Description and Validation of TAVIApp: A Novel Mobile Application for Support of Physicians in the Management of Aortic Stenosis—Management of Aortic Stenosis with TAVIApp

Background. Aortic stenosis (AS) is the most common heart valve disease in developed countries. The advent of transcatheter aortic valve implantation (TAVI) significantly improved patients’ outcome but made clinical management more complex. The aim of the present study was to describe TAVIApp, a mobile app we developed to guide the management of AS, and test its efficacy. Methods and Results. Clinical cases comprising 42 patients with AS were blindly evaluated by (A) an interventional cardiologist, assisted by the Heart Team (EXPERT), (B) young residents in cardiology, and (C) a young resident supported by TAVIApp. There was poor concordance between Group A and Group B with low performance by young residents (k=0.52; p<0.001). However, concordance increased to an optimal value when young residents were supported by TAVIApp (k=1.0; p<0.001) for the diagnosis of severe AS and eligibility assessment. Furthermore, regarding the selection of the most appropriate prosthesis size, concordance to Group A was poor without TAVIApp support (Group B) (k=0.78; p=0.430), but excellent with TAVIApp (k=1.0; p<0.001). Conclusions. This study is the first describing and validating a new mobile application to support the management of AS. TAVIApp supports cardiologists in the evaluation of stenosis severity, eligibility for TAVI or AVR, and selection of the most appropriate prosthesis size in individual patients

Acute expansion of nitinol-based self-expandable device in patients undergoing transfemoral aortic valve implantation

Background: The acute adaptation of the nitinol-based stent frame self expandable valve to the aortic root after deployment is poorly understood. Accordingly, this study aimed to assess the occurrence, degree and determinants of acute adaptation of the nitinol-based stent frame self-expandable valves after implantation. Methods: This is a single-site prospective registry including patients undergoing transcatheter aortic valve replacement (TAVR) with a widely used second-generation nitinol-based self-expandable device (Evolut R, Medtronic, Minneapolis, Minnesota, USA). We measured valve diameters at three different sections: distal (aortic) level, central (annulus) level and proximal (ventricular) level. Valve expansion was estimated by the difference between the diameters calculated immediately after valve deployment (A) and at the end of the procedure (B). The absolute and relative stent changes were defined as B-A and (B-A)/B∗100, respectively. A linear regression model was performed to test the association between the degree of valve extension at each segment with baseline and procedural characteristics. Results: A total of 58 consecutive TAVR patients were included in this analysis, with a mean age of 82.12 ± 5.28 years. Out of the total, 46% of the patients had chronic kidney disease, 32% had diabetes and 76% had dyslipidaemia. The mean procedural time was 28.11 ± 11.6 min, with 53.45% of predilation. Postdilation was performed only in 3.5% of patients. Final stent diameters were significantly higher than those achieved immediately after valve implantation - an observation that was consistent for all the segments: 0.50 ± 0.51 mm and 2.48 ± 2.57% ( P  < 0.01) in the proximal, 0.46 ± 0.57 mm and 2.39 ± 2.96% ( P  < 0.01) in the central, as well as 0.58 ± 0.59 mm and 2.14 ± 2.14% ( P  < 0.01) at the distal segments. Postdilation significantly affected the expansion of the central segment, and, albeit not significantly, the proximal one, while no changes were observed for the distal portion of the platform. Conclusion: This is the first study to have documented a significant degree of the Evolut R self-expandable valve expansion after deployment. However, further studies are required to assess the short- and long-term time course of self-expandable valve enlargement and the clinical relevance of this finding

Non-invasive myocardial work is reduced during transient acute coronary occlusion.

BackgroundDuring ischemia a close relationship exists between sub-endocardial blood flow and myocardial function. Strain parameters can capture an impairment of regional longitudinal function but are load dependent. Recently, a novel non-invasive method to calculate Myocardial Work (MW) showed a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW indices to identify the ischaemic risk area during transient acute coronary occlusion (TACO).Methods and resultsThe study population comprises 50 individuals with critical coronary stenosis (CCS). Echocardiography recordings were obtained before coronary angiography, during TACO and after revascularization to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial work efficiency (MWE). Compared to baseline, we found a significant reduction of GLS (p = 0.005), MWI, MCW and MWE (pConclusionsThe non-invasive measurement of MW parameters is a sensitive and early marker of myocardial ischemia during TACO

Non-invasive myocardial work is reduced during transient acute coronary occlusion

BackgroundDuring ischemia a close relationship exists between sub-endocardial blood flow and myocardial function. Strain parameters can capture an impairment of regional longitudinal function but are load dependent. Recently, a novel non-invasive method to calculate Myocardial Work (MW) showed a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW indices to identify the ischaemic risk area during transient acute coronary occlusion (TACO).Methods and resultsThe study population comprises 50 individuals with critical coronary stenosis (CCS). Echocardiography recordings were obtained before coronary angiography, during TACO and after revascularization to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial work efficiency (MWE). Compared to baseline, we found a significant reduction of GLS (p = 0.005), MWI, MCW and MWE (pConclusionsThe non-invasive measurement of MW parameters is a sensitive and early marker of myocardial ischemia during TACO

