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Objectives: Systolic and diastolic dysfunctions are related to adverse clinical outcomes in patients with sinus rhythm. The aim of this study was to clarify the prognostic significance of systolic and diastolic dysfunctions in patients with chronic persistent atrial fibrillation (AF). Methods: We evaluated data for 114 consecutive patients with chronic AF who underwent measurement of LVEDP at our hospital between 1 March 2011 and 31 December 2014. In total, 114 consecutive patients with chronic AF were divided into two groups according to the left ventricular ejection fraction (LVEF): LVEF < 50 (reduced ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group). The PEF group was further divided into two subgroups according to the left ventricular end-diastolic filling pressure (LVEDP): LVEDP >15 mmHg and LVEDP ≤ 15 mmHg. The 3-year clinical outcomes were compared between the PEF and REF groups and the LVEDP ≥15 mmHg and LVEDP more...

Percutaneous transluminal angioplasty (PTA) is considered an effective treatment in patients with critical limb ischemia (CLI). However, the long-term durability of below-the-knee (BTK) PTA is known to be limited. This study sought to compare the 1-year clinical outcomes following stenting versus balloon angioplasty alone in BTK lesions. This study included 357 consecutive patients (400 limbs, 697 lesions) with BTK lesions who underwent PTA from September 2010 to December 2016. All enrolled patients were treated either by stenting (stent group; 111 limbs of 102 patients) or plain old balloon angioplasty (POBA group; 289 limbs of 255 patients). Stent group includes both primary and provisional stenting. Angiographic outcomes, procedural success, complications, and clinical outcomes were compared between the two groups up to 1 year. After propensity score matching (PSM) analysis, 56 pairs were generated, and the baseline and angiographic characteristics were balanced. The procedural success and complications were similar between the two groups; however, the incidence of procedure-related perforation was higher in the POBA group than in the stenting group [5(11.9%) vs.1 (0.9%), P = 0.009]. Six- to 9-month computed tomography or angiographic follow-up showed similar incidences of binary restenosis, primary patency, and secondary patency. In the 1-year clinical follow-up, there were similar incidences of individual hard endpoints, including mortality, myocardial infarction, limb salvage, and amputation rate, with the exception of target extremity revascularization (TER), which tended to be higher in the stenting group than in the POBA group [21 (20.8%) vs. 11 (10.9%), P = 0.054]. Although there was a trend toward a higher incidence of TER risk in the stenting group, stent implantation, particularly in bail-out stenting seemed to have acceptable 1-year safety and efficacy compared to POBA alone in patients undergoing BTK PTA. more...

Coronary artery spasm (CAS) and significant coronary stenosis are known to be major causes of myocardial ischemia. However, their association and the impact of insignificant coronary stenosis (ICS) on long-term clinical outcomes of CAS patients are largely unknown.A total of 2797 patients without significant coronary artery disease (CAD) who underwent the acetylcholine (ACH) provocation test between November 2004 and October 2010 were enrolled. Significant CAS was defined as having ≥70% of temporary narrowing by ACH test and ICS as having70% of fixed stenosis on angiography. Patients were divided into two groups: ICS group (n=764) and non-ICS group (n=845). To adjust potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. Primary endpoint was the composite of total death, myocardial infraction (MI), de novo percutaneous coronary intervention (PCI), and cerebrovascular accidents (CVA). Secondary endpoint was the incidence of recurrent angina requiring repeat coronary angiography (CAG) at 3years.After PSM analysis, two well-balanced groups (548 pairs, total=1096) were generated. The baseline clinical characteristics were similar between the two groups. During the ACH test, compared with the non-ICS group, the ICS group had smaller spastic narrowing diameter (0.69±0.35 vs. 0.73±0.37, P=0.039) and incidence of ST-segment depression (4.0% vs. 0.9%, P=0.001). The incidence of primary and secondary endpoints was similar between the two groups up to 3years.Although, the ICS group was expected to have more adverse long-term clinical outcomes, it was not associated with the increased incidence of major adverse clinical outcomes compared with the non-ICS group up to 3years. Longer term follow-up studies are needed. more...

