The use of artificial intelligence in interventional cardiology.

Artificial intelligence can be employed in many cardiological applications including image analysis, risk assessment, and patient monitoring. In the catheterization laboratory, it can act as a physician assistant, technician, or co-worker. First, by giving voice commands to the operator of the coronary angiography machine, it can ensure that the C-arm moves to the desired angle. It is able to make recommendations for stent size and type based on the analysis of angiography images which is also possible for peripheral and carotid interventions. For transcatheter aortic valve implantation, it can make recommendations for valve placement and size. Artificial intelligence-based image analysis algorithms can be used to support image analysis during catheter laboratory procedures. The challenges include the need for large, high-quality data sets and the development of accurate, reliable, and interpretable artificial intelligence algorithms.

The use of strain-gauge plethysmography in the functional assessment of chronic venous disease: five-year experience at a single centre.

OBJECTIVE: Plethysmography can be used in the diagnosis and evaluation of chronic venous disease in the lower extremities. This study aimed to evaluate the applicability and reliability of strain-gauge plethysmography (SDP) in the functional assessment of chronic venous disease. METHODS: This descriptive study was conducted between 2016 and 2021 at a single centre. Four hundred and thirty-two patients with symptomatic chronic venous disease were included in the study. All participants were diagnosed initially with Doppler ultrasonography. SGP was then performed to evaluate venous outflow capacity, venous reflux and muscle pump function. RESULTS: The average age was 45.16 ± 12.54 years (median age 46 years; range 20-78 years), and 239 (55.3%) women and 193 (44.7%) men were included in the study. The age groups, diagnosis, pathological distribution and risk factors were quantitatively determined according to gender. Localisation and lateralisation statistics of the pathologies are given. SGP measurements, including venous volume (V), venous emptying (VE), expelled volume ratio in four seconds (EV4/V), half refilling time (t½) and refilling volume (RV) of each lower extremity, were done individually to compare the involved extremity with the normal contralateral side. SGP measurements of each affected lower limb were also compared separately by gender, age group and disease onset. The correlation between t½ values and skin discolouration or oedema of the affected limb was examined. Finally, receiver operating characteristic curve analyses of the V, VE, EV4/V, t½ and RV values were done, and the cut-off values of each parameter were defined accordingly. CONCLUSION: High reliability and consistent results indicate that SGP is a practical and sensitive test for quantitative functional assessment of patients with chronic venous disease. It can be used as an effective method in diagnosing and following up chronic venous disorders. As there are no currently accepted cut-off values, we suggest that ours can be used as new reference values for SGP measurements.

Evaluation of 3D printing in planning, practicing, and training for endovascular lower extremity arterial interventions.

BACKGROUND: In this study, we aimed to investigate the potential role of 3D-printed physical and digital anatomical models in pre-procedural planning, practice and training in lower extremity arterial interventions. METHODS: A total of 16 patients (9 males, 7 females; mean age: 72.1±1.5 years; range, 69 to 75 years) who underwent superficial femoral artery balloon angioplasty between February 2016 and April 2019 were retrospectively reviewed for vascular access site preference and balloon sizing. Pre-procedural computed tomography volumetric images used for diagnosis were analyzed and modeled with 3D printing. Procedural and 3D-based data regarding the size of the balloon and deployment sites and the severity of the stenosis were compared. RESULTS: Measurements obtained from 3D models manually and segmentation images from software were similar (p>0.05). Both were smaller than the actual size of balloons used (p<0.001). Stenosis severity was similar with manual and software methods and both were significantly lower than the reported quantitative angiographic measurements (p<0.001). Vascular access site preference was changed in five (31.2%) patients, when the model was simulated by a non-sterile practice on 3D-printed physical models. The wire and catheter selection differed in eight patients, while practicing with models. CONCLUSION: The planning and practicing of lower extremity arterial procedures with 3D models may reduce operator-dependent variables, avoid unnecessary interventions, reduce endothelial damage, and increase procedural success. The 3D-printed models may be used for educational purposes for medical professionals.

Comparison of P-Wave Duration and Dispersion in Mitral Valve Replacement Surgery Via Right Atrial Transseptal or Left Atrial Approach in Rheumatic Mitral Stenosis Patients.

