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The benefits of distal radial balloon aortic valvuloplasty were recently reported: same efficacy as the classical femoral approach, with no vascular complications. The long-term outcomes for these patients remain unknown.

Introduction: The contraction–relaxation pattern of the left atrial (LA) walls is opposite to that detected in the left ventricle, which includes thinning in radial, lengthening in longitudinal, and widening in circumferential directions in the systolic reservoir phase of LA function as measured by three-dimensional speckle-tracking echocardiography (3DSTE). Global longitudinal strain (GLS) is a quantitative feature of longitudinal wall contraction referring to the whole LA. The present study aims to clarify the expected prognostic impact of peak LA-GLS as assessed by 3DSTE in healthy participants during a long-term follow-up period. Methods: The study consisted of 142 healthy adults (with an average age of 32.1 ± 12.7 years; 72 of the participants were men), in whom complete two-dimensional Doppler echocardiography and 3DSTE were performed on a voluntary basis. Results: Thirteen adults suffered from a cardiovascular event, including two cardiac deaths during a mean follow-up of 8.35 ± 4.20 years. Peak LA-GLS ≥ 20.9%, as assessed by 3DSTE, was found to be a significant predictor for cardiovascular event-free survival by using ROC analysis (specificity 74%, sensitivity 62%, area under the curve 0.69, p = 0.025). Healthy individuals with peak LA-GLS < 20.9% had a lower LV-EF and a significantly higher ratio of cardiovascular events compared to cases with peak LA-GLS ≥ 20.9%. Subjects who experienced cardiovascular events had lower peak LA-GLS and the ratio of subjects with peak LA-GLS < 20.9% proved to be significantly increased compared to that of cases without cardiovascular events. Conclusions: 3DSTE-derived peak LA-GLS representing LA lengthening in the end-systolic reservoir phase of LA function predicts future cardiovascular events in healthy adults. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a cornerstone of the management of ischemic heart disease. However, in-stent restenosis (ISR) remains a significant clinical challenge, occurring in approximately 5–10% of patients undergoing PCI. This study is designed to compare the efficacy and safety of the primary therapeutic approaches for DES-ISR, specifically drug-coated balloons (DCBs)—paclitaxel-coated balloons (PCBs) and sirolimus-coated balloons (SCBs)—with a new-generation everolimus-eluting stent (EES), contributing to the evolving field of personalized medicine. Methods and Analysis: This prospective, multicentre, randomised, non-inferiority trial aims to enroll 150 patients with DES-ISR, who will be randomised into one of the following: SCB, PCB, or EES. The primary endpoint comparing DCB and EES is late lumen loss (LLL) at 6 months, as measured by quantitative coronary angiography (QCA). Secondary endpoints comparing the three arms include a device-oriented composite endpoint, intraluminal gain, optical coherence tomography (OCT) measured LLL, and correlations between LLL and quantitative flow ratio (QFR). The primary endpoint will be analysed using a non-inferiority design, with a margin set at 0.25 mm, for which the sample size was calculated. Statistical analysis of the primary endpoint will be conducted on an intention-to-treat basis with a one-tailed Mann–Whitney U test with a significance level of 95. Secondary endpoints will be analysed via superiority testing using ANOVA, the Kruskal–Wallis test, logistic regression, or Fisher's exact test, as appropriate. Ethics and Dissemination: The study protocol has been approved by the Medical Devices Department of the Hungarian National Institute of Pharmacy and Nutrition, ensuring compliance with ethical standards as outlined in the Declaration of Helsinki. All investigators declare no conflicts of interest related to this study. The trial is registered in ClinicalTrials.gov under the ID: NCT04862052. [ABSTRACT FROM AUTHOR]

Objectives Data about coronary bifurcations treated with ultrathin strut drug-eluting stents (DES) using T-and-protrusion (TAP) technique is limited. Methods In this study, a total of 84 consecutive patients, who underwent bifurcation percutaneous coronary intervention (PCI) with TAP technique using Orsiro® DES (Biotronik, Berlin, Germany), were included. All pre- and post-procedural data, as well as 1- and 2-year follow-up angiograms, were analyzed. Primary endpoints were procedural success and target lesion failure (TLF); secondary endpoints were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) during follow-up. Results Procedural success was achieved in 100% of cases. TLF rate was higher in patients presented with acute coronary syndrome compared to the ones with chronic coronary syndrome (19% vs. 5% p = 0.09). All-cause mortality was 30% during follow-up, from which 26% was due to non-cardiovascular cause, and the MACCE rate was 46%. Conclusions Coronary bifurcations treated with ultrathin strut DES showed good short-term results and were associated with acceptable cardiovascular mortality. However, in these long-term patients, the rate of MACCE and non-cardiovascular death were rather high. [ABSTRACT FROM AUTHOR]

