Appropriate use criteria for optical coherence tomography guidance in percutaneous coronary interventions: Recommendations of the working group of interventional cardiology of the Netherlands Society of Cardiology

Introduction: Optical coherence tomography (OCT) enables detailed imaging of the coronary wall, lumen and intracoronary implanted devices. Responding to the lack of specific appropriate use criteria (AUC) for this technique, we conducted a literature review and a procedure for appropriate use criteria. Methods: Twenty-one of all 184 members of the Dutch Working Group on Interventional Cardiology agreed to evaluate 49 pre-specified cases. During a meeting, factual indications were established whereupon members individually rated indications on a 9-point scale, with the opportunity to substantiate their scoring. Results: Twenty-six indications were rated ‘Appropriate’, eighteen indications ‘May be appropriate’, and five ‘Rarely appropriate’. Use of OCT was unanimously considered ‘Appropriate’ in stent thrombosis, and ‘Appropriate’ for guidance in PCI, especially in distal left main coronary artery and proximal left anterior descending coronary artery, unexplained angiographic abnormalities, and use of bioresorbable vascular scaffold (BVS). OCT was considered ‘Rarely Appropriate’ on top of fractional flow reserve (FFR) for treatment indication, assessment of strut coverage, bypass anastomoses or assessment of proximal left main coronary artery. Conclusions: The use of OCT in stent thrombosis is unanimously considered ‘Appropriate’ by these experts. Varying degrees of consensus exists on the appropriate use of OCT in other settings

Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation

BACKGROUND The roles of anticoagulation alone or with an antiplatelet agent after transcatheter aortic-valve implantation (TAVI) have not been well studied. METHODS We performed a randomized trial of clopidogrel in patients undergoing TAVI who were receiving oral anticoagulation for appropriat

LADUMA: looking at the distant universe with the MeerKAT array

The cosmic evolution of galaxies’ neutral atomic gas content is a major science driver for the Square Kilometre Array (SKA), as well as for its South African (MeerKAT) and Australian (ASKAP) precursors. Among the H I large survey programs (LSPs) planned for ASKAP and MeerKAT, the deepest and narrowest tier of the “wedding cake” will be defined by the combined L-band+UHF-band Looking At the Distant Universe with the MeerKAT Array (LADUMA) survey, which will probe H I in emission within a single “cosmic vuvuzela” that extends to z = 1.4, when the universe was only a third of its present age. Through a combination of individual and stacked detections (the latter relying on extensive multi-wavelength studies of the survey’s target field), LADUMA will study the redshift evolution of the baryonic Tully–Fisher relation and the cosmic H I density, the variation of the H I mass function with redshift and environment, and the connection between H I content and galaxies’ stellar properties (mass, age, etc.). The survey will also build a sample of OH megamaser detections that can be used to trace the cosmic merger history. This proceedings contribution provides a brief introduction to the survey, its scientific aims, and its technical implementation, deferring a more complete discussion for a future article after the implications of a recent review of MeerKAT LSP project plans are fully worked out

Early Detection and Treatment of the Vulnerable Coronary Plaque: Can We Prevent Acute Coronary Syndromes?

Early identification and treatment of the vulnerable plaque, that is, a coronary artery lesion with a high likelihood of rupture leading to an acute coronary syndrome, have gained great interest in the cardiovascular research field. Postmortem studies have identified clear morphological characteristics associated with plaque rupture. Recent advances in invasive and noninvasive coronary imaging techniques have empowered the clinician to identify suspected vulnerable plaques in vivo and paved the way for the evaluation of therapeutic agents targeted at reducing plaque vulnerability. Local treatment of vulnerable plaques by percutaneous coronary intervention and systemic treatment with anti-inflammatory and low-density lipoprotein-lowering drugs are currently being investigated in large randomized clinical trials to assess their therapeutic potential for reducing adverse coronary events. Results from these studies may enable a more patient-tailored strategy for the treatment of coronary artery disease

Experiences with the Absorb everolimus-eluting bioresorbable vascular scaffold in all comers: The St. Antonius hospital single centre registry

