Valuckienė, Živilė

The current success rates of percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) are estimated to be above 90% by experienced CTO operators. The retrograde approach has contributed significantly to this increase. Wire externalisation represents the important final step within the retrograde approach. This expert review article aims to illustrate and explain the different kinds of techniques of wire externalisation as well as important tips and tricks. Crucial steps and bail-out techniques of wire externalisation during retrograde PCI of CTOs are summarised. Further information is given on how to avoid possible complications. This expert review addresses both the beginner and the experienced CTO operator.

BACKGROUND: Ischaemic mitral regurgitation (IMR) is associated with adverse prognosis after myocardial infarction (MI) as a result of left ventricular remodelling and geometric deformation of the mitral apparatus (MA). AIM: The aim of this study was to assess MA from anatomically correct imaging planes in acute inferoposterior MI and IMR. METHODS: Ninety-three patients with no structural cardiac valve abnormalities and the first acute inferoposterior MI were prospectively enrolled into the study. Two-dimensional transthoracic echocardiography for MA assessment was performed within 48 h of presentation after reperfusion therapy. Based on the degree of mitral regurgitation (MR), patients were divided into either a no significant MR (NMR) group (n = 52 with no or mild, grade 0-I MR) or an IMR group (n = 41 with grade ≥ 2 MR). The control group consisted of 45 healthy individuals. RESULTS: Ischaemic MR was related with dilatation of the left ventricle chambers, decrease in ejection fraction, increase in mitral annulus diameter and area, and changes in subvalvular apparatus when compared with the NMR group or healthy individuals. CONCLUSIONS: Ischaemic MR in acute inferoposterior MI is related with worse lesions in MA geometry that cause insufficiency of mitral valve function.

BACKGROUND: Retrograde recanalization of coronary chronic total occlusions (CTO) via contralateral (CL) collateral connections (CCs) is successful in 60-70% of patients in whom conventional antegrade approach fails or is unpromising. This study describes our experience with retrograde CTO-PCI via ipsi-lateral (IL) CCs in patients with unfavorable CL CCs. METHODS: Between January 2013 and September 2015, 392 consecutive CTO procedures were performed by two high volume CTO-operators and the relevant data were fed into an online registry (ERCTO® EuroCTO-club). Most patients (222/392; 57%) were approached antegradely, whereas 43% were attempted retrogradely (170/392). After exclusion of all procedures performed via bypass-grafts (n = 12), PCI via CL CCs, the CL-group (n = 114/158; 72%), was compared with the IL-group that was attempted via IL CCs (n = 44/158; 28%). RESULTS: Both groups were similar with respect to risk factors and morphologic criteria of CTO-severity. The initial primary strategy was successful in 78% in the CL-group and in 68% in the IL-group. In both patient groups, the initial strategy had to be switched in five patients from CL toward IL (4.4%, n = 5/114) and from IL to CL (11.3% n = 5/44). The rate of major complications was 7% (CL) and 5% (IL), respectively (n.s.). After retrograde failure and cross-over to an antegrade controlled re-entry strategy the overall success rates increased to 92% (CL) and 93% (IL). CONCLUSIONS: In experienced hands retrograde CTO-PCI via IL CCs appears as safe and successful as the CL approach.

Introduction: Functional mitral regurgitation (MR) developed after inferoposterior myocardial infarction (MI) may result in pulmonary hypertension (PH) and potentially leading to RV systolic and diastolic impairment. However, patients with left ventricular (LV) heart failure and functional MR and without RV dysfunction may have initial hyperkinetic response to increased afterload [1, 2]. Aims: We aimed to assess RV systolic and diastolic deformation parameters in patients with ischemic MR after inferoposterior MI. Methods: 78 patients with acute first ever inferoposterior MI, single vessel coronary artery disease and no structural cardiac valve abnormalities were included in the study. All patients underwent emergency percutaneous coronary intervention (PCI) within the first 12 hours of presentation and two-dimensional (2D) transthoracic echocardiography (TTE) within 48 hours of presentation. Fourty five patients wrote concent for cardiac magneticresonance (CMR). Mitral regurgitation was assessed by quantitative PISA method. 45 patients had no or mild (grade 0-1) MR (control (NMR) group) and 33 patients had grade ≥2 ischemic MR (IMR group). Offline 2D speckle-tracking imaging (STE) analysis was performed with GE EchoPAC software. χ2 test was used for the descriptive data, and Student t test (for normaly distributed data) and Man Whitney test (for non-normally distributed data) for comparison between variables. P<0.05 was considered as statistically significant.[...].