New antithrombotic strategies and coronary stent technologies for patients at high bleeding risk undergoing percutaneous coronary intervention

: Patients at High Bleeding Risk (HBR) are a sizable part of the population undergoing Percutaneous Coronary Intervention (PCI) and stent implantation. This population historically lacks standardized definition, thus limiting trial design, data generalizability, and clinical decision-- making. To overcome this limitation, the Academic Research Consortium (ARC) has recently released comprehensive guidelines defining HBR criteria for study design purposes and daily clinical practices. Furthermore, several risk scores have been developed aiming to discriminate against HBR patients and support physicians for clinical decision-making when faced with this complex subset of patients. Accordingly, the first part of this review article will explore guideline-recommended risk scoring as well as ARC-HBR criteria and their relative application for daily clinical practice. The second part of this review article will explore the complex interplay between the risk of bleeding and coronary thrombotic events in patients deemed at HBR. Indeed, several features that identify these patients are also independent predictors of recurrent ischemic events, thus challenging revascularization strategies and optimal antithrombotic therapy. Accordingly, several clinical trials have been conducted to evaluate the safety and efficacy of the new generation of coronary platforms and different antithrombotic strategies for HBR patients to minimize both ischemic and bleeding events. Accordingly, in this part, we discuss current guidelines, trials, and observational data evaluating antithrombotic strategies and stent technologies for patients at HBR

Hand Laser Perfusion Imaging to Assess Radial Artery Patency: A Pilot Study

Objectives: To test a novel diagnostic technique to assess radial artery perfusion after transradial catheterization. Background: Despite being mostly asymptomatic, radial artery occlusion (RAO) is not a benign complication, and its diagnosis is frequently missed because it requires time-consuming diagnostic testing. We developed a novel operator-independent diagnostic test to assess RAO after coronary procedures through a transradial access (TRA) by means of hand Laser Perfusion Imaging (LPI). Methods: One hundred patients were evaluated before and after TRA by means of the LPI. A radial perfusion index (RPI) was calculated as the ratio between the total perfusion measured during ulnar occlusion and total basal perfusion. Vascular Duplex scan (VDS) was used as the standard of reference to assess the artery patency. Results: LPI correctly identified RAO in 100% of cases. Post-procedural RPI was 0.89 ± 0.13 in patients with radial patency vs. 0.15 ± 0.04 in patients with RAO (p &lt; 0.001). In line with these results, ROC analysis showed an excellent diagnostic performance of the LPI, that correctly identified all RAO cases (Area Under the Curve, AUC = 1.0; p &lt; 0.001), with an optimal diagnostic cutoff at 0.2 RPI. Conclusions: LPI is a reliable diagnostic technique for RAO, offering the advantages of being quick and simple to perform

B-Type Natriuretic Peptide as Biomarker of COVID-19 Disease Severity—A Meta-Analysis

Up to 15% of coronavirus disease 2019 (COVID-19) patients experience severe clinical presentation, resulting in acute respiratory distress (ARDS) and finally death. N-terminal natriuretic peptide (NT-proBNP) is associated with a worse prognosis in patients with ARDS. However, whether or not this peptide can help discriminate high-risk COVID-19 patients remains unclear. Therefore, in this meta-analysis, we summarized the available evidence on NT-proBNP in patients admitted for COVID-19. Pooled mean, mean differences (MD) and standardized mean difference (SMD) were the summary metrics. Thirteen studies were finally selected for this analysis with a total of 2248 patients, of which 507 had a severe condition (n = 240) or died (n = 267). Pooled mean NT-proBNP levels on admission were 790.57 pg/mL (95% confidence intervals (CIs): 532.50 to 1048.64) in patients that experienced a severe clinical condition or died, and 160.56 pg/mL (95% CI: 118.15 to 202.96) in non-severe patients (SMD: 1.05; 95% (CI): 0.83 to 1.28; p &lt; 0.001; I2 74%; and MD was 645.84 pg/mL (95% CI: 389.50&ndash;902.18). Results were consistent in studies categorizing patients as non-survivors versus survivors (SMD: 1.17; 95% CI 0.95 to 1.40; p &lt; 0. 001; I2: 51%), and in those classifying populations in severe versus non-severe clinical condition (SMD: 0.94 95% CI 0.56 to 1.32; p &lt; 0.001; I2: 81%; pinteraction = 0.30). In conclusion, our results suggest that assessing NT-proBNP may support physicians in discriminating high-risk COVID-19 patients