Coronary computed tomography angiography (CCTA) is emerging as a valuable adjunct for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), particularly for lesions in which angiography incompletely def...Coronary computed tomography angiography (CCTA) is emerging as a valuable adjunct for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), particularly for lesions in which angiography incompletely defines procedural anatomy. In this systematic review, the authors evaluated the role of CCTA in CTO diagnosis, lesion characterization, prediction of guidewire crossing and procedural success, and procedural guidance. CCTA provides a detailed assessment of key features that directly influence CTO PCI strategy and outcomes. Randomized and observational data suggest that preprocedural CCTA can improve procedural planning, increase technical success in complex lesions, and support safer and more efficient CTO PCI through fluoroscopic co-registration and other real-time guidance applications. These findings highlight the clinical value of CCTA as a tool that can enhance case selection, optimize crossing strategy, and improve procedural success in contemporary CTO PCI.
Am J Cardiol
· 2026 Jul · PMID 42069284
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Full text
Temporizing balloon aortic valvuloplasty (BAV) may be utilized in the management of decompensated severe aortic stenosis. BAV is occasionally used as a bridge to eventual transcatheter aortic valve replacement (TAVR). We...Temporizing balloon aortic valvuloplasty (BAV) may be utilized in the management of decompensated severe aortic stenosis. BAV is occasionally used as a bridge to eventual transcatheter aortic valve replacement (TAVR). We sought to evaluate the outcomes of urgent inpatient TAVR versus BAV followed by TAVR (BAVTAV). The United States Medicare database was used to evaluate all beneficiaries undergoing TAVR (n = 227,145) or BAV (n = 16,643) from 2018 to 2022. Patients were stratified into 3 cohorts: urgent inpatient TAVR without BAV, urgent BAV followed by inpatient TAVR (urgent BAVTAV), and urgent BAV followed by elective outpatient TAVR (elective BAVTAV). To adjust for selection bias, doubly robust risk adjustment was performed using inverse probability weighting and multilevel regression to assess peri-procedural and 5-year outcomes. A total of 23,762 patients underwent urgent TAVR without BAV, while 4,404 patients received BAVTAV (1,503 urgent and 2,901 elective). Inpatient mortality of urgent TAVR, urgent BAVTAV, and elective BAVTAV was 3.0%, 5.3%, and 1.5%, respectively, with a similar association for acute stroke (2.1% vs 2.7% vs 2.0%) and new pacemaker implantation (8.5% vs 8.5% vs 6.0%). After risk adjustment, elective BAVTAV was associated with lower index mortality (odds ratios 0.61, p = 0.011), stroke (odds ratios 0.55, p < 0.0001), and longitudinal mortality (hazard ratio 0.67, p < 0.001) compared with urgent TAVR. Urgent BAVTAV was associated with a higher index and longitudinal mortality. In conclusion, among Medicare beneficiaries with acutely decompensated severe aortic stenosis, temporizing BAV as a bridge to future outpatient elective TAVR appears to be a viable treatment strategy when felt to be medically possible.
