2024 TSOC/TSPS Joint Consensus: Strategies for Advanced Vascular Wound Management in Arterial and Venous Diseases.

The Taiwan Society of Cardiology (TSOC) and Taiwan Society of Plastic Surgery (TSPS) have collaborated to develop a joint consensus for the management of patients with advanced vascular wounds. The taskforce comprises experts including preventive cardiologists, interventionists, and cardiovascular and plastic surgeons. The consensus focuses on addressing the challenges in diagnosing, treating, and managing complex wounds; incorporates the perfusion evaluation and the advanced vascular wound care team; and highlights the importance of cross-disciplinary teamwork. The aim of this joint consensus is to manage patients with advanced vascular wounds and encourage the adoption of these guidelines by healthcare professionals to improve patient care and outcomes. The guidelines encompass a range of topics, including the definition of advanced vascular wounds, increased awareness, team structure, epidemiology, clinical presentation, medical treatment, endovascular intervention, vascular surgery, infection control, advanced wound management, and evaluation of treatment results. It also outlines a detailed protocol for assessing patients with lower leg wounds, provides guidance on consultation and referral processes, and offers recommendations for various wound care devices, dressings, and products. The 2024 TSOC/TSPS consensus for the management of patients with advanced vascular wounds serves as a catalyst for international collaboration, promoting knowledge exchange and facilitating advancements in the field of advanced vascular wound management. By providing a comprehensive and evidence-based approach, this consensus aims to contribute to improved patient care and outcomes globally.

Association of health information technology-driven multidisciplinary approaches with low-density lipoprotein cholesterol target achievement in patients with an acute coronary syndrome.

Objective: Controlling of low-density lipoprotein cholesterol (LDL-C) in patients with acute coronary syndrome (ACS) remains a challenge. Health information technology (HIT) is increasingly being applied to close quality gaps in chronic illness care. The aim of this study was to perform a qualitative review of the association of implementing HIT on lipid management processes of care and LDL-C goal attainment in patients with ACS. Method: Eligible patients with a discharge diagnosis of ACS from January 2018 to December 2021 at a tertiary medical center were retrospectively reviewed. An HIT system with a multidisciplinary approach including initiating high-intensity statin therapy, periodic laboratory follow-up, titration of lipid-lowering agents, patient education, patient-level and system-level interventions involving database monitoring and outreach by centralized care teams was introduced in October 2018. Electronical medical records including data on medications and laboratory findings at discharge and within 1 year were compared before and after implementing the HIT system. Results: A total of 2001 ACS patients (average age 63 ± 12.7 years, 79.66 % men) were analyzed. The LDL-C < 70 mg/dL goal attainment rates (36.52 %, 53.57 %, 59.22 %, 62.18 % in 2018-2021) and medium serum LDL-C levels (80.5 mg/dL, 68 mg/dL, 65 mg/dL, 64 mg/dL in 2018-2021) significantly improved within 6 months (2018 as the reference, all p<0.001). The LDL-C attainment rate at 12 months also steadily increased (53.80 %, 61.82 %, 64.21 % in 2019-2021, p = 0.019). Most of the patients switched to a high-intensity statins regimen at discharge (0.57 %, 63.67 %, 72.41 %, 84.44 %, in 2018-2021, p<0.001 with 2018 as the reference), with low adverse event rates. The maintenance rates of high-intensity statin regimens at 12 months continued to improve (41.36 %, 49.04 %, 61.39 % in 2019-2021, p<0.001). Conclusions: Efforts to control LDL-C should be increased in ACS patients by initiating and intensifying statin treatment earlier. Our results confirmed that a team-based strategy with HIT improved LDL-C target achievement for most patients with ACS.

Three-dimensional nanoprinting via charged aerosol jets.

Three-dimensional (3D) printing1-9 has revolutionized manufacturing processes for electronics10-12, optics13-15, energy16,17, robotics18, bioengineering19-21 and sensing22. Downscaling 3D printing23 will enable applications that take advantage of the properties of micro- and nanostructures24,25. However, existing techniques for 3D nanoprinting of metals require a polymer-metal mixture, metallic salts or rheological inks, limiting the choice of material and the purity of the resulting structures. Aerosol lithography has previously been used to assemble arrays of high-purity 3D metal nanostructures on a prepatterned substrate26,27, but in limited geometries26-30. Here we introduce a technique for direct 3D printing of arrays of metal nanostructures with flexible geometry and feature sizes down to hundreds of nanometres, using various materials. The printing process occurs in a dry atmosphere, without the need for polymers or inks. Instead, ions and charged aerosol particles are directed onto a dielectric mask containing an array of holes that floats over a biased silicon substrate. The ions accumulate around each hole, generating electrostatic lenses that focus the charged aerosol particles into nanoscale jets. These jets are guided by converged electric-field lines that form under the hole-containing mask, which acts similarly to the nozzle of a conventional 3D printer, enabling 3D printing of aerosol particles onto the silicon substrate. By moving the substrate during printing, we successfully print various 3D structures, including helices, overhanging nanopillars, rings and letters. In addition, to demonstrate the potential applications of our technique, we printed an array of vertical split-ring resonator structures. In combination with other 3D-printing methods, we expect our 3D-nanoprinting technique to enable substantial advances in nanofabrication.

