Estimation of ejection fraction with ventriculography versus echocardiography in patients referred for cardiac surgery

Abstract: Aim: The aim of this study was to compare the estimation of ejection fraction (EF) by ventricuography (VG) and echocardiography (ECHO) in patients referred for surgery and to validate the results by comparison with other published data. Methods: One hundred patients who underwent VG prior to surgery were subjected to a trans-thoracic ECHO. Radiographers calculated the EF by tracing the outer border of the ventriculogram during systole and diastole. A single cardiologist, who was blinded to the angiogram result, measured EF during trans-thoracic ECHO using the biplane Simpson’s method. Results: EF was significantly higher by VG versus ECHO for the whole group (67.9±13.2 vs 55.7±8.5, p=0.000). In 81 patients the EF estimated at VG was higher than that calculated at ECHO (71.7±10.2 vs 55.9±7.2, p=0.000). In 19 patients the EF estimated at VG was lower than that calculated at ECHO, but the difference was not significant (51.8±12.9 by VG vs 55.4±12.8, p=0.387). In 13 patients, with an EF less than 50% on VG, the correlation with ECHO was very good (42.0±9.0 vs 42.0±8.3, p=0.995). Two patients with an EF fraction under 30% had similar measurements by VG and ECHO. The EF range as measured by ECHO was consistent with published data. Conclusion: Ventriculography overestimates EF when compared with ECHO. When EF is less than 50% on VG, ECHO findings were similar. The value of ventriculography in patients referred for cardiac surgery is now being brought into question when ECHO, a better and less invasive test that measures EF, is available.peer-reviewe

Estimation of Ejection Fraction with Ventriculography Versus Echocardiography in Patients Referred for Cardiac Surgery

Aim: The aim of this study was to compare the estimation of ejection fraction (EF) by ventricuography (VG) and echocardiography (ECHO) in patients referred for surgery and to validate the results by comparison with other published data.Methods: One hundred patients who underwent VG prior to surgery were subjected to a trans-thoracic ECHO. Radiographers calculated the EF by tracing the outer border of the ventriculogram during systole and diastole. A single cardiologist, who was blinded to the angiogram result, measured EF during trans-thoracic ECHO using the biplane Simpson’s method.Results: EF was significantly higher by VG versus ECHO for the whole group (67.9±13.2 vs 55.7±8.5, p=0.000). In 81 patients the EF estimated at VG was higher than that calculated at ECHO (71.7±10.2 vs 55.9±7.2, p=0.000). In 19 patients the EF estimated at VG was lower than that calculated at ECHO, but the difference was not significant (51.8±12.9 by VG vs 55.4±12.8, p=0.387). In 13 patients, with an EF less than 50% on VG, the correlation with ECHO was very good (42.0±9.0 vs 42.0±8.3, p=0.995). Two patients with an EF fraction under 30% had similar measurements by VG and ECHO. The EF range as measured by ECHO was consistent with published data.Conclusion: Ventriculography overestimates EF when compared with ECHO. When EF is less than 50% on VG, ECHO findings were similar. The value of ventriculography in patients referred for cardiac surgery is now being brought into question when ECHO, a better and less invasive test that measures EF, is available

Clinical outcomes of bioresorbable versus durable polymercoated everolimus-eluting stents in real-world complex patients

AIMS: The aim of this study was to evaluate the safety and efficacy profile of new-generation, SYNERGY everolimus-eluting stents (S-EES) as compared to XIENCE everolimus-eluting stents (X-EES) with a durable polymer coating in "complex patients". METHODS AND RESULTS: We included 2,001 consecutive patients treated with S-EES (n=400) or X-EES (n=1,601) at two Italian centres between May 2013 and May 2015. We used propensity score matching to obtain two cohorts of patients with similar baseline risk profiles. Patients were stratified according to baseline complexity based on the EVOLVE II trial exclusion criteria. The primary outcome was major adverse cardiac events (MACE), defined as the composite of all-cause death, myocardial infarction (MI), and target lesion revascularisation (TLR), at one year. Among 391 matched pairs of patients treated with S-EES or X-EES, we identified 253 (63%) as complex. At one-year follow-up, among "complex" patients, MACE rates did not differ between the S-EES and X-EES groups (9.9% vs. 9.5%, p=0.830, HR 1.04, CI: 0.72-1.48). Similarly, death, MI, and TLR, stratified for complexity, were comparable between S-EES and X-EES treated patients at one year. Of note, no definite ST was observed in either the S-EES or the X-EES cohort. CONCLUSIONS: New-generation S-EES with a bioresorbable polymer coating appear to be safe and effective irrespective of patient complexity as compared to X-EES

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

International audienc

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

International audienc

Impact of the COVID-19 Pandemic on Global TAVR Activity:The COVID-TAVI Study

Background: The COVID-19 pandemic adversely affected health care systems. Patients in need of transcatheter aortic valve replacement (TAVR) are especially susceptible to treatment delays. Objectives: This study sought to evaluate the impact of the COVID-19 pandemic on global TAVR activity. Methods: This international registry reported monthly TAVR case volume in participating institutions prior to and during the COVID-19 pandemic (January 2018 to December 2021). Hospital-level information on public vs private, urban vs rural, and TAVR volume was collected, as was country-level information on socioeconomic status, COVID-19 incidence, and governmental public health responses. Results: We included 130 centers from 61 countries, including 65,980 TAVR procedures. The first and second pandemic waves were associated with a significant reduction of 15% (P &lt; 0.001) and 7% (P &lt; 0.001) in monthly TAVR case volume, respectively, compared with the prepandemic period. The third pandemic wave was not associated with reduced TAVR activity. A greater reduction in TAVR activity was observed in Africa (−52%; P = 0.001), Central-South America (−33%; P &lt; 0.001), and Asia (−29%; P &lt; 0.001). Private hospitals (P = 0.005), urban areas (P = 0.011), low-volume centers (P = 0.002), countries with lower development (P &lt; 0.001) and economic status (P &lt; 0.001), higher COVID-19 incidence (P &lt; 0.001), and more stringent public health restrictions (P &lt; 0.001) experienced a greater reduction in TAVR activity. Conclusions: TAVR procedural volume declined substantially during the first and second waves of the COVID-19 pandemic, especially in Africa, Central-South America, and Asia. National socioeconomic status, COVID-19 incidence, and public health responses were associated with treatment delays. This information should inform public health policy in case of future global health crises.</p