GLP-1 receptor agonists (GLP-1 RAs) are increasingly evaluated for cardiovascular outcomes, including heart failure (HF), due to their weight-reducing and anti-inflammatory effects. Individual trials in HF have reported...GLP-1 receptor agonists (GLP-1 RAs) are increasingly evaluated for cardiovascular outcomes, including heart failure (HF), due to their weight-reducing and anti-inflammatory effects. Individual trials in HF have reported heterogeneous results, which appear to differ by HF subtype. No previous quantitative synthesis has systematically compared GLP-1 RA effects in heart failure with preserved (HFpEF) versus reduced ejection fraction (HFrEF) across a wide range of clinically relevant outcomes. This meta-analysis addresses this gap by evaluating subtype-specific efficacy across clinical, functional, biochemical, and hemodynamic domains to guide therapy and inform future research. Eight randomized controlled trials enrolling 11,234 patients were included following a systematic search of major databases per PRISMA 2020 guidelines. Risk of bias was assessed using the Cochrane ROB 2.0 tool. Data were pooled using random-effects models with Hartung-Knapp adjustment. Sensitivity analyses assessed robustness, and the certainty of evidence was rated using GRADE. In HFpEF, GLP-1 RAs significantly reduced HF worsening events (hazard ratios [HR] 0.67, 95% confidence intervals [CI] 0.50-0.89; I² = 9.9%, high certainty) and improved NT-proBNP (ratio 0.85), 6-minute walk distance (+17.6 m), Kansas City Cardiomyopathy Questionnaire score (+7.4 points), and systolic blood pressure (-3.6 mmHg). The composite of HF worsening events or cardiovascular death was also reduced (HR 0.76, 95% CI 0.64-0.90). In HFrEF, no benefit was observed for HF worsening events (HR 1.23, 95% CI 0.89-1.69; I² = 0%, moderate certainty) or secondary outcomes. Gastrointestinal adverse events were the most frequent cause of drug discontinuation (risk ratio 3.12, 95% CI 1.28-7.63). In conclusion, GLP-1 RAs improve clinical, functional, and biomarker outcomes in HFpEF but not in HFrEF, highlighting subtype-specific efficacy. Gastrointestinal intolerance remains a key limitation, emphasizing the need for careful patient selection to optimize adherence. PROSPERO Registration: CRD420251138529. (Central Illustration).
Atrial fibrillation (AF) commonly complicates myocardial infarction (MI) and is associated with adverse outcomes. However, the prognostic significance of AF timing after MI remains incompletely understood. We conducted a...Atrial fibrillation (AF) commonly complicates myocardial infarction (MI) and is associated with adverse outcomes. However, the prognostic significance of AF timing after MI remains incompletely understood. We conducted a retrospective cohort study of 3,390 patients with myocardial infarction, stratified by MI subtype (non-ST-segment elevation myocardial infarction [NSTEMI] and ST-segment elevation myocardial infarction [STEMI]). AF was categorized as early (during index hospitalization), late (after discharge), or absent. Clinical, echocardiographic, and angiographic data were collected. Outcomes were assessed using Kaplan-Meier analyses and log-rank testing. The association between AF timing and outcomes was evaluated using multivariable time-dependent Cox proportional hazards models with pairwise comparisons, adjusting for relevant demographic and clinical covariates. Predictors of late AF were evaluated using multivariable logistic regression. Among patients with MI, AF developed in 451 patients (13.3%), 114 with STEMI and 337 with NSTEMI, occurring as early AF in 249 and late AF in 202. Kaplan-Meier analyses demonstrated a significant in long-term major adverse cardiovascular events (MACE), defined as recurrent MI with or without repeat revascularization, stroke, and all-cause mortality, according to AF timing, with late AF associated with the poorest outcomes (p < 0.001). In multivariable time-dependent Cox models, late-onset AF was independently associated with an increased risk of MACE (HR: 1.5 [1.0-2.2], p = 0.044; HR: 2.4 [1.1-5.3], p = 0.032 in NSTEMI and STEMI, respectively). In contrast, early AF was not consistently associated with long-term MACE after adjustment (HR: 0.7 [0.4-1.0], p = 0.060, HR: 1.3 [0.8-2.3], p = 0.327 in NSTEMI and STEMI, respectively). Pairwise comparisons confirmed a higher risk with late AF compared with no AF. In contrast, the late versus early AF comparison did not reach statistical significance in STEMI, likely due to limited event numbers. In multivariable logistic regression, older age and diabetes mellitus were independently associated with the development of late AF. AF timing after MI is prognostically relevant. Late-onset, but not early, AF was independently associated with adverse outcomes in time-dependent analyses, supporting a temporal classification of AF.