Background and objective: Left atrium (LA) is an important biomarker of adverse cardiovascular outcomes and cerebrovascular events. This study aimed to evaluate LA myocardial deformation using cardiac magnetic resonance feature tracking (CMR-FT) in patients with acute ST-segment elevation myocardial infarction (STEMI) and secondary mitral regurgita- tion (MR). Additionally, to assess interobserver and intraobserver variability of the technique. Materials and methods: Twenty patients with STEMI underwent CMR with a 1.5 Tesla MRI scanner. According to the presence of MR patients were divided into two groups: MR(+) and MR( ). Total LA strain (es), passive LA strain (ee), and active LA strain (ea) were obtained. Additionally, total, passive and active strain rates (SRs, SRe, and SRa) were calculated. To assess interobserver agreement data analysis was performed by second independent observer. Results: LA volumetric and functional parameters were similar in both groups. All LA strain values were significantly higher in patients with MR: es (27.67 10.25 for MR( ) vs. 32.80 6.95 for MR(+); P = 0.01), ee (15.29 7.30 for MR( ) vs. 19.22 6.04 for MR(+); P = 0.01) and ea (12.38 4.23 for MR( ) vs. 14.44 5.19 for MR(+); P = 0.03). Only SRe significantly increased in patients with MR ( 0.57 0.24 for MR( ) vs. 0.70 0.20 for MR(+); P = 0.01). All LA deformation parameters demonstrated high interobserver and intraobserver agreement. Conclusions: Conventional volumetric and functional LA parameters do not detect early changes in LA performance in patients with STEMI and secondary MR. In contrast, LA reservoir, passive and active strain are significantly higher in patients with MR. Only peak early negative strain rate substantially increases during secondary MR. LA deformation parameters derived from conventional cine images using CMR-FT technique are highly reproducible.

Background Stenting — it is a widespread procedure for patients that are suffering from coronary artery disease. Possibility to use drugs-covered stents, improved stenting safety and treatment efficiency. Using second generation Biolimus drugs-covered Stents A9 is associated reduced risk of stent thrombosis copaired with rst generation. However the possibility of stent thrombosis and restenosis as late complication still persist. In this survey we tried to evaluate 2 years treatment results after Biolimus A9 stents implantation in coronary arteries. Methods The retrospective study performed in LSMUL KK Cardiology department. There was 216 patients suffered from coronary artery disease, and were treated using Biolimus A9 drugs-covered stents, in this way eliminating all bigger than 50 % stenosis. Data collected from hospital case histories and e-Biomatrix PMR questionnaire. The rate of complication after stenting were evaluated, when stenosis were eliminated or reduced to 30% or TIMI 3 ow were determined. We evaluated the rate of complications( myocardial infarction, Stent thrombosis, the need of revascularization, stroke, death) in 2 years period. Data was analyzed using SPSS v. 22.0 programme. Categorical variables were summarized as frequencies with percentages and were compared using Chi-square test or Fisher's exact test. Survival curves were constructed using Kaplan-Meier estimates and were compared using log-rank test. Results There were 216 patients in a survey, 69.91% men and 30.09% women. The age mean was 60.17 ± 10.13 years. Diabetes was diagnosed for 19% of patients. The success of Biolimus A9 implantation was 110%. The rate of complications after stenting was 0.93% (2 cases) There were no complication in hospital. There rate of complication during one year period was 1.4% (1 stent thrombosis, 2 new revascularizations, 1 stroke). There rate of complication during second year period was 0.46% (1 revascul

Introduction LV function may improve after revascularization of coronary occlusions or using a significant amount of medication. However the quality of life of every patient who is indicated with a acute coronary syndrome is not well characterized. Aim The purpose of the current study was to evaluate the effect of coronary stenting on systolic and diastolic LV function. Material and Methods We studied 98 patient with coronary artery disease , ages 42-86 years (mean 56.6 years) referred for PCI with stenting. Echocardiography was performed in all patients before and within 48 hours after PCI stenting. Results From systolic indices : left ventricular EF (ejection fraction) significantly increased (from 42.55 % to 57.32 % p-value < 0.001), left ventricular Fs (fractional shortening) significantly increased (from 26.54% to 29.75%, p- value <0.001) and left ventricular wall motion scoring index significantly reduced (from 1.05 to 1.00, p value<0.001). From diastolic indicators : left ventricular E velocity increased significantly (from 0.79 to 0.84 Cm/sec, p-value <0.001), E/a ratio increased significantly (from 1.18 to 1.34, p value <0.001), left ventricular deceleration time had a significant reduction (from 230.33 to 219.42 msec, p value <0.001) and left ventricular IVRT decreased significantly (from 84.74 to 79.2 p value < 0.001). Conclusion In this study, significant improvement in systolic and diastolic left ventricular function after angioplasty stenting were observed.

