One-year results of primary stenting for TASC II D lesions of the superficial femoral and popliteal arteries.

Objective This study aimed to evaluate the safety and the efficacy of primary stenting to treat Trans-Atlantic Inter-Society Consensus II (TASC) D femoropopliteal lesions. Background Advances in wire, balloon and stent design have been reported to improve the durability of stenting of longer femoropopliteal lesions. Methods A total of 57 limbs of 53 patients with Rutherford stage 3 to 6 due to TASC D femoropopliteal lesions were treated with a self-expanding nitinol stent in a prospective, single-centre, observational study. End points of interest included primary and secondary patency, target lesion revascularization, in-stent restenosis, major adverse cardiovascular events, Rutherford class improvement and change in walking capacity at 1 year. Results A total of 53 patients (57 lesions) were treated with a self-expanding nitinol stent and final procedural success was 91.2%. The median length of the treated segment was 330 ± 96 mm. The median stented segment was 366 ± 71 mm and the mean number of the stents was 2.1 ± 0.9. At 1 year, primary and secondary patency rates were 63.9% and 82.1%, respectively. Major adverse cardiovascular events occurred in 11 patients (22.9%), and[[strike_start]] [[strike_end]]significant benefits were observed in Rutherford class and walking distance (both P < 0.001). Conclusions Primary implantation of self-expanding nitinol stents for the treatment of TASC D femoropopliteal lesions appears to be safe and effective, especially in patients who have multiple co-morbidities and a high risk for surgical bypass. The risk of restenosis was higher when long stenting was extended to the popliteal artery.

Time-to-reperfusion in STEMI undergoing interhospital transfer using smartphone and WhatsApp messenger.

OBJECTIVE: The objective of this study is to assess the efficacy of WhatsApp application as a communication method among the emergency physician (EP) in a rural hospital without percutaneous coronary intervention (PCI) capability and the interventional cardiologist at a tertiary PCI center. BACKGROUND: Current guidelines recommend that patients with ST-segment elevation myocardial infarction (STEMI) receive primary PCI within 90 minutes. This door-to-balloon (D2B) time has been difficult to achieve in rural STEMI. METHODS AND RESULTS: We evaluated 108 patients with STEMI in a rural hospital with emergency department but without PCI capability to determine the impact of WhatsApp triage and activation of the cardiac catheterization laboratory on D2B time. The images were obtained from cases of suspected STEMI using the smartphones by the EP and were sent to the interventional cardiologist via the WhatsApp application (group 1, n=53). The control group included concurrently treated patients with STEMI during the same period but not receiving triage (group 2, n=55). The D2B time was significantly shorter in the intervention group (109±31 vs 130±46 minutes, P<.001) with significant reduction in false STEMI rate as well. CONCLUSION: This study demonstrates that use of WhatsApp triage with activation of the cardiac catheterization laboratory was associated with shorter D2B time and results in a greater proportion of patients achieving guideline recommendations. The method is cheap, quick, and easy to operate.

Relation of epicardial fat thickness to the severity of heart failure in patients with nonischemic dilated cardiomyopathy.

BACKGROUND: The aim of this study was to assess whether epicardial fat thickness (EFT) is associated with the severity of heart failure in patients with nonischemic dilated cardiomyopathy (NICMP). METHODS: The study group was composed of 93 patients with NICMP and38 age- and sex-matched healty individuals as the control group. The EFT was identified during end-systole at the point on the free wall of the right ventricle. RESULTS: Patients with NICMP had significantly lower mean EFT than those in the control group (4.1 ± 0.8 vs. 6.1 ± 1.8 mm, P < 0.001). EFT was thinnest in patients with New York Heart Association (NYHA) functional class III or IV (3.5 ± 0.5, P < 0.001). There was a significant correlation between EFT, left ventricle EF (r = 0.540 P < 0.001), and B-type natriuretic peptide (BNP) (r = -0.695, P < 0.001) values in patients with NICMP. In addition, when EFT was corrected for BMI, EFT/BMI was lower in patients with NYHA functional class III-IV than patients with NYHA class I-II and control group (0.13 ± 0.01, 0.16 ± 0.02, 0.23 ± 0.04, respectively; P < 0.001). There was a significant correlation between EFT/BMI, left ventricle EF (r = 0.489, P < 0.001), and BNP (r = -0.549, P < 0.001) in patients with NICMP. In multivariate regression analysis, EFT (P = 0.009), BNP (P = 0.039), and left atrium volume index (P = 0.039) were independently associated with impaired functional status. CONCLUSION: Echocardiographic EFT is an inexpensive, simple, and readily available marker that may be used to asses the severity of chronic heart failure in patients with NICMP.