Both cardiorespiratory fitness (CRF) and exercise systolic blood pressure (ESBP) have been individually linked to adverse cardiovascular outcomes, but their combined impact remains underexplored. Cardiorespiratory fitnes...Both cardiorespiratory fitness (CRF) and exercise systolic blood pressure (ESBP) have been individually linked to adverse cardiovascular outcomes, but their combined impact remains underexplored. Cardiorespiratory fitness and maximal ESBP were assessed during exercise testing at baseline in 4,032 participants with a mean age of 50.7 years. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During a median follow-up of 26.5 years, 1,302 deaths occurred, including 460 cardiovascular disease (CVD) and 296 coronary heart disease (CHD) deaths. Higher CRF showed a strong inverse association with all outcomes. Compared with participants in the lowest CRF category, those in the highest CRF category had substantially lower risks of CHD mortality (HR 0.40, 95% CI 0.23-0.70), CVD mortality (HR 0.32, 95% CI 0.20-0.51), and all-cause mortality (HR 0.42, 95% CI 0.33-0.53). Higher maximal ESBP categories were also associated with lower risks of CHD and CVD mortality; participants in the highest ESBP category had lower risks of CHD mortality (HR 0.52, 95% CI 0.36-0.75) and CVD mortality (HR 0.58, 95% CI 0.43-0.78) compared with those in the lowest category. In joint analyses, participants with medium-low, medium-high, or high CRF had consistently lower mortality risk across all ESBP categories. The most favorable prognosis was observed among individuals with high CRF combined with low ESBP levels. In conclusion, higher CRF is consistently associated with lower CHD, CVD, and all-cause mortality across all ESBP categories. The combined evaluation of sex-specific CRF and exercise blood pressure responses may improve cardiovascular risk stratification.
Despite device improvement and systematic procedure planning based on multislice computed tomography (MSCT), vascular and bleeding complications remain common adverse events after transfemoral transcatheter aortic valve...Despite device improvement and systematic procedure planning based on multislice computed tomography (MSCT), vascular and bleeding complications remain common adverse events after transfemoral transcatheter aortic valve implantation (TF-TAVI). To date, the best way to conduct a TF-TAVI procedure in order to reduce the occurrence and facilitate the treatment of vascular/bleeding complications is unknown. TF-TAVI streamlining includes skipping femoral protection strategies and might be the ideal solution for patients with low vascular risk. To quantify the incidence and clinical impact of operative iliofemoral vascular events after TF-TAVI and to identify MSCT-derived predictors that may inform selective use of femoral protection strategies. We analyzed 960 consecutive patients undergoing TF-TAVI with high-quality preprocedural MSCT imaging of the operative aorto-iliofemoral axis. The primary endpoint was 30-day vascular events, defined as a composite of operative iliofemoral access vascular complications (VARC-3) and/or need for balloon hemostasis. Complications related to the secondary access were adjudicated separately. Independent predictors were assessed using multivariable logistic regression. Vascular events occurred in 128 patients (13.3%), driven by operative access-site vascular (major or minor) complications (9.8%) and balloon hemostasis need (3.5%). Patients with vascular events were more often female and had smaller iliofemoral lumen dimensions, higher sheath-to-artery ratio (STAR), and more extensive circumferential calcification. At multivariable analysis, independent predictors were female sex (odds ratios [OR] 1.90; 95% confidence intervals [CI] 1.38-2.60; p < 0.001), STAR >1 (OR 1.63; 95% CI 1.12-2.40; p = 0.011), and calcification arc ≥90° across all 3 iliofemoral segments (common iliac, external iliac, and common femoral arteries) (OR 2.45; 95% CI 1.04-5.74; p = 0.040). Vascular events were associated with higher 30-day mortality (4.7% vs 1.3%; p = 0.022) and major bleeding (VARC-3 type 3: 3.1% vs 1.0%; p = 0.040; type 4: 1.6% vs 0.1%; p = 0.006). In conclusion, in contemporary TF-TAVI, approximately 1 in 8 patients experiences operative iliofemoral vascular events requiring peripheral bailout measures. An MSCT-derived "fragile access" profile (female sex, STAR >1, and diffuse circumferential iliofemoral calcification) may help target protection strategies. Condensed abstract In a large cohort of 960 TF-TAVI patients, operative ilio-femoral vascular events occurred in 13.3% and were associated with increased 30-day mortality and major bleeding. Patients with events had smaller ilio-femoral lumen dimensions, higher sheath-to-artery ratio (STAR), and more extensive circumferential calcification. Independent CT-guided predictors were female sex (OR 1.90), STAR >1 (OR 1.63), and calcification arc ≥90° across all three iliofemoral segments (OR 2.45). These findings support CT-based selection of femoral protection strategies, reserving ancillary access and bailout readiness for "fragile access" anatomy and reducing invasiveness when anatomy is favorable.
