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BACKGROUND: Intermediate coronary lesions (ICLs) are highly prevalent but ported mixed prognosis. Radial strain has been associated with plaque vulnerability, yet its role in predicting lesion progression is largely unknown. The purpose of this study was to determine the predictive value of angiography-derived radial wall strain (RWS) for progression of untreated non-culprit ICLs. METHODS: Post-hoc analysis was conducted in a study cohort including 603 consecutive patients with 808 ICLs identified at index procedure with angiographic follow-up of up to two years. RWS analysis was performed on selected angiographic frames with minimal foreshortening and vessel overlap. Lesion progression was defined as ≥ 20% increase in percent diameter stenosis. RESULTS: Lesion progression occurred in 49 ICLs (6.1%) with a median follow-up period of 16.8 months. Maximal RWS (RWS(max)), frequently located at the proximal and throat plaque regions, distinguished progressive ICLs from silent ones. The largest area under the curve value of 0.75 (95% CI: 0.67–0.82, P < 0.001) was reached at the optimal RWS(max) cutoff value of > 12.6%. According to this threshold, 178 ICLs were classified as having a high strain pattern. Exposure to a high strain amplitude with RWS(max) > 12.6% was independently associated with an increased risk of lesion progression (adjusted HR = 6.82, 95% CI: 3.67–12.66, P < 0.001). CONCLUSIONS: Assessment of RWS from coronary angiography is feasible and provides independent prognostic value in patients with untreated ICLs.

This study aimed to evaluate the impact of the echocardiographic parameter ratio E/E’ on the late recurrence of paroxysmal atrial fibrillation in patients after receiving radiofrequency catheter ablation. We retrospectively examined total of 288 paroxysmal atrial fibrillation (PAF) patients that underwent a preliminary radiofrequency catheter ablation (RFCA) in our hospital. During the first phase in this study, the patients were divided into 2 groups upon AF recurrence after RFCA: Recurrent group, n = 67 patients with rapid trial arrhythmia that lasted for more than 30 seconds at 3 months after RFCA and the Nonrecurrent group, n = 221. The clinical conditions were compared between the 2 groups. During the second phase of this study, based on the results in the first phase, the patients were divided into another 2 groups according to whether the ratio of E/E’ ≥13 .45: Higher ratio of E/E’ group, n = 55 and Lower ratio of E/E’ group n = 233. The late AF recurrent rates were also compared between the 2 groups. During the first phase, the univariate analysis indicated that the risk factors(P

Supplemental Digital Content is available in the text, Background: In patients with complex true coronary bifurcation lesions (CBLs), Crush or Culotte stenting has been the commonest approaches of percutaneous coronary intervention (PCI). However, the optimal one remains in debate. Methods: A systematic review and meta-analysis of cohort studies searched from PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese National Knowledge Infrastructure (CNKI), VIP information database, and WangFang Data Information Site, to compare the long-term safety and efficacy of PCI with Crush versus Culotte in patients with CBLs. The primary end point was target lesion revascularization (TLR) and secondary end points were a composite of major adverse cardiac events (MACE) including cardiac death (CD), myocardial infarction (MI), stent thrombosis (ST), and target vessel revascularization (TVR) by PCI or bypass surgery, and each individual component at long-term follow-up. Furthermore, omitting each study in turn was used to sensitivity analysis for high heterogeneity of studies. Results: A total of 7 studies were included to perform a meta-analysis, 3 randomized trials and 4 observational studies with 2211 patients, 1281 treated with Crush and 930 with Culotte. There was no significant difference in TLR and MACE between Crush and Culotte [RR 0.76, 95% CI (0.48–1.23), I2 = 57%; RR 0.78, 95% CI (0.47–1.29), I2 = 83%, respectively]. ST tended to be lower in patients treated with Crush [RR 0.61, 95% CI (0.37–1.01), I2 = 23%]. CD and MI were comparable between the 2 groups [RR 0.80, 95% CI (0.43–1.49), I2 = 0%; RR 0.74, 95% CI (0.49–1.13), I2 = 32%, respectively]. TVR was also associated with the similar risk [RR 0.76, 95% CI (0.49–1.16), I2 = 60%]. However, high heterogeneity was detected for TLR, MACE, and TVR, and the source of heterogeneity was DKCRUSH-III study by Chen, SL. Conclusions: In the treatment of coronary bifurcation lesions, TLR and MACE were not significant difference between the Crush and Culotte groups, but TLR and MACE were also regarded as high heterogeneity mainly due to better outcomes achieved by DK Crush and there was a trend toward lower ST in the Crush group. Crush, particularly DK Crush, may be superior to conventional Culotte for treatment of CBLs. PROSPERO registration number: CRD42018111868.

Transfemoral and perventricular device occlusions are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. Few comparative studies have been conducted of these three procedures.Inpatients with isolated dcVSD who had undergone transfemoral and perventricular device occlusions or conventional surgical repair from January 2009 to June 2013 were reviewed to compare the three procedures.Procedure success was achieved in 33 transfemoral (66%), in 74 perventricular (94.9%), and in 205 repair (97.6%) procedures. The transfemoral group had the lowest success rate (p0.001), whereas the perventricular and repair groups had similar success rates (p = 0.418). Transfemoral patients were the oldest (p0.001) and had a dcVSD size similar to that of patients in other two groups (p = 0.518). The repair group required the longest hospitalization and longest stays in the intensive care unit (p0.001), required the longest operating room and mechanical ventilation times (p0.001), and had the highest rate of transfusion (p0.001). Major adverse events occurred in one transfemoral (3%), in two perventricular (2.7%), and in three repair (1.4%) procedures. Minor adverse events were absent in transfemoral (0%) and occurred in three perventricular (4%) and 14 repair (6.7%) procedures. No significant difference was noted in the rates of adverse events the three groups (p = 0.569). No grade 3 valvular regurgitation or complete atrioventricular block was observed in the studied patients.Device occlusion may be an alternative to surgical repair in selected patients with dcVSD. Perventricular occlusion was the preferred approach because it showed a higher success rate than transfemoral occlusion.

ObjectivesThe present study established criteria to differentiate simple from complex bifurcation lesions and compared 1-year outcomes stratified by lesion complexity after provisional stenting (PS) and 2-stent techniques using drug-eluting stents.BackgroundCurrently, no criterion can distinguish between simple and complex coronary bifurcation lesions. Comparisons of PS and 2-stent strategies stratified by lesion complexity have also not been reported previously.MethodsCriteria of bifurcation complexity in 1,500 patients were externally tested in another 3,660 true bifurcation lesions after placement of drug-eluting stents. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) at 12 months. The secondary endpoint was the rate of stent thrombosis (ST).ResultsComplex (n = 1,108) bifurcation lesions were associated with a higher 1-year rate of MACE (16.8%) compared with simple (n = 2,552) bifurcation lesions (8.9%) (p < 0.001). The in-hospital ST and 1-year target lesion revascularization rates after 2-stent techniques in the simple group (1.0% and 5.6%, respectively) were significantly different from those after PS (0.2% [p = 0.007] and 3.2% [p = 0.009], respectively); however, 1-year MACE rates were not significantly different between the 2 groups. For complex bifurcation lesions, 2-stent techniques had lower rates of 1-year cardiac death (2.8%) and in-hospital MACE (5.0%) compared with PS (5.3%, p = 0.047; 8.4%, p = 0.031).ConclusionsComplex bifurcation lesions had higher rates of 1-year MACE and ST. The 2-stent and PS techniques were overall equivalent in 1-year MACE. However, 2-stent techniques for complex lesions elicited a lower rate of cardiac death and in-hospital MACE but higher rates of in-hospital ST and revascularization at 1 year for simple lesions.

Background and Objectives Pyrrole-Imidazole polyamide (PIP) is a novel gene silencer that can be readily designed and synthesised to target any gene. Contrary to traditional gene-silencing agents, PIP is resistant to nucleases and can enter into the nuclei of target cells without any particular delivery system. Moreover, PIP has a low molecular weight, a high efficiency of cellular uptake and bioavailability, and is hydrophobic and lipophilic, making it pharmacokinetically suitable for loading onto the metal stent. The present study was designed to evaluate the potential effects of PIP on in-stent restenosis and re-endothelialisation in rat abdominal aorta stenting models. Methods Rats were assigned to four groups (n=10 for each group): Control group, Bare-metal stent group, PIP-eluting stent group and Mismatch PIP-eluting stent group. In vitro pharmacological release kinetics was analysed by HPLC. The re-endothelialisation indices were determined by scanning electron microscopy (n=3). The expression of LOX-1, NADPH p22phox, NADPH p47phox will be determined by quantitative real-time PCR and Westernblot. The oxidative stress in the aorta will be determined by measuring aortic MDA levels. Sections in methylmethacrylate will be cut into 5-μm thickness and stained with hematoxylin-eosin. The area of neointimal hyperplasia (NIH), the rate of restenosis, and the injury and inflammation scores were measured. Results In vitro pharmacological release kinetics showed that PIP eluting stents showed almost complete release of the PIP with in 24h. In vivo pharmacological release kinetics demonstrated that trace amount of PIP was still remained in the local aorta tissues. Scanning electron microscopy showed that re-endothelialisation was nearly complete in all the three stents groups (n=3) at 14 days after stents implantation. The expression of LOX-1, NADPH p22phox, NADPH p47phox and the vascular MDA levels was significantly increased in BMS group compared with control group at 28 days after stents implantation (p 0.05). Conclusions PIP targeting LOX-1 eluting stents could decrease in-stent restenosis (ISR) without impairing re-endothelialisation by silencing LOX-1 and lowering oxidative stress. These results indicated that PIP targeting LOX-1 is considered to be a feasible gene silencing agent using the next generation of DES for the prevention of in-stent restenosis of the coronary artery.

Background and Objectives Myocardial ischemia-reperfusion injury (MIRI) can be alleviated by ischemia post-conditioning (IPC) and/or statin post-conditioning (SPC), and their combination. However, it is unclear how the cardio-protection works in impaired glucose tolerance (IGT) state since IGT significantly abolishes intrinsic myocardial self-protection, and if it does so, what mechanisms are involved in the process. This study aims to investigate the cardio-protective effects and possible mechanisms by combination of SPC and IPC in the IGT rats. Methods An IGT model was successfully created in 72 out of 117 male Wistar rats by injecting STZ, which were randomly allocated into six groups (n=12 per group): Sham group, treated with open chest operation but without myocardial ischemia as controls; I/R group, with ischemia 30 min and reperfusion 2 h in LAD territory but without other interventions; IPC group, treated with initial ischemia 30 min, then 3 consecutive runs of 10 s reperfusion/10s ischemia, and final reperfusion 2 h; SPC group, with initial ischemia 30 min, then pitavastatin (0.1 mg/kg) intravenously 3 min before reperfusion, and final reperfusion 2 h; ISPC group, with initial ischemia 30 min, then combination of three consecutive runs of 10 s reperfusion/10 s ischemia and pitavastatin 3 min before reperfusion, and final reperfusion 2 h; ISPC+LY294002 group, with initial ischemia 30 min, then combination of 3 consecutive runs of 10 s reperfusion/10 s ischemia, pitavastatin and PI3-K inhibitor LY294002 (0.3 mg/kg, intravenously) 3 and 15 mins before reperfusion, respectively. Results Compared with sham group, I/R group had larger infarct size (70.1±3.1% vs 0±0%, p Conclusions The combination of pitavastain and ischemic postconditioning enhances the cardioprotection against myocardial ischaemia-reperfusion injury in impaired glucose tolerance rats, and PI3K-Akt-eNOS may be a major signaling pathway mediated this cardioprotection.

Objectives Mesenchymal stem cells are sensitive to hypoxia under myocardial micro-environment of ischaemia and reperfusion. Ischemic postconditioning, which is cardioprotective against ischaemia-reperfusion injury, enhances in vivo survival and therapeutic effects of transplanted stem cells. In this study, we investigateded the effects of coronary effluent from postconditioned rat hearts on proliferation and survival of mesenchymal stem cells in vitro under hypoxia. Methods Isolated perfused rat hearts were subjected to 30 minutes of ischaemia and 60 minutes of reperfusion, and postconditioning was induced by 3 cycles of 30 sec reperfusion and 30 sec ischaemia before sustain edreperfusion. Inflammation-related factors in coronary effluent were assessed by ELISA. Mesenchymal stem cells from bone marrow of Sprague-Dawley rats were cultured with coronary effluentunder hypoxia (95% nitrogen and 5% carbon dioxide)for 18 hours. Cell proliferation was determined by methylthiazolyl tetrazolium. Survival was detected by Annexin V/PI. Results Compared with ischaemia-reperfusion group, postconditioning treatment increased the level of interleukin-10 and decreased the level of tumour necrosis factor-α, interleukin-1β in coronary effluent ( P P Conclusions We have demonstrated that coronary effluent from postconditioned hearts may promote the proliferation and survival of mesenchymal stem cells by suppressing inflammation under hypoxia.

Objectives group Methods group Results Compared with I/R group, different dosage (0.1, 0.5, 1.0 or 2.0 mg/kg) of atorvastatin intervention significantly decreased IS (p 0.05), cTnT (p>0.05), Flameng score (p>0.05) as well as myocardial expression of phosphorylated AKt (p>0.05), phosphorylated eNOS (p>0.05) and HSP70 (p>0.05) between groups. Conclusions Our data suggests that activation of the upstream PI3K-Akt-eNOS pathway and up regulation of the downstream protein HSP70 contribute to atorvastatin post conditioning cardio-protection in type 2 diabetic rat.

Background Both Transcatheter device closure (TCDC) or intraoperative device closure (IODC) have emerged as new minimally invasive alternatives to the classic surgery in the treatment of secundum atrial septal defect (ASD). However, the long-term safety and efficacy by the two methods for closuring large particularly huge ASD remains uncertain. Present study sought to investigate and compare the long-term clinical outcomes by using TC DC and IODC for closure of large-to-huge ASD. Methods A total 92 patients with large-to-huge ASD (a defect diameter of ≥30 mm), treated from January 2003 to Dec 2009, were included in this study. All the patients have been followed up until Dec 2010. The patients were assigned to either TCDC or IODC group according to the patients′ or their parents′ preference. Baseline physical exams, chest roentgenography, electrocardiography, and echocardiography were performed pre-procedure and at each follow-up visit. Results 42 patients underwent TCDC and 50 patients received IODC by using Amplatzer septal occluder (ASO). The average diameter of ASD was similar in the two groups (35.2±4.8 mm vs 34.9±4.4 mm, p>0.05). The immediate procedural success rate was 92.9% for TCDC and 98.0% for IODC (p=0.328). The peri-procedural complication rate was 9.5% for TCDC and 28.0% for IODC p Conclusions Present study confirmed the long-term safety and efficacy by using ASO for closure of large-to-huge ASD either by TCDC or IODC. However, the acute complication rate was lower and the length of hospital stay was shorter by TCDC.

Background High thrombus burden (HTB) is an independent predictor of no- or low-reflow during primary percutaneous coronary intervention (pPCI). This study sought to compare immediate versus delayed stenting in ST-elevation acute myocardial infarction (STEMI) patients with high thrombus burden. Methods We retrospectively analysed myocardial perfusion and cardiac function in 103 acute STEMI patients with HTB (Thrombus score, TS≥2), who underwent pPCI. All patients received standard antithrombotic therapies and initial interventions such as manual thrombus aspiration or balloon dilatation. The immediate stenting group (IS, n=53) received stent placement immediately after angiography if necessary regardless of HTB, while the delayed stenting group (DS, n=50) was deferred for stent implantation for 37 days if TIMI flow was ≥1 at initial angiography or after initial interventions and received enhanced antithrombotic therapy with Tilofiban infusion for 48 h, and thereafter stent implantation was at discretion of the operator based on the residual stenosis in the infarcted related artery. TIMI score (TIMIs), TIMI frame count (TFC) and myocardial blush grade (MBG) were compared immediately after stent implantation for both groups. Results The baseline major clinical characteristics including gender, age, TS and TIMIs were similar in both groups. Immediately after stent implantation, TIMIs, TFC and MBG in the DS group were better than those in IS group (p Conclusions Compared with immediate stenting, delayed stenting seems to improve myocardial perfusion and cardiac function in STEMI patients with high thrombus burden.

Background and Objectives The optimal stenting strategy for the treatment of unprotected left main coronary bifurcation lesions (UPLMCBLs) remains uncertain. Present study observed the technical feasibility and immediate outcomes of the modified culotte stenting (MCS) for the treatment of UPLMCBLs with drug-eluting stents. Methods Forty patients with true UPLMCBLs according Medina9s classification were included in the study. The MCS main steps were described as follows: (1) pre-imbedding a balloon in the larger branch (LB) and stenting the smaller branch (SB) first with mini-protrusion of 1–2 mm into the left main stem, (2) removing the stent balloon out of the SB and wiring the LB via a side-hole of the expanded SB stent, (3) removing the pre-imbedded balloon out of the LB after successfully wiring the LB, (4) deploying the LB stent and rewiring the SB, (5) performing sequential high pressure dilation of each branch followed by a final balloon kissing (FBK). Results The immediate success angiographically (residual stenosis Conclusions MCS for the treatment of UPLMCBLs was technically safe and feasible, readily to complete final balloon kissing, and was associated with high immediate angiographic and procedural success rate.

Background and objectives Circumferential pulmonary vein isolation (CPVI) has become a major treatment of atrial fibrillation (Af). However, the postprocedural early recurrence rate is still high, which may be related to postoperative inflammatory reaction. With pleiotropic effects, statins are expected to inhibit the inflammatory response and thus reduce the Af recurrence after catheter ablation. The authors sought to clarify the efficacy of a large dose of atorvastatin therapy for preventing early Af recurrence after CPVI. Methods A total of 40 patients with paroxysmal Af and with hypercholesterolemia were randomly divided into two groups: control group (n=20) and high-dose atorvastatin intervention group (intervention group, n=20). Both groups received routine clinical medical treatment, and control group only received atorvastatin of £20 mg/day if indicated. Intervention group was given atorvastatin 80 mg 24 h and 40 mg 2 h before CPVI, and then atorvastatin 40 mg/day for 1 month. Blood samples were collected 24 h before and immediately after, 3 days and 1, 2 and 3 months after CPVI. The inflammatory markers including high-sensitivity C reactive protein (hs-CRP), interleukin 6 (IL-6) and tumour necrosis factor α (TNFα), and myocardial injury markers CK-MB and cTn-T were measured. The Af early recurrence was monitored clinically and by 72 h Holter monitoring. Results At a mean follow-up period of 3 months, as compared with the control group, AF burden was significantly reduced in the intervention group (p 0.05). The level of inflammatory markers including hs-CRP, IL-6, TNFα were increased immediately and 3 days after ablation in both groups. However, compared with those of the control group, the levels of hs-CRP, IL-6 and TNFα were significantly reduced in intervention group (p 0.05, each). Conclusions The pilot study showed that high-dose atorvastatin pretreatment and short-term enhanced intervention can reduce the peri-procedural inflammatory response and atrial fibrillation burden after catheter ablation, but does not decrease the early recurrence of atrial fibrillation.

Objective This study was to investigate the outcome of transcatheter closuring large-to-huge ASD with the AOD within one year. Methods 35 consecutive patients with large-to-huge ASD (330 mm) underwent transcatheter defect closure and then were followed up peri-procedurally, at 1-, 6-, and 12-month periods following the operation by clinical assessment, electrocardiographic and echocardiographic examination. All patients received 6-month anti-thromboembolic therapy by using either aspirin or warfarin at the discretion of the operator. The major adverse cardiac events (MACE) include cardiac death, occluder dislodgment leading to urgent cardiac surgery, occluder occupation significantly impeding haemodynamics or cardio-electrical activities, AOD-related thrombo-embolism, AOD-related atrial rupture, the minor adverse cardiac events (MACE) include occluder occupation with or without slight interference of haemodynamics, AOD-related arrhythmia and residual shunting. Results The average diameter of ASD in 35 patients was 33.7±5.2 mm (range 30 mm to 38 mm), and the average diameter of final AOD used was 38.1±7.1 mm (range 32 mm to 42 mm). The immediate technical success was 100% without severe peri-procedural complications. MACE was not found in each stage within a one year follow-up, but MAC Ewas frequently encountered, among which occluder occupation with asympathetic haemodynamic interference occurred 45.7% peri-procedurally, 42.9% at 1-month, 40.0% at 6-month, and 34.3% at 12-month, and AOD-related atrial arrhythmia occurred 51.4% peri-procedurally, 14.3% at 1-month, 8.6% at 6-month, and 2.9% at 12-month. Persistent small residual shunting was found in 24 (68.6%) patients and I°AVB in one (2.9%) patient. Conclusions The large-to-huge ASD can be occluded by using AOD without technical difficulty, but the long-term safety and efficacy requires further study.