Circulating fatty-acid binding-protein 4 levels predict CV events in patients after coronary interventions.

BACKGROUND: Fatty-acid binding protein-4 (FABP4) has been associated with the metabolic syndrome, diabetes mellitus, atherosclerosis, incident heart failure, and the prognosis of coronary heart disease (CHD). However, recent studies have not reported a significant correlation between FABP4 and cardiovascular (CV) mortality in high-risk patients or those with documented CHD. The present study aimed to evaluate the association between FABP4 and the prognosis in a cohort of patients with CHD who received coronary interventions. METHODS: Serum FABP4 levels were measured in 973 patients after a successful intervention for CHD, who were then prospectively followed for 30 months. RESULT: During this period, 223 patients experienced composite CV outcomes (22.92%), defined as cardiovascular/cerebrovascular death, nonfatal myocardial infarction (MI), nonfatal stroke, hospitalization for refractory or unstable angina, hospitalization for heart failure, and peripheral artery occlusive disease. Kaplan-Meier curves showed a significant association between FABP4 levels at baseline (categorized in tertiles) and composite CV outcomes during follow-up (log-rank test, p < 0.003). The patients with the highest tertile of baseline FABP4 had an increased risk of composite CV outcomes (hazard ratio (HR) 1.662; 95% confidence interval (CI), 1.2-2.302; p = 0.0022), which remained significant after multivariate adjustments for traditional risk factors and hs-CRP (HR 1.596; 95% CI, 1.088-2.342; p = 0.0168). In contrast, FABP4 failed to show a significant association with cardiovascular/cerebrovascular death, nonfatal MI, or nonfatal stroke after multivariate adjustments (HR, 1.594; 95% CI, 0.651-3.904, p = 0.3073). CONCLUSION: In conclusion, circulating FABP4 is an independent prognostic predictor for the composite cardiovascular events in the patients with stable CHD after coronary interventions.

Clinical significance of quantitative assessment of glucose utilization in patients with ischemic cardiomyopathy.

BACKGROUND: The aim of this study was to prospectively quantify the rate of myocardial glucose uptake (MRGlu) in myocardium with different perfusion-metabolism patterns and determine its prognostic value in patients with ischemic cardiomyopathy. METHODS AND RESULTS: 79 patients with ischemic cardiomyopathy were prospectively enrolled for dynamic cardiac FDG PET, and then followed for at least 6 months. Perfusion-metabolism patterns were determined based on visual score analysis of 201Tl SPECT and FDG PET. MRGlu was analyzed using the Patlak kinetic model. The primary end-point was cardiovascular mortality. Significantly higher MRGlu was observed in viable compared with non-viable areas. Negative correlations were found between MRGlu in transmural match and a history of hyperlipidemia, statin usage, and triglyceride levels. Diabetic patients receiving dipeptidyl peptidase-4 inhibitors (DPP4i) had a significantly lower MRGlu in transmural match, mismatch, and reverse mismatch. Patients with MRGlu in transmural match ≥ 23.40 or reverse mismatch ≥ 36.90 had a worse outcome. CONCLUSIONS: Myocardial glucose utilization was influenced by substrates and medications, including statins and DPP4i. MRGlu could discriminate between viable and non-viable myocardium, and MRGlu in transmural match and reverse mismatch may be prognostic predictors of cardiovascular death in patients with ischemic cardiomyopathy.

Clinical significance of quantitative assessment of right ventricular glucose metabolism in patients with heart failure with reduced ejection fraction.

PURPOSE: Dynamic 18F-fluorodeoxyglucose (FDG) PET can be used to quantitatively assess the rate of myocardial glucose uptake (MRGlu). The aim of this study was to evaluate the clinical significance and prognostic value of right ventricular (RV) MRGlu in patients with coronary artery disease and heart failure with reduced ejection fraction. METHODS: Patients with left ventricular ejection fraction (LVEF) ≤ 40% were consecutively enrolled for FDG PET between November 2012 and May 2017. Global LV and RV MRGlu (µmol/min/100 g) were analyzed. Outcome events were independently assessed using electronic medical records to determine hospitalization for revascularization, new-onset ischemic events, heart failure, cardiovascular, and all-cause death. Differences between LV and RV MRGlu and associations with clinical characteristics and echocardiographic data were evaluated. Associations among FDG PET findings and outcomes were analyzed using Kaplan-Meier survival analysis. RESULTS: Seventy-five patients (mean age 62.2 ± 12.7 years, male 85.3%, LVEF 19.3 ± 8.6%) were included for analysis. The mean glucose utilization ratio of RV-to-LV (RV/LV MRGlu) was 89.5 ± 264.9% (r = 0.77, p < 0.001). Positive correlations between RV MRGlu and maximal tricuspid regurgitation peak gradient (r = 0.28, p = 0.033) and peak tricuspid regurgitation jet velocity (r = 0.29, p = 0.021) were noted. LVEF was positively correlated with LV MRGlu (r = 0.27, p = 0.018), but negatively correlated with end-diastolic volume (r = - 0.37, p = 0.001), end-systolic volume (r = - 0.54, p < 0.001), and RV/LV MRGlu (r = - 0.40, p < 0.001). However, RV MRGlu was not well correlated with LVEF. Forty-three patients received revascularization procedures after FDG PET, and 13 patients died in a mean follow-up period of 496 ± 453 days (1-1788 days), including nine cardiovascular deaths. Higher RV and LV MRGlu values, LVEF ≤ 16% and LV end-diastolic volume ≥ 209 ml of gated-PET were associated with poor overall survival and cardiac outcomes. CONCLUSIONS: In patients with coronary artery disease and ischemic cardiomyopathy, RV glucose utilization was positively correlated with RV pressure overload, but not LVEF. Global LV and RV MRGlu, LVEF, and LV end-diastolic volume showed significant prognostic value.