BACKGROUND: Predisposition to atrial fibrillation in mitral valve surgery has been well demonstrated. The changes in electrocardiographic parameters (Pmax, Pmin and P-wave dispersion) related to AF risk are unknown. We aimed to document the relationship between electrocardiographic changes and mitral valve replacement through right or left atrial surgical approaches. METHODS: We retrospectively studied 154 patients, who underwent mitral valve replacement surgery from 2008 to 2018. Seventy-nine patients were operated with right atriotomy and transseptal approach (Group 1), and 75 patents were operated with left atriotomy (Group 2). ECGs obtained at hospital admittance and postoperatively at 24 hours were blindly analyzed. RESULTS: Preoperative demographic characteristics were similar. Pmax, Pmin and P-wave dispersion were similar preoperatively. All parameters increased in both groups compared with the preoperative values (P < .05). Postoperative Pmax, Pmin and P-wave dispersion all were statistically significantly higher with the right atrial approach (P < .05). Postoperative AF also was more common in Group 1 (P < .05). CONCLUSION: Right atrial approach may lead to higher P-wave changes and atrial arrhythmias. This may be due to more extensive surgical disruption. The changes in atrial anatomic structure can increase atrial arrhythmic propensity and can cause atrial fibrillation.

A Novel Method to Adjust Saphenous Vein Graft Lengths Using 3D Printing Models.

BACKGROUND: The optimal length of saphenous vein grafts can be challenging in surgical coronary revascularization. It is the cornerstone for graft patency. In this study, we tried to demonstrate the value of 3D printing in determining optimal saphenous graft length. METHODS: Sixteen patients who underwent bypass surgery with only vein grafts were examined. Patients' measurements of graft lengths were obtained from postoperative CT images and from both 3D print models manually with plastic tubes and via 3D print digital images of Mimics software during segmentation. Another measurement was done using the Fit Centerline tool in the analysis module of Mimics software after segmentation. These 3 measurements were compared. RESULTS: There was a statistically significant difference between 3 measurement methods for each graft length (P < .001). Measurements of actual grafts were longer than measurements of 3D printed models manually and segmentation images from software were similar (P > .05). CONCLUSION: 3D printing models and their software may be used to determine optimal saphenous graft length and the anastomosis site to decrease operation time. It can be deducted from these results that 3D printing is a promising method for reducing operator dependent variables in adjusting graft size and finding optimal anastomosis sites.

Determination of acute changes in new electrocardiography parameters during veno-venous extracorporeal membrane oxygenation support.

INTRODUCTION: Veno-venous extracorporeal membrane oxygenation (ECMO) support has been used for respiratory insufficiency. Its role in blood oxygenation has been well documented. However, the effects on myocardial electrophysiology have not been studied in detail. AIM: To reveal the acute effects of extracorporeal support on new electrocardiography (ECG) parameters in patients with preserved left ventricular functions. MATERIAL AND METHODS: This retrospective study was conducted in three separate clinics. Sixteen consecutive patients under veno-venous ECMO for respiratory insufficiency who soon could be successfully weaned were analyzed. Immediately before and 2 hours after initiation of ECMO, ECG was performed. P wave, QT, QTc and T wave peak to end were measured and calculated from obtained surface 12-lead ECG. RESULTS: There were statistically significant differences immediately before and 2 hours after initiation of ECMO treatment in the Tp-e interval and Tp-e/QTc ratio, the maximum QTc, minimum QTc, and QTc dispersion values, and P wave dispersion (p < 0.0001 for each). All ECG parameters were significantly decreased with ECMO support. CONCLUSIONS: All atrial and ventricular repolarization parameters were decreased in patients with VV-ECMO support. Despite the limited role of ECMO in intractable arrhythmias, the findings of the study revealed that ECMO therapy for respiratory insufficiency may improve atrial ventricular depolarization and repolarization. Therefore, simple 12-lead surface ECG with new ECG parameters may be evaluated for better outcomes.

A novel method for cannulation of the short limb of aortic stent grafts during endovascular aneurysm repair: Göçer technique.

Cannulation of the shorter limb of an abdominal aortic endograft can be demanding. Confirmation of the accurate cannulation is equally challenging. Interventional cardiologists and cardiovascular surgeons may encounter certain difficulties during this procedure. In particular, cardiologists have a wide variety of experience in interventions from coronary practice. This novel method we describe herein consists of peripheral balloon usage in wiring the short limb of an aortic stent graft. In this method, an over-the-wire peripheral balloon is employed to centralize the wire at the gate of the short limb. The centralized wire in three-dimensional arterial lumen can cross the short limb of the graft easily.

Closure of an acquired aortocoronary venous fistula after coronary artery bypass grafting causing heart failure and stable angina: A case report.

