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86±12.7%); p<0.001, and lower LAA emptying velocity (17.53cm/s, IQR 9.54-77.4 vs 63.5cm/s, IQR 7.89-86.4; p<0.001). There was a good correlation between LA TDI and speckle tracking PALS and PALSR and LAA EF% and velocity p<0.001. TDI and PALS and PALSR were found to be significant predictors for LAA thrombus (P<0.05) with good sensitivity and specificity.
Left atrium deformation indices are predictors of LAA thrombus or SEC in patients with non-valvular AF with accepted sensitivity and specificity.
Left atrium deformation indices are predictors of LAA thrombus or SEC in patients with non-valvular AF with accepted sensitivity and specificity.
Machine learning (ML)-based stroke risk stratification systems have typically focused on conventional risk factors (CRF) (AtheroRisk-conventional). Besides CRF, carotid ultrasound image phenotypes (CUSIP) have shown to be powerful phenotypes risk stratification. This is the first ML study of its kind that integrates CUSIP and CRF for risk stratification (AtheroRisk-integrated) and compares against AtheroRisk-conventional.
Two types of ML-based setups called (i) AtheroRisk-integrated and (ii) AtheroRisk-conventional were developed using random forest (RF) classifiers. AtheroRisk-conventional uses a feature set of 13 CRF such as age, gender, hemoglobin A1c, fasting blood sugar, low-density lipoprotein, and high-density lipoprotein (HDL) cholesterol, total cholesterol (TC), a ratio of TC and HDL, hypertension, smoking, family history, triglyceride, and ultrasound-based carotid plaque score. AtheroRisk-integrated system uses the feature set of 38 features with a combination of 13 CRF and 25 CUSIP features (6 types of current CUSIP, 6 types of 10-year CUSIP, 12 types of quadratic CUSIP (harmonics), and age-adjusted grayscale median). Logistic regression approach was used to select the significant features on which the RF classifier was trained. The performance of both ML systems was evaluated by area-under-the-curve (AUC) statistics computed using a leave-one-out cross-validation protocol.
Left and right common carotid arteries of 202 Japanese patients were retrospectively examined to obtain 404 ultrasound scans. RF classifier showed higher improvement in AUC (~57%) for leave-one-out cross-validation protocol. Using RF classifier, AUC statistics for AtheroRisk-integrated system was higher (AUC=0.99,p-value<0.001) compared to AtheroRisk-conventional (AUC=0.63,p-value<0.001).
The AtheroRisk-integrated ML system outperforms the AtheroRisk-conventional ML system using RF classifier.
The AtheroRisk-integrated ML system outperforms the AtheroRisk-conventional ML system using RF classifier.
Patients undergoing successful balloon mitral valvuloplasty (BMV) have variable improvement in New York Heart Association (NYHA) functional class (FC), exercise capacity (EC) and regression of systolic pulmonary artery pressure (sPAP). Improvement in net atrioventricular compliance (Cn), one of the major determinants of above factors is not routinely assessed. Aim of present study was to assess the change in Cn after successful BMV and its correlation with above factors.
50 patients of very severe mitral stenosis in sinus rhythm who underwent successful BMV have been studied. Staurosporine price NYHA FC, 6min walk test (6MWT) and echocardiographic evaluation was done 24h before and at 2 weeks, 12 weeks and 24 weeks after BMV. Echocardiographic parameters of patients with improvement in NYHA class of ≥2 (group A) were also compared with those with improvement in NYHA class of ≤1 (group B).
Following successful BMV, there was progressive improvement in Cn upto 12 weeks with no further significant improvement till 24 weeks. Change in Cn showed very good correlation with change in NYHA class [r=0.62, p<0.01], 6MWT [r=0.30, p0.03] and regression of sPAP assessed at 12 weeks and was maintained upto 24 weeks. Change in MVA did not show any correlation with above factors. Group B patients had significantly lower Cn post BMV as compared to group A patients inspite of comparable MVA and trans valvular gradients.
Improvement in Cn following BMV has good correlation with clinical improvement. So Cn should also be assessed along with MVA to better predict clinical outcome.
Improvement in Cn following BMV has good correlation with clinical improvement. So Cn should also be assessed along with MVA to better predict clinical outcome.
To study the immediate maternal and fetal outcomes and long term maternal outcomes in pregnant women undergoing balloon mitral valvotomy.
We retrospectively analyzed balloon mitral valvotomy during pregnancy performed between January 2008 and July 2018.
BMV was carried out in 97 pregnant women with mean age of 26.1±4.5 years, at mean gestational age of 23.1±4.6 weeks. The procedure was successful in 95 patients (97.9%). There was one maternal death post procedure due to intra-uterine death and disseminated intravascular coagulation. Adverse immediate fetal outcome was seen in 2 cases with one intra-uterine fetal demise and one preterm labour. Mitral valve area increased from mean of 0.82±0.12cm to 1.66±0.14cm (p<0.001). Mean trans-mitral diastolic gradient decreased from 19.7±5.6mm Hg to 7.5±2mm Hg. Right ventricular systolic pressure decreased significantly from mean of 56.7±16.2mm Hg to mean of 35.6±11mm Hg. Survival analysis showed cumulative event free survival of 89% at 5 years and 65% at 10 years, considering a composite endpoint of clinical restenosis, repeat BMV or MVR or cardiovascular death.
Balloon mitral valvotomy is a safe and effective treatment for severe mitral stenosis during pregnancy. Long term maternal outcomes after BMV done during pregnancy are good and comparable to that of BMV done in non-pregnant patients.
Balloon mitral valvotomy is a safe and effective treatment for severe mitral stenosis during pregnancy. Long term maternal outcomes after BMV done during pregnancy are good and comparable to that of BMV done in non-pregnant patients.
There is a lack of sufficient data regarding the protective effects of remote ischemic preconditioning (RIPC) in patients at risk of developing contrast-induced nephropathy (CIN). Thus, this study was conducted to determine whether RIPC as an adjunct to standard therapy prevents CIN in high-risk patients undergoing coronary intervention.
In a single-center, double-blinded, randomized controlled trial, 162 patients who were at risk of CIN received standard hydration combined with RIPC or hydration with sham preconditioning. RIPC was accomplished by four cycles of 5min ischemia and 5min reperfusion of the forearm. The primary endpoint was a rise in serum creatinine (>0.5mg/dL or >25%) from baseline to serum creatinine 48-72h after contrast administration.
Of the 162 patients, 81 were randomly allocated to receive sham preconditioning and 81 to receive RIPC. Significantly reduced serum creatinine levels were observed in patients with a Mehran moderate risk allocated to sham group compared to the RIPC group (0.070±0.16mg/dL vs. 0.107±0.13mg/dL, p=0.001). With regards to the primary endpoint, a significantly higher change in serum creatinine from baseline to 48-72h was observed in the sham group compared to the RIPC group (0.023±0.2μmol/L vs-0.064±0.1μmol/L, p<0.001).
RIPC as an alternative to standard therapy, improved serum creatinine levels after contrast administration in patients at risk of CIN. However, present data indicate that RIPC might have beneficial effects in patients with a moderate or high risk of CIN.
RIPC as an alternative to standard therapy, improved serum creatinine levels after contrast administration in patients at risk of CIN. However, present data indicate that RIPC might have beneficial effects in patients with a moderate or high risk of CIN.
The aim of this study was to evaluate the feasibility of heparinised saline as flushing media for frequency-domain optical coherence tomography (FD-OCT) image acquisition during percutaneous coronary intervention (PCI) optimisation.
Twenty-seven patients undergoing FD-OCT-guided PCI were enrolled. Heparinised saline was injected into the coronary during FD-OCT image acquisition. A total of 118 runs were analysed for image quality and diagnostic value. FD-OCT runs were categorised as follows good runs (GRs), clinically usable runs (CURs) and clinically not usable runs (NURs); GRs and CURs were combined as clinically effective runs (ERs). Saline FD-OCT enabled visualisation of all possible coronary lesions. Of the 118 runs analysed, 61%, 27.1%, 11.9% and 88.1% were GRs, CURs, NURs and ERs, respectively. Sixty-one percent of total runs were left coronary system (LCS) and 39% were right coronary system (RCS) runs. Among LCS runs, 55.6%, 30.6%, 13.8% and 86.2% were GRs, CURs, NURs and ERs, respectively. Among RCS runs, 69.6%, 21.7%, 8.7% and 91.3% were GRs, CURs, NURs and ERs, respectively.
This is the first study to demonstrate the technical feasibility of isolated saline FD-OCT for PCI optimisation.
This is the first study to demonstrate the technical feasibility of isolated saline FD-OCT for PCI optimisation.
To study the incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) at a high volume center in South-east Asia.
Data from patients who had CAP during PCI from January 2016 to December 2019at our center were collected. Clinical features, angiographic and procedural characteristics, their management and outcomes were analyzed retrospectively.
A total of 40,696 patients underwent PCI during the study period and the incidence of CAP was 0.13% (n=51). Mean age was 60.0±10.8 years and 69% were males. CAP cases involved complex type B2/C lesions in 73%, calcified lesions in 58%, and chronic total occlusions in 25%. Majority of patients presented as acute coronary syndrome (65%) and STEMI was the most frequent indication for PCI (33%). Most of the CAPs were Ellis type II (33%) and III (55%). CAP most frequently occurred during post dilation (n=20) and wire manipulation (n=17). Majority were treated by prolonged balloon inflation (53%) and covered stents (33%). Pericardiocentesis was required in 19 patients to alleviate tamponade. In one patient coil embolisation was done and two patients required bail-out emergency cardiac surgery. Periprocedural myocardial infarction occurred in 6% and in-hospital mortality was 10%. All-cause mortality accrued to 14% at 30 days and 16% at 6 months.
Although incidence of CAP in contemporary interventional practice remains low, the morbidity and mortality are considerable. Early recognition and management strategies tailored to the severity of perforation play a key role in achieving better outcomes.
Although incidence of CAP in contemporary interventional practice remains low, the morbidity and mortality are considerable. Early recognition and management strategies tailored to the severity of perforation play a key role in achieving better outcomes.
Studies comparing the outcome of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) versus OMT alone in treatment of chronic total occlusion (CTO) are limited by observational design, variable follow-up period, diverse clinical outcomes, high drop-out and cross-over rates. This study aims to conduct a meta-analysis of published data of observational as well as randomized studies comparing long term outcomes of PCI+OMT versus OMT alone.
PubMed, Embase and Cochrane databases were systematically reviewed. 15 studies meeting criteria were included in the meta-analysis. The New-castle Ottawa scale was used to appraise the overall quality of the studies. Random-effects model with inverse variance method was undertaken. Major adverse cardiovascular events (MACE) which comprises of cardiac death, myocardial infarction, stroke, and un-planned revascularization were significantly lower in the PCI+OMT group (RR0.76; 95% CI0.61 to 0.95; P=<0.00001; I
=85%). All-cause mortality and cardiac death were significantly lower in the PCI+OMT group (P=<0.
