The Contemporary Role of Percutaneous Coronary Intervention in Left Main Disease Management

Since the 1980s coronary artery bypass grafting (CABG) has been considered as the gold standard for treating left main disease. The continuous evolution of tools and techniques concerning coronary angioplasty and the advent of drug-eluting stents (DES) have established percutaneous coronary intervention (PCI) as a possible alternative to CABG. Initial randomized studies that were conducted during the previous decade, with main representative the SYNTAX study, compared conventional CABG to PCI with first generation DES and showed non-inferiority regarding hard clinical outcomes. The results of two randomized studies comparing CABG versus PCI with second generation DES were simultaneously published in the end of 2016 to further support PCI as a credible alternative to CABG for patients with left main disease with low and intermediate SYNTAX scores. A Heart Team is indispensable to best evaluate the anatomic parameters of coronary lesions, the clinical variables and the technical possibilities regarding disease complexity in order to define the ideal revascularization strategy for each patient in the elective setting. Percutaneous treatment for left main disease has been increasingly performed during the last decade, since the procedural steps and optimal techniques for left main PCI are nowadays standardized and well described in expert consensus documents and therefore should be respected and applied in order to optimize patient outcomes. Rhythmos 2018;13(3):48-53

Percutaneous Revascularization Strategy for Acute Coronary Syndrome With Two Culprit Arteries and Distal Left Main Disease With Consecutive Bifurcation Lesions

The case of a patient with NSTEMI is presented who was shown to have two culprit thrombotic coronary lesions and underwent successful percutaneous coronary intervention for multivessel coronary artery disease at a staged approach. Rhythmos 2018;13(3):54-58

No-Reflow Phenomenon: A Major Issue Concerning Revascularization in Acute Coronary Syndromes

The no-reflow phenomenon (NRp), a dreaded complication of primary and also of any complex percutaneous coronary intervention (PCI), is characterized by insufficient myocardial perfusion in a territory of a coronary artery without evidence of mechanical obstruction. Microvascular injury is the underlying mechanism of NRp and its manifestation is not only impaired TIMI flow (<3), but also impaired TIMI myocardial perfusion grade (TMPG) which should be assessed in case of chest pain, persistent ST segment elevation or hemodynamic compromise despite the presence of TIMI III flow. The NRp mechanism is multifaceted, the evidence base for its treatment is inconsistent and limited, but its predictors are well known. The armamentarium against NRp consists of preventive and therapeutic strategies, both mechanical and pharmacological. A brief overview of all the above issues concerning NRp is attempted herein. Rhythmos 2019;14(2):27-30

Defensive coping and health-related quality of life in chronic kidney disease: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Coping with the stresses of chronic disease is considered as a key factor in the perceived impairment of health related quality of life (HRQL). Little is known though about these associations in chronic kidney disease (CKD). The present study aimed to investigate the relationship of defensive coping and HRQL among patients in different CKD stages, after adjusting for psychological distress, sociodemographic and disease-related variables.</p> <p>Methods</p> <p>The sample consisted of 98 CKD patients, attending a university nephrology department. Seventy-nine (79) pre-dialysis patients of disease stages 3 to 4 and 19 dialysis patients were included. HRQL was assessed by the 36-item Short-Form health survey (SF-36), defensive coping by the Rationality/Emotional Defensiveness (R/ED) scale of the Lifestyle Defense Mechanism Inventory (LDMI) and psychological distress by the depression and anxiety scales of the revised Hopkins Symptom CheckList (SCL-90-R). Regression analyses were carried out to examine the association between SF-36 dimensions and defensive coping style.</p> <p>Results</p> <p>Patients on dialysis had worse scores on SF-36 scales measuring physical aspects of HRQL. In the fully adjusted analysis, a higher defensive coping score was significantly associated with a lower score on the mental component summary (MCS) scale of the SF-36 (worse mental health). In contrast, a higher defensive score showed a small positive association with the physical component summary (PCS) scale of the SF-36 (better health), but this was marginally significant.</p> <p>Conclusions</p> <p>The results provided evidence that emotional defensiveness as a coping style tends to differentially affect the mental and the physical component of HRQL in CKD. Clinicians should be aware of the effects of long-term denial and could examine the possibility of screening for defensive coping and depression in recently diagnosed CKD patients with the aim to improve both physical and mental health.</p

Transcatheter Aortic Valve Implantation (TAVI) and Mitral Valve Transcatheter Edge-To-Edge Repair (TEER): Current Frontiers and Horizons: TAVI and Mitral Valve Transcatheter Edge-To-Edge Repair

During the last two decades transcatheter aortic valve implantation (TAVI) and mitral valve transcatheter edge-to-edge repair (TEER) have evolved in parallel to provide percutaneous interventional treatment solutions for patients with the two most common valvular heart diseases, aortic stenosis and mitral regurgitation, respectively. Having initially been conceived and used to treat patients considered inoperable, TAVI indications have been expanded to include high operative risk and more recently moderate or even low risk patients. The TAVI techniques have also improved to permit tackling challenging complex anatomies and bioprosthetic valve degeneration and structural failure. Similarly, TEER has been initially used to treat inoperable patients with severe symptomatic primary mitral regurgitation (MR), but recently published data have shown that it can provide benefit in carefully selected patients with refractory to optimal medical treatment (OMT) symptomatic severe secondary MR. Furthermore, apart from TEER with the traditional MitraClip system and its iterations, a second TEER system (Pascal) has provided promising results in initial clinical trials and can alternatively be used. We attempt herein a concise overview of the TAVI and mitral valve TEER current state of play. Rhythmos 2021;16(3): 57-6

Novel Angiography-Derived Techniques for Functional Assessment of Coronary Artery Disease: Functional Assessment of Coronary Artery Disease

Background: The importance of coronary physiology in identifying hemodynamically significant lesions is well established. Objective: The current review summarizes the most important studies of the novel techniques developed over the last decade that allow the computation of fractional flow reserve (FFR) from either invasive or computed coronary angiography. Methods: A systematic review of all published research in PubMed and Google Scholar databases, regarding the angiography-derived functional assessment of coronary artery disease (CAD) has been performed. The following terms were used: “functional angiography”, “quantitative flow ratio”, “computed tomography-derived FFR”, “FFR angiography” and “virtual FFR”. Results: Several multicenter clinical trials have presented the currently available techniques for physiological assessment of coronary artery stenosis, such as quantitative flow ratio (QFR), computed tomography-derived FFR, FFRangio and virtual FFR, their theoretical basis and methodology, as well as their diagnostic performance, using invasive FFR as reference standard. Conclusion: A variety of novel angiography-derived techniques for physiological assessment of CAD exist, showing high diagnostic performance and are expected to increase the use of coronary physiology in the guidance of clinical decision making upon revascularization strategy. Rhythmos 2020;15(4):73-77