Mechaniczna protekcja zatorowości mózgowej w TAVI

In the recent years ischemic brain injury after transcatheter aortic valve replacement (TAVR) has received increased attention as new embolic protection strategies emerged to protect the brain from embolic debris. Diverse cerebral protection devices have been developed to reduce cerebral embolization during TAVR. These devices work through various mechanisms and are in different stages of testing. This review provides the evidence-based outlook on peri-procedural stroke prevention during TAVR and summarizes currently available cerebral embolic protection devices.Ryzyko zdarzeń naczyniowo-mózgowych w ciągu 30 dni od zabiegu przezcewnikowej implantacji zastawki aortalnej (TAVI) wynosi około 5,5%. W dużym odsetku są one nieme klinicznie. Ryzyko zatorowości wiąże się z przejściem cewnikami przez zastawkę, predylatacją, pozycjonowaniem zastawki oraz jej uwolnieniem. Pociągnęło to za sobą rozwój nowych strategii mechanicznej ochrony mózgu przed potencjalnie zatorowym materiałem uwalnianym podczas zabiegów TAVI. Większość danych wskazuje, że stosowanie neuroprotekcji w zabiegach TAVI jest bezpieczne i znacznie zmniejsza liczbę zgonów lub udarów w porównaniu z grupami kontrolnymi bez protekcji mózgowej, niemniej aby udowodnić korzystną rolę neuroprotekcji podczas TAVI, potrzebne są dalsze, wieloośrodkowe, dobrze zaplanowane badania. Ochrona mózgu stanie się jeszcze ważniejsza, gdy wskazania do TAVI obejmą grupę pacjentów młodszych i/lub o niższym ryzyku zabiegowym

The influence of high-density lipoprotein cholesterol on maximal lipid core burden indexing thin cap fibrous atheroma lesions as assessed by near infrared spectroscopy

Background: Previous studies suggest that higher plasma concentrations of several lipid molecules are associated with higher lipid core burden index (LCBI) NIRS imaging. The aim of this study was to investigate whether an association between plasma lipids depends on plaque morphology (thin cap fibrous atheroma [TCFA] vs. non-TFCA) as measured by near-infrared spectroscopy–intravascular ultrasound (NIRS-IVUS). Methods: 64 patients retrospectively enrolled were diagnosed with stable coronary artery disease or acute coronary syndrome who underwent NIRS-IVUS imaging. Before percutaneous coronary intervention, blood samples were collected for measurement of serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (HDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. Patients were divided into two groups based on maxLCBI4mm and IVUS imaging. Those with maxLCBI4mm ≥ 323 were included into TCFA group (n = 35) while others were assigned to the non-TCFA group (n = 29). Results: Thin cap fibrous atheroma (TCFA) lesions were significantly longer than the non-TCFA lesions (25.66 ± 9.56 vs. 17.03 ± 9.22, p = 0.001). TCFA characterizes greater plaque burden (78.4 [70.9, 82.2] vs. 72.70 [64.77, 76,05]; p = 0.021) and plaque volume (176.1 [110.75, 247.5] vs. 68.1 [55.58, 143.35]; p = 0.000) as compared to non-TCFA. In TCFA suspected lesions, there was no correlation between maxLCBI4mm and LDL levels (r = 0.105, p = 0.549) nor TC levels (r = –0.035, p = 0.844) but a negative correlation was found between HDL-C and maxLCBI4mm (r = –0.453, p = 0.007). Conclusions: The present study showed that there was no correlation between plasma LDL-C, TCH and TG level and the amount of lipids in coronary plaque assessed by NIRS in both TCFA and non-TCFA groups. Only HDL-C correlated with maxLCBI4mm in TCFA lesions

Primary versus facilitated percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock

Background: Mortality in patients with cardiogenic shock (CS) due to acute myocardial infarction (MI) may be decreased by fibrynolytic therapy combined with intraaortic balloon counterpulsation or by invasive treatment, either with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The aim of the study was to compare in-hospital and long-term outcomes in patients with acute MI complicated by CS who were treated with primary or facilitated PCI. Methods: Among 98 consecutive patients with acute MI complicated by CS, 93 patients were treated with PCI and 5 patients underwent CABG. Patients treated with PCI were divided into two groups: group I included 59 patients treated with facilitated PCI and group II included 34 patients treated with primary PCI. Patients in group II were older, had higher systolic and diastolic blood pressure, and more often presented with 1-vessel disease and previous MI, while 3-vessel disease was more common in group I (all p < 0.05). Results: Immediate PCI success rate was similar in both groups (83% in group I vs. 74% in group II, p = NS), as was in-hospital mortality (41% vs. 36%, respectively, p = NS) and mortality rate in the cardiac cathetherization laboratory (20% vs. 15%, respectively, p = NS). The need for repeated PCI was significantly more common in group I (22% vs. 3%, p = 0.02). The two groups did not differ with respect to the need for CABG or the rate of hemorrhagic complications. During one year follow-up, three deaths occurred in every group, including two patients in each group who died suddenly.Conclusions: Comparable immediate PCI success rate, in-hospital mortality, and long-term mortality were seen in patients with acute MI complicated by CS treated with primary or facilitated PCI. More coronary reinterventions were needed in patients treated with facilitated PCI compared to those treated with primary PCI

