Publications by authors named "Michele M Viscusi"
Context: Both primary hyperparathyroidism (PHPT) and chronic hypoparathyroidism (HypoPT) are associated with the onset and development of cardiovascular diseases (CVDs). However, the molecular mechanisms underlying the effects of parathyroid disorders on endothelial dysfunction and platelet aggregation, two main determinants of CVDs, are not completely understood.
Objective: To evaluate the effects of PHPT and HypoPT on oxidative stress, endothelial and platelet function.
Background: Coronary computed tomography angiography (CCTA) is emerging as a valuable tool for noninvasive surveillance of cardiac allograft vasculopathy (CAV) in patients with heart transplant (HTx). We assessed the diagnostic performance of a comprehensive CCTA-based approach compared with the invasive reference, which includes invasive coronary angiography, intravascular ultrasound, and fractional flow reserve, for detecting CAV.
Methods: This was a multicenter prospective study including 37 patients with HTx who underwent CCTA, invasive coronary angiography, intravascular ultrasound, and fractional flow reserve.
Impact of Robotic Percutaneous Coronary Intervention (R-PCI) With and Without CCTA-Guidance on Clinical Outcomes and Hospital Economics: A Single Center Registry.
Catheter Cardiovasc Interv
February 2025
Article Synopsis
- Robotic-assisted coronary interventions (R-PCI) have shown safety and effectiveness in treating various coronary lesions, but their real-world clinical outcomes remain unclear.
- A study evaluated 111 patients to assess major adverse cardiovascular events (MACE) and found a low occurrence of 5.4% during a median follow-up period.
- The research indicated that while procedural complexity increased time and radiation exposure, it did not impact in-hospital or long-term outcomes, and CCTA-guided procedures allowed for a higher rate of same-day discharge (64.6% vs. 44.2%).
This analysis of real-world data examines the efficacy, safety, and long-term outcomes of renal denervation in hypertensive patients for up to 10 years. Sixty-five consecutive patients underwent renal denervation (RDN) (single operator) for uncontrolled resistant hypertension. Efficacy was defined as the interindividual change of office (OBPM) and ambulatory blood pressure monitoring (ABPM) at 1, 6, 12 months, 2-4 and 5-10 years after RDN.
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- Aortic valve calcification (AVC) is examined as a predictor for complications in transcatheter aortic valve implantation (TAVI), with a focus on its impact on intra-annular devices.
- Patients with high AVC have a higher risk of developing mild to severe paravalvular leak (PVL) and conduction disorders requiring pacemaker implantation, indicating AVC's significant role in post-TAVI outcomes.
- The study found that higher AVC levels predict poor 30-day clinical outcomes after TAVI, highlighting the importance of assessing AVC to improve patient management.
Background: Discrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia.
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- Severe aortic stenosis (AS) leads to changes in the heart’s left ventricle and can affect blood flow and resistance in coronary arteries.
- A study assessed coronary blood flow and microvascular resistance in AS patients before and after transcatheter aortic valve implantation (TAVI) and found no immediate changes right after the procedure.
- Six months post-TAVI, patients showed significant improvement in hyperaemic perfusion, indicating that over time, left ventricular remodelling positively affected blood flow during increased demand.
Article Synopsis
- A study was conducted to see if adding platelet reactivity (PR) evaluation to the existing ACEF score could enhance the diagnostic accuracy for patients with stable coronary artery disease (CAD) treated with percutaneous coronary intervention.
- The findings showed that the new PR-ACEF score significantly outperformed the original ACEF score in predicting outcomes such as death and myocardial infarction (MI) as well as major adverse cardiovascular events (MACE).
- The PR-ACEF score also demonstrated strong long-term predictive ability, with high values indicating a greater risk of death/MI and MACE over a 5-year period.
Background: The optimal index of microvascular function should be specific for the microvascular compartment. Yet, coronary flow reserve (CFR), despite being widely used to diagnose coronary microvascular dysfunction (CMD), is influenced by both epicardial and microvascular resistance. Conversely, microvascular resistance reserve (MRR) adjusts for fractional flow reserve (FFR), and thus is theoretically independent of epicardial resistance.
