Carmen Moldovan

A new non-invasive method for detection of local inflammation in atherosclerotic plaques: experimental application of microwave radiometry.

Inflammation is implicated in theprogression and the instability f atheromatic plaques [1–9]. Previous studies have demonstrated hat local inflammatory activation is correlated with the temperture of the atheromatic plaques [1,2,5,10–12,8]. For the in vivo ssessment of plaque inflammatory activation intravascular therography (IVT) has been applied with dedicated intravascular atheters [2,8,10,12,13,14]. Indeed, IVT is an invasive method, hichprovides additional diagnostic andprognostic information in he identification of the high-risk atheromatic plaques in patients ith coronary artery disease [3,5,9,10,13]. Although IVT has diagnostic and prognostic implications, there re several limitations of current technology limiting its clinical use 13,15,16]. The invasive approachof themethodexcludes the appliation of IVT in primary prevention. Moreover, as there are several echnical shortcomings of the available intravascular catheters, a rospective study with distinct endpoints cannot be performed. hus, the evaluation of the diagnostic and prognostic implications f IVT is infeasible with the current technology.

Predictive Factors of Vascular Complications after Transcatheter Aortic Valve Implantation in Patients Treated with a Default Percutaneous Strategy

BACKGROUND Percutaneous approach techniques with closure device after transcatheter aortic valve implantation (TAVI) have diminished vascular complications (VC). In this retrospective study, we will report incidence and angiographic factors predisposing to major VC in patients undergoing TAVI using Prostar® XL closure device as a default strategy. METHODS Consecutive patients, who underwent TAVI transfemorally using Prostar® XL, were evaluated for the incidence of VC according to VARC criteria. Using arterial angiography, the femoral-iliac arterial tortuosity was adjusted for large arterial diameters and expressed as the ratio total tortuosity/arterial diameter (TT/AD). Arterial calcification, the combination of angulation and atheromatosis at the puncture site and ideal puncture were evaluated too. In all patients, 30 days of follow-up was available. RESULTS Eighty-four patients (80.2 ± 5.86 years, 39 males [46.4%]), who were consecutively treated with the transfemoral approach, were evaluated. In patients with major VC (17/84 [20.23%]) comparing to those without, arterial calcification (11 [64.7%] vs. 8 [11.9%], P < 0.01) and the TT/AD (30.2 ± 11.25 vs. 22.06 ± 8.64, P < 0.01) were independent predictors. Ideal puncture was achieved more frequently among patients without VC comparing to those with major (94.1% vs. 70.6%, P = 0.01). Blood transfusions (1.48 ± 0.37 vs. 2.45 ± 0.59, P = 0.023) were more frequent among patients with major VC. Finally, minimum creatinin clearance after TAVI predicted all-cause 30-day mortality (P = 0.021). CONCLUSIONS Major VC after TAVI with the use of Prostar closure device can be predicted by arterial calcification at the puncture site and TT/AD ratio. Minimum creatinin clearance after TAVI predicted 30-day mortality.

Residual Platelet Reactivity After Clopidogrel Loading in Patients With ST-Elevation Myocardial Infarction Undergoing an Unexpectedly Delayed Primary Percutaneous Coronary Intervention

BACKGROUND Residual platelet reactivity (RPR) after clopidogrel loading, measured by the VerifyNow assay, has been shown to predict 12-month clinical events in patients with acute coronary syndromes. However, links between coronary angiographic findings and outcome in patients with ST-elevation myocardial infarction (STEMI), with RPR have not been reported. We investigated whether RPR is associated with the amount of intracoronary thrombus burden (TB) in patients with STEMI undergoing unexpectedly-delayed primary percutaneous coronary intervention (pPCI). Moreover, we evaluated whether RPR might influence coronary flow and myocardial perfusion immediately post-pPCI. METHODS AND RESULTS The VerifyNow assay was used to determine RPR after clopidogrel loading, expressed in P2Y12-Reaction-Units (PRU). Intracoronary-TB was angiographically estimated and stratified as TB-Grade-A, -B and -C. Thrombolysis In Myocardial Infarction (TIMI) flow and Myocardial Blush (MB) were also estimated post-PCI. A total of 74 consecutive patients who presented with STEMI were enrolled in the study. Patients with greater TB presented significantly higher PRU-levels (174.1 ± 91.5, 196.23 ± 113.4 and 252.8 ± 107.8 for TB-Grade A, B and C, respectively; P=0.044). PRU-levels >251.5 were shown to predict Large-TB (LTB; TB-Grade-C) (sensitivity=57.9%; specificity=77.8%; P=0.014). Impaired TIMI-flow and MB after PCI were significantly associated with higher PRU-levels (P < 0.001). CONCLUSIONS Among the studied patients, those with a higher RPR after clopidogrel loading presented larger intracoronary TB, worse post-PCI myocardial flow and perfusion.

Inferior epigastric artery as a landmark for transfemoral TAVI. Optimizing vascular access

This study sought to investigate whether the site of common femoral artery (CFA) cannulation in regard to the inferior epigastric artery (IEA) is associated with the incidence of vascular complications in patients undergoing transfemoral aortic valve implantation (TAVI).

