20966 research outputs found
Sort by
A Pilot Study of CO(2) Laser-Assisted Drug Delivery of Hyaluronidase for the Treatment of Scleroderma-Induced Microstomia
No full textFlattening The Saddle: Minimum Intensity Projection Overcomes Saddle-shaped Distortions In Tricuspid Annular Sizing For Transcatheter Tricuspid Valve Replacement
No full textIntroduction: Transcatheter tricuspid valve replacement (TTVR) has emerged as an effective treatment for severe tricuspid regurgitation. Accurate preprocedural assessment of the tricuspid annulus is critical for successful device sizing and deployment. However, the saddle-shaped geometry of the annulus introduces variability in simple planar measurements derived from standard multiplanar reformatted (MPR) images. Dedicated tricuspid annular postprocessing software can account for the saddle shape but typically requires significant and ongoing licensing costs. Minimum intensity projection (minIP) imaging is a standard 3D workstation feature which can provide a virtual flattening of the annular saddle minimizing the impact of annular distortions, without incurring additional expense. Methods: A total of 72 patients who underwent ECG-gated CT angiography (CTA) for preprocedural TTVR planning were evaluated. The imaging planers were aligned to the tricuspid annulus using standard 3D MPR techniques. Additional reconstructions were performed with a minIP reconstruction technique at an increased slide thickness of approximately 10-15 mm. Annular areas and dimensions measured on MPR and minIP reconstructions and compared to vendor-supplied annular reference values from dedicated postprocessing software. Analyses performed using adjusted R2 correlation. Results: MinIP-derived annular measurements demonstrated superior correlation with vendor-supplied reference values compared to MPR: minIP (AdjR2 = 0.91) vs. MPR (AdjR2 = 0.87). This correlation persisted when vendor-supplied maximum annular dimensions were correlated to minIP and MPR maximum annular dimensions: minIP (AdjR2 = 0.90) vs. MPR (AdjR2 = 0.83). When comparing vendor-supplied minimum annular dimension there was no difference between minIP and MPR minimum annular dimensions (AdjR2 = 0.83 each). Conclusions: MinIP derived tricuspid annular measurements have better correlation with vendor supplied measurements, driven by less overestimation of maximum annular dimensions. The effect is likely related to mitigation of saddle-shaped distortion allowing for a more planar measurement. This technique offers a practical and cost-efficient alternative for centers without access to dedicated tricuspid annulus analysis software. By reducing measurement variability, minIP may enhance prosthesis selection and optimize procedural outcomes for TTVR. Future direction is needed to determine specific impact on valve sizing. [Formula presented
Carotid artery stenting with open vs closed stent cell configurations in the CREST-2 Registry
No full textObjective: Intraprocedural atheroembolization during carotid artery stenting (CAS) can be reduced through careful patient selection, consideration of vascular anatomy and lesion characteristics, operator and institutional experience, peri-procedural antithrombotic and antiplatelet therapy, and use of embolic protection. However, CAS can also result in stroke as the stent is deployed and embolic protection withdrawn. The free-cell area of most closed-cell stents is \u3c5 mm2, and ≥5 mm2 for open-cell stents. The larger area may permit escape of more atheromatous debris. Comparisons of clinical outcomes between closed-cell and open-cell stents have been inconclusive. The aim of this study is to compare clinical outcomes associated with CAS using open-cell vs closed-cell stents. Methods: The CREST-2-Registry (C2R) enrolls asymptomatic and symptomatic patients for whom CAS is favored because of high risk for surgery or patient preference. C2R implements operator- and site-credentialing, careful lesion selection, and standardized procedural protocols. Patient characteristics, procedural details, and outcomes are recorded. Interventionists may use United States Food and Drug Administration-approved devices including open-cell stents (Rx Acculink [Abbott Vascular], Precise Pro Rx [Cordis-Cardinal Health], and Protégé Rx [Medtronic/Covidien]), or