Novel use of percutaneous thrombosuction to rescue the early thrombosis of the conduit vein graft after living donor liver transplantation.

A 54-year-old woman with liver cirrhosis and hepatocellular carcinoma received a living donor liver transplant. Thrombosis of the segmental hepatic vein occurred on postoperative day 7. We undertook percutaneous catheter thrombosuction under local anesthesia to extract the thrombus successfully without re-exploration. Thrombosuction has been used for thrombosis of the cardiovascular system, limbs, and brain. We first used it in hepatic venous thrombus after liver transplantation. This procedure is simple, less invasive, feasible, safe, repeatable, and effective.

Evolutional change in epicardial fat and its correlation with myocardial diffuse fibrosis in heart failure patients.

OBJECTIVES: The aim of this study was to characterize the characteristics of epicardial fat (EAT) in different stage heart failure (HF) patients and its relationship between cardiac fibrosis. BACKGROUND: EAT is visceral adipose tissue that possesses inflammatory properties. Inflammation and obesity are associated with cardiac fibrosis, but the relationship between cardiac fibrosis and EAT is unknown. METHODS: EAT volume was measured using cardiac magnetic resonance imaging (CMR) in 180 subjects: 58 patients with systolic HF, 63 patients with HF and preserved ejection fraction, and 59 patients without HF. CMR derived myocardial extracellular volume (ECV) was used for fibrosis quantification. RESULTS: Patients with systolic HF had significantly more EAT compared with patients with HF and preserved ejection fraction or the control group (patients without HF) (indexed EAT volume [mL/m2], 27.0 [22.7-31.6] vs 25.6 [21.4-31.2] and 24.2 [21.0-27.6], P < .05). The adjusted EAT amount was associated with ECV completely independent of age, hypertension, diabetes, etiology of HF, left ventricular ejection fraction, CMR-late gadolinium enhancement (LGE), left ventricular mass index, and left ventricular end-diastolic volume index (correlation coefficient: 0.49; 95% confidence interval: 0.12-0.86, P < .01). Increased CMR ECV was more associated with EAT in those with advanced age, male sex, LGE on magnetic resonance imaging-LGE images, and less left ventricular end-diastolic volume index. CONCLUSIONS: EAT volume is highly associated with CMR ECV independent of traditional risk factors and left ventricular mass or volume. Whether EAT plays a role in the long-term prognosis of HF requires future investigation.

Pericardial fat is associated with ventricular tachyarrhythmia and mortality in patients with systolic heart failure.

OBJECTIVE: Pericardial fat (PF) has been hypothesized to exert local pathogenic effects on nearby cardiac structures above and beyond that of systemic adiposity which might be associated with the presence of arrhythmia or even worse outcomes. The aims of this study was to characterize the relationship between PF and the prognosis in patients with systolic heart failure (HF). METHODS: This is a retrospective cohort study of a cardiac magnetic resonance imaging (CMRI) database from 2004 to 2011. Fifty patients with systolic HF underwent CMRI examinations were included. We also enrolled twenty patients with HF as the control group. The cine imaging was analyzed to derive total PF volumes, left ventricular volumes and mass and left ventricular ejection fraction by using a previously validated technique. The outcomes, including ventricular tachycardia (VT), ventricular fibrillation (VF) and total mortality were obtained by reviewing medical records. RESULTS: After a median follow-up of 694 days, patients with VT/VF had significant larger indexed PF volumes than those without [36.3 (32.8-43.1) ml/m(2) vs. 24.1 (20.2-27.6) ml/m(2), p = 0.001]. The mortality group also had significant larger indexed PF volumes (PF/body surface area) than those without [31.3 (22.8-38.4) ml/m(2) vs. 23.9 (19.8-27.3) ml/m(2), p = 0.010]. Indexed PF volumes were associated with the development of VT/VF (Hazard ratio, 7.510; 95% C.I, 0.901-62.582, p = 0.062) and mortality (Hazard ratio, 3.998; 95% C.I, 1.077-14.845, p = 0.038) by Cox's regression analyses. CONCLUSION: PF is associated with the development of VT/VF and long-term overall mortality in patients with systolic HF.