We describe the use of a 0.009-inch tapered-tip guidewire to achieve successful revascularization of tibial chronic total occlusions in a patient with chronic limb-threatening ischemia initially referred for major amputa...We describe the use of a 0.009-inch tapered-tip guidewire to achieve successful revascularization of tibial chronic total occlusions in a patient with chronic limb-threatening ischemia initially referred for major amputation. Initial revascularization attempts using multiple non-tapered 0.014-inch and 0.018-inch guidewires were unsuccessful. Subsequent use of 0.009-inch and 0.010-inch tapered-tip guidewires enabled intraluminal crossing of the tibioperoneal trunk, posterior tibial, and peroneal artery CTOs, followed by angioplasty and restoration of in-line flow. This case highlights the feasibility of leveraging microchannels within peripheral CTOs using tapered-tip guidewires to achieve successful revascularization and limb salvage.
Patients with small aortic annuli (SAA) undergoing transcatheter aortic valve replacement (TAVR) are at increased risk of elevated transvalvular gradients and prosthesis-patient mismatch (PPM), making valve selection cri...Patients with small aortic annuli (SAA) undergoing transcatheter aortic valve replacement (TAVR) are at increased risk of elevated transvalvular gradients and prosthesis-patient mismatch (PPM), making valve selection critical. We hypothesized that balloon-expandable valves (BEVs) and self-expandable valves (SEVs) differ in their clinical and hemodynamic outcomes in this population. We searched PubMed, Cochrane, ScienceDirect, and Google Scholar for studies published before May 2025. Randomized controlled trials (RCTs) and propensity score matched (PSM) studies comparing BEVs and SEVs were included. Outcomes were pooled using mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CIs). Analyses were performed in R (v4.4.2), and heterogeneity was assessed using the I² statistic. Fourteen studies, 2 RCTs, and 12 PSM studies met the inclusion criteria. Compared to SEVs, BEVs were associated with a significantly lower indexed effective orifice area (MD -0.18; 95% CI -0.24 to -0.11; p <0.01), higher mean transvalvular gradient (MD 4.27; 95% CI 3.07-5.47; p <0.01), and increased risk of PPM (RR 1.56; 95% CI 1.14-2.13; p = 0.006) and severe PPM (RR 2.66; 95% CI 1.97-3.60; p <0.001). BEVs were linked to lower rates of pacemaker implantation (RR 0.64; 95% CI 0.46-0.89; p = 0.008) and major bleeding (RR 0.69; 95% CI 0.50-0.96; p = 0.028). In SAA patients undergoing TAVR, BEVs show inferior hemodynamics but reduced need for pacemakers and bleeding risk. In conclusion, long-term prospective studies with contemporary devices are needed to clarify these trade-offs.
Timely reperfusion is key to ensuring better outcomes in patients with large-vessel acute ischemic stroke. The role of thrombolysis (IVT) prior to endovascular thrombectomy (EVT) remains controversial, with previous stud...Timely reperfusion is key to ensuring better outcomes in patients with large-vessel acute ischemic stroke. The role of thrombolysis (IVT) prior to endovascular thrombectomy (EVT) remains controversial, with previous studies yielding contradictory findings. This meta-analysis compares the efficacy and safety of IVT prior to EVT in acute ischemic stroke. A comprehensive literature search was performed across PubMed MEDLINE, Cochrane Library, ScienceDirect, Google Scholar, and ClinicalTrials.gov for eligible studies. Twenty-one studies (8 RCTs, 13 observational studies; n = 10,538) published between 2013 and 2025 were included in the meta-analysis. The primary outcome was 90-day functional independence (mRS 0-2), with secondary outcomes including successful reperfusion (mTICI ≥ 2b), 90-day mortality, symptomatic intracranial hemorrhage (sICH), and any ICH. Pooled risk ratios (RR) were calculated. The certainty of evidence was evaluated using the GRADE framework. Bridging therapy resulted in higher rates of 90-day functional independence (RR 1.12, 95% confidence intervals [CI] 1.05-1.20), successful reperfusion (RR 1.04, 95% CI 1.01-1.06), and lower 90-day mortality (RR 0.80, 95% CI 0.69-0.91). However, the benefit was offset by significantly increased risk of sICH (RR 1.35, 95% CI 1.03-1.65). Results were consistent for subgroups with similar baseline NIHSS scores, time to groin puncture, full-dose alteplase, and cohorts, while RCTs and low-dose alteplase did not show significant results. While observational data suggest a clinical advantage, randomized evidence does not consistently demonstrate superiority of bridging therapy over EVT alone. In conclusion, these findings support individualized treatment decisions based on workflow efficiency, stroke severity, and bleeding risk rather than a universal approach.