Background: Vascular access site complications (VASCs) after endovascular interventions requiring a large-bore access are frequent and known to be associated with increased morbidity and mortality. Although balloon-expandable covered stents (BECSs) are increasingly used in such indications, their performance in this rather hostile territory is currently unknown. We aimed to evaluate the safety and efficacy of BECSs in common femoral artery (CFA) VASCs management. Methods: This is a national multicenter retrospective study of all patients who underwent BECS implantation of the CFA due to a VASCs after an endovascular procedure between January 2020 and May 2023 in major tertiary referral centers in Hungary. Operative data were collected and follow-up ultrasound examinations were performed. Our study is registered on ClinicalTrials.gov (NCT05220540) and followed the STROBE guidelines. Results: Of the 23 patients enrolled (13 females, mean age: 74.2 ± 8.6), technical success was achieved in 21 (91.3%) cases, with one perioperative death. After an average follow-up of 18.0 ± 11.4 months, another nine (39.1%) deaths occurred, and one was VASCs-associated. BECS occlusion was detected in one (4.3%) patient, being the only reintervention (4.3%) where revascularization was also achieved. Conclusions: Although BECS implantation for CFA VASCs is feasible with a relatively high technical success rate, the mortality rate is non-negligible. Until adequately evaluated, BECS implantation in such indications is to be used with caution, ideally only within the framework of a trial. [ABSTRACT FROM AUTHOR]

Background: The left ventricular (LV) rotational mechanics are of particular importance in the function of the LV. The rotational movement is the consequence of the arrangement of the subepicardial and subendocardial muscle fibers. These muscle fibers are perpendicular to each other, their contraction creates a characteristic motion. The aim of the present study was to examine the prognostic impact of LV twist assessed by three-dimensional speckle-tracking echocardiography (3D-STE) in healthy circumstances. Methods: 302 healthy adults participated in the study, 181 subjects were excluded due to certain reasons (LV could not be analysed during 3D-STE, subjects were unidentifiable, or lost to follow-up). 121 subjects were involved in the final analysis (mean age of 33.1 ± 12.3 years, 75 males), who were willing to be examined on a voluntary basis. Results: During a mean follow-up of 7.93 ± 4.21 years, 11 healthy adults suffered a cardiovascular event including 2 cardiac deaths. Using receiver operating characteristic analysis, LV twist ≥14.65 degrees as assessed by 3D-STE proved to be significantly predictive regarding the cardiovascular event-free survival (area under the curve 0.70, specificity 70%, sensitivity 65%, p = 0.028). Subjects with LV twist ≥14.65 degrees had higher basal and apical rotations and a significantly higher ratio of these individuals developed cardiovascular events compared to cases with LV twist <14.65 degrees. Subjects with cardiovascular events had lower LV global longitudinal strain, higher basal LV rotation and twist and the ratio of subjects with LV twist ≥14.65 degrees was elevated as compared to cases without events. Conclusions: 3D-STE-derived LV twist independently predicts future cardiovascular events in healthy adults. [ABSTRACT FROM AUTHOR]

Background Severe aortic paravalvular leaks (PVLs) after surgical mechanical aortic valve replacement (AVR) represent a high risk for congestive heart failure, haemolysis, and infective endocarditis. This is the first reported case of distal radial artery (DRA) access for severe mechanical aortic PVL closure with a sequential double vascular plug guided by computed tomography angiography (CTA), transoesophageal echocardiography (TOE), and 3D TOE in an acute setting. Case summary A 51-year-old male presented with significant mixed aortic valve disease. Aortic valve replacement was performed (Slimline Bicarbon A-25 mm) according to guidelines. Four and 16 days later, a re-exploration was carried out due to pericardial effusion. Four months after discharge from rehabilitation, the patient was readmitted due to worsening dyspnoea on exertion and then at rest. Transthoracic echocardiography, TOE, and consequently, CTA, revealed severe PVL, following which the procedure of transcatheter PVL closure was chosen, with a preference for DRA access. After a CTA scan analysis and angiographic, TOE, and 3D TOE visualization of the leak, a 14/5 mm and a 10/5 mm vascular plug (AVPIII) were deployed to achieve good results. A 9-month clinical, echocardiographic, and CTA follow-up revealed good long-term results. Discussion For transcatheter PVL closure, CTA is helpful for not only vascular access planning, but also a visualization of the magnitude of the leak, location, and device planning. This case report demonstrates that the distal radial approach is feasible in patients with severe mechanical aortic valve PVL retrograde transcatheter closure. DRA access could possibly represent less bleeding and vascular access site complications when compared with femoral access and has some potential advantages over regular radial access. [ABSTRACT FROM AUTHOR]