Retrograde recanalisation of popliteal artery occlusion.

The increasing prevalence of critical lower limb ischemia is frequently associated with complex tibioperoneal obstructive disease and a high rate of amputation. In this article, we report our recent experience in order to highlight this valuable and underutilised technique, which proved successful in a complicated case where a conventional approach failed.

Adherence to Current Dyslipidemia Guideline in Patients Utilizing Statins According to Risk Groups and Gender Differences: The AIZANOI Study.

BACKGROUND: The aim of this study was to assess the adherence to the current European Society of Cardiology dyslipidemia guidelines, the ratio of reaching target values according to risk groups, and the reasons for not reaching LDL-cholesterol (LDL-C) goals in patients on already statin therapy in a cardiology outpatient population. METHODS: The AIZANOI study is a multi-center, cross-sectional observational study including conducted in 9 cardiology centers between August 1, 2021, and November 1, 2021. RESULTS: A total of 1225 patients (mean age 62 ± 11 years, 366 female) who were already on statin therapy for at least 3 months were included. More than half (58.2%) of the patients were using high-intensity statin regimens. Only 26.2% of patients had target LDL-C level according to their risk score. Despite 58.4% of very high-risk patients and 44.4% of high-risk patients have been using a high-intensity statin regimen, only 24.5% of very-high-risk patients and only 34.9% of high-risk patients have reached guideline-recommended LDL-C levels. Most prevalent reason for not using target dose statin was physician preference (physician inertia) (40.3%). CONCLUSION: The AIZANOI study showed that we achieved a target LDL-C level in only 26.2% of patients using statin therapy. Although 58.4% of patients with a very high SCORE risk and 44.4% of patients with a high SCORE risk were using a target dose statin regimen, we were only able to achieve guideline-recommended LDL-C levels in 24.5% and 34.9% of them, respectively, in cardiology outpatients clinics. Physician inertia is one of the major factors in non-adherence to guidelines. These findings highlight that combination therapy is needed in most of the patients.

Relation of Plasma Fibrinogen Level With the Presence, Severity, and Complexity of Coronary Artery Disease.

BACKGROUND: Relation of plasma fibrinogen levels with extent, severity, and complexity of coronary artery disease (CAD) in patients with stable angina pectoris (SAP) has not been adequately investigated. The aim of this study was to evaluate whether plasma fibrinogen level is associated with coronary complexity, severity, and extent assessed by SYNTAX (Synergy between percutaneous coronary intervention with TAXUS and Cardiac Surgery) score (SS). METHODS: We enrolled 134 consecutive patients with SAP who underwent coronary angiography. Baseline serum fibrinogen levels were measured, and SS was calculated from the study population. The patients were classified into 3 groups by tertiles of SS (SS, control group = 0; intermediate group < 22; and high group ≥ 22). RESULTS: Plasma fibrinogen levels demonstrated a stepwise increase from control group to high SS group. There was a strong correlation between fibrinogen and the SS ( r = .535, P < .001). Area under the receivers operating characteristic curve of fibrinogen was 0.72 (95% confidence interval [CI] 0.61-0.82; < .001) for predicting a high SS. Fibrinogen value higher than 411 mg/dL has a sensitivity of 75% and a specificity of 64% in prediction of high SS. In multivariate analyses, plasma fibrinogen was observed to be an independent predictor for high SS in patients with stable CAD (odds ratio [OR] 1.01; 95% CI, 1.01-1.02; P < .001). CONCLUSION: Plasma fibrinogen is a readily measurable systemic inflammatory marker and is independently associated coronary severity and complexity in patients with CAD.

Intermittent QT prolongation induced by short-term oral amiodarone therapy.

Although amiodarone appears to have few pro-arrhythmic effects, torsade de pointes (TdP) has been observed after administration of a low dose and short term use of oral amiodarone, in the absence of predisposing factors. We describe the case of a 41-year-old woman admitted to hospital because of a cardiac arrest from TdP. On hospital admission, ECG showed sinus bradycardia 46 bpm with marked QT prolongation.