Drug-coated balloons (DCB) have emerged as a valuable alternative to drug-eluting stents for obstructive coronary artery disease (CAD). While paclitaxel-coated balloons (PCB) are the most employed DCB, sirolimus-coated b...Drug-coated balloons (DCB) have emerged as a valuable alternative to drug-eluting stents for obstructive coronary artery disease (CAD). While paclitaxel-coated balloons (PCB) are the most employed DCB, sirolimus-coated balloons (SCB) have been evaluated in recent years to address potential safety concerns associated with PCB. However, real-world comparisons of the clinical outcomes of PCB and SCB remain limited. We combined 2 large prospective registries involving patients undergoing percutaneous coronary intervention with DCB: the EASTBOURNE registry (n = 2,078 patients, treated with MagicTouch SCB) and the PEARL registry (n = 513 patients, treated with Protégé PCB). The primary outcome was major adverse cardiac events (MACE), a composite of all-cause mortality, myocardial infarction (MI), and target lesion revascularization (TLR) at 2-year follow-up. All analyses were stratified according to clinical presentation: de novo CAD and in-stent restenosis (ISR). Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression. Adjustment was performed for clinical and angiographic variables that differed between the 2 groups. At 24 months, the risk of MACE was similar between SCB and PCB both in de novo CAD (unadjusted HR 0.80, 95% CI 0.43-1.50; p = 0.487; adjusted HR 0.94, 95% CI 0.47-1.95; p = 0.849) and ISR (unadjusted HR 0.96, 95% CI 0.70-1.32; p = 0.544; adjusted HR 0.90, 95% CI 0.63-1.28; p = 0.555). This real-world comparison demonstrated comparable outcomes between new-generation PCB and SCB with respect to MACE at 2 years of follow-up.
Comparative data on clinical outcomes between drug-coated balloons (DCB) and drug-eluting stents (DES) in percutaneous coronary intervention (PCI) for de novo coronary artery disease (CAD) remain limited. To assess the s...Comparative data on clinical outcomes between drug-coated balloons (DCB) and drug-eluting stents (DES) in percutaneous coronary intervention (PCI) for de novo coronary artery disease (CAD) remain limited. To assess the short- and long-term safety and efficacy of DCB versus DES in patients with de novo CAD. A total of 14 randomized controlled trials, including 7,983 patients (3,999 assigned to DCB and 3,984 to DES), were analyzed. The primary endpoint was a composite endpoint of all-cause mortality, myocardial infarction (MI), and target lesion or vessel revascularization (TLR/TVR). The study was registered in PROSPERO (CRD420251172926). In a mean follow-up of 2.1 years (ranging from 6 months to 5 years), DCB and DES showed no significant difference in the primary composite endpoint (risk ratio [RR] 0.95; 95% confidence interval [CI] 0.68 to 1.32; p = 0.76). There were no differences in all-cause mortality (RR 1.02; 95% CI 0.79 to 1.31; p = 0.88), cardiac death (RR 1.04; 95% CI 0.75 to 1.45; p = 0.80), MI (RR 0.90; 95% CI 0.68 to 1.20; p = 0.47), target vessel MI (RR 1.09; 95% CI 0.78 to 1.53; p = 0.60), TLR (RR 1.27; 95% CI 0.70 to 2.31; p = 0.43), or target vessel thrombosis (RR 0.51; 95% CI 0.04 to 6.20; p = 0.60). However, DCB therapy was associated with a significantly lower incidence of Bleeding Academic Research Consortium 3 to 5 bleedings (RR 0.65; 95% CI 0.43 to 0.98; p = 0.04). In conclusion, DCB demonstrated comparable safety and efficacy to DES in patients with de novo CAD, with a significantly lower rate of major bleeding events at 2-year follow-up. These findings support DCB therapy as a viable "leave-nothing-behind" alternative to stent implantation across diverse vessel sizes and follow-up durations.