Iatrogenic aortocoronary venous fistula arising from anastomosing an aortocoronary graft to a cardiac vein is a rare a complication following coronary artery bypass grafting. A 75-year-old male patient was admitted with recurrent angina accompanied by congestive heart failure six years after surgery. He was diagnosed with an acquired saphenous vein graft-to- cardiac vein fistula. Based on the estimation of risks versus benefits, the heart team decided to perform percutaneous closure with a vascular occlusion device. Subsequently, complaints and echocardiographic findings of the patient resolved.

Evaluation of 3D printed carotid anatomical models in planning carotid artery stenting.

BACKGROUND: We aimed to investigate the potential role of threedimensional printed anatomical models in pre-procedural planning, practice, and selection of carotid artery stent and embolic protection device size and location. METHODS: A total of 16 patients (10 males, 6 females; mean age 75.6±4.7 years; range, 68 to 81 years) who underwent carotid artery stenting with an embolic protection device between January 2017 and February 2019 were retrospectively analyzed. The sizing was based on intraprocedural angiography findings with the same brand stent using distal protection device. Pre-procedural computed tomography angiography images used for diagnosis were obtained and modeled with three-dimensional printing method. Pre-procedural and threedimensional data regarding the size of stents and protection devices and implantation sites were compared. RESULTS: Measurements obtained from three-dimensional models manually and segmentation images from software were found to be similar and both were smaller than actually used for stent and embolic protection device sizes. The rates of carotid artery stenosis were similar with manual and software methods, but were lower than the quantitative angiographic measurements. Device implantation sites detected by the manual and software methods were different than the actual setting. CONCLUSION: The planning and practicing of procedure with threedimensional models may reduce the operator-dependent variables, shorten the operation time, decrease X-ray exposure, and increase the procedural success.

A Rare Access Site Complication after Transcatheter Aortic Valve Implantation.

In the majority of patients undergoing transcatheter aortic valve implantation, the transfemoral access is the suggested approach due to its less invasive nature and feasibility in patients with suitable vascular anatomy. The complications of the transfemoral access site are generally vascular; however, we herein present a rare case of colon perforation following the transfemoral procedure owing to prior abdominal surgery. A transfemoral aortic valve was inserted on account of severe aortic stenosis and a high probability of surgical mortality. The patient developed acute abdomen following the procedure. Hemicolectomy was performed because of colonic perforation caused by femoral catheterization. The patient was well at 3 months' follow-up.

Myocardial ischemia caused by a coronary anomaly left anterior descending coronary artery arising from right sinus of Valsalva.

We present the case of a patient in anomalous origin of the left anterior descending coronary artery that caused myocardial ischemia and led to positive myocardial scintigraphic results. Coronary angiography showed that the left anterior descending coronary artery arose from the right coronary ostium-an anomaly that has been associated with chest discomfort-without atherosclerotic lesions. Left circumflex artery and the diagonal branches were arising from the left main coronary artery and the whole coronary tree were free of atherosclerosis.

[Evaluation of diastolic function by transmitral color M-mode flow propagation velocity in hypertensive patients]. / Hipertansif olgularda transmitral renkli M-mod akim yayilma hizi ile diyastolik fonksiyonlarin degerlendirilmesi.

OBJECTIVE: Diastolic dysfunction is considered as the most important cause of heart failure and morbidity in hypertensives. This study was designed to evaluate the relationship between the transmitral diastolic color M-mode flow propagation velocity (FPV) and left ventricular relaxation by using Doppler echocardiography. METHODS: In the present study, thirty-nine patients (21 male, 58.3%, age mean 52.7+/-5.9 years) with hypertension stage-I and over, were included. Transmitral diastolic E and A velocities, E-deceleration time (DT) and isovolumic relaxation time (IVRT) were measured by pulse Doppler method. We performed color M-mode technique for measurement of FPV of transmitral diastolic flow in the apical four-chamber view. We measured slope of aliasing velocity (blue aliasing) determined by color M-mode images. RESULTS: Flow propagation velocity values were not statistically related with age and gender, whereas differentiation of age groups were estimated as poor parabolic relationship, specially in patients over fifty years, FPV is estimated to be decreasing. Color M-mode FPV is correlated with DT, (r=-0.715, p<0.01), IVRT (r=-0.736, p<0.01) and interventricular septum thickness (r=-0.498, p<0.01), but not correlated with E/A ratio. CONCLUSION: Color M-mode FPV is correlated with DT and IVRT, which are important parameters for evaluation of diastolic function in hypertensive patients. This parameter is related with left ventricular relaxation and should be considered as a routine echocardiographic evaluation, because it is not affected by minimal changes in left ventricular filling pressure.

