1,721,186 research outputs found
A novel algorithm for the computation of the diastolic pressure ratio in the invasive assessment of the functional significance of coronary artery disease
Full text linkBACKGROUND: Invasive functional assessment is a mainstay in the management of patients with coronary artery disease (CAD), but there is uncertainty on the comparative accuracy of diagnostic indices of functional significance. We aimed to validate the diagnostic performance of a novel non-hyperemic diastolic pressure ratio (dPR). METHODS: We performed a retrospective analysis including two separate registries (VERIFY 2, Latina, Italy) of patients in whom functional indices were measured for lesions with angiographically moderate severity. On top of fractional flow reserve, distal coronary pressure (Pd)/aortic pressure (Pa) ratio, instantaneous wave-free ratio (iFR) and diastolic pressure ratio (dPR) were computed using a novel dedicated algorithm over 4 consecutive beats. Agreement/discrepancy between indexes was appraised Bland-Altman analysis, area under the receiver operating charac-teristic curve (AUC), and unsupervised machine learning. RESULTS: A total of 525 lesions from 479 patients were included. The novel dPR was highly correlated with iFR (R2=0.99, P<0.001), with a mean difference of -0.004±0.014. The diagnostic performance of dPR (best cutoff value: ≤0.89) against iFR was as follows: Accuracy =96%; sen-sitivity =94%; specificity =97%; positive-predictive value =94%; and negative-predictive value =96%. Additionally, AUC to predict iFR≤0.89 was 0.99, which was significantly higher than that of Pd/Pa (0.97, P<0.001). In the iFR range of 0.85-0.93 ("grey zone"), the diagnostic perfor-mance was well maintained (accuracy =91%; sensitivity =87%; specificity =93%; and AUC=0.96). Results were supported also by unsupervised learning analysis. CONCLUSIONS: This multicenter registry suggests this novel dPR algorithm provides results that are numerically equivalent to iFR. Pending further studies, physicians may consider using this novel dPR algorithm to gauge the functional significance of a coronary lesion. (Cite this article as: Versaci F, Conte M, van't Veer M, Lalancette S, Oldroyd K, Calcagno S, et al. a novel algorithm for the computation of the diastolic pressure ratio in the invasive assessment of the functional significance of coronary artery disease
A novel signalling mechanism regulating telomere length in cardiomyocytes
Full text linkClinical management and treatment of human diseases are continuously improving, with a progressive elongation of life expectancy in Western countries. As a consequence of the elevation of the average age of the population, the incidence of ageing-related diseases will progressively in- crease in the next years. Among ageing-related diseases, cardiovascular diseases still represent the first of cause of death in the Western world
Focusing on kidneys and platelets in acute coronary syndromes: pre hoc and post hoc risk profiling
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A Stepwise Approach to Systematic Reviews and Meta-analyses of Endovascular Interventions
No full textThe accrual of clinical studies poses important challenges to researchers and practitioners, especially in the field of endovascular therapy, where patient, lesion, technique, and device subtleties abound. Systematic reviews and meta-analyses may prove particularly fruitful in such settings by increasing statistical precision and bolstering external validity if the evidence base on a specific topic is consistent or by highlighting important discrepancies in the opposite scenario. However, mastering the correct approach to systematic review and meta-analysis is challenging for careful readers or for those interested in conducting such an evidence synthesis exercise. The present article highlights a stepwise approach to systematic reviews and meta-analyses, focusing on endovascular interventions, which will prove useful to anyone reading or wishing to synthesize the evidence base on endovascular topics to optimize decision making or shape future research efforts
How to manage an athlete with mitral valve prolapse
No full textIntroduction: Under the term degenerative mitral valve prolapse different pathophysiological and clinical entities coexist in a spectrum ranging from Barlow’s disease to fibroelastic deficiency, and represent the most common cause of mitral regurgitation in the general population and in athletes. Carrying a mitral valve prolapse is usually considered a benign condition for athletes, but recently the scientific literature has focused on the malignant, thus rare, arrhythmic mitral valve prolapse and its dramatic association with sudden cardiac death, so that specific features should be considered a red flag and prompt additional exams before clear for competition. Discussion: As the athlete’s heart is morphologically accompanied by remodelling and dilatation of the cardiac chambers induced by exercise, it may be challenging to differentiate the degree of left ventricular and atrial dilation induced by significant mitral regurgitation from physiological remodelling, especially in endurance athletes. Conclusion: This how-to article provides clinical and useful data to manage athletes with mitral valve prolapse and to distinguish high-risk athletes carrying the features of arrhythmic mitral valve prolapse
Cocaine and acute coronary syndromes: Novel management insights for this clinical conundrum
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A broken promise: 4-year optical coherence tomography follow-up of a bioresorbable vascular scaffold
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Periprocedural anemia management in severe aortic stenosis patients undergoing transcatheter aortic valve implantation
No full textPreoperative anemia is a common finding in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI), and it has been shown to be associated with high mortality. The present review provides an overview of current management strategies of perioperative anemia in TAVI patients, including red blood cell transfusion, blood conservative protocol, iron supplementation, and erythropoietin administration. The goal is to recognize the treatable causes of anemia and treat them, in order to reduce transfusions and improve the outcome
Simultaneous Hybrid Revascularization with Carotid Stenting and Coronary Artery Bypass Grafting: Long-term Results of the SHARP Study
No full textWe have recently introduced a new therapeutic strategy (“SHARP protocol”) consisting of a simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by coronary artery bypass grafting (CABG) with the aim to reduce operative risk and minimize surgical trauma as compared to traditional approaches. Ninety-five consecutive patients (mean age 68.87.8 years, 79 males,) underwent simultaneous CAS-CABG from January 2005 to July 2013 for treatment of concomitant critical (>70% stenosis) carotid and multivessel coronary artery obstructive disease. In-hospital mortality was 2.1%, perioperative myocardial infarction 0%, CAS periprocedural stroke 0%, TIA 3.2%. Actuarial 9-year survival was 8210%. Freedom from cardiac death was 962%, from myocardial infarction 953%, from neurological events 907%, from CAS procedure-related stroke 100%. The proposed hybrid approach confers a mortality rate comparable to that of isolated CABG; CABG immediately following CAS minimizes the risk of periprocedural myocardial infarction. At a long-term period a high rate of event-free survival and freedom from neurological events can be expected using the SHARP protocol
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