Drug-coated balloons (DCB), also termed drug-eluting balloons, deliver an antiproliferative drug to the coronary vessel wall during a single balloon inflation without leaving a permanent implant. The "leave-nothing-behin...Drug-coated balloons (DCB), also termed drug-eluting balloons, deliver an antiproliferative drug to the coronary vessel wall during a single balloon inflation without leaving a permanent implant. The "leave-nothing-behind" paradigm is established for in-stent restenosis and has a mature randomized evidence base in small-vessel de novo disease. Its role in large native vessels (here operationally ≥2.75 mm) remains debated because large-vessel percutaneous coronary intervention has a high bar set by contemporary drug eluting stents (DES) and because DCB performance is strongly dependent on lesion preparation, dissection management, and bailout stenting rules. In de novo noncomplex disease, REC-CAGEFREE I-an open-label randomized strategy trial enrolling acute and chronic coronary syndromes irrespective of vessel diameter-did not demonstrate noninferiority of a paclitaxel DCB strategy with rescue stenting compared with intended DES at 24 months and showed a directionally unfavorable signal in the non-small-vessel subgroup (device diameter ≥3.0 mm). Conversely, large-vessel-focused meta-analyses report broadly comparable clinical outcomes between DCB strategies and DES in selected lesions, with consistently greater acute gain after DES but no consistent differences in major adverse events or late lumen loss. In small vessels, high-certainty evidence supports DCB effectiveness: Basel Kosten Effektivitatis Trial -drug coated balloons versus drug-eluting stents in small vessel interventions 2 (BASKET-SMALL 2) confirmed long-term noninferiority of DCB versus DES at 3 years, diabetes subgroup analyses provide further granularity, and the assessment of long-term clinical outcomes of de novo DCB performance (ANDROMEDA) individual patient data meta-analysis demonstrated lower 3-year major adverse cardiovascular events after paclitaxel-coated balloon angioplasty compared with DES, with similar target lesion failure. In conclusion, this review synthesizes the full provided evidence set (acute coronary syndromes and stable disease), clarifies what is device/platform-specific versus strategy-specific, and provides an operator-oriented framework for the implementation of DCB strategies in contemporary clinical practice.
Mortada I, Lee AW, Sahu A
… +10 more, Vidal E, Buckingham D, Paul K, Alhanbali Y, Mansour S, Chatila K, Iturrizaga Murrieta J, Jehle D, Blackwell TA, Jneid H
Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve outcomes in heart failure (HF), yet comparative effectiveness between individual agents in heart failure with mildly reduced ejection fraction (HFmrEF) remains li...Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve outcomes in heart failure (HF), yet comparative effectiveness between individual agents in heart failure with mildly reduced ejection fraction (HFmrEF) remains limited. We conducted a retrospective cohort study using the TriNetX Global Collaborative Network electronic health record database. Adults (≥18 years) with HF and left ventricular ejection fraction (LVEF) 41% to 49% initiating empagliflozin or dapagliflozin between September 1, 2021, and September 1, 2022, were included. Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory values, yielding 1,386 patients per group. Outcomes were assessed over 1 year after treatment initiation and included all-cause mortality, hospitalization, HF exacerbation, and urinary tract infection (UTI). Risk analyses and Kaplan-Meier survival analyses with hazard ratios (HRs) were performed. In the matched cohort, empagliflozin was associated with significantly lower hazards of hospitalization (HR 0.54, 95% CI 0.49 to 0.60), HF exacerbation (HR 0.63, 95% CI 0.55 to 0.71), and UTI (HR 0.70, 95% CI 0.55 to 0.90) compared with dapagliflozin. All-cause mortality was numerically lower with empagliflozin but did not reach statistical significance (HR 0.86, 95% CI 0.67 to 1.10). In conclusion, in this large real-world HFmrEF population, empagliflozin was associated with lower hazards of hospitalization, HF exacerbation, and UTI compared with dapagliflozin, with no significant difference in mortality. These findings suggest potential heterogeneity in clinical effectiveness among SGLT2 inhibitors in HFmrEF and warrant confirmation in prospective comparative studies.
