- Humans, Stents, Angioplasty, Balloon, Coronary, Coronary Artery Disease surgery, Percutaneous Coronary Intervention, Robotics
- Abstract
Interventional cardiovascular medicine has seen constant progress over the last few decades. Since the first angiograms and percutaneous transluminal coronary angioplasty were carried out, this progress has been tremendous and has led to a substantial decline in cardiovascular morbidity and mortality. The purpose of this article is to report and review the latest developments and evidence in robotics-assisted percutaneous coronary intervention (rPCI) and its potential future applications, opportunities, and limitations. Contemporary evidence shows that rPCI can lead to a significant reduction in radiation exposure as well as medical hazards for cardiologists. Rates of device and procedural success remain high and there is no evidence of a disadvantage for the patient. The accuracy of implantation with a reduced geographic mismatch is a further advantage that can result in a higher quality of treatment. Even in complex coronary lesions and procedures, rPCI seems to be safe and efficient. The latest developments include telestenting over hundreds of kilometers from a remote platform. Currently, the main limitations are the absence of large-scale randomized trials for the valid assessment of the benefits and disadvantages of rPCI as well as the technical limitations of the currently available rPCI systems. rPCI is a forward-looking innovation in cardiology that is applicable to a wide range of coronary interventions. Despite the present lack of knowledge and the limited data concerning the outcome for the patient, the available literature reveals promising results that should lead to improvements for physicians and patients.
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- 2021
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41. Determinants of ST-segment elevation myocardial infarction as clinical presentation of acute coronary syndrome.
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Kurihara O, Takano M, Kakuta T, Soeda T, Crea F, Adriaenssens T, Nef HM, Boeder NF, Yamamoto E, Kim HO, Russo M, McNulty I, Araki M, Nakajima A, Lee H, Mizuno K, and Jang I-
- Subjects
- Aged, Coronary Angiography, Humans, Platelet Aggregation Inhibitors therapeutic use, Tomography, Optical Coherence, Acute Coronary Syndrome drug therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Plaque, Atherosclerotic diagnostic imaging, ST Elevation Myocardial Infarction complications, Thrombosis
- Abstract
Antiplatelet agents and statin therapies are widely used in patients with known cardiovascular disease. Plaque rupture (PR) and plaque erosion (PE) are the most frequent underlying mechanisms of acute coronary syndromes (ACS). The conditions and medications that are associated with ST-segment elevation myocardial infarction (STEMI) following PR or PE have not been systematically studied. A total of 838 ACS patients (494 with STEMI, 344 with NSTE-ACS) who were diagnosed with PR or PE by optical coherence tomography were included. The patients were categorized into two groups based on underlying pathology, and the baseline characteristics and culprit plaque morphology associated with STEMI were investigated within each group. Among 838 patients, 467 (55.7%) had PR, and 371 (44.3%) were diagnosed with PE. Among patients with PR, older age, hyperlipidemia, no antiplatelet therapy, higher level of low-density lipoprotein cholesterol, and greater lipid burden and macrophage infiltration were associated with increased probability of STEMI. Among patients with PE, no dual antiplatelet therapy and no statin therapy were associated with increased probability of STEMI. The incidence of STEMI caused by PR was significantly lower on antiplatelet therapy (P < 0.001), and the incidence of STEMI caused by PE was significantly lower on antiplatelet therapy (P < 0.001) or on statin therapy (P < 0.001). Antiplatelet therapy is associated with lower probability of STEMI, regardless of underlying pathology, and statin therapy is associated with lower probability of STEMI in PE as clinical presentation of ACS. Statin therapy prior to the onset of acute coronary syndromes (ACS) may reduce the probability of plaque rupture. Antiplatelet therapy prior to the onset of ACS is associated with reduced probability of ST-segment elevation myocardial infarction (STEMI) following both plaque rupture and plaque erosion, and dual antiplatelet therapy offers additional protection compared to a single antiplatelet agent in plaque erosion. The combination of statin and antiplatelet therapy may have an additive effect on reducing the probability of STEMI caused by plaque erosion. Yellow: lipid pool(necrotic core); red: fibrin-rich thrombus; gray; platelet-rich thrombus.
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- 2021
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42. Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study.
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Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, Higuma T, Kimura S, Takano M, Yan BP, Adriaenssens T, Boeder NF, Nef HM, Kim CJ, Crea F, Kakuta T, and Jang IK
- Subjects
- Aged, Circadian Rhythm, Female, Humans, Longitudinal Studies, Male, Middle Aged, Plaque, Atherosclerotic complications, Plaque, Atherosclerotic diagnostic imaging, ST Elevation Myocardial Infarction complications, ST Elevation Myocardial Infarction diagnostic imaging, Tomography, Optical Coherence, Plaque, Atherosclerotic pathology, ST Elevation Myocardial Infarction pathology
- Abstract
Previous studies have reported a circadian variation in the onset of ST-segment elevation myocardial infarction (STEMI). However, underlying mechanisms for the circadian variation have not been fully elucidated. We investigated the relationship between onset of STEMI and the underlying pathology using optical coherence tomography (OCT). Patients with a diagnosis of STEMI were selected from a multicenter OCT registry. Patients were divided into 4 groups based on the estimated time of onset (00:00-05:59, 06:00-11:59, 12:00-17:59, or 18:00-23:59). Underlying pathologies of MI (plaque rupture, plaque erosion, and calcified plaque) were compared among the 4 groups. Among 648 patients, plaque rupture was diagnosed in 386 patients (59.6%), plaque erosion in 197 patients (30.4%), and calcified plaque in 65 patients (10.0%). A marked circadian variation was detected in the incidence of plaque rupture with a peak at 09:00, whereas it was not evident in plaque erosion or calcified plaque. The probability of plaque rupture significantly increased in the periods of 06:00-11:59 [odds ratio (OR) 2.13, 95% confidence interval (CI) 1.30-3.49, p = 0.002] and 12:00-17:59 (OR 2.10, 95% CI 1.23-3.58, p = 0.005), compared to the period of 00:00-05:59. This circadian pattern was observed only during weekdays (p = 0.010) and it was not evident during the weekend (p = 0.742). Plaque rupture occurred most frequently in the morning and this circadian variation was evident only during weekdays. Acute MI caused by plaque rupture may be related to catecholamine surge.
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- 2021
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43. Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study.
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Nef HM, Elsässer A, Möllmann H, Abdel-Hadi M, Bauer T, Brück M, Eggebrecht H, Ehrlich JR, Ferrari MW, Fichtlscherer S, Hink U, Hölschermann H, Kacapor R, Koeth O, Korboukov S, Lamparter S, Laspoulas AJ, Lehmann R, Liebetrau C, Plücker T, Pons-Kühnemann J, Schächinger V, Schieffer B, Schott P, Schulze M, Teupe C, Vasa-Nicotera M, Weber M, Weinbrenner C, Werner G, Hamm CW, and Dörr O
- Subjects
- Aged, Cardiac Catheterization adverse effects, Cardiac Catheterization mortality, Cardiovascular Diseases diagnosis, Cause of Death trends, Female, Germany, Hospital Mortality trends, Humans, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Risk Factors, Time Factors, COVID-19, Cardiac Catheterization trends, Cardiovascular Diseases mortality, Cardiovascular Diseases therapy, Hospitalization trends, Percutaneous Coronary Intervention trends
- Abstract
Aims: During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region., Methods and Results: Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99-1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01-1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05-1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures., Conclusion: During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality.
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- 2021
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44. Safety and effectiveness of coronary intravascular lithotripsy in eccentric calcified coronary lesions: a patient-level pooled analysis from the Disrupt CAD I and CAD II Studies.
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Blachutzik F, Honton B, Escaned J, Hill JM, Werner N, Banning AP, Lansky AJ, Schlattner S, De Bruyne B, Di Mario C, Dörr O, Hamm C, and Nef HM
- Subjects
- Aged, Coronary Angiography, Coronary Stenosis diagnosis, Coronary Stenosis etiology, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Treatment Outcome, Vascular Calcification complications, Vascular Calcification diagnosis, Coronary Stenosis therapy, Coronary Vessels diagnostic imaging, Endovascular Procedures methods, Lithotripsy methods, Stents, Vascular Calcification surgery
- Abstract
Background: The aim of this study was to assess the safety and effectiveness of intravascular lithotripsy (IVL) in treating eccentric calcified coronary lesions., Methods: Between December 2015 and March 2019, 180 patients were enrolled in the Disrupt CAD I and CAD II studies across 19 sites in 10 countries. Patient-level data were pooled from these two studies (n = 180), within which 47 eccentric lesions (26%) and 133 concentric lesions were identified., Results: Clinical success, defined as residual stenosis < 50% after stenting and no in-hospital MACE, was similar between the eccentric and concentric cohorts (93.6% vs. 93.2%, p = 1.0). There were no perforations, abrupt closure, slow flow or no reflow events observed in either group, and there were low rates of flow-limiting dissections (Grade D-F: 0% eccentric, 1.7% concentric; p = 0.54). Final acute gain and percent residual stenosis were similar between the two groups. Final residual stenosis of 8.6 ± 9.8% in eccentric and 10.0 ± 9.0% (p = 0.56) in concentric stenosis confirms the significant effect of IVL in calcified coronary lesions., Conclusion: In this first report from a pooled patient-level analysis of coronary IVL from the Disrupt CAD I and CAD II studies, IVL use was associated with consistent improvement in procedural and clinical outcomes in both eccentric and concentric calcified lesions.
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- 2021
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45. Five-year follow-up of patients who underwent everolimus-eluting bioresorbable scaffold implantation.
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Wiebe J, Hofmann FJ, Dörr O, Bauer T, Boeder N, Liebetrau C, Blachutzik F, Möllmann H, Elsässer A, Achenbach S, Hamm CW, and Nef HM
- Subjects
- Absorbable Implants, Aged, Everolimus adverse effects, Follow-Up Studies, Humans, Middle Aged, Prosthesis Design, Treatment Outcome, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease surgery, Drug-Eluting Stents, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: The aim of this study was to evaluate very long-term results after unrestricted everolimus-eluting bioresorbable scaffolds (BRS) implantation., Background: Previous randomized studies mainly included selected patients differing from those seen during daily routine and long-term data from all-comers registries are sparse., Methods: Consecutive patients undergoing BRS implantation were included in this observational, single center study. Clinical follow-up was conducted up to 5 years. Endpoint of interest was the composite of target lesion failure (TLF), including target-vessel myocardial infarction and target lesion revascularization and cardiac death. Furthermore, ARC-defined scaffold thrombosis (ScT) were assessed., Results: A total of 176 patients with a median age of 64 (55 - 72) years were analyzed, of which 59.6% presented an acute coronary syndrome. A total of 183 mainly complex lesions (55.8%) were treated. At 5 years, the rate for TLF was 21.6%. Definite or probable ScT rate was 4.1%. The rate of ScT within the first year was 2.8% and afterwards 1.2%. Notably, no ScT was seen later than 2 years., Conclusions: Although this real-world registry displays high rates of clinical events during long-term follow-up, no ScT was seen after 2 years., (© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc.)
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- 2021
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46. German Multicenter Experience With a New Leaflet-Based Transcatheter Mitral Valve Repair System for Mitral Regurgitation.
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Mauri V, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Horn P, Grothusen C, Mehr M, Becher MU, Mues C, Boeder N, Kreidel F, Friedrichs K, Westenfeld R, Braun D, Öztürk C, Baldus S, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, and Pfister R
- Subjects
- Aged, Aged, 80 and over, Cardiac Catheterization, Female, Humans, Male, Mitral Valve surgery, Treatment Outcome, Heart Valve Prosthesis Implantation, Mitral Valve Insufficiency surgery
- Abstract
Objectives: The aim of this study was to investigate the procedural and short-term safety and efficacy of a new leaflet-based transcatheter mitral valve repair system., Background: The PASCAL repair system has been recently approved for percutaneous treatment of mitral regurgitation (MR). Novel characteristics are broad paddles positioned around a central spacer and the ability for independent leaflet capture., Methods: Procedural and 30-day outcomes were investigated in the first 309 patients with symptomatic MR 3+/4+ treated with the PASCAL repair system at 10 sites. Primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE)., Results: Among the 309 patients (mean age 77 ± 10 years, 42% women, mean European System for Cardiac Operative Risk Evaluation II score 5.8 ± 4.5%) included in this study, MR etiology was degenerative in 33%, functional in 52%, and mixed in 16%. Eighty-six percent of patients were in New York Heart Association functional class III or IV. The technical success rate was 96%. Of 308 patients discharged alive, MR was ≤2+ in 93.5%. At 30 days, the MAE rate was 4.1%, with an estimated all-cause mortality rate of 2.0%, and 72% of patients were in New York Heart Association functional class ≤II (p < 0.001). Rates of device success and CLASP (Edwards PASCAL Transcatheter Mitral Valve Repair System Study) trial-defined clinical success were 81.9% and 86.9%, respectively. Single-leaflet device attachment occurred in 7 patients (2.3%)., Conclusions: Mitral valve repair with the PASCAL system in the early post-approval phase was effective and safe, with high procedural success rates and low rates of MAE. MR was significantly reduced, accompanied by significant improvement in functional status., Competing Interests: Author Disclosures Drs. Pfister and Baldus have received honoraria for consulting from Edwards Lifesciences. Dr. Luedike has received honoraria for consulting and lectures from Edwards Lifesciences. Dr. Rudolph has received research grants and honoraria for consulting from Edwards Lifesciences. Dr. Hausleiter has received research grants and speaking honoraria from Abbott Cardiovascular and Edwards Lifesciences. Dr. Lurz has received institutional fees and research grants from Abbott Cardiovascular, Edwards Lifesciences, and Medtronic. Dr. Nef has received speaking and consulting honoraria from Abbott Vascular and Edwards Lifesciences. Dr. Möllmann has received speaking honoraria from Abbott Cardiovascular and Edwards Lifesciences. Dr. von Bardeleben has received consulting and lecture honoraria from Abbott Cardiovascular, Boehringer Ingelheim, Cardiac Dimensions, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2020
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47. Everolimus- vs. novolimus-eluting bioresorbable scaffolds in patients with acute coronary syndrome.
- Author
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Nef HM, Wiebe J, Schmidt G, Möllmann H, Boeder NF, Dörr O, Bauer T, Blachutzik F, Liebetrau C, Elsässer A, Foin N, and Hamm CW
- Subjects
- Absorbable Implants, Everolimus, Humans, Macrolides, Prosthesis Design, Retrospective Studies, Treatment Outcome, Acute Coronary Syndrome surgery, Cardiovascular Agents, Coronary Artery Disease, Percutaneous Coronary Intervention
- Abstract
Background: Limited data exist on bioresorbable scaffolds (BRS) in patients with acute coronary syndrome (ACS). The aim of the present study was to evaluate novolimus-eluting BRS (DESolve) as interventional treatment for patients with ACS, and to compare its 12-month outcomes with the everolimus-eluting bioresorbable scaffolds (Absorb)., Methods: In this retrospective study, patients with ACS (including unstable angina pectoris, ST-segment elevation myocardial infarction, or non-ST-segment elevation myocardial infarction) treated with either the Absorb or the DESolve BRS were evaluated in a 1:1 matched-pair analysis. Major adverse cardiac events (MACE), including death, myocardial infarction, and target lesion revascularization, were evaluated as a major endpoint. The occurrence of scaffold thrombosis was also assessed., Results: A total of 102 patients were eligible for this analysis. The rate of MACE at 12 months was comparable between the Absorb and the DESolve group (8.3% vs. 6.8%, p = 0.738). The occurrence of target lesion revascularization (6.2% vs. 4.7%; p = 0.700) and scaffold thrombosis (4.1% vs. 2.1%; p = 0.580) was comparable as well. All instances of scaffold thrombosis occurred within 30 days of the index procedure., Conclusion: In this study, similar 12-month event rates were observed for both BRS types after implantation for the treatment of ACS.
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- 2020
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48. First-in-Man Lithoplasty of a LIMA Bypass With ECMO Support in a Last-Remaining Vessel.
- Author
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Boeder NF, Bayer M, Niemann B, and Nef HM
- Subjects
- Aged, Coronary Angiography, Drug-Eluting Stents, Humans, Non-ST Elevated Myocardial Infarction, Treatment Outcome, Extracorporeal Membrane Oxygenation
- Abstract
We report the case of a 70-year-old patient with history of chronic heart disease who underwent bypass surgery twice beforehand and was admitted due to non-ST segment elevation myocardial infarction. Angiography showed degeneration of all bypass grafts except the LIMA bypass, which showed significant ostial stenosis with severe calcification. Peri-operative risk was computed to be as high as 12.3% (STS Score). An interventional strategy was chosen: the very high-risk procedure was performed safely under the protection afforded by venoarterial ECMO and cardiac surgeons on standby using a coronary intravascular lithoplasty (IVL) balloon. After implantation of a drug eluting stent, the primary angiogram showed a satisfactory result. The patient was discharged without further complications short after the procedure and is closely followed-up., Competing Interests: Declaration of competing interest The authors have no conflict to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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49. Impact of coronary calcification on outcomes after ABSORB scaffold implantation: insights from the GABI-R registry.
