Diastolic dysfunction and clinical outcomes after transcatheter or surgical aortic valve replacement in patients with atypical aortic valve stenosis.

Background: Diastolic dysfunction is a predictor of poor outcomes in many cardiovascular conditions. At present, it is unclear whether diastolic dysfunction predicts adverse outcomes in patients with atypical aortic stenosis who undergo aortic valve replacement (AVR).

Methods: Five hundred and twenty-three patients who underwent transcatheter AVR (TAVR) (n = 303) and surgical AVR (SAVR) (n = 220) at a single institution were included in our analysis.

A goal-oriented hemodynamic approach to acute myocardial infarction complicated by cardiogenic shock-A single center experience.

Background: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is the most common cause of mortality following AMI, and treatment algorithms vary widely. We report the results of an analysis using time-sensitive, hemodynamic goals in the treatment of AMI-CS in a single center study.

Methods: Consecutive patients with AMI-CS from November 2016 through December 2021 were included in our retrospective analysis.

Technical success and long-term outcomes after anomalous right coronary artery stenting with cardiac computed tomography angiography correlation.

Introduction: Anomalous origin of coronary arteries has been observed in about 0.35-2.10% of the population.

Impact of Emergency Medical Services Activation of the Cardiac Catheterization Laboratory and a 24-Hour/Day In-Hospital Interventional Cardiology Team on Treatment Times (Door to Balloon and Medical Contact to Balloon) for ST-Elevation Myocardial Infarction.

The incremental benefit of emergency medical services (EMS) activation of the cardiac catheterization laboratory (CCL) for ST-elevation myocardial infarction (STEMI) in the setting of an established in-house interventional team (IHIT) is uncertain. We evaluated the impact of EMS activation on door-to-balloon (D2B) time and first medical contact-to-balloon (FMC2B) time for STEMI when coupled with a 24-hour/day IHIT. All patients presenting with STEMI to Loyola University Medical Center had demographic, procedural, and outcome data consecutively entered in a STEMI Data Registry.

Meta-Analysis of Studies Comparing Dual- Versus Mono-Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation.

Current guidelines recommend dual-antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI), although some studies suggest mono-antiplatelet therapy is equally efficacious with an improved safety profile. We performed a meta-analysis of studies comparing DAPT with mono-antiplatelet therapy after TAVI. Study quality and heterogeneity were assessed using Jadad score, Newcastle-Ottawa Scale, and Cochran's Q statistics.

Comparison of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction during and prior to availability of an in-house STEMI system: early experience and intermediate outcomes of the HARRT program for achieving routine D2B times <60 minutes.

Background: Over the last decade, significant advances in ST-elevation myocardial infarction (STEMI) workflow have resulted in most hospitals reporting door-to-balloon (D2B) times within the 90 min standard. Few programs have been enacted to systematically attempt to achieve routine D2B within 60 min. We sought to determine whether 24-hr in-house catheterization laboratory coverage via an In-House Interventional Team Program (IHIT) could achieve D2B times below 60 min for STEMI and to compare the results to the standard primary percutaneous coronary intervention (PCI) approach.

Usefulness of wide pulse pressure as a predictor of poor outcome after renal artery angioplasty and stenting.

Renal artery stenosis is a common cause of secondary hypertension and ischemic nephropathy. Percutaneous angioplasty and stent placement has allowed select patients with renal artery stenosis to use fewer antihypertensive agents and improve or stabilize renal function. The associations of baseline systolic, diastolic, and pulse pressures (PPs) with outcomes of blood pressure (BP) and renal function were examined in 243 patients who underwent renal angioplasty and stent placement.

Outcomes of bare metal versus drug-eluting stents in allograft vasculopathy.

Background: Because of improved outcomes with drug-eluting stents (DES), we examined angiographic and clinical outcomes of bare metal stents (BMS) vs DES for discrete lesions in chronic allograft vasculopathy.

Methods: Heart transplant patients who underwent percutaneous coronary intervention were divided into one of two groups: BMS or DES. Baseline clinical characteristics, rejection episodes and procedural details were compared.

Long-term clinical outcomes of real-world experience using sirolimus-eluting stents in saphenous vein graft disease.

Objective: To evaluate the long-term clinical outcomes of patients undergoing percutaneous coronary intervention for saphenous vein graft (SVG) disease. Specifically, we compared clinical endpoints of patients who received sirolimus-eluting stents (SES) versus bare-metal stents (BMS) for SVG disease.

Background: A recent small randomized-controlled trial (RCT) reported increased mortality with the use of SES in SVG disease.

Femoral angiogram prior to arteriotomy closure device does not reduce vascular complications in patients undergoing cardiac catheterization.

Objectives: To compare the efficacy of achieving hemostasis without vascular access site complications (VCs) in patients who did not undergo femoral angiogram (FA) prior to arteriotomy closure device (ACD) placement.

Background: Following coronary angiogram/percutaneous coronary intervention (CA/PCI), VCs increase morbidity and mortality. Previous studies in which an FA was highly recommended but not mandatory suggest that a predictor of VC is ACD use.

Utility of BNP in differentiating constrictive pericarditis from restrictive cardiomyopathy in patients with renal insufficiency.

Background: Differentiating between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCMP) is difficult because of similar clinical and hemodynamic presentation. Brain natriuretic peptide (BNP) has been reported a useful noninvasive biomarker to differentiate CP from RCMP; however, its utility in patients with renal insufficiency has not been evaluated.

Methods And Results: Consecutive patients with suspected CP or RCMP were enrolled.

Troponin I levels in patients with preeclampsia.

Introduction: Preeclampsia involves a diffuse inflammatory state and elevated levels of troponins in patients with preeclampsia have been anecdotally reported. It is, however, unknown whether it is attributable to the preeclampsia.

Objective: We sought to determine the troponin I levels at the time of delivery in pregnant women with and without preeclampsia.

Presence of asymmetric dimethylarginine gradients across high-grade lesions in patients with coronary artery disease.

Background: Asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, is a systemic marker of endothelial dysfunction. Although experimental evidence indicates that asymmetric dimethylarginine may play an important role in atherogenesis, local asymmetric dimethylarginine levels have not been measured in vivo.

Objectives: We sought to determine whether: (i) asymmetric dimethylarginine is elevated locally at sites of coronary lesions, (ii) systemic asymmetric dimethylarginine concentrations correlate with local levels, and (iii) percutaneous coronary intervention produces immediate local asymmetric dimethylarginine elevation.

The influence of low (81 mg) versus high (325 mg) doses of ASA on the incidence of sirolimus-eluting stent thrombosis.

Background: Conflicting opinion exists regarding the optimal dose of acetyl salicylic acid (ASA) to be given after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). We sought to evaluate the influence of ASA dose on the incidence of unexplained subacute and late stent thrombosis in the era of DES.

Methods: We performed a retrospective analysis of the incidence of subacute and late stent thrombosis in our patient population over a 2-year period.

Invasive assessment of mitral regurgitation: comparison of hemodynamic parameters.

Objectives: We sought to analyze several new hemodynamic characteristics which address the interplay of left atrial (LA) and left ventricular (LV) pressures, as well as to re-analyze several other V wave characteristics employed in the determination of mitral regurgitation (MR) severity in order to determine which, if any, had adequate correlation with grade of MR for clinical utility.

Background: Invasive assessment of mitral regurgitation includes analysis of intracardiac pressures and LV angiography. The V wave, when obtained from the pulmonary capillary wedge position (PCWP), and its various characteristics are believed to be of limited value for prediction of MR severity.

Clinical experience with rotational atherectomy in patients with severe left ventricular dysfunction.

Objective: To evaluate the safety and efficacy of rotational atherectomy (RA) in patients with severe left ventricular (LV) dysfunction.

Background: RA, using a rotating diamond-crystal burr, is most commonly used to open lesions with severe calcification or diffuse disease that may prove difficult to cross or dilate. However, RA generates microparticular debris that may attenuate the coronary microcirculation, inducing transient myocardial stunning and LV dysfunction.

Coronary artery perforation during percutaneous coronary intervention: incidence and outcomes in the new interventional era.

Background: Coronary artery perforation (CP) is a serious complication of percutaneous coronary intervention (PCI). We sought to define the incidence and outcome of CP given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa).

Methods: We retrospectively reviewed the records of patients who underwent PCI at our institution over a four-year period.

Antiplatelet therapy in anticoagulated patients requiring coronary intervention.

Objective: To define the optimal antiplatelet regime in patients requiring long-term anticoagulation who undergo percutaneous coronary intervention.

Background: Antiplatelet therapy following coronary intervention consists of a regime of aspirin and clopidogrel for the prevention of subacute stent thrombosis. The optimal antiplatelet therapy post-coronary intervention in patients on ongoing anticoagulation therapy remains to be defined.