Appadurai V, Bavishi A, Slostad B
… +13 more, Thomas JD, Rigolin VH, Shah S, An S, Baldridge AS, Edwards N, Scalia GM, Chan J, Hamilton-Craig C, Zielinski A, Engel DJ, Martinez MW, Puthumana JJ
Elite basketball athletes undergo unique physiological cardiac adaptations. Novel myocardial strain indices, such as global myocardial work index (GWE) and left ventricular mechanical dispersion (LVMD), provide valuable...Elite basketball athletes undergo unique physiological cardiac adaptations. Novel myocardial strain indices, such as global myocardial work index (GWE) and left ventricular mechanical dispersion (LVMD), provide valuable insight into myocardial mechanics and have never been previously investigated in a large elite athlete population. Investigating the ranges of left ventricular myocardial work indices and LVMD within a normal elite basketball athlete population. A retrospective cross-sectional study analyzing echocardiographic and strain-based indices of elite basketball athletes from the National Basketball Association (NBA) Draft Combine. Participants were classified by various cutoffs of indexed left ventricular end-diastolic volume (iLVEDV), racial differences, and myocardial work efficiency (GWE). Of 201 athletes, mean age was 20 ± 2 years, height 198 ± 9 cm, BSA 2.3 ± 0.2 m, and 86.6% were black. Mean global longitudinal strain (GLS) -17.8 ± 1.7%, LVMD 49.6 ± 22 ms and global work index 1,594.1 ± 232.3 mmHg% within the entire cohort. No significant differences in LVGLS, LVMD, or myocardial work indices were observed between racial groups or between athletes with iLVEDV >74 ml/m vs iLVEDV <74 ml/m. Athletes with GWE <96% were significantly taller, had lower LV GLS (p = <0.001), global work indices (p = <0.001), and higher LVMD (p = <0.001) compared to GWE >96%. In conclusion, myocardial work and mechanical dispersion were not significantly different between athletes of different racial groups or iLVEDV. Athletes with GWE <96% had significantly lower LV GLS, global myocardial work indices, and higher LVMD compared to athletes with GWE >96%.
Aortic valve area (AVA) is used to assess aortic stenosis severity, yet normal reference values remain poorly defined, partly owing to technical limitations with two-dimensional echocardiography. We aim to characterize A...Aortic valve area (AVA) is used to assess aortic stenosis severity, yet normal reference values remain poorly defined, partly owing to technical limitations with two-dimensional echocardiography. We aim to characterize AVA using three-dimensional transesophageal echocardiography (3D TEE) in patients with non-calcified aortic valves (AV) and to clarify its associations with age, sex, body surface area (BSA), and aortic root geometry. We retrospectively analyzed the data of 239 Japanese adults (mean age, 66 years; 27% women) without AV or root diseases. Anatomically normal AVA was quantified by 3D planimetry during early systole. The median AVA was 3.2 cm and was significantly associated with age, sex, and BSA. AVA was smaller in women than in men (2.7 vs 3.4 cm, p <0.001), even after adjusting for BSA. AVA remained largely unchanged with age in women but declined significantly with aging in men. Similar trends were observed in annular areas, except for a modest reduction in older women. Consequently, the AVA-to-annulus area ratio was higher in women (0.79 vs 0.76). AVA correlated most strongly with annular area (R = 0.69), followed by sinus of Valsalva diameter (R = 0.60) and sinotubular junction area (R = 0.50) (all p <0.001). A multivariate model adjusted for age, sex, stroke volume, and annular area explained AVA well (adjusted R = 0.66), whereas substituting BSA for annular area markedly reduced explanatory power (adjusted R = 0.42). Annular area may be a key determinant of anatomically normal AVA. Indexing AVA to annular area, rather than BSA, may provide a more accurate assessment of aortic stenosis severity.
