Diagnosis and management challenges of in-stent restenosis in coronary arteries.

Over the course of the 3 decades, percutaneous coronary intervention (PCI) with stent implantation transformed the practice of cardiology. PCI with stenting is currently the most widely performed procedure for the treatment of symptomatic coronary disease. In large trials, drug-eluting stents (DES) have led to a significant reduction in in-stent restenosis (ISR) rates, one of the major limitations of bare-metal stents.

Post myocardial infarction left ventricular pseudoaneurysm.

Left ventricular pseudoaneurysm is a rare yet serious and challenging complication of myocardial infarction that requires a high index of suspicion as the clinical presentation is highly variable. We present a case of post infarction thrombosed left ventricular pseudoaneurysm in a patient who presented with non-specific complaints months after the initial cardiac injury. Multimodality imaging helped in characterizing the pseudoaneurysm and planning for definite therapy.

Effect of Bleeding Risk on Type of Stent Used in Patients Presenting With Acute Coronary Syndrome.

Patients at high bleeding risk (HBR) are at increased risk of bleeding following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) due to the need for longer dual antiplatelet duration. We sought to evaluate the likelihood of receiving DES during PCI in HBR populations and to characterize DES utilization trends over time. Consecutive patients who underwent PCI from April 2003 to September 2015 were identified.

Correlates and Significance of Elevation of Cardiac Biomarkers Elevation Following Transcatheter Aortic Valve Implantation.

The Valve Academic Research Consortium-2 recommends cutoff levels of cardiac troponin of >15 and of creatine kinase MB (CKMB) of >5 of the upper limit of normal (ULN) as markers of periprocedural myocardial infarction. We aimed to evaluate the correlation of these cutoffs with the survival rate in patients who underwent transcatheter aortic valve implantation (TAVI) through the femoral access. Patients who underwent TAVI were classified according to the postprocedural peak marker level of >15 and >5 ULN for troponin and CKMB, respectively.

Contemporary transcatheter aortic valve replacement with third-generation balloon-expandable versus self-expanding devices.

Objectives: To evaluate balloon-expandable and self-expanding third-generation transcatheter aortic valve replacement (TAVR) devices according to patient selection criteria and outcomes.

Background: Two competing third-generation TAVR technologies are currently commercially available in the US. There are no published head-to-head comparisons of the relative performance of these two devices.

Comparison of Propensity Score-Matched Analysis of Acute Kidney Injury After Percutaneous Coronary Intervention With Transradial Versus Transfemoral Approaches.

Transradial percutaneous coronary intervention (TR-PCI) may be associated with reduced rates of acute kidney injury (AKI). There is limited data from real-world registries about AKI rates stratified by PCI access. Our aim was to evaluate AKI rates and correlates in TR-PCI versus transfemoral PCI (TF-PCI) in a propensity score-matched analysis of patient data from a large, single-center registry.

Relation of Prolonged P-Wave Duration to Risk of Sudden Cardiac Death in the General Population (from the Atherosclerosis Risk in Communities Study).

Prolonged P-wave duration, a marker of left atrial abnormality, is associated with myocardial fibrosis, atrial fibrillation, and all-cause death. It is not known if prolonged P-wave duration is associated with sudden cardiac death (SCD) in the general population. We aimed to evaluate whether prolonged P-wave duration is independently associated with SCD risk in the Atherosclerosis Risk in Communities Study, a community-based prospective cohort study.

Late-breaking Trials from the 2016 American Heart Association's Scientific Sessions.

The late breaking trials released at the American Heart Association scientific sessions conference in November in New Orleans, LA covered a wide range of topics, including new devices within the field of heart failure, new registry data on transcatheter aortic valve replacement (TAVR) in intermediate risk patients, and medical management of peripheral arterial disease, coronary artery disease, and hypercholesterolemia. The following review highlights the late breaking trials presented at the conference that will have significant impact on clinical practice.

Use of an ePTFE-covered nitinol self-expanding stent graft for the treatment off pre-closure device failure during transcatheter aortic valve replacement.

Objectives: Our aim was to describe our experience with the use of an ePTFE-covered nitinol self-expanding stent graft (GORE® VIABAHN® Endoprosthesis, Gore Medical, USA) placed in the common femoral artery for the treatment of suture-mediated pre-closure device failure following transcatheter aortic valve replacement (TAVR).

Background: Access site-related vascular complications (VC) following sheath removal related to pre-closure device failure during TAVR are common and treatment options may vary.

Methods: We performed an observational study on a series of consecutive patients who underwent TAVR between 2013 and 2015.

Coronary artery spatial distribution of chronic total occlusions: Insights from a large US registry.

Objective: To assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI).

Background: Acute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery.

Methods: We examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree.

Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality.

Background: Aortic insufficiency (AI) is a significant long-term complication of continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate its impact on clinical outcomes and mortality in CF-LVAD recipients.

Methods: We retrospectively analyzed 237 patients implanted with HeartMate II CF-LVADs at our institution from June 2005 through June 2013.

Premature ventricular contractions: Reassure or refer?

When patients present with palpitations, the primary care physician can perform the initial evaluation and treatment for premature ventricular contractions (PVCs). Many patients need only reassurance and do not need to see a cardiologist.

Long-Term Outcomes of Patients Who Had Cardiac Arrest After Cardiac Operations.

Background: Cardiac arrest after cardiac procedures has a case fatality rate of approximately 60%. However, the long-term risk of death and outcomes among survivors of postoperative cardiac arrest is less clear.

Methods: We examined the mortality and outcomes of 6,979 consecutive patients who underwent cardiac operations from 1991 to 2014 in the Minneapolis Veterans Affairs Health Care System.

Catheter Ablation for Atrial Fibrillation in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials.

Background: Rhythm control with antiarrhythmic drugs (AADs) is not superior to rate control in patients with heart failure (HF) and atrial fibrillation (AF), but AF ablation may be more successful at achieving rhythm control than AADs. However, risks for both ablation and AADs are likely higher and success rates lower in patients with HF.

Objective: To compare rate control versus AF catheter ablation strategies in patients with AF and HF.

Pericardiectomy is Associated with Improvement in Longitudinal Displacement of Left Ventricular Free Wall Due to Increased Counterclockwise Septal-to-Lateral Rotational Displacement.

Background: Pericardiectomy is an effective intervention for constrictive pericarditis. Speckle-tracking echocardiography can provide quantitative information not only about longitudinal strain (LS) but about longitudinal displacement (LD) and septal-to-lateral rotational displacement (SLRD). The aim of this study was to investigate whether pericardiectomy improves myocardial mechanics using speckle-tracking analysis.

Rare cause of a common symptom: primary cardiac lymphoma.

Cardiac tumors may be symptomatic or found incidentally during evaluation for a seemingly unrelated problem or physical finding. Because symptoms may mimic other cardiac conditions, the clinical challenge is to consider the possibility of a cardiac tumor so that the appropriate diagnostic test(s) can be conducted. In this case, we describe an exceedingly rare cardiac tumor.