Plasma Bin1 Correlates With Heart Failure And Predicts Arrhythmia In Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder characterized by fibrofatty replacement of the right ventricular myocardium and associated arrhythmias that originate from the right ventricle. BIN1 is a membrane-associated protein that is involved in cardiac T-tubule homeostasis and is down-regulated in cardiomyopathy. BIN1 has also been shown to be essential to the differentiation of myoblasts and the induction of skeletal muscle T-tubule invagination. We hypothesized that BIN1 is released into the circulation andthat circulatory BIN1 would provide useful cardiac monitoring data on patients suffering from heart failure in ARVC. The objective was to determine whether plasma BIN1 can measure disease severity in patients with ARVC. The study presented is a retrospective cohort of 24 patients with ARVC. Plasma BIN1 levels were quantified and analyzed against clinical data to determine its ability to predict cardiac functional status and ventricular arrhythmias. Mean plasma BIN1 levels were decreased in ARVC patients compared to controls (37 ± 1 vs. 60 ± 10, p \u3c 0.05). In a cross-sectional analysis, ARVC patients with heart failure had lower BIN1 (15 ± 7 vs. 60 ± 17 in patients without heart failure, p \u3c 0.05). BIN1 levels correlated inversely with ventricular arrhythmia burden (R = -0.46, p \u3c 0.05), and low BIN1 correctly classified patients with advanced heart failure or ventricular arrhythmia (ROC Area under the curve, AUC, 0.88 ± 0.07). Low BIN1 also predicted future ventricular arrhythmias (ROC AUC 0.89 ± 0.09). In a stratified analysis, BIN1 predicted future arrhythmias in patients without severe heart failure to an accuracy of 82%. In ARVC patients with serial blood draws who had evidence of disease progression during follow up, plasma BIN1 decreased by 63% (p \u3c 0.05). In conclusion, plasma BIN1 correlates with disease severity in patients with ARVC and predicts future ventricular arrhythmias

Procedural and Mid-Term Outcomes of Coronary Protection During Transcatheter Aortic Valve Replacement in Patients at Risk of Coronary Occlusion: Insight From a Single-Centre Retrospective Analysis

BACKGROUND: Detailed procedural analysis and long-term data is limited for coronary protection (CP) during transcatheter aortic valve replacement (TAVR) for patients with high anatomical risk for coronary occlusion (CO). We aim to assess the procedural and mid-term outcomes of CP during TAVR. METHODS: We retrospectively analyzed patients who underwent TAVR at Henry Ford Hospital, USA from January 2015 to August 2019 and identified those considered at risk of CO and underwent pre-emptive CP with or without subsequent chimney stenting (i.e. coronary stenting with intentional protrusion into the aorta). Procedural features, immediate and mid-term clinical outcomes were reviewed. RESULTS: Twenty-five out of 1166 (2.1%) patients underwent TAVR with CP, including 10 (40%) valve-in-valve procedures. Twenty-eight coronary arteries (Left: n = 11, Right: n = 11; Left + Right: n = 3) were protected. Eleven coronaries (39.3%) were electively chimney -stented due to angiographic evidence of coronary impingement (63.6%), tactile resistance while withdrawing stent (27.3%) and electrocardiogram change (9.1%). Twenty-four patients (24/25, 96%) had successful TAVR without CO. Procedure-related complications included stent-balloon entrapment (n = 1), stent entrapment (n = 1) and occlusive distal stent edge dissection (n = 1). After a mean follow-up of 19.1 months, there was 1 cardiac death but no target vessel re-intervention or myocardial infarction. CONCLUSIONS: Our study found that angiographic evidence of coronary impingement (63.6%) was the most common reason for stent deployment during TAVR with CP. The mid-term clinical outcome of CP with TAVR was favorable

Additive Value of Preprocedural Computed Tomography Planning Versus Stand-Alone Transesophageal Echocardiogram Guidance to Left Atrial Appendage Occlusion: Comparison of Real-World Practice

Background: Transesophageal echocardiogram is currently the standard preprocedural imaging for left atrial appendage occlusion. This study aimed to assess the additive value of preprocedural computed tomography (CT) planning versus stand-alone transesophageal echocardiogram imaging guidance to left atrial appendage occlusion. Methods and Results: We retrospectively reviewed 485 Watchman implantations at a single center to compare the outcomes of using additional CT preprocedural planning (n=328, 67.6%) versus stand-alone transesophageal echocardiogram guidance (n=157, 32.4%) for left atrial appendage occlusion. The primary end point was the rate of successful device implantation without major peri-device leak (\u3e5 mm). Secondary end points included major adverse events, total procedural time, delivery sheath and devices used, risk of major peri-device leak and device-related thrombus at follow-up imaging. A single/anterior-curve delivery sheath was used more commonly in those who underwent CT imaging (35.9% versus 18.8%; P\u3c0.001). Additional preprocedural CT planning was associated with a significantly higher successful device implantation rate (98.5% versus 94.9%; P=0.02), a shorter procedural time (median, 45.5 minutes versus 51.0 minutes; P=0.03) and a less frequent change of device size (5.6% versus 12.1%; P=0.01), particularly device upsize (4% versus 9.4%; P=0.02). However, there was no significant difference in the risk of major adverse events (2.1% versus 1.9%; P=0.87). Only 1 significant peri-device leak (0.2%) and 5 device-related thrombi were detected in follow-up (1.2%) with no intergroup difference. Conclusions: Additional preprocedural planning using CT in Watchman implantation was associated with a higher successful device implantation rate, a shorter total procedural time, and a less frequent change of device sizes