Optical coherence tomography evaluation of late strut coverage patterns between first-generation drug-eluting stents and everolimus-eluting stent.

OBJECTIVES: To compare strut coverage patterns between everolimus-eluting stent (EES) and first-generation drug-eluting stents (DES) at more than 12 months after successful implantation, using optical coherence tomography (OCT). BACKGROUND: No sufficient OCT data has been reported comparing late strut coverage patterns between EES and first-generation DES. The favorable late results after EES implantation could be related to lower rates of uncovered and malapposed struts. METHODS: A total of 66 DES (21 EES, 23 SES, and 22 PES) that were implanted at least 1 year in advance in 40 patients and met good late angiographic results were evaluated by OCT. The percentage of uncovered and malapposed struts, calculated as the ratio of uncovered or malapposed struts to total struts in all cross-sectional images per stent, was compared among the three groups. RESULTS: A total of 35,061 struts were analyzed: 11,967 from EES, 11,855 from SES, and 11m239 from PES. The average tissue coverage thickness of the struts per stent was greater in EES than in SES and PES (109 ± 40 µm vs. 72 ± 27 µm and 83 ± 26 µm, respectively; P = 0.001). The percentage of uncovered struts (1.9 ± 4.1% in EES vs. 11.6 ± 12.7% in SES, P = 0.01 and vs. 7.1 ± 5.2% in PES, P < 0.001) and malapposed struts (0.1 ± 0.3% in EES vs. 1.8 ± 3.5% in SES, P = 0.01 and vs. 3.5 ± 5.1% in PES, P = 0.02) was much lower in EES than in first-generation DES, with no significant differences between SES and PES. CONCLUSIONS: Late strut coverage patterns are not similar between EES and first-generation DES. EES showed a lower percentage of uncovered and malapposed struts.

Feasibility of bidimensional speckle-tracking echocardiography for strain analysis in consecutive patients in daily clinical practice.

PURPOSE: We aimed to analyze the feasibility of two-dimensional speckle-tracking echocardiography (2DSTE) in evaluating myocardial strain in consecutive, nonselected patients in daily clinical practice. METHODS: Strain analysis using 2DSTE was attempted in 59 consecutive patients: 24 patients with severe aortic stenosis, 28 patients with dilated cardiomyopathy, and 7 healthy controls. The analysis was done by four expert echocardiographers and one cardiology resident. RESULTS: It was possible to obtain reliable data for radial strain in 175 of 354 segments (49%), circumferential strain in 192 of 354 segments (54%), and longitudinal strain in 319 of 354 segments (90%). Experienced echocardiographers felt assessment of radial and circumferential strain was appropriate in more segments than did the cardiology resident (57% and 58% vs. 23% and 40%, respectively, P < 0.01). CONCLUSION: Longitudinal strain analysis with 2DSTE is feasible in most segments, but the radial and circumferential strain evaluation was only feasible in approximately half of the patients.

Measurement of aortic valve annulus using different cardiac imaging techniques in transcatheter aortic valve implantation: agreement with finally implanted prosthesis size.

AIMS: To compare the measurements of the aortic annulus obtained with various imaging techniques in patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation, and to determine the grade of agreement between the predicted size of the prosthesis for each technique, and the size of the finally implanted valve. METHODS AND RESULTS: The aortic annulus was measured in 40 patients treated by transcatheter aortic valve implantation (CoreValve aortic valve) with transthoracic (TTE) and transesophageal echocardiography (TEE), 64-slice tomography, and angiography. A large valve was implanted when annulus was >23 mm and a small one if it was ≤23 mm. If the size of the prosthesis predicted by several techniques was not the same in one case, we selected the size in which more techniques presented agreement. Forty aortic valves, 26 small and 14 large, were implanted percutaneously. The best correlation was obtained with TTE and TEE (r = 0.93, P < 0.001). The correlation of TTE and TEE with angiography also was good (r = 0.58, P < 0.001 and r = 0.53, P < 0.001, respectively). Correlations between these techniques and computed tomography were poor (P = NS for all comparisons). The best agreement between estimated aortic annulus and implanted valve size was obtained with transtoracic and TEE (κ= 0.88 and 0.76). CONCLUSIONS: The aortic annulus measurements obtained by TTE, TEE, and angiography correlated well, while tomography correlated poorly with other techniques. The imaging techniques that showed the best agreement between estimated aortic annulus size and implanted aortic valve size were TTE and TEE.