BackgroundSuccessful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is known to be associated with improved clinical outcomes compared with failed CTO PCI. However, it is not clear whether the angiographic and clinical outcomes of long CTO lesionis different with those of short CTO lesion in the drug eluting stent (DES) era.Method sand ResultsA total of 235 consecutive patients underwent successful CTO intervention were divided into two groups according the CTO lesion length. Six-month angiographic and two-year clinical outcomes were compared between the two groups. The baseline clinical characteristics were similar between the two groups except prior PCI was more frequent in long CTO group whereas bifurcation lesion was more frequent in the short CTO group. In-hospital complications were similar between the two groups except intimal dissection was more frequent in long CTO group. Both groups had similar angiographic outcomes at 6 months and clinical outcomes up to 2 years except the incidence of repeat PCI, predominantly target vessel revascularization (TVR) was higher in long CTO group. In multivariate analysis, long CTO was an important predictor for repeat PCI (OR;4.26, CI 1.53-11.9, p=0.006).ConclusionThe safety profile, angiographic and 2-year clinical outcomes were similar between the two groups except higher incidence of repeat PCI in long CTO group despite of successful PCI with DESs. more...

There are limited long-term outcome data comparing BioLinx polymer (B)-zotarolimus-eluting stents (ZES) with phosphorylcholine polymer (P)-ZES. The aim of this study was to compare the efficacy and safety of B-ZES with P-ZES in patients who underwent percutaneous coronary intervention (PCI) during a 3-year follow-up period.One thousand two hundred fifty four patients who underwent PCI with P-ZES (Endeavor [ZES-E] or Endeavor sprint [ZES-S], n = 356) or B-ZES (Endeavor resolute [ZES-R] or Resolute Integrity [ZES-I], n = 889) were enrolled. The primary endpoint was major adverse cardiac events (MACE); the composite of total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-target vessel revascularization (Non-TVR), and the secondary endpoint was stent thrombosis (ST).After PSM, 2 propensity-matched (PSM) groups (275 pairs, n = 550, C-statistic = 0.730) were generated. During the 3-year follow-up period, the cumulative incidence of MACE (hazard ratio [HR], 1.525; 95% confidence interval [CI], 0.920-2.526; P = .101) and ST (HR, 1.248; 95% CI, 0.335-4.4649; P = .741) were similar between P-ZES and B-ZES after PSM. However, TLR rate was significantly higher in ZES-S than ZES-I (11.3% vs 3.8%, log rank P = .029) and TVR rate was higher in ZES-S than ZES-R (14.1% vs 4.8%, log rank P = .025).In this single-center, all-comer registry, despite different polymers, P-ZES, and B-ZES showed comparable safety and efficacy during a 3-year follow-up period after PCI. more...

The Outback LTD re-entry catheter system has become a valuable tool for peripheral intervention and it has been widely used for variable peripheral chronic total occlusion (CTO). However, its use in the setting of the aorta was restricted because of concerns of bleeding risks resulting from re-entry puncture or ballooning. This report presents a case of successful re-entry using the Outback LTD Re-Entry Catheter (Cordis, Bridgewater, New Jersy) at the aorta in a patient with bilateral common iliac artery occlusion. more...

Min-Suk Kim, Tae-Jin Kim, Jong Joo Moon, Jae-Hyung Nam, Dong-Hoon Han, Ji-Hun Ahn, Tae-Hoon Kim, Do-Hoi Kim, Young-Nam Youn, Yoon-Nyun Kim Division of Cardiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi; Division of Cardiology, Chungdam Wooridul Hospital; Division of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul; Division of Cardiology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea more...

Although percutaneous transluminal angioplasty (PTA) is considered as an effective treatment in patients (pts) with critical limb ischemia (CLI). This study sought to compare the 1-year clinical outcomes between stenting and standard plan old balloon angioplasty (POBA) in below-the-knee (BTK) more...

Coronary stent loss is a rare but serious complication during interventional cardiology. This complication occurs not only in the intracoronary area but also in the extracoronary area, such as the aortic root or the left ventricle. An 83-year-old man with stable angina had a stent inserted into a heavy calcific left anterior descending artery. The stent was lost twice during the procedure. The first stent was dislodged from the left main coronary artery to the proximal left anterior descending artery, and the second stent migrated to the aortic root following separation from the balloon. We successfully redeployed the first stent at the dislodged site and retrieved the second stent using a goose-neck snare after moving the stent to the descending aorta. These steps circumvented the need for the patient to undergo emergency cardiovascular surgery. more...

Patient initials or identifier number 64 year-old male ### Relevant clinical history and physical exam The patient was 64 year-old male and presented with transient loss of conciousness.Transthoracic echocardiography and trans esophagealechocardiography revealed the right atriam (RA) and more...

