Ultrasound Lung Comets versus cardiac natriuretic peptides in patients with acute dyspnoea

Background: Acute shortness of breath as a presenting symptom is a frequent challenge for physicians. The main differential diagnosis is between cardiac and non-cardiac origin of dyspnoea. Natriuretic peptides levels have been used to successfully aid in the diagnosis of congestive heart failure (CHF) in patients presenting with dyspnoea. Ultrasound lung comets (ULCs) are a useful chest sonography sign of increased extravascular lung water. Aim: To assess the concordance rate between ULCs and cardiac natriuretic peptides. Methods: 275 patients (87 females; age 70?14 yrs) admitted with dyspnoea (NYHA class II, III or IV) to a Cardiology-Pneumology or Emergency Department were evaluated. Cardiac peptides assessment and chest sonography, scanning along the intercostal spaces, were performed in all (within 3 hours) and independently analyzed. NT-proBNP values &#8805;157 ng/l, BNP &#8805;100 ng/l and ULCs &#8805;5 were considered abnormal, according to pre-determined cut-offs. Results: Abnormal values of natriuretic peptides were found in 251 patients, while ULCs were present in 220 patients. The total number of discordant cases was 36 (13%), with a concordance rate of 87%. The dominant source of discordance was due to abnormal natriuretic peptides and absence of ULCs (34 patients, see figure): in these patients the mean hospitalization time was significantly lower than in patients with abnormal cardiac peptides and presence of ULCs (7.8?3.7 vs 10.9?6 days, p<.001). Conclusions: ULCs findings are in broad concordance with natriuretic peptides values. Being natriuretic peptides analysis not always available, especially in peripheral Emergency Departments, ULCs assessment could be a plausible alternative to identify CHF in patients with acute dyspnoea

Ultrasound lung comets for serial assessment of pulmonary congestion in heart failure

Background: Serial chest radiographs are too insensitive and therefore NOT recommended for monitoring pulmonary congestion in heart failure patients (AHA/ACC guidelines 2006). Ultrasound lung comets (ULCs) are a simple, quantitative chest sonography sign of pulmonary congestion, originating from water-thickened interlobular septa, and might represent a convenient alternative to chest x-ray in this clinical setting. Aim: To assess whether dynamic changes in ULCs could mirror variations in clinical status and natriuretic peptides. Methods: 104 patients (28 females; age 70?11 years) admitted with dyspnoea (NYHA class &#8805;II) to a Cardiology or Emergency Department were evaluated. NT-proBNP assessment and ULC were independently performed at admission and again before discharge. A patient ULC score was obtained by summing the number of comets from each of the scanning spaces from second to fifth intercostal spaces on anterior chest. Patients were considered "responders" to therapy when NYHA class decreased &#8805;1 grade at discharge. Results: Responders (group I, n=90) and non-responders (group II, n=14) had similar NT-proBNP (I=5560?6643 vs II=5470?4047 ng/l, p=.313), and ULCs number (I=27?34 vs II=34?24, p=.133) at admission. At discharge, responders had lower NT-proBNP (I=3633?5194 vs II=4654?3366 ng/l, p<.05) and ULCs (I=11?12 vs II=28?32, p<.01, see figure) when compared to non-responders. Variation in NT-proBNP somewhat mirrored variations in ULCs (r=.322, p<0.0001). Conclusions: ULC variations mirror changes in clinical functional class and natriuretic peptides in patients hospitalized with acute dyspnoea. ULCs represent an objective parameter of clinical improvement, useful for serial assessment of extra-vascular lung water in patients admitted with acute dyspnoea

Impact on outcome of different types of carotid stent: Results from the European Registry of Carotid Artery Stenting

AIMS: Conflicting data exist on the impact on outcome of the use of different stent types during carotid artery stenting (CAS). The aim of this study was to evaluate clinical outcomes according to different carotid stent design among the population of the European Registry of Carotid Artery Stenting (ERCAS). METHODS AND RESULTS: The present study was conducted in 1,604 patients who underwent neuroprotected CAS in ERCAS. All types of commercially available carotid stent were used. Open-cell design stents were classified according to free cell area into 7.5 mm2. A total of 713 closed-cell, 456 hybrid-cell, 238 7.5 mm2 open-cell stents were implanted. Overall, the 30-day stroke and death rate was 1.37%. At 30 days, 19 strokes occurred (1.18%): eight in the group of patients treated with a closed-cell (1.12%), two in those with a hybrid-cell (0.44%), three in those with a 7.5 mm2 open-cell stent (3.05%) (p=0.045). CONCLUSIONS: Data of the present study suggest that, in the setting of neuroprotected CAS performed in high-volume centres by properly trained operators, the use of an open-cell design stent with a free cell area >7.5 mm2 may be associated with an increased 30-day stroke risk

Rationale and Design of the PARTHENOPE Trial: A Two-by-Two Factorial Comparison of Polymer-Free vs. Biodegradable-Polymer Drug-Eluting Stents and Personalized vs. Standard Duration of Dual Antiplatelet Therapy in All-Comers Undergoing PCI.

BACKGROUND Over the past few decades, percutaneous coronary intervention (PCI) has undergone significant advancements as a result of the combination of device-based and drug-based therapies. These iterations have led to the development of polymer-free drug-eluting stents. However, there is a scarcity of data regarding their clinical performance. Furthermore, while various risk scores have been proposed to determine the optimal duration of dual antiplatelet therapy (DAPT), none of them have undergone prospective validation within the context of randomized trials. DESIGN The PARTHENOPE trial is a phase IV, prospective, randomized, multicenter, investigator-initiated, assessor-blind study being conducted at 13 centers in Italy (NCT04135989). It includes 2,107 all-comers patients with minimal exclusion criteria, randomly assigned in a 2-by-2 design to receive either the Cre8 amphilimus-eluting stent or the SYNERGY everolimus-eluting stent, along with either a personalized or standard duration of DAPT. Personalized DAPT duration is determined by the DAPT score, which accounts for both bleeding and ischemic risks. Patients with a DAPT score <2 (indicating higher bleeding than ischemic risk) receive DAPT for 3 or 6 months for chronic or acute coronary syndrome, respectively, while patients with a DAPT score ≥2 (indicating higher ischemic than bleeding risk) receive DAPT for 24 months. Patients in the standard DAPT group receive DAPT for 12 months. The trial aims to establish the non-inferiority between stents with respect to a device-oriented composite endpoint of cardiovascular death, target-vessel myocardial infarction, or clinically-driven target-lesion revascularization at 12 months after PCI. Additionally, the trial aims to demonstrate the superiority of personalized DAPT compared to a standard approach with respect to a net clinical composite of all-cause death, any myocardial infarction, stroke, urgent target-vessel revascularization, or type 2 to 5 bleeding according to the Bleeding Academic Research Consortium criteria at 24-months after PCI. SUMMARY The PARTHENOPE trial is the largest randomized trial investigating the efficacy and safety of a polymer-free DES with a reservoir technology for drug-release and the first trial evaluating a personalized duration of DAPT based on the DAPT score. The study results will provide novel insights into the optimizing the use of drug-eluting stents and DAPT in patients undergoing PCI