closed-cell stents (XACT [Abbott Vascular] and Wallstent Monorail Endoprosthesis [Boston Scientific]). Multivariable logistic regression was used to assess relate stent cell configuration to peri-procedural (30-day) stroke or death (SD). Results: Of 5307 procedures performed by 163 interventionists across 101 clinical centers, 2054 (38.7%) received open-cell stents, and 3253 (61.3%) received closed-cell stents. In the periprocedural period, 91 patients (1.7%) experienced a stroke (3 were fatal), and 16 patients died without experiencing strokes (0.4%). After adjusting for age, sex, symptomatic status, and case urgency, and for effect-modification by indication, periprocedural SD was significantly higher when an open-cell stent was placed in a primary lesion compared with closed-cell stents (3.5 events per 100 procedures using open-cell stents [95% confidence interval [CI], 2.6-4.7] vs 2.2% [95% CI, 1.6-3.0] using closed-cell stents (odds ratio, 1.59; 95% CI, 1.13-2.23; P \u3c .01). Periprocedural SD was not significantly different between stent types when placed in a restenotic lesion (1.2% [95% CI, 0.4-3.3]) using open-cell stents vs 4.0% (95% CI, 2.2-7.2) using closed-cell stents (odds ratio, 0.31; 95% CI, 0.09-1.01; P = .052). Conclusions: Stent design influences periprocedural stroke or death in carotid stenting. Closed-cell stents are associated with a lower event rate when treating primary atherosclerosis, but not in the setting of restenosis
TCT-780 Higher One-Year Event Rates With Cardiac MRI–Selected Microvascular Dysfunction MINOCA: A Nationwide Matched Analysis
No full textBackground: Cardiac magnetic resonance (CMR) is a pillar of the diagnostic algorithm for myocardial infarction with non-obstructive coronary arteries (MINOCA), helping in the identification of underlying mechanisms including coronary microvascular dysfunction (CMD). Methods: We queried TriNetX for US nationwide adults with CMD diagnoses since 2016. Patients who underwent CMR before or after one months of the diagnosis formed CMR cohort; those who were diagnosed without CMR served as controls. Propensity-score matching yielded 350 patients per group with excellent balance (all SDs ≤0.015). Mean age was 59; 53 % were female; racial distribution: 66 % White, 19 % Black, 5 % Asian; 5 % identified as Hispanic. Hypertension (69 %) and diabetes (33 %) were equally prevalent. The primary endpoint was a composite of all-cause death, acute myocardial infarction or ischemic stroke from day 1 to 365. Results: During 1-year follow-up, the cardiac-MRI cohort experienced 160 primary events versus 112 among their matched controls. Kaplan–Meier analysis showed significantly lower event-free survival with MRI (47.1 % vs 63.1 %, p = 0.0003). Multivariable Cox regression that included CMD phenotype (MRI vs no-MRI) and potential confounders, cardiac MRI remained an independent predictor of the composite of all-cause death, acute MI or ischemic stroke (hazard ratio 1.55, 95 % CI 1.22–1.98). Heart-failure history and active smoking were additional significant covariates, whereas age, hypertension and hyperlipidemia were not. Thus, even after rigorous adjustment, patients selected for cardiac MRI had a 55 % higher risk of major events within the first year (Table 1). [Formula presented] Conclusion: Our findings indicate that CMR is underutilized in the diagnosis of CMD, probably more among the sicker patients which may explains higher complications rate among this group. This underscores the importance of following MINOCA diagnosis algorithm. Categories: CORONARY: Acute Coronary Syndrome
TCT-950 Clinical Outcomes of Coronary Artery Perforation Treated with Covered Stents: The Impact of Intravascular Ultrasound Guidance in a Contemporary Cohort
