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.

Early improvement of the regional and global ventricle function estimated by two-dimensional speckle tracking echocardiography after percutaneous aortic valve implantation speckle tracking after CoreValve implantation.

BACKGROUND: To assess changes in myocardial deformation and ejection fraction (EF) by two-dimensional speckle tracking echocardiography (2DSTE) after transcatheter aortic valve implantation (TAVI). METHODS: A total of 24 patients (50% males, age 78 ± 4 years) were selected for TAVI because of severe aortic stenosis. A comprehensive echocardiographic study was performed before TAVI, at discharge, and after 1-month follow-up. EF was assessed by 2D conventional echocardiography with Simpson method and by 2DSTE. Radial and circumferential strains were evaluated in six segments in the short-axis view at the level of the papillary muscles, and longitudinal strain in six segments in the four-chamber apical view, by means of 2DSTE. All studies were performed with an iE-33 echocardiography device (Philips). RESULTS: At discharge, the mean EF estimated by 2DSTE improved significantly when compared with the basal one (56 ± 7% vs. 51 ± 8%, P < 0.01), while EF by Simpson method did not change (67 ± 9% vs. 64 ± 16%, P = 0.2). At that time, global radial (21.4 ± 9% vs. 11.5 ± 7.6%, P = 0.000), circumferential (-20.7 ± 8% vs. -15.2 ± 7%, P = 0.02), and longitudinal strains (-14.8 ± 6.2% vs. -12 ± 6%, P = 0.02) improved significantly when compared with the basal one. At 1-month follow-up, global radial (20.1 ± 5.6% vs. 21.4 ± 9%, P = 0.88) and circumferential (-20 ± 8% vs. -20.7 ± 8%, P = 0.35) strains did not vary and a new significant improvement was observed in longitudinal global strain (-19.2 ± 6.5% vs. -14.8 ± 6.2%, P = 0.002). CONCLUSIONS: A new echocardiographic technique, such as 2DSTE, shows a significant early improvement in global and segmental left ventricular systolic function after TAVI, which could not be detected by conventional methods.