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Introduction: In patients with chronic coronary syndromes (CCS), the benefit of percutaneous coronary intervention (PCI) added to optimal medical therapy (OMT) remains unclear. The indication to PCI may be driven either by angiographic evaluation or ischemia assessment, thus depicting different potential strategies which have not yet been thoroughly compared., Methods: Randomized controlled trials (RCTs) comparing OMT versus PCI angio-guided or versus PCI non-invasive or invasive ischemia guided were identified and compared via network meta-analysis. Major adverse clinical events (MACE), as defined by each included trial, were the primary endpoint, while cardiovascular (CV) death, myocardial infarction (MI), and unplanned revascularization the secondary ones., Results: 18 studies, encompassing 17,512 patients, were included, with a mean follow-up of 3.5 years. PCI guided by ischemia defined either invasively or not was associated with a reduced risk of MACE compared with OMT alone. Furthermore, PCI guided by non-invasive assessment of ischemia was associated with a reduced risk of MI compared with OMT (hazard ratio [HR]: 0.61 [95% confidence interval: 0.37-0.94). This strategy ranked best also in preventing CV death. Notably, iFR and FFR guided approaches showed the highest probability of performing best for reduction of subsequent revascularizations., Conclusion: In patients with CCS, ischemia-guided PCI, either by invasive or non-invasive assessment, resulted in a reduced risk of MACE compared with OMT alone. The use of invasive or non-invasive tests influenced the benefit of ischemia-driven PCI: non-invasive tests significantly reduced risk of MI compared with OMT, while iFR or FFR showed the highest probability of reducing the need of subsequent revascularization., (© 2025 Wiley Periodicals LLC.)

Aims: Haemodynamic assessment can be determinant in phenotyping cardiogenic shock (CS) and guiding patient management. Aim of this study was to evaluate the correlation between echocardiographic and invasive assessment of haemodynamics in acute decompensated heart failure-related CS (ADHF-CS)., Methods and Results: All consecutive ADHF-CS patients (SCAI shock stage ≥B) undergoing right heart catheterization (RHC) between 2020 and 2022 were prospectively enrolled. Patients underwent echocardiography 30 min before RHC. The evaluated haemodynamic parameters and their echocardiographic estimates ('e') comprised cardiac index (CI), wedge pressure (WP), pulmonary artery pressures (PAP), cardiac power output (CPO) and pulmonary artery pulsatility index (PAPi). Hundred and one ADHF-CS patients (56 ± 11 years, 64% SCAI shock stage C, left ventricular ejection fraction 29 ± 5%) were included. Good correlation was found for CI, systolic PAP, RAP, and CPO (Pearson r > 0.8 for all), moderate correlation for ePAPi (r = 0.67) and PVR (r = 0.51), while estimation of WP was weak. The sensitivity and specificity of eCI to identify low output state (CI ≤2.2 L/min/m2) were 0.97 and 0.73, respectively, those of eWP for elevated filling pressures (WP >15 mmHg) were 0.84 and 0.55, those of ePAPs for PAPs ≥35 mmHg were 0.87 and 0.63, those of eCPO for CPO <0.6 W were 0.76 and 0.85, those of ePAPi for PAPi <1.85 were 0.89 and 0.92. Echocardiographic phenotyping of CS showed a good agreement with invasive classification (K value 0.457, P < 0.001)., Conclusion: Echocardiographic estimation of haemodynamics and subsequent phenotypization of CS is feasible with good agreement with invasive evaluation., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Among different coronary stents implanted in High Bleeding Risk (HBR) patients with an indication for short antiplatelet therapy, no comparisons in terms of efficacy have been provided., Methods: A Network Meta Analysis was performed including all randomized controlled trials comparing different coronary stents evaluated in HBR patients. Major Adverse Cardiovascular Events (MACEs) as defined by each included trial were the primary end point, whereas TLR (target lesion revascularization), TVR (target vessel revascularization), stent thrombosis and total and major (BARC3-5) bleedings were the secondary ones., Results: A total of four studies (ONYX ONE, LEADERS FREE, SENIOR and HBR in BIO-RESORT) including 6637 patients were analyzed with different kind of stents and dual antiplatelet therapy (DAPT) length (1 or 6 months) on 12 months follow-up. About one-third of these patients were defined HBR due to indication for oral anticoagulation. All drug eluting stents (DESs) reduced risk of MACE compared to Bare Metal Stents (BMSs) when followed by a 1-month DAPT. At SUCRA analysis, Orsiro was the device with the highest probability of performing best. Rates of TLR and TVR were significantly lower when using Resolute Onyx, Synergy and BioFreedom stents in comparison to BMS when followed by 1-month DAPT, with Synergy ranking best. Synergy also showed a significantly lower number of stent thrombosis compared to BMS (RR 0.28, 95% CI 0.06-0.93), while Orsiro and Resolute Integrity showed the highest probability of performing best., Conclusion: In HBRs patients, all DESs were superior to BMSs in terms of efficacy and safety. Among DESs, Orsiro was the one with the highest ranking in terms of MACE, mainly driven by a reduced incidence of repeated revascularization and stent thrombosis., (© 2024 Wiley Periodicals LLC.)

Background: The aim of this study was to determine the safety and feasibility of in-hospital sacubitril/valsartan initiation after clinical stabilization in patients with acute decompensated heart failure (ADHF) and reduced ejection fraction (EF)., Methods: This retrospective, multicenter observational study included patients admitted for ADHF in 2 Italian centers between February 2017 and January 2022. Feasibility was evaluated by assessing the proportion of patients discharged on sacubitril/valsartan. Key safety endpoints were the incidences of adverse events during hospitalization and during follow-up planned at 1 month, 3-6 months and 12-18 months after discharge., Results: One hundred and twenty-two patients were included. Median age was 71 (60-78) years, 78% male, 63% New York Heart Association (NYHA) Class III at admission with a median left ventricular ejection fraction (EF) of 25% (20-30). During hospitalization, 94 (77%) patients were treated with intravenous diuretics, 39 (32%) with inotrope/vasopressor, 51 (42%) with continuous positive airway pressure ventilation and 7 (6%) were assisted with an intra-aortic balloon pump. Median time from hospitalization to sacubitril/valsartan initiation was 4 (2-7) days. Sacubitril/valsartan was started at a dosage of 12/13 mg in 52 (43%) patients, 24/26 mg in 61 (50%) patients and 49/51 mg in 8 (7%) patients. Overall, 111 (91%) patients were discharged on sacubitril/valsartan. At 12-18-month follow-up, the vast majority of patients were still on sacubitril/valsartan therapy., Conclusions: In-hospital initiation of sacubitril/valsartan treatment in real-world ADHF patients may be a safe and feasible treatment option.

DNA microarrays are one of the most used technologies for gene expression measurement. However, there are several distinct microarray platforms, from different manufacturers, each with its own measurement protocol, resulting in data that can hardly be compared or directly integrated. Data integration from multiple sources aims to improve the assertiveness of statistical tests, reducing the data dimensionality problem. The integration of heterogeneous DNA microarray platforms comprehends a set of tasks that range from the re-annotation of the features used on gene expression, to data normalization and batch effect elimination. In this work, a complete methodology for gene expression data integration and application is proposed, which comprehends a transcript-based re-annotation process and several methods for batch effect attenuation. The integrated data will be used to select the best feature set and learning algorithm for a brain tumor classification case study. The integration will consider data from heterogeneous Agilent and Affymetrix platforms, collected from public gene expression databases, such as The Cancer Genome Atlas and Gene Expression Omnibus.

Ceramic seeds were synthesized by the sol-gel technique with Si:Sm:Ca and Si:Ho:Ca. One set of seeds was irradiated in the TRIGA type nuclear reactor IPR-R1 and submitted to instrumental neutron activation analysis (INAA), K(0) method, to determine mass percentage concentration of natural samarium and holmium in the seed as well as to determine all existing radionuclides and their activities. Attention was paid to discrimination of Si-31, Ca-40, Ca-45, Ca-47, Ca-49, Sm-145, Sm-155, Sm-153 and Ho-166. A second sample was submitted to atomic emission spectrometry (ICP-AES) also to determine samarium and holmium concentrations in weight. A third sample was submitted to X-ray fluorescence spectrometry to qualitatively determine chemical composition. The measured activity was due to Sm-153 and Ho-166 with a well-characterized gamma spectrum. The X-ray fluorescence spectrum demonstrated that there is no discrepancy in seed composition. The maximum ranges in the water of beta particles from Sm-153 and Ho-166 decay were evaluated, as well as the dose rate and total dose delivered within the volume delimited by the range of the beta particles. The results are relevant for investigation of the viability of producing Sm-153 and Ho-166 radioactive seeds for use in brachytherapy., (Copyright 2010 Elsevier Ltd. All rights reserved.)