Al Fazir Omar

The effect of complete percutaneous revascularisation with and without intravascular ultrasound guidance in the drugeluting stent era.

AIMS Our aim was to compare the outcomes of complete revascularisation (CR) and incomplete revascularisation (IR) in multivessel coronary artery disease (CAD), with and without intravascular ultrasound (IVUS) guidance, in the drug-eluting stent (DES) era. METHODS AND RESULTS Overall, 2,132 consecutive patients with multivessel CAD, defined as at least two epicardial vessels with >70% stenosis, had at least one DES implant. Chronic total occlusions were not analysed. Successful treatment of epicardial vessels and significant branches was termed CR; otherwise, treatment was defined as IR. CR and IR were further categorised according to the use of IVUS. The primary outcome was death or Q-wave myocardial infarction (QWMI). Secondary outcomes included the rates of non-QWMI and repeat revascularisation, the latter assessed as either target vessel revascularisation (TVR) or target lesion revascularisation (TLR) at one year. CR was associated with lower rates of death/QWMI (HR 0.66 [0.4-0.9]; p=0.048) and non-QWMI at one year (1.1% vs. 2.6%; p=0.017). Completeness of revascularisation was not independently associated with repeat intervention, but rates of both TVR (89% vs. 93%; p<0.001) and TLR (91% vs. 95%; p<0.001) were higher with CR than IR. IVUS decreased the rates of TLR irrespective of completeness of revascularisation (p-interaction=0.75). CONCLUSIONS CR in selected patients gives better outcomes than IR in multivessel CAD at one year. IVUS guidance can further improve results by reducing rates of repeat intervention irrespective of completeness of revascularisation.

THE IMPACT OF PERMANENT PACEMAKER IMPLANTATION FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT ON OUTCOME

Timing, causality, and outcomes of permanent pacemaker (PPM) following transcatheter aortic valve replacement (TAVR) remains poorly described. Symptomatic aortic stenosis patients undergoing TVAR were followed for timing and underlying causes of PPM implantation. They were categorized into 3 groups

The correlation of features in detecting cardiovascular vulnerable plaque

The combination of different medical modalities from single or multiple sensors produces higher reliability in diagnosis, pre-surgical planning and surgical intervention. Multimodal fusion is an option to exploit medical images in the context of coronary plaques detection. It is most sensible to detect the vulnerability of plaque as diseases related to it are among the leading cause of death. CTA and ICA were chosen as both modalities can visualize the blood vessel anatomically and functionally in the images, which were taken at a certain point in time and during the angioplasty intervention. The cross-sectional diameter of the blood vessel in an ICA was measured thus detecting vessel narrowing due to stenosis. Meanwhile, the high intensity pixels in CTA image, which indicated the calcification of plaque, were calculated after applying multilevel threshold. The severity of stenosis in ICA correlating to the pixel coverage in CTA was investigated. Compared to the diagnosis from one modality alone, the feature correlation delivered more information and consumes less time. The research results will support cardiologists by providing enhanced diagnosis capabilities of cardiovascular vulnerable plaques to improve the quality of data interpretation.

Interdisciplinary approach to multimodal image fusion for vulnerable plaque detection

In diagnosis, planning, intervention and monitoring of the potentially fatal Coronary Artery Disease multimodal medical imaging plays an important role. Medical cardiac images of patients suffering from Atherosclerosis exhibit information on cardiovascular plaque that can cause a sudden death due to its vulnerability. The identification of vulnerable plaque is an important research field and can be supported by the use of multimodal image fusion combining anatomical as well as functional information in one image medium. Image fusion has proven to enhance critical components of the multimodal data sources that enable improved diagnostics and intervention. The advancement of image fusion techniques and an intelligent selection of multimodal medical image combinations in the context of vulnerable plaque detection require an interdisciplinary approach. This paper reports on the first achievements of a collaborative research project involving clinicians and image processing engineers. During the first stage an interdisciplinary workflow was established. Critical research questions were identified. The second phase will concentrate on image processing to fuse selected multimodalities to obtain images of higher quality which will ease the daily work of the clinicians and reduce invasiveness for the patients.

CRT-145 Clinical Impact of Diabetes Mellitus on Long-term Clinical Outcomes in Patients Treated with Everolimus-Eluting Stent for Multivessel Percutaneous Coronary Intervention

Newer generation stents by means of more biocompatible components limiting inflammatory response have led to significant improvement in the cardiovascular outcomes. The purpose of the present study is to evaluate the long term outcomes of diabetic patients undergoing multivessel PCI with the use of

CRT-706 Humoral Response Following Transcatheter Aortic Valve Replacement Comparing Transapical and Transfemoral Approaches

High serum brain natriuretic peptide (BNP) (>400 pg/ml) is associated with high morbidity and mortality following Transcatheter Aortic Valve Replacement (TAVR). However, whether TA is associated with a distinct humoral response pattern has not been established. We compared the BNP distribution (

CRT-704 What are the Correlates with Significant Post Transcatheter Aortic Valve Replacement Aortic Regurgitation?

Aortic Regurgitation (AR) post Transcatheter Aortic Valve Replacement (TAVR) was correlated with poor outcome. Heterogeneity in the clinical and procedural parameters associated with the post-TAVR of AR still exists. All patients undergoing TAVR (n=407) had a post-procedural echocardiography and