View Article and Find Full Text PDFAims: A majority of acute coronary syndromes (ACS) present without typical ST elevation. One-third of non-ST-elevation myocardial infarction (NSTEMI) patients have an acutely occluded culprit coronary artery [occlusion myocardial infarction (OMI)], leading to poor outcomes due to delayed identification and invasive management. In this study, we sought to develop a versatile artificial intelligence (AI) model detecting acute OMI on single-standard 12-lead electrocardiograms (ECGs) and compare its performance with existing state-of-the-art diagnostic criteria.
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- - The study aimed to evaluate the clinical outcomes of patients with coronary artery disease based on whether they received fractional flow reserve (FFR)-guided or angiography-guided revascularization, amidst previously conflicting research.
- - A total of 30 studies involving nearly 394,000 patients were analyzed, revealing that FFR-guided revascularization was linked to significantly lower rates of all-cause death, myocardial infarction, and major adverse cardiovascular events (MACE) compared to angiography.
- - However, when focusing only on randomized controlled trials, no major differences in outcomes were found between the two methods, indicating that FFR's benefits may decrease in scenarios with higher revascularization rates or more acute coronary syndromes present
Diagnosing coronary microvascular dysfunction remains challenging, primarily due to the lack of direct measurements of absolute coronary blood flow (Q) and microvascular resistance (R). However, there has been recent progress with the development and validation of continuous intracoronary thermodilution, which offers a simplified and validated approach for clinical use. This technique enables direct quantification of Q and R, leading to precise and accurate evaluation of the coronary microcirculation.
View Article and Find Full Text PDFBackground: To identify anatomical and morphological plaque features predictors of PCI and create a multiparametric score to increase the predictive yield. Moreover, we assessed the incremental predictive value of FFR (Fractional Flow Reserve derived from CCTA) trans-lesion gradient (ΔFFR) when integrated into the score.
Methods: Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with FFR available, referred to invasive coronary angiogram and assessment of fractional flow reserve.
Article Synopsis
- The study aimed to compare two methods (continuous and bolus thermodilution) for measuring coronary flow reserve (CFR) and microvascular resistance reserve (MRR) in patients with chest pain and nonobstructive coronary artery disease.
- Results indicated that mean CFR and MRR values were significantly higher when measured using continuous thermodilution compared to bolus thermodilution, with continuous allowing for greater precision and lower variability in the results.
- The correlation between CFR and MRR values from both methods was significant but weak, suggesting that while both methods provide useful information, continuous thermodilution is generally more reliable for assessments.
Background: Cardiac damage (CD) staging enhances risk stratification in patients with clinically significant aortic stenosis (AS). We aimed to assess the prognostic value and reclassification rate of right heart catheterization (RHC) compared with transthoracic echocardiography (TTE) in characterising CD staging at 3-year follow-up in patients with clinically significant AS, to identify patients that would benefit from RHC for prognostic stratification, and to test the prognostic value of combined CD staging.
Methods: An observational cohort study of 432 AS patients undergoing TTE and RHC were divided into moderate or asymptomatic severe (m/asAS) and symptomatic severe (ssAS) AS.
Article Synopsis
- Takotsubo syndrome (TTS) is thought to be linked to issues with coronary microvascular dysfunction (CMD), which can cause temporary heart problems but might be reversible when blood flow is normalized.
- Researchers used invasive techniques to directly assess microcirculation in TTS patients for the first time, finding CMD present in all patients at admission, but improving significantly during follow-up.
- The results suggest that sudden issues in coronary microvascular function are key to understanding how TTS develops and progresses.
Article Synopsis
- The text describes a rare heart condition known as Dual LAD, where two parts of the left anterior descending artery exist in the same area of the heart.
- In the case mentioned, one segment originated from the Left Coronary Sinus and the other from the Right Coronary Sinus, with the left circumflex artery also coming from the right side and the right coronary artery being normal.
- The condition was found incidentally during an examination, emphasizing the importance of using Coronary Computed Tomography Angiography (CCTA) for better patient management and understanding of such anomalies.
Acute decompensated heart failure (ADHF) is a major cause of hospitalizations in older adults, leading to high mortality, morbidity, and healthcare costs. To address the persistent poor outcomes in ADHF, novel device-based approaches targeting specific pathophysiological mechanisms are urgently needed. The recently introduced DRIPS classification categorizes these innovative therapies based on their mechanisms.
View Article and Find Full Text PDFBackground: