Search

Aims: Intracardiac dynamics during atrial fibrillation(AF) complicated by heart failure(HF) are not fully understood. The aim of this study was to evaluate the impact of intracardiac dynamics assessed by echo-vector flow mapping on AF complicated by HF., Methods and Results: We enrolled 76 AF patients receiving sinus restoration therapy and assessed energy loss(EL) by echo-vector flow mapping during both AF rhythm and sinus rhythm. Patients were divided into 2 groups according to serum NT-proBNP level: high NT-proBNP group(≥1800 pg/ml during AF rhythm: N = 19), and low NT-proBNP group(N = 57). Outcome measures were average ELs/stroke volume(SV) in left ventricle(LV) and left atrium(LA). Average EL/SVs during AF rhythm in the LV and LA were significantly larger in the high NT-proBNP group than the low NT-proBNP group(54.2 mE/m·L versus 41.2 mE/m·L, P = 0.02; 3.2 mE/m·L versus 1.9 mE/m·L, P = 0.01). The significantly larger EL/SV in the high NT-proBNP group was recorded for maximum EL/SVs. In patients with high NT-proBNP, large vortex formation with extreme EL was detected in the LV and LA during the diastolic phase. After sinus restoration, the average decrease of EL/SV in the LV and LA was larger in the high NT-proBNP group(-21.4 mE/m·L versus +2.6 mE/m·L, P = 0.04; -1.6 mE/m·L versus -0.3 mE/m·L, P = 0.02). Average EL/SV during sinus rhythm did not significantly differ between the high and low NT-proBNP groups in the LV and LA., Conclusions: High EL during AF rhythm as intracardiac energy inefficiency was associated with high serum NT-proBNP levels and improved after sinus restoration., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The main drawback of current available drug coated balloons (DCB) is that a certain percentage of the coated drug is lost in the bloodstream during its delivery to the target lesion. We integrated the nanoparticle-mediated drug delivery technology and polydimethylsiloxane (PDMS) as a new excipient to facilitate an efficient drug delivery and uptake by endothelial cells. The present study aimed to evaluate the efficacy of the new DCB., Method and Results: The novel DCB were coated with 5.6mg of paclitaxel-incorporated nanoparticles using PDMS. The efficacy of the new DCB was examined in rabbit iliac stent model (n=12) and in the swine in-stent restenosis model (n=8) by quantitative coronary angiography (QCA) and optical coherence tomography (OCT). At 28days follow-up in the swine in-stent restenosis model, the area stenosis was significantly lower in DCB group as compared with that of the control group in OCT analysis (0.31±0.05 vs 0.49±0.06, p=0.04) though there was no significant differences observed in the rabbit iliac stent model in QCA and OCT analysis., Conclusion: The study results indicated that the paclitaxel-incorporated nanoparticle-coated balloon using PDMS has an inhibitory effect for the proliferation of smooth muscle cell in a swine coronary in-stent restenosis model., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: The present study aimed to develop a swine coronary bifurcation model., Background: In human coronary bifurcation lesion, atherosclerotic plaques are usually observed in the lateral wall, whereas the flow divider regions are spared. There is currently no suitable coronary bifurcation animal model, on which a new stent can be tested., Methods: We developed a novel directional heat injury catheter, which comprised of a non-compliant balloon catheter (diameter: 3.0mm, length: 15mm), and two electrode cables, that were attached to either side of the balloon catheter. The technique was performed on 4 healthy pigs, and assessed in 7 lesions. We inflated the balloon at the main bifurcation branch, following which a high frequency generator was used to transmit heat to the opposite side of the electrode, towards the bifurcation carina (duration: 5min, frequency: 2 times). We performed a post-angiography 28days after the pre-angiography, to observe the distribution of neointima. The neointimal area was divided into the carina side and the opposite side of carina, and the 2 sides were compared., Results: The neointimal area at the opposite side of the carina was significantly larger than the carina side (1.51±0.40mm 2 vs. 0.95±0.27mm 2 , p<0.0001). The percentage of area of stenosis on the opposite side of carina was also higher than that on the carina side (55.4±7.0% vs. 34.9±4.2%, p<0.0001)., Conclusions: We successfully developed a novel swine coronary bifurcation model using directional heat injury catheter., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Transcatheter aortic valve implantation (TAVI) is an established therapy for patients who are inoperable or at high risk for open heart surgery. The retrograde transfemoral approach is the most widely used and is the first choice in TAVI. However, existence of peripheral vascular disease or a small iliofemoral artery often limits the application of the transfemoral approach. Transvenous antegrade transseptal TAVI is an attractive option, but has already been abandoned due to its technical complexities., Methods and Results: We have previously described a novel technique to simplify antegrade transseptal balloon aortic valvuloplasty, which utilizes a custom-made Inoue balloon catheter with two stylets. The technique is named as the looped Inoue balloon technique, and its feasibility and efficacy were proven in an animal model and a clinical case. We applied this technique to TAVI. The present study aimed to assess the feasibility of the looped Inoue balloon technique for TAVI in two healthy pigs. The valve implantation was successful in both pigs, although the pigs died soon after the implantation (2 and 24h). The causes of death were access site bleeding (Case 1) and migration of the prosthetic valve (Case 2)., Conclusions: Although several improvements and further studies are required, the study results indicate that antegrade TAVI using the looped Inoue balloon technique is feasible., (Copyright © 2016. Published by Elsevier Ltd.)

Background: Donor artery fractional flow reserve (FFR) often improves after treatment of recipient artery stenosis, but the physiological mechanism underlying this phenomenon has not been elucidated. This study aimed to assess two novel equations that explain the donor-recipient artery interaction., Method: Eq. (A) predicts the donor artery FFR after complete release of recipient artery stenosis, while Eq. (B) predicts the donor artery FFR after partial release of recipient artery stenosis. Eq. (B) is a general form of Eq. (A). FFR'1−pred = ((FFR1−CFI1)(FFR2−CFI2)−CFI1CFI2(1−FFR1)(1−FFR2)+CFI1(1−FFR1)(1−CFI2))/((1−C FI1)(FFR2−CFI2)) (A) FFR''1−pred = ((FFR1−CFI1)(FFR2−CFI2)−CFI1CFI2(1−FFR1)(1−FFR2)+CFI1(1−FFR1)(1−CFI2))FFR'2/((1−C FI1)(FFR2−CFI2)) (B) Eqs. (A) and (B) were assessed using an in vitro model of coronary circulation with a collateral channel connecting the donor and recipient arteries., Results: The donor artery FFR always improved after releasing the recipient artery stenosis. A good linear correlation was found between the predicted FFR of Eq. (A) and the actual FFR (n=40, r=0.95, p<0.0001) and between the predicted FFR of Eq. (B) and the actual FFR (n=40, r=0.94, p<0.0001)., Conclusions: Eqs. (A) and (B) accurately predicted the true FFR value of the donor artery in a coronary circulation model and explain the donor-recipient artery interaction observed in clinical practice., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Little is known about the prognostic implications of anemia in patients undergoing elective percutaneous coronary intervention (PCI), especially when they have coexisting chronic kidney disease (CKD)., Methods: We identified 7299 patients who underwent elective PCI from the CREDO-Kyoto registry cohort-2. The primary outcome was 3-year major adverse cardiac events (MACE); composite of all cause death, heart failure hospitalization, and myocardial infarction., Results: In total, 1466 patients (20.0%) had mild anemia (hemoglobin=11.0-11.9 g/dL for women and 11.0-12.9 g/dL for men), and 740 patients (10.1%) had moderate-to-severe anemia (hemoglobin<11.0 g/dL both for women and for men). Compared to the no-anemia group, cumulative incidence of MACE was significantly higher in the mild and moderate-to-severe anemia groups (7.9%, 20.1%, and 34.2%, respectively). The adjusted hazard ratios of mild and moderate-to-severe anemia versus no-anemia for MACE were 1.77 (95% confidence interval: 1.47-2.15) and 2.53 (95% confidence interval: 2.03-3.14), respectively. In a subgroup analysis, significantly higher risk for MACE was consistently observed with mild and moderate-to-severe anemia both in patients with and without CKD. The risk for MACE showed an accretive increment with exacerbation in either the renal function or anemia (interaction p<0.001)., Conclusions: Even mild anemia was associated with significantly worse 3-year clinical outcomes in patients who underwent elective PCI. Coexisting CKD additively increased the risk for MACE in these patients., (© 2013.)

Background: The influence of β-blocker therapy on prognosis in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) has not been fully explored., Methods and Results: We identified 5288 CAD patients who did not have myocardial infarction (MI) or heart failure (HF) but underwent PCI from a large multi-center registry enrolling consecutive patients undergoing first coronary revascularization from 2005 to 2007. The primary outcome was a composite endpoint of cardiac death and/or MI (cardiac death/MI) at 3 years after hospital discharge for PCI. β-blockers were prescribed in 1117 patients (β group, 21.1%) at discharge, while 4171 patients did not (no-β group, 78.9%). Patients in the β group more often had hypertension, multivessel disease, use of statin and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, but less often had chronic obstructive pulmonary disease. The 3-year incidence of cardiac death/MI was higher in the β group (4.9% vs. 3.4%, log-rank p=0.02). After adjusting for potential confounders, β-blocker therapy was associated with significantly increased risk for cardiac death/MI (hazard ratio 1.48, 95% confidence interval 1.05-2.10, p=0.02)., Conclusions: β-blocker therapy was associated with worse 3-year clinical outcomes in CAD patients who underwent PCI but had no history of MI or HF. Randomized trials are warranted to identify appropriate subsets of patients who could truly benefit from long-term use of β-blockers in this setting., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)