The transradial technique has become standard of care for coronary angiography and intervention. In the field of diagnostic coronary angiography, studies have compared single and dual catheter approaches, yet there is pa...The transradial technique has become standard of care for coronary angiography and intervention. In the field of diagnostic coronary angiography, studies have compared single and dual catheter approaches, yet there is paucity of literature comparing all 3 commonly used strategies for transradial coronary angiography, Judkins (JU) dual catheters or single Tiger (T) or Jacky (JA) catheters. We aimed to assess the procedural performance of 3 commonly used catheter strategies. We conducted a single-center, randomized trial with 1:1:1 group allocation (T, JA, and JU as initial strategy) with patients undergoing elective right transradial coronary angiography performed by experienced operators. Primary endpoints included procedure time, contrast volume, and fluoroscopy time. A total of 99 patients were randomized: 33 were enrolled in the T-study group, 33 in the JA group, and 33 in the JU group. Median contrast volume utilization was significantly lower in the T group relative to the other groups ([T: 40 mL {35 to 50 mL}, JA: 50 mL {40 to 59 mL}, JU: 55 mL {45 to 60 mL}, p = 0.04]). The Tiger group was noted to have significantly lower times total procedural time (T: 9.2 minute [6.92 to 11.3 minute], JA: 11.92 minute [8.2 to 17.57 minute], JU: 12.8 minute [10.3 to 15.58 minute], p = 0.003). However, there was no difference in fluoroscopy time (T: 2.8 minute [2.17 to 5.6 minute], JA: 4.35 minute [2.7 to 7.43 minute], JU: 4.3 minute [3.1 to 7.1 minute], p = 0.08).
Diastolic dysfunction is a key determinant of symptoms and adverse remodeling in hypertrophic cardiomyopathy (HCM). Data describing the durability of diastolic improvement with long-term cardiac myosin inhibitor therapy...Diastolic dysfunction is a key determinant of symptoms and adverse remodeling in hypertrophic cardiomyopathy (HCM). Data describing the durability of diastolic improvement with long-term cardiac myosin inhibitor therapy in real-world settings remain limited. We performed a real-world cohort study of adults with HCM treated with at least 18 months of mavacamten with serial echocardiography at approximately 3-month intervals through 24 months. Left ventricular (LV) structure, standard diastolic indices and diastolic dysfunction grade were assessed. Paired baseline and end-point measures were compared. Fifty-one patients were included (mean age 58 ± 14 years; 45% men). From baseline to 24 months, left atrial volume index decreased from 42.2 ± 14.4 to 30.2 ± 11.7 ml/m² (Δ -12.0, p <0.001); LV wall thickness decreased from 18.7 ± 3.0 to 15.2 ± 2.3 mm (Δ -3.5, p <0.001); and LV mass index decreased from 121.6 ± 33.5 to 98.1 ± 22.3 g/m² (Δ -23.4, p <0.001). Lateral e' increased from 0.08 ± 0.03 to 0.09 ± 0.03 m/s (p <0.001) and medial e' increased from 0.05 ± 0.02 to 0.07 ± 0.02 m/s (p <0.001). Lateral E/e' decreased from 14.3 ± 8.9 to 9.8 ± 3.9 (p <0.001) and medial E/e' decreased from 18.8 ± 11.3 to 13.3 ± 4.7 (p <0.001). RVSP decreased from 30.0 ± 12.0 to 26.5 ± 8.9 mm Hg (p = 0.01). Diastolic dysfunction grade distribution shifted toward lower grades over time. In conclusion, in a real-world HCM cohort treated with mavacamten, echocardiographic measures of diastolic function, LA remodeling, and pulmonary pressures improved and remained durable through 24 months.