- Author
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Hemetsberger R, Abdelghani M, Mankerious N, Allali A, Toelg R, Gori T, Achenbach S, Riemer T, Mehilli J, Nef HM, Naber C, Wöhrle J, Zahn R, Kastner J, Schmermund A, Hamm C, Münzel T, and Richardt G
- Subjects
- Absorbable Implants adverse effects, Drug-Eluting Stents, Female, Humans, Long Term Adverse Effects diagnosis, Long Term Adverse Effects etiology, Male, Middle Aged, Registries, Severity of Illness Index, Tissue Scaffolds adverse effects, Vascular Patency, Coronary Artery Disease diagnosis, Coronary Artery Disease physiopathology, Coronary Artery Disease surgery, Coronary Vessels diagnostic imaging, Coronary Vessels pathology, Myocardial Infarction diagnosis, Myocardial Infarction etiology, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention methods, Postoperative Complications diagnosis, Postoperative Complications etiology, Vascular Calcification diagnosis, Vascular Calcification surgery
- Abstract
Objective: To investigate the outcomes after bioresorbable scaffold (BRS) implantation in calcified coronary lesions. In calcified coronary lesions, durable metallic drug-eluting stent (DES) implantation is associated with worse clinical outcomes compared to noncalcified lesions. Although not recommended, BRSs were frequently implanted in calcified lesions in clinical practice. Their outcome is not well investigated., Methods: Between November 2013 and January 2016, 3326 patients were enrolled in the German-Austrian ABSORB ReglstRy (GABI-R). Lesion calcification severity was classified into no (n = 1144), mild (n = 1306), and moderate-to-severe (n = 690) calcification., Results: Patients with calcification were older (none: 59.1 ± 11.2 vs. mild: 61.6 ± 10.9 vs. moderate to severe: 62.4 ± 10.5 years, P < 0.001), had more diabetes (19.1 vs. 20.8 vs. 23.9%, P = 0.015), and more often had previous myocardial infarction (MI) (19.3 vs. 23.1 vs. 25.4%, P = 0.002). Despite a higher rate of postdilatations (P < 0.001), lesions with calcification had more residual stenosis (2.05 ± 9.36% vs. 3.11 ± 9.36% vs. 3.89 ± 9.39%, P < 0.001). Consequently, procedural success was achieved in 97.7 vs. 96.2 vs. 93.6% of cases in none, mild, and moderate-to-severe calcification (P < 0.001). At 24 months, cardiac death (0.3 vs. 0.7 vs. 1.6%, P = 0.009) was higher with increasing calcification. However, no significant between-group difference was observed in the incidence of target vessel MI, target vessel revascularization, or target lesion failure. The rate of probable scaffold thrombosis was significantly higher with increasing calcification., Conclusion: In GABI-R, ABSORB scaffolds in calcified lesions required more postdilation, led to more residual stenosis, but did not portend increased target lesion revascularization over 2 years. Nevertheless, coronary calcification severity emerged as a cardiovascular risk marker and was predictive of cardiovascular mortality. Clinicaltrial.gov NCT02066623.
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- 2020
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50. Seasonal Variations in the Pathogenesis of Acute Coronary Syndromes.
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Kurihara O, Takano M, Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Yan BP, Crea F, Higuma T, Kimura S, Minami Y, Adriaenssens T, Boeder NF, Nef HM, Kim CJ, Thondapu V, Kim HO, Russo M, Sugiyama T, Fracassi F, Lee H, Mizuno K, and Jang IK
- Subjects
- Acute Coronary Syndrome diagnostic imaging, Aged, Coronary Artery Disease diagnostic imaging, Europe epidemiology, Female, Heart Disease Risk Factors, Humans, Incidence, Japan epidemiology, Male, Middle Aged, Plaque, Atherosclerotic, Prevalence, Registries, Rupture, Spontaneous, Time Factors, Tomography, Optical Coherence, United States epidemiology, Vascular Calcification diagnostic imaging, Acute Coronary Syndrome epidemiology, Coronary Artery Disease epidemiology, Seasons, Vascular Calcification epidemiology
- Abstract
Background Seasonal variations in acute coronary syndromes (ACS) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative. Methods and Results Patients with ACS who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with ACS (885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter ( P =0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157-2.359; P =0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429-0.905; P =0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter ( P =0.010), whereas no significant difference was observed in the other 2 groups. Conclusions Seasonal variations in the incidence of ACS reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT03479723.
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- 2020
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