We present a case of persistent left superior vena cava, anomalous right pulmonary venous connection to the right-sided superior vena cava and sinus venosus atrial septal defect detected by computed tomography (CT) pulmonary angiography and echocardiography. These defects were surgically corrected using a double-patch technique. In fact, CT can provide anatomical information about a complex anomaly in the systemic and pulmonary vasculatures. Though modern imaging techniques are useful for detecting complex cardiovascular disease, careful echocardiographic examination should be performed to diagnose complex cardiac anomalies. more...

It has not been examined whether high Lp(a) levels are able to predict long-term adverse cardiovascular outcomes in patients (pts) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). The aim of this study is to assess the impact of Lp(a) levels on the major clinical more...

Trimetazidine (VastinanTM) is an anti-ischemic metabolic agent, which improves myocardial glucose utilization through inhibition of fatty acid metabolism, also known as fatty acid oxidation inhibitor. Trimetazidine usually prescribed as a long-term treatment of angina pectoris. The aim of this study more...

Echocardiographic assessments including E/e' are a good predictor of elevated left ventricular (LV) filling pressure during sinus rhythm. However, the evaluation of LV filling pressure using classic echocardiographic assessment has been challenging in the setting of atrial fibrillation (AF). The aim of this study was to investigate the methods for predicting LV filling pressure in patients with chronic AF.Clinical data, echocardiography findings, and brain natriuretic peptide (BNP) levels were assessed in 59 patients with chronic AF who were undergoing diagnostic left-heart catheterization. LV end-diastolic filling pressure (LVEDP) and standard echocardiographic measurements including pulmonary arterial systolic pressure (PASP) were evaluated. Blood samples were taken for serum BNP measurements within 24 h of the echocardiographic examination.E/e' correlated well with LVEDP (r = 0.558, p 0.001). Using receiver operating characteristic analysis, the optimal cut-off for E/e' was 16 (sensitivity, 64 %; specificity, 82 %) to predict LVEDP of 15 mmHg. PASP was also well correlated with LVEDP (r = 0.503, p 0.001). PASP greater than 32 mmHg predicted elevated LVEDP ( 15 mmHg) with a sensitivity of 64 % and a specificity of 71 %.E/e' and PASP were well correlated with LVEDP in patients with AF. PASP greater than 32 mmHg and E/e' greater than 16 may suggest elevated LVEDP ( 15 mmHg) in patients with chronic AF. more...

Recently, it was reported that statins are associated with lower rates of major adverse cardiovascular events and amputations in critical limb ischemia (CLI) patients (pts). However, the impact of statin administration duration on clinical outcomes for pts undergoing percutaneous transluminal more...

Atherosclerotic renal artery stenosis (RAS) usually involves the ostium and the proximal one-third of the renal artery main branch. Percutaneous renal artery angioplasty with stent placement is a well recognized treatment for atherosclerotic RAS. Occasionally, atherosclerotic RAS involves renal artery bifurcations. However, stent implantation in atherosclerotic RAS involving bifurcation is not only troublesome, but also challenging because of side branch occlusion and in-stent restenosis (ISR). In the present report, we describe the use of drug-eluting stents (DES) with provisional T-stenting technique for the treatment of renal artery bifurcation lesion. Follow-up angiogram showed no significant ISR 18 months after the procedure. In the treatment of renal bifurcation lesions, a two-stent strategy using DES could be a viable option in selected patients. more...

There have been limited data comparing efficacy and safety of Biolimus-eluting Stents (BES, BiomatrixTM, Biosensors and NoboriTM, Terumo) with Platinum Chromium Everolimus-eluting Stent (PtCr-EES, Promus ElementTM, Boston Scientific) in a series of Asian population in real world clinical practice. more...

It has been well known that a major cause of vasospastic angina is endothelial dysfunction and subsequent significant coronary vasoconstriction. Thus, diltiazem and nitrate can be beneficial as selective coronary vasodilators for pts with significant vasoconstriction. However, there is no study more...

Chronic alcohol consumption is known to be a risk factor of significant coronary artery disease (CAD). However, currently there is no available data with larger study population regarding long-term clinical outcomes of CAS patients (pts) with chronic alcohol consumption in real world clinical more...

There have been limited data comparing efficacy and safety of Biolimus-eluting Stents (BES, BiomatrixTM, Biosensors and NoboriTM, Terumo) with Zotarolimus-eluting Stent (ZES, Resolute Integrity, Medtronic) in a series of Asian population in real world clinical practice. A total of 626 patients (pts more...