The effects of handgrip stress test on hemodynamic parameters before and after cilazapril treatment in patients with heart failure.

OBJECTIVE: To assess the effect of cilazapril treatment on several hemodynamic parameters during handgrip maneuvers in patients with congestive heart failure. Cilazapril, an ACE inhibitor with high affinity, has been shown to be highly effective against a variety of vascular disorders. The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamic parameters before and after cilazapril treatment in patients with congestive heart failure is unknown. METHODS: The study population included 30 patients (16 male, 14 female) with mean age of 65+/-18 years. The effects of handgrip maneuver on hemodynamic parameters were studied by right heart catheterization and Doppler echocardiography. RESULTS: Heart rate (HR) and mean arterial pressures (MAP) increased significantly after handgrip maneuver (from 95+/-6 beats/min to 101+/-12 beats/min; from 109+/-15 mm Hg to 118+/-19 mm Hg, p<0.05 respectively). Pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic (s) and diastolic (d) pressures (PAP), cardiac index (CI), right ventricular systolic and diastolic pressures (RVPs and RVPd), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) did not change after handgrip maneuvers (p>0.05). On the other hand, PAPs and PAPd, RVPs and RVPd, MAP and HR (p<0.05) decreased significantly during handgrip maneuvers after cilazapril treatment. However PCWP and CI, LVEF, RVEF did not change after treatment (p>0.05). CONCLUSION: Cardiovascular response to handgrip maneuver may be a marker of failure to respond to compensatory mechanisms. Cilazapril treatment was associated with significant improvement in hemodynamic parameters during handgrip stress test, the mechanisms of which are increased sympathetic and renin-angiotensin system activation, and altered vascular tonus.

Effects of low-dose combination therapy with an angiotensin-converting enzyme inhibitor and a diuretic on flow-mediated vasodilation in hypertensive patients: a 6-month, single-center study.

BACKGROUND: Combination therapy with an angiotensin-converting enzyme (ACE) inhibitor and a diuretic has been shown to be highly effective in hypertension. Clinical trials have demonstrated that ACE inhibitors may improve endothelial cell dysfunction in hypertension. However, the effectiveness of the combination treatment in endothelial cell dysfunction is unknown. OBJECTIVE: This study investigated the effects of a new low-dose combination, perindopril 2 mg plus indapamide 0.625 mg, on brachial artery flow-mediated vasodilation (FMD) and left ventricular diastolic function in hypertension. METHODS: Patients aged 18 to 75 with newly diagnosed stage I or II hypertension were eligible. Endothelium-dependent brachial artery FMD and endothelium-independent vasodilation were assessed at baseline. Patients were treated with oral perindopril 2 mg plus indapamide 0.625-mg tablets once daily for 6 months. FMD measurements were then repeated. Percentage changes in FMD from baseline to 6 months, as well as left ventricular diastolic function parameters (isovolumic relaxation time [IVRT] and mitral diastolic E-wave deceleration time [EDT]), indicated the effectiveness of the intervention. RESULTS: Twenty-nine Turkish patients were enrolled (17 women, 12 men; mean [SD] age, 54.5 [9.5] years [range, 38-75 years]). The mean (SD) baseline FMD was 7.00% (2.39%) (endothelial cell dysfunction) and increased significantly to 8.68% (2.78%) at 6 months (P = 0.02); FMD improved in 15 patients (51.7%). At baseline and 6 months of therapy, mean (SD) IVRT was 101.7 (12.4) ms and 95.5 (7.7) ms, respectively (P<0.001), and EDT was 234.7 (33.9) ms and 217.9 (25.6) ms, respectively (P<0.001). CONCLUSIONS: In this small sample of hypertensive patients, a low-dose combination ACE inhibitor and diuretic significantly improved brachial artery FMD and left ventricular diastolic function. The improvement in FMD values was independent of the stage of hypertension. These findings suggest a relationship between improvement in endothelial cell function and diastolic function.

Effects of cilazapril on endothelial function and pulmonary hypertension in patients with congestive heart failure.

Flow-mediated vasodilation (FMV), brachial artery flow (BAF), and brachial artery diameter were evaluated in 30 patients with congestive heart failure before and after cilazapril treatment. While mean pulmonary artery pressure and pulmonary capillary wedge pressure decreased significantly, flow-mediated vasodilation and left ventricular ejection fraction increased significantly following cilazapril administration (P < 0.001). Brachial artery diameter and brachial artery flow did not change following the treatment period (P > 0.05). In conclusion, short-term cilazapril administration improved endothelial function and pulmonary pressure in patients with congestive heart failure.