American Journal of Cardiology

Aortic dissection is the most common of the acute aortic syndromes.1 Acute aortic dissection remains a highly morbid and potentially lethal condition despite contemporary advances in medical and surgical care. Type B aortic dissection (TBAD) is classified as uncomplicated, uncomplicated with high-risk features, and complicated. The role of thoracic endovascular aortic repair (TEVAR) in uncomplicated TBAD remains uncertain and is the topic of ongoing clinical trials. In most complicated cases, TEVAR is effective at restoring visceral and extremity blood flow...

BACKGROUND: Data on the long-term outcomes of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) remain controversial. OBJECTIVES: The aim of this study was to investigate the incidence and clinical outcomes of measured PPM (PPMM ) and predicted PPM (PPMP ) in patients undergoing TAVI. METHODS: This is a retrospective analysis of 3,016 patients who underwent TAVI at a large Healthcare System between 2012 and 2021...

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Cardiac complications are the leading cause of morbidity and mortality in liver transplant (LT) recipients. Prior guidelines recommended stress testing to exclude coronary artery disease (CAD), though recent guidelines recommend coronary computed tomography angiography (CCTA). We aimed to assess the prevalence and predictors of CAD on CCTA and compare CCTA with stress testing in consecutive adult LT candidates undergoing CAD non-invasive assessment between 2020 to 2023. Patients who underwent a stress test between 01/2020 and 12/2020 formed the stress cohort, and patients who underwent CCTA between 01/2021 and 09/2023 formed the CCTA cohort...

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INTRODUCTION: Frailty status is linked with a poorer clinical outcome and frail patients are often less revascularized even with percutaneous coronary intervention (PCI). We therefore sought to assess the impact of frailty on clinical outcome of elderly patients with non ST-elevation acute-myocardial-infarction (NSTEMI) undergoing PCI. METHODS: We prospectively enrolled 141 consecutive elderly (>75 years) patients admitted for NSTEMI. 104 patients underwent PCI (35 frail, 69 non-frail), 37 were not revascularized (22 frail, 15 non frail)...

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INTRODUCTION: Culotte stenting is an effective strategy for left main coronary bifurcation lesions. Increased side branch ostial restenosis is the main drawback of Culotte stenting. This is due to a napkin ring or potential gap produced at the ostium of the side branch. A bench study by Toth et al. has shown that additional sequential kissing balloon dilation before main vessel stenting can prevent this deformity. AIM: We report immediate and short-term results of Double Kissing (DK) mini-Culotte stenting with a one-year angiographic follow-up...

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Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at mid-term follow-up while limited long-term (≥ 3-year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients. We searched databases up to July 7th 2024, for randomized clinical trials (RCTs) comparing TAVR versus SAVR in low-risk patients (defined as STS-PROM Score less than 4%)...

This study aimed to investigate the acute changes in proximal aortic distensibility, a measure of aortic stiffness, induced by acute exercise in individuals with and without heart failure (HF). Individuals with HF (n=24) and without HF (n=26), underwent cardiovascular magnetic resonance (1.5T CMR) imaging at rest and following submaximal supine bicycle ergometry. The participants were further categorized into HF with reduced ejection fraction (HFREF, n=14) and HF with preserved ejection fraction (HFPEF, n=10) based on left ventricular ejection fraction (LVEF)...

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A single high-sensitivity troponin-T (hs-TnT) measurement may be sufficient to risk-stratify emergency department (ED) patients with possible acute coronary syndrome (ACS) using the recalibrated History, Electrocardiogram, Age, Risk Factors, Troponin (rHEART) score. We sought to validate this approach in a multi-ethnic population of US patients and investigate sex-specific differences in performance. We conducted a secondary analysis of a prospective cohort study of adult ED patients with possible ACS at a single, urban, academic hospital...

Transcatheter pulmonary valve replacement (TPVR) is now frequently performed in adult congenital heart disease (ACHD) patients. As the life-expectancy of the ACHD population continues to improve, more patients will require pulmonary valve intervention. This study details the short-term and mid-term clinical outcomes of patients aged 40 years and older undergoing TPVR. We performed an institutional retrospective cohort study that included patients aged 40 and older undergoing TPVR (and clinical follow up) from January 1, 2012 to January 1, 2024...

Sickle cell disease (SCD) is characterized by chronic anemia and recurrent ischemia-reperfusion episodes, which can lead to high output heart failure. The impact of SCD on cardiac structure and function remains under-investigated. We conducted a single-institution retrospective analysis of clinical and echocardiographic data from patients with hemoglobin SS SCD (SCD-SS) between January 2016 and June 2022. Patients with known heart failure, left ventricular (LV) ejection fraction <50%, moderate or severe valvular heart disease, congenital heart disease, established coronary artery disease, diabetes mellitus, hypertension, or coexistent lung disease were excluded...

Although the adverse effects of long-term use of vitamin K oral anticoagulant (OAC), warfarin, on the coronary vasculature are well-established, it remains unknown whether nonvitamin K oral anticoagulants play a role in the attenuation of plaque progression and coronary calcification. This study aimed to compare the changes in atherosclerotic plaques and calcification of the coronary arteries in patients with atrial fibrillation (AF) treated with edoxaban and warfarin. A total of 150 OAC-naïve patients with AF and atherosclerotic lesions on coronary computed tomography angiography (CCTA) were enrolled and randomly assigned to the edoxaban or warfarin treatment groups...

Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are not recommended during the second and third trimester due to the significant risk of congenital anomalies associated with their use. However, data are scarce, especially regarding their use in the first trimester and about the impact of stopping just before pregnancy. Our study illustrates the profile of the women who used ACE-Is or ARBs during pregnancy and evaluates the impact on perinatal outcomes. The Registry of Pregnancy and Cardiac disease (ROPAC) is a prospective, global registry of pregnancies in women with structural heart disease...

Valve-in-Valve (ViV) Transcatheter aortic valve replacement (TAVR) has been associated with favorable outcomes in patients with degenerated stentless bioprosthesis. However, whether the outcomes after ViV TAVR for failed stentless bioprosthesis differ between balloon-expandable valves (BEV) and self-expanding valves (SEV) remains unknown. Therefore, we retrospectively analyzed 59 consecutive patients who underwent ViV TAVR for failed stentless bioprsothesis with BEV (N= 42) versus SEV (N= 17) in a single-healthcare system between 2013 and 2022...

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