Biomarkers as a guide of medical treatment in cardiovascular diseases.

There is increasing interest in utilizing novel markers of cardiovascular disease risk and consequently, there is a need to assess the value of their use. In this paper, we will review the role of biomarkers in acute coronary syndromes, heart failure and risk stratification for cardiovascular events as guide for treatment scribing. In particular, high sensitivity assays for troponin evaluation detect with greater precision patients with elevated troponin. Therefore, direct and appropriate management is succeeded in these patients with reduction of complications due to earlier treatment, as well. Regarding heart failure, randomized trials that have evaluated biomarker guided treatment approach have not succeeded in establishing specific results for natriuretic peptides (BNP, NT-proBNP) use in terms of therapy guidance. Apart from them, a variety of novel or already used biomarkers, have been tested by small trials for heart failure management, without however, managing to dominate in every day care. Finally, as far as risk stratification for cardiovascular events is concerned, hsCRP has proved to be a strong but doubted biomarker. Therefore, lifestyle and behavioral modification remain the cornerstone of primary prevention.

Dual or Single Antiplatelet Therapy After Transcatheter Aortic Valve Implantation? A Systematic Review and Meta-Analysis

BACKGROUND Transcatheter aortic valve implantation (TAVI) has undeniably earned a prestigious post in the quiver of interventional cardiologists against symptomatic severe aortic stenosis. Cerebrovascular events are listed within the most frequent complications. METHODS We performed a systematic search of EMBASE, MEDLINE, and the Cochrane library from inception to March 2016 for the following search terms (transcatheter AND antiplatelet) OR (transcatheter AND antithrombotic) to retrieve studies of dual antiplatelet treatment (DAPT) and single antiplatelet treatment (SAPT) in patients after TAVI to study thrombotic, hemorrhagic and cardiovascular events at 30 days post procedure. From a total of 208 records 4 studies met inclusion criteria. RESULTS In the included studies, 286 patients were enrolled in the DAPT group and 354 patients in the SAPT group. There was no difference in all-cause mortality, cardiovascular mortality, stroke, and myocardial infraction 30 days post TAVI between DAPT and SAPT. However, patients in the DAPT group had a significantly increased incidence of lethal and major bleeding at 30 days of follow-up and the incidence of the combined end-point of stroke, spontaneous MI, all-cause mortality and major bleeding was significantly higher in the DAPT group in comparison to the SAPT group. CONCLUSION DAPT compared to SAPT in patients after TAVI increases incidence of hemorrhagic events with no benefits in terms of thrombotic events and cardiovascular mortality. However, these data must be interpreted cautiously and the choice of DAPT over SAPT must be based on an individual patient characteristic according to medical practice criteria.

Percutaneous closure of a large ascending aorta pseudoaneurysm due to mediastinitis using an amplatzer occluder device.

A 63-year old man presented with chest pain. He had undergone coronary artery bypass graft surgery 15 years earlier and mitral valve repair due to severe regurgitation 6 months earlier with a simultaneous right internal mammary artery (RIMA) to left anterior descending artery graft. The early

Troponin levels after TAVI are related to the development of distinct electrocardiographic changes

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Residual platelet reactivity after clopidogrel loading in ST-elevation myocardial infarction patients undergoing a delayed catheterization. Impact on long term clinical events

Residual platelet reactivity after clopidogrel loading in ST-elevation myocardial infarction patients undergoing a delayed catheterization. Impact on long term clinical events Manolis Vavuranakis ⁎, Konstantinos Kalogeras , Nikolaos Dagres , Maria Kariori , Dimitrios Vrachatis , Carmen Moldovan , Maria Lavda , Evelina Mpei , Aristeidis Androulakis , Gerasimos Siasos , Dimitris Tousoulis , Christodoulos Stefanadis a

CoreValve deployment during cardiopulmonary resuscitation without angiographic injections guidance: An additional capability of Accutrak system?

Transcatheter aortic valve implantation (TAVI) has become an accepted treatment option for high-risk patients with symptomatic severe aortic stenosis (AS), for whom conventional surgical replacement has been previously denied [1,2]. TAVI is a technically demanding procedure, which sometimes may be accompanied by dreadful complications [3]. The accurate prosthesis positioning is of major significance for the success of the procedure and is performed under continuous fluoroscopy guidance. The previous CoreValve (Medtronic, Inc) device has been criticized for the tendency to advance during deployment. The new Accutrak stability layer of the delivery catheter system is promoted to ensure stability during the procedure. We report a case of CoreValve prosthesis deployment during Cardiopulmonary Resuscitation (CPR) without angiographic injections guidance, with the new Accutrak stability layer. An 81-year old female presented to our hospital suffering from shortness of breath on exertion and fatigue in ordinary physical activity (New York Heart Association functional classification class III). She had a medical history of extracardiac arteriopathy. The transthoracic echocardiogram was diagnostic for severe aortic valve stenosis revealing severe calcification of the valve, mean gradient 42 mm Hg,