Background Dealing with complex chronic total occlusions (CTOs) in patients undergoing percutaneous coronary intervention (PCI), it is important to evaluate not only the CTO lesion itself but also atherosclerotic lesions of the whole coronary artery tree. The aim of this study was to evaluate the utility of the SYNTAX score in patients having CTO undergoing PCI. Methods This retrospective study included 72 consecutive patients with CTO lesions who underwent PCI. Primary endpoints were procedural failure and major adverse cardiac events (MACE) within 30 days. The SYNTAX and J-CTO scores were assessed before the procedures, and patients were divided into 2 groups according to SYNTAX criteria: high (>22) and low (≤22). Results Procedural success was obtained in 86,1% of patients. Patients with a high SYNTAX score had significantly lower procedural success than those with a low SYNTAX score (72.5% versus 90.2%, p<0.0001). There were 82% MACE in patients with high SYNTAX scores and 1.2% MACE in those with low scores. Both the SYNTAX and J-CTO scores had odds ratios of 1.39 (94%CI, 1.03–1.81) and 3.31 (94%CI, 1.12–9.43) for procedural failure. Higher SYNTAX scores were also an independent predictor of 30-day MACE after PCI (Odds ratio 1.65, 94%Cl 1.54–2.26), though the J-CTO score failed to predict the development of MACE. Conclusion The SYNTAX score appeared predictive of procedural failure in patients undergoing CTO-PCI, to a similar degree as with the established J-CTO score. High SYNTAX scores were strongly associated with an increased risk of 30-day MACE.

Background Most attempts to intervene on coronary chronic total occlusions fail because the wire cannot cross the occlusion. Three main strategies can be used to cross a CTO: antegrade wire escalation, antegrade dissection/re-entry and retrograde. The basic underlying principle of the hybrid approach (HA) is that no single procedural crossing strategy should be pursued to exhaustion, but an alternative strategy should be attempted if a given crossing strategy does not progress. Methods The success rates, complication rates, procedural characteristics and clinical outcomes of 72 consecutive CTO-PCIs with single crossing strategy (control group) were compared to 34 cases of hybrid approach to CTO-PCI. In the HA group successful crossing strategy was assessed. The SYNTAX and J-CTO scores were assessed to evaluate the potential severity of the procedure. The complications included major adverse cardiac and cerebrovascular events (MACCE) and the procedural complications. At 6 month follow-up clinical outcomes including target vessel revascularization (TVR), target lesions revascularization (TLR) and major adverse cardiac events (MACE) were evaluated. Results Procedural success was achieved in 91.2% cases in HA group and was significantly higher than cases in control group (86.1% respectively). The final successful CTO crossing strategy in HA group was antegrade in 48.4%, retrograde in 29%, and antegrade dissection/reentry in 22.6%. The retrograde approach in control group was used in 45.8% cases with 87.9% procedural success. Major procedural complications occurred 2.9% and 2.8% respectively, with no statistically significant difference. Conclusion Use of the hybrid approach to CTO-PCI is associated with higher success and similar complication rates compared to other CTOs crossing strategies. High CTO-PCI success rates can be achieved without incurring more complications, which is important for an elective procedure, such[...].

Objective Coronary plaque composition cannot be assessed accurately using gray-scale intravascular ultrasound (IVUS). Using virtual histology IVUS (VH-IVUS), a comparison of coronary plaque composition between acute coronary syndromes (ACS) and stable angina pectoris (SAP) was performed. Methods Pre-intervention IVUS of de novo culprit and target lesions was performed in 46 patients (20 with ACS and 26 with SAP). Using VH-IVUS, plaque was characterized as fibrotic, fibro-fatty, dense calcium, and necrotic core. VH-IVUS-derived thin-cap fibro-atheroma (VH-TCFA) was defined as necrotic core >10% of plaque area without overlying fibrous tissue in a plaque burden >40%. Lesions were classified into 3 groups: ruptured, VH-TCFA, and non-VH-TCFA plaque. Unstable lesions were defined as either VH-TCFA or ruptured plaque. Results Compared with patients with SAP, those with ACS had significantly more unstable lesions (89% vs 62%, p <0.001). Planar VH-IVUS analysis at the minimum luminal site and at the largest necrotic core site and volumetric analysis over a 10-mm-long segment centered at the minimum luminal site showed that the percentage of necrotic core was significantly greater and that the percentage of fibro-fatty plaque was significantly smaller in patients with ACS. The percentages of fibrotic and fibro-fatty plaque areas and volumes were smaller, and the percentages of necrotic core areas and volumes were larger in VH-TCFAs compared with non-TCFAs. Ruptured plaques in VH-IVUS analyses showed intermediate findings between VH-TCFAs and non-VH-TCFAs. Conclusion Culprit lesions in patients with ACS were more unstable and had greater amounts of necrotic core and smaller amounts of fibro-fatty plaque compared with target lesions in patients with SAP.