Needle versus cannula over needle for radial artery cannulation during transradial coronary angiography and interventions.

PURPOSE: To evaluate the efficacy of radial artery cannulation with needle versus cannula over needle during transradial coronary angiography and intervention. METHODS: Five hundred patients scheduled to undergo transradial catheterization were randomized between the two methods. Primary endpoint of the study was the combined endpoint of switching to another access site due to inability of successful sheath insertion or switching to another method of cannulation (from needle to cannula over needle and vice versa). RESULTS: The primary end point was met in 12 patients (4.8%) from the needle group and 14 patients (5.6%) from the cannula over needle group (p=0.695). There were no differences in switching of cannulation method [10 (4.0%)% versus 11 (4.4%), p=0.831], switching of access site [6 (2.8%) versus 9 (3.6%), p=0.441), time for artery cannulation [1.20 (0.80-2.20) min versus 1.26 (1.01-2.39) min, p=0.152], total procedure time [15.05 (9.47-29.03) min versus 19.14 (10.13-32.02) min, p=0.112] number of attempts [2 (1-4) versus 2 (1-5), p=0.244] and number of skin punctures [1 (1-2) versus 1 (1-2), p=0.399] before successful radial artery cannulation. There were no differences recorded in the safety endpoints of EASY grade III or more radial hematomas [2 (0.8%) versus 1 (0.4%), p=1.000] or the incidence of radial artery occlusion after the procedure [9 (3.6% versus 16 (6.8%), p=0.358]. CONCLUSION: Radial artery cannulation with needle and cannula over needle seems to be equal in terms of efficacy and safety.

Atrial fibrillation in hypertrophic cardiomyopathy: A turning point towards increased morbidity and mortality.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmic event in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to identify the clinical impact and prognostic significance of AF on a large cohort of patients with HCM. METHODS: Echocardiographic and clinical correlates, risk factors for AF and thromboembolic stroke and the prognostic significance of AF were evaluated in 509 patients with an established diagnosis of HCM. RESULTS: A total of 119 patients (23.4%) were diagnosed with AF during the index evaluation visit. AF patients had a higher prevalence of stroke and presented with worse functional impairment. Left atrial diameter (LA size) was a common independent predictor of the arrhythmia (OR: 2.2, 95% CI 1.6-3.3) and thromboembolic stroke (OR: 1.6, 95% CI 1.01-2.40). AF was an important risk factor for overall mortality (HR=3.4, 95% CI: 1.7-6.5), HCM-related mortality (HR=3.9, 95% CI: 1.8-8.2) and heart failure-related mortality (HR=6.0, 95% CI: 2.0-17.9), even after adjusting for statistically significant clinical and demographic risk factors. However, AF did not affect the risk for sudden death. CONCLUSIONS: LA size is an independent predictor of both AF and thromboembolic stroke. Moreover, patients with AF, regardless of type, have significantly higher mortality rates than patients without AF.

Acute Invasive Hemodynamic Effects of Transcatheter Aortic Valve Replacement.

BACKGROUND: Aortic stenosis imposes a chronic pressure overload on the left ventricle, with attendant adaptations in hemodynamics, muscle mass and performance. The hemodynamic changes that occur during the initial 24 h following abrupt removal of the impediment to left ventricular outflow have not been previously examined. METHODS: A total of 52 patients with right heart catheterization was evaluated before, within 6 h and at 24 h after successful transcatheter aortic valve replacement (TAVR). Echocardiographic data were examined before and within 30 days of the procedure. RESULTS: TAVR was successful in all 52 patients, and at 24 h after the procedure resulted in: (i) an increase in cardiac index (CI) (from 2.0 ± 0.6 to 3.1 ± 0.7 l/min/ m2, p <0.001) and stroke volume (SV) (from 62.3 ± 18.7 to 76.6 ± 21.3 ml, p <0.001); (ii) reductions in systemic vascular resistance (from 1555 ± 458 to 1021 ± 280 dyne·s/cm5, p <0.001) and pulmonary vascular resistance (from 174 ± 150 to 112 ± 76 dyne·s/cm5, p = 0.001); (iii) reductions in pulmonary capillary wedge pressure (from 24.2 ± 6.7 to 19.7 ± 7.3 mmHg, p <0.001), mean pulmonary artery pressure (from 32.2 ± 9.9 to 27.5 ± 8.8 mmHg, p = 0.002) and in central venous pressure (from 13.5 ± 4.8 to 9.4 ± 3.9 mmHg, p <0.001); and (iv) an increase in systolic arterial pressure (from 127 ± 25 to 135 ± 14 mmHg, p = 0.04), along with a decrease in diastolic arterial pressure (from 58 ± 11 to 53 ± 9 mmHg, p = 0.009). CONCLUSIONS: Successful TAVR results in immediate and sizeable improvements in SV and CI, reductions in left and right ventricular filling pressures, and marked reductions in systemic and pulmonary vascular resistances.

Paravalvular aortic prosthetic valve leak closure: technical aspects of the percutaneous approach.

We describe the successful closure of an aortic paravalvular bioprosthetic valve leak with the simultaneous percutaneous deployment of two vascular plugs.

Differences in Clinical Presentation and Findings between Idiopathic Dilated and Ischaemic Cardiomyopathy in an Unselected Population of Heart Failure Patients.

We explored the differences in epidemiologic, clinical, laboratory and echocardiographic characteristics between idiopathic dilated (IDCM) and ischaemic cardiomyopathy (ICM).Consecutive patients with stable chronic heart failure evaluated at a tertiary cardiac centre were enrolled. Clinical examination, blood tests and echocardiographic study were performed. A total of 76 patients (43 IDCM, 33 ICM) were studied. IDCM patients were younger (p<0.001) and female gender was more prevalent (p=0.022). NYHA class and left ventricular ejection fraction were similar. IDCM patients had lower rates of dyslipidaemia (p<0.001) but smoked more than ICM patients (p=0.023) and had higher rates of family history of sudden cardiac death (p=0.048). Blood pressure was similar but resting heart rate was higher in IDCM patients (p=0.022). IDCM patients presented less frequently with peripheral oedema or ascites (p=0.046 and 0.020, respectively) and showed better right ventricular function on echocardiogram. QRS duration was similar between groups but only in IDCM patients there was a positive correlation between QRS duration and age (r=0.619, p<0.001). Cardiac output was similar but functional capacity assessed by the Duke Activity Status Index was better in IDCM (p=0.036). Despite these differences, IDCM and ICM patients received similar treatments. Patients with IDCM were younger, presented lower rates of right ventricular dysfunction and clinical right ventricular failure and had better functional capacity. Additional differences in clinical and laboratory findings exist pointing to a different patient population with diverse prognosis and potential need for individualized management.

Measurements of endothelin-1, C-reactive protein and fibrinogen plasma levels in patients with acute ischemic stroke.

OBJECTIVE: To assess plasma endothelin-1 (ET-1), C-reactive protein (CRP) and fibrinogen (FIB) levels in acute ischemic stroke (AIS) and explore the potential association among them. METHODS: In 23 consecutive patients with AIS diagnosed clinically and confirmed by CT brain scan, we measured plasma levels of ET-1 by radioimmunoassay, and CRP and FIB on the first and fifth days after the onset of AIS and we compared them with the levels of ten healthy volunteers in the control group. RESULTS: The mean plasma levels of ET-1 in AIS patients on the first and fifth days were respectively 19.93+/-6.72 and 16.47+/-26.3 pmol/l (p<0.001) compared with 3.68+/-1.2 pmol/l in the control group (p<0.001 versus mean values on the first and fifth days). The mean plasma levels of CRP in the patients on the first and fifth days were respectively 2.7+/-4.7 and 3.0+/-4.4 mg/dl (p>0.05) compared with 0.2+/-0.1 mg/dl in the control group (p<0.05 versus mean values on the first and fifth days). The mean plasma levels of FIB in the patients on the first and fifth days were respectively 361+/-98.89 and 392.7+/-144.89 mg/dl, while in the control group, it was 330.5+/-90.28 mg/dl (p>0.05 versus mean values on the first and fifth days). A positive association was found between the plasma levels of ET-1 and CRP on the fifth day (p<0.05). CONCLUSIONS: ET-1 was found to be significantly elevated in the plasma in the AIS. There is association between ET-1 and CRP on the fifth day after AIS. Plasma levels of ET-1 and its association with CRP levels may be used as additional biomarkers for AIS.

In vivo comparative study of linear versus geometrically correct three-dimensional reconstruction of coronary arteries.

Although conventional linear 3-dimensional (3D) reconstruction of coronary arteries by intravascular ultrasound has been widely used for the assessment of plaque volume and progression; the volumetric error (VE) that is produced has not been adequately studied. Linear and geometrically correct 3D reconstruction was applied in 16 coronary arterial segments from 9 patients. Using geometrically correct reconstruction as reference, VE was assessed in 1-mm-long arterial slices. Although for the entire length of the coronary arteries VEs for lumen, external elastic membrane (EEM), and intima-media volumes were minimal (lumen VE 0.4%, -0.8 to 1.8; EEM VE 0.3%, -0.9 to 1.9; intima-media VE 0.4%, -1.4 to 2.2), the VE in each arterial slice exhibited a large variation from -15.6% to 36.2% for lumen volume, from -12.9% to 33.1% for EEM volume, and from -17.2% to 46.7% for intima-media volume, suggesting that linear reconstruction over- or underestimates the true arterial volumes. Lumen VE, EEM VE, and intima-media VE were also significantly higher in curved arterial subsegments than in relatively straight arterial subsegments (p <0.05). In conclusion, in highly curved arterial subsegments, the VE that is produced by linearly stacking the intravascular ultrasound images may be not negligible. Geometrically correct reconstruction of coronary arteries provides more reliable arterial reconstructions and plaque volume measurements. It is anticipated that clinical application of this technique will contribute to more accurate follow-up of the progression of atherosclerosis and assessment of arterial remodeling.