Electrocardiograms in school-aged healthy Polish children — an observational study

Background: Electrocardiographic (ECG) examination has long been used to assess cardiovascular function in clinical practice. Age-related ECG changes are observed as the cardiovascular system matures from the neonatal period to adolescence.  Aim: This study aimed to evaluate the effects of sex and age on ECG parameters in healthy schoolchildren. Methods: The study included 336 healthy participants aged 5–12 years from Masovian voivodeship. Children were divided into age groups of 5–8 and 9–12 years. Values for heart rate (HR), time intervals and amplitudes of P and QRS waves, and QRS axis for pediatric ECGs were estimated. Results: Significant differences between boys and girls aged 5–8 years old were discovered for such parameters as PR interval, R-wave, and S-wave, R/S ratio. Age-related decline in HR, Q-wave in V5, and V6, R-wave in V1–V4, and increase in QRS duration were noted. Girls presented higher HR and shorter QRS than boys. HR, QRS axis, P wave amplitude in the II lead, and amplitude of R and S in the precordial leads were different in our population than previously reported. Conclusions: Pediatric ECG tracings were estimated for the first time for school-aged Polish healthy children. Sex-related differences in selected ECG parameters in the younger age group were noticed. Several parameters differed from those previously reported in other ethnic populations. These findings are clinically significant and suggest that diagnostic criteria for pediatric ECG should be revised to establish if they are justifiable for the entire population

Hybrid Revascularization for Multivessel Coronary Artery Disease

AbstractObjectivesThe aim of this study was to assess the feasibility of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD) referred for standard coronary artery bypass grafting (CABG).BackgroundConventional CABG is still the treatment of choice in patients with MVCAD. However, the limitations of standard CABG and the unsatisfactory long-term patency of saphenous grafts are commonly known.MethodsA total of 200 patients with MVCAD involving the left anterior descending artery (LAD) and a critical (>70%) lesion in at least 1 major epicardial vessel (except the LAD) amenable to both PCI and CABG and referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG (in a 1:1 ratio). The primary endpoint was the evaluation of the safety of HCR. The feasibility was defined by the percent of patients with a complete HCR procedure and the percent of patients with conversions to standard CABG. The occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeated revascularization, and major bleeding within the 12-month period after randomization was also assessed.ResultsMost of the pre-procedural characteristics were similar in the 2 groups. Of the patients in the hybrid group, 93.9% had complete HCR and 6.1% patients were converted to standard CABG. At 12 months, the rates of death (2.0% vs. 2.9 %, p = NS), myocardial infarction (6.1% vs. 3.9%, p = NS), major bleeding (2% vs. 2%, p = NS), and repeat revascularization (2% vs. 0%, p = NS) were similar in the 2 groups. In both groups, no cerebrovascular incidents were observed.ConclusionsHCR is feasible in select patients with MVCAD referred for conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease [POL-MIDES]; NCT01035567)

Prediction models for different plaque morphology in non-significantly stenosed regions of saphenous vein grafts assessed with optical coherence tomography

Introduction: Coronary artery bypass grafting (CABG) is a method of choice in treatment of diffuse coronary artery disease (CAD), although it has some limitations such as late saphenous vein graft (SVG) patency loss, which occurs in one fifth of all conduits at 5 years. Since atherosclerosis in SVG has diffuse characteristics, it appears that significantly and non-significantly stenosed lesions may have an equal impact on worse prognosis. Aim: To assess non-significant lesions of SVG by the use of optical coherence tomography (OCT) and investigate the clinical and laboratory findings with the potential impact on plaque composition. Material and methods: Twenty-nine patients with 43 non-significant lesions were enrolled in the study. All variables were assessed using uni- and multivariable logistic regression analysis with each plaque morphology as a dependent variable. Odds ratio (OR) and 95% confidence interval (CI) were computed. Results: Plaque rupture (PRT) was independently associated with age (OR = 1.49, 95% CI: 1.09–2.04, p = 0.015) and lower rates of high-density lipoproteins (HDL) cholesterol (OR = 0.67, 95% CI: 0.49–0.92, p = 0.016). Intimal tearing or rupture (ITR) was related to reduced GFR (OR = 0.52, 95% CI: 0.38–0.72, p = 0.0004). Lipid-rich plaque (LRP) was associated with raised platelet count (PLT) (OR = 1.51, 95% CI: 1.16–1.96, p = 0.004) and increased frequency of smoking (OR = 1.45, 95% CI: 1.12–1.89, p = 0.007). Conclusions: Atherosclerosis of SVG is not restricted to significantly stenosed lesions. Plaque composition is independently associated with different types of clinical and laboratory findings, mostly recognized as risk factors of CAD