No full textBackground: Coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) carries significant morbidity and mortality; however, data are limited regarding the specific role of intravascular ultrasound (IVUS) in evaluating and guiding management after CAP occurs and Whether this approach improves clinical outcomes. Methods: This study consisted of a retrospective analysis of all patients who underwent PCI and experienced a coronary perforation at a single tertiary care hospital between December 2014 and January 2024. All included patients underwent PCI with coronary artery perforation treated using covered stents. The primary outcome was target vessel revascularization (TVR). Secondary outcomes included mortality, myocardial infarction (MI), in-stent restenosis, and emergency cardiac surgery. Multivariable logistic regression assessed IVUS’s association with outcomes. Results: Between 2014 and January 2024, 127 cases of CAP during PCI were identified. Of these, 34 patients (26.8%) underwent IVUS-guided stent optimization, whereas 93 patients (73.2%) did not undergo IVUS. Patients in the IVUS group were older (75.1±8.4 vs. 61.0±10.3 years, p\u3c0.001) and predominantly female (55.9% vs. 31.2%, p=0.020). IVUS was more frequently used for left anterior descending artery perforations (64.7% vs. 36.6%, p=0.009). IVUS was associated with a reduced risk of TVR during an average 60.3 months of follow-up (adjusted odds ratio: 0.04, 95% confidence interval: 0.02–0.56, p=0.031). Other outcomes, including mortality and repeat MI, were similar between both two groups. Conclusion: IVUS use in patients requiring covered stents for CAP treatment, despite higher procedural complexity and prevalence of severe perforations were associated with significantly reduced TVR, suggesting IVUS\u27s potential role in improving clinical outcomes following CAP. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP
TCT-1083 Association of Weekend Admission With Clinical Outcomes and Invasive Management in ST-Elevation Myocardial Infarction: A National Cohort Analysis
No full textBackground: ST-elevation myocardial infarction (STEMI) requires urgent revascularization to improve outcomes. The “weekend effect”—worse outcomes for weekend admissions—has been observed across various conditions, but its impact on all-comer STEMI hospitalizations remains unclear. Prior studies have focused on those receiving prompt PCI; less is known about overall access and outcomes. This study assesses whether weekend admission independently affects treatment and clinical outcomes in all STEMI admissions. Methods: We analyzed the 2017–2022 National Inpatient Sample for adults (≥18 years) with a primary STEMI diagnosis. Weekend admission was identified via the AWEEKEND variable. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, AKI, vasopressor use, sepsis, CVA, ICU admission, cardiac arrest, PCI and CABG (within 24h or overall), and mechanical circulatory support. Weighted logistic regression adjusted for patient and hospital factors. Results: Among 1.5 million STEMI admissions (25.9% weekend), weekend admission was linked to higher mortality (aOR 1.026), shock, AKI, sepsis, CVA, ICU use, and arrest (all p \u3c 0.05). Odds of PCI within 24h, CABG, and any revascularization were lower (all p \u3c 0.001). No differences were found in bleeding, ECMO, or balloon pump use. Impella use was slightly lower. [Formula presented] Conclusion: Weekend STEMI admission remains associated with worse outcomes and reduced revascularization. System-wide strategies are needed to close these gaps. Categories: CORONARY: Acute Coronary Syndrome
Smarter Repositories—Leveraging AI and APIs to Power Institutional Knowledge
No full textInstitutional repositories (IRs) are vital tools for preserving and showcasing the intellectual output of healthcare organizations, yet they often struggle to keep pace with the volume and complexity of modern research. This presentation explores how a librarian-led initiative is reimagining the IR as a dynamic, accessible, and strategic resource. By integrating automated harvesting and metadata enhancement tools, the repository supports more efficient collection, organization, and discovery of institutional publications—without placing undue burden on library staff or researchers
Evidence-Informed Decision Making at Monash Health
No full textThis presentation explores the development, implementation, and value of the Evidence Report Service at Monash Health Library – an initiative designed to reinforce evidence-informed decision-making across one of Australia’s largest public health services. The service provides timely, tailored evidence summaries in response to clinical, operational, and strategic queries from Monash Health employees, helping inform policy, practice, and service improvements. This presentation will outline the collaborative workflows that underpin the service, from question clarification and systematic searching to screening and report building. Following a systematic literature search, reports are produced by health librarians in a consistent, branded format that enhances readability and usability while also building the library\u27s identity as a trusted support service for evidence-based information. As part of our commitment to cultivating knowledge and open access, completed reports are added to the Monash Health Research Repository, increasing their potential for broader impact within the organisation and beyond. The presentation will share analytics about the service and highlight library strategies for disseminating these reports through internal channels and global discovery systems – positioning health librarians as expert searchers and key contributors to knowledge translation. By showcasing the Evidence Report Service, we aim to inspire other health libraries to embed similar practices, demonstrating how librarianship can not only support but actively drive innovation, learning, and improved outcomes across healthcare organisations
Safety of seladelpar in primary biliary cholangitis patients with cirrhosis and clinical signs of portal hypertension: data from the ENHANCE and RESPONSE studies
No full textBackground and aims: Primary biliary cholangitis (PBC) is a chronic, progressive, autoimmune, cholestatic liver disease that can cause cirrhosis and portal hypertension (PHT). Seladelpar is a first-in-class delpar (selective PPAR-delta agonist) approved for the treatment of PBC in combination with ursodeoxycholic acid (UDCA) in adults who have an inadequate response to UDCA, or as monotherapy in patients (pts) unable to tolerate UDCA. In two Phase 3, placebo-controlled studies (ENHANCE [NCT03602560] and RESPONSE [NCT04620733]), seladelpar significantly reduced cholestatic markers of disease and pruritus with a safety profile similar to placebo (primary analyses at month 3 in ENHANCE and month 12 in RESPONSE). Here, we present pooled safety data from these studies in a subgroup of patients with cirrhosis and clinical signs of PHT. Method: Pts with PBC who received UDCA for ≥ 12 months or were UDCA intolerant with alkaline phosphatase (ALP) ≥ 1.67 × upper limit of normal (ULN) and total bilirubin (TB) ≤ 2 × ULN were randomised 1:1:1 to daily placebo, seladelpar 5 mg, or seladelpar 10 mg for up to 52 weeks in ENHANCE and 2:1 to daily seladelpar 10 mg or placebo for 52 weeks in RESPONSE. Cirrhosis was defined by medical history, liver biopsy, transient elastography, laboratory findings, radiological features, or clinical determination by the investigator. Pts with cirrhosis were identified as having signs of PHT at baseline (BL) if they had thrombocytopenia (platelet count \u3c 140 × 103 μL), low albumin, elevated TB, or medical history of varices or ascites. Data are reported for the seladelpar (5 mg and 10 mg) and placebo groups. Results: Among 56 pts with a diagnosis of cirrhosis at BL across the two studies, 27 had signs of PHT at BL (21 pts on seladelpar [15 21 on 10 mg] and 6 placebo). The majority of pts were female (85%) and White (89%), with a mean (range) age of 55.6 (33–74) years, and BL mean ALP and TB levels of 319.9 U L and 1.2 mg dL. Mean (SD) liver stiffness was 17.4 (3.5) kPa with placebo and 21.0 (11.8) kPa with seladelpar. In total, 5 6 (83%) pts on placebo and 15 21 (71%) pts on seladelpar experienced an adverse event (AE); 2 6 (33%) pts on placebo and 1 21 (5%) pts on seladelpar discontinued treatment due to AEs. Serious AEs occurred in 1 6 (17%) pts on placebo and 1 21 (5%) pts on seladelpar and deemed unrelated to study drug. Liver-related AEs by a predefined search strategy were similar across pts on placebo (2 6, 33%) or seladelpar (3 21, 14%) and included hepatomegaly, ascites, hyperbilirubinaemia, and portal hypertensive gastropathy. Liver-related laboratory abnormalities by predefined categories occurred in 2 6 (33%) placebo-treated pts and 1 21 (5%) seladelpar treated pts. Conclusion: In this pooled analysis of pts with PBC and cirrhosis with clinical signs of PHT from the ENHANCE and RESPONSE studies, safety outcomes were overall similar between seladelpar and placebo, with no new safety signals