Buchananweeks5058
Cardiac computed tomography angiography (CCTA) appears to be an appropriate imaging technique for device surveillance after left atrial appendage occlusion (LAAO). However the available experience is limited.
To determine the prevalence, mechanisms and clinical impact of left atrial appendage (LAA) patency and device-related thrombosis (DRT) following LAAO utilising a novel CCTA-based classification.
Consecutively enrolled patients who underwent LAAO with Amplatzer device were followed-up with CCTA.Mechanisms and frequency of residual patency were evaluated and correlated with clinical events. Atrial-side device thrombus, device positioning and presence of signs of device stability were also analysed.
137 patients were included. LAA patency was observed in 56.9% (n=78). Mechanisms and frequency of patency were malapposition of proximal segment of the device lobe (55.1%), peri-device leak (PDL, 34.6%) and fabric permeability (5.8%). Lobe-LAA axis misalignment was the only independent predictor of device patency after LAAO (HR 38.3; 95% CI 13.6 - 107.0; p<0.001). After a median follow-up of 638 days, patency was not associated with an increased risk of death (all-cause or cardiovascular death) or cerebral/peripheral embolism regardless of its mechanism. Any degree of hypo-attenuated thickening was found in 16.8% (n=23) of patients; of which 16 (11.7%) had low-grade HAT and 7 patients (5.1%) had high-grade HAT or definite DRT. Complete sealing was associated with increased rates of low-grade HAT.
LAA patency on CCTA follow-up is a frequent phenomenon due to malapposition of the proximal segment of the device lobe, PDL or fabric permeability.
LAA patency on CCTA follow-up is a frequent phenomenon due to malapposition of the proximal segment of the device lobe, PDL or fabric permeability.
Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography.
We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites.
We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of intra- and interobserver reproducibility. Key secondary analysis was identification of clinical and procedural characteristics predicting reproducibility.
The intraobserver CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The interobserver CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low FFR were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03).
The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01±0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed with FFR.
The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01±0.08 for repeated measurements. Entospletinib solubility dmso The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed with FFR.
The atrial septal occluder (ASO) becomes a major obstacle to the widespread adoption of atrial fibrillation (AF) catheter ablation in patients with prior atrial septal defects (ASD) closure.
To describe the "Sequential Technique" of transseptal puncture (TSP) in AF patients with ASO.
Sixty-four drug-refractory AF patients with ASO who underwent catheter ablation in our center from September 2007 to March 2020 were enrolled.
Puncture through the native septum was acquired in 29 patients (Group A) and through the device in 35 patients (Group B). The mean diameter of the occluder was significantly larger in Group B than in Group A (31.6 ± 4.6 mm vs. 22.8 ± 3.5 mm, P <0.001). The mean time of TSP (24.9 ± 8.8 vs. 5.8 ± 2.1min, P <0.001), total fluoroscopy time (23.7 ± 10.9 vs. 7.5 ± 4.4 min, P <0.001), and total procedure time (172.7 ± 58.3 vs. 123.4 ± 43.8 min, P =0.001) of Group B were significantly longer than that of Group A. In group B, 21 patients got the external sheath crossed the device by reshaping the needle and adjusting the puncture angle and position (Group B1), 12 patients got the external sheath crossed the device with assistance of the balloon dilation (Group B2). No patient had thrombus, periprocedural interatrial shunt and procedural complications.
TSP and AF ablation in patients with ASO are feasible and safe. The "Sequential Technique" could be safely used in patients with ASO.
TSP and AF ablation in patients with ASO are feasible and safe. The "Sequential Technique" could be safely used in patients with ASO.
Balloon pulmonary angioplasty (BPA) is a promising therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy.
The present study evaluated the safety and efficacy of BPA for CTEPH using the first multicentre registry of a single European country.
Data were obtained from the Database of Pulmonary Hypertension in the Polish Population (NCT03959748), a prospective, multicentre registry of adult and paediatric PAH and CTEPH, for a total of 236 patients with confirmed CTEPH (124 women; mean age 67 years) who underwent 1056 BPA procedures at eight institutions in Poland.
In 156 patients who underwent follow-up assessments after a median of 5.9 (IQR 3.0-8.0) months after final BPA, the mean pulmonary arterial pressure decreased from 45.1±10.7 to 30.2±10.2 mmHg (P<0.001) and pulmonary vascular resistance from 642±341 to 324±183 dynes (P<0.001), and 6MWT improved from 341±129 to 423±136 m (P<0.001). Pulmonary injury related to BPA procedure occurred in 6.