Background: Data on procedural and clinical outcomes of the everolimus-eluting bioresorbable vascular scaffold (BVS, Abbott) in percutaneous coronary intervention in a real-world setting is limited. Early and mid-term clinical outcomes of the BVS in a real-world population were investigated in this single centre study. Methods: Patients treated with the BVS in the St. Antonius Hospital from April 2012 to February 2015 were included in a prospective single centre registry. Procedural success defined as <20% residual restenosis and 30-day and 6-month clinical outcome were investigated. Cumulative event rates were expressed using Kaplan−Meier method. Results: A total of 108 patients were included in the study, including patients with ST-segment elevation myocardial infarction (STEMI) 18.5%, non-STEMI 22.2% and unstable angina 9.3%. In total 125 lesions were treated with the BVS, of which 48.8% B2/C type lesions including 19.2% bare metal or drugs-eluting in-stent restenosis. Procedural angiographic success was achieved in 99.2% of all patients. Clinical follow-up rate was 100% at 30-day and 87% at 6-month. The rate of cardiac death, target vessel revascularization and definite stent thrombosis was 0%, 0.9% and 0.9% at 30-day and 0.9%, 5.6% and 1.9% at 6-month. The composite end point of target lesion failure (Cardiac death, target lesion myocardial infarction MI and target lesion revascularization) was 1.9% at 30-day and 5.6% at 6-month, respectively. Conclusions: The use of the BVS in a real-world setting demonstrated excellent procedural success and acceptable mid-term clinical outcomes. The rate of definite scaffold thrombosis was not dissimilar to other BVS registries

CT measurement of changes in cerebral perfusion in patients with asymptomatic carotid artery stenosis undergoing carotid stenting prior to cardiac surgery: "proof of principle"

Item does not contain fulltextAIMS: To identify asymptomatic patients with impaired cerebral perfusion using CT perfusion (CTP) technique during staged carotid stenting (CAS) and cardiac surgery. METHODS AND RESULTS: This is a prospective, non-randomised study in 16 neurologically asymptomatic patients designed to analyse cerebral perfusion using CTP before and after CAS. Mean transit time (MTT) was significant lower and cerebral blood flow (CBF) was significantly higher in the non-target hemisphere compared to the target hemisphere before treatment (4.64 +/- 1.08 s vs. 5.67 +/- 1.29 and 57.37 +/- 24.90 s vs. 48.19 +/- 13.02, respectively). Mean dMTT (absolute difference in MTT values between treated and untreated hemisphere) decreased from 0.92 +/- 1.08 s before to 0.04 +/- 0.30 s after carotid revascularisation (p<0.05) and mean relative CBF (ratios of the treated to the untreated hemisphere) increased from 0.92 +/- 0.12 to 1.04 +/- 0.12 after revascularisation (p<0.05). Subgroup analysis based on pre-treatment dMTT showed significant changes in 50% of the patients with larger dMTT. There was one transient ischaemic attack reported 30 days after combined procedure. CONCLUSIONS: A significant improvement of cerebral perfusion after carotid stenting is shown in about 50% of the asymptomatic patients in this study. This suggests the potential presence of a compromised cerebral circulation in asymptomatic patients with severe carotid artery disease scheduled for cardiac surgery

Hyperpolarization Induces Differentiation in Human Cardiomyocyte Progenitor Cells

In the past years, cardiovascular progenitor cells have been isolated from the human heart and characterized. These cells can differentiate into cardiomyocytes, smooth muscle cells and endothelial cells and are therefore of great value for investigation of the mechanisms that drive progenitor cell function and plasticity, drug testing and, potentially, therapeutical purposes. In this respect, most studies have focused on enhancing differentiation with chemicals or growth factors, or co-culture with other cell types. Although they have revealed important mechanisms, protocols need to be established that exclude the need for such factors when one considers using progenitor cells to repair the human heart. In this study we tested whether we could induce cardiomyogenic differentiation of human cardiomyocyte progenitor cells (CMPCs) by altering their membrane potential. We induced hyperpolarization in CMPCs by either co-culturing them with a K(ir)2.1-overexpressing cell line or by overnight culture in medium containing low potassium concentrations. Hyperpolarization led to increased intracellular calcium concentrations, activation of calcineurin signaling, increased cardiac-specific gene and protein expression levels and, ultimately, to the formation of spontaneously beating cardiomyocytes. Thus, hyperpolarization is sufficient to induce differentiation of CMPCs, thereby revealing a novel mechanism for cardiomyogenic differentiation of heart-derived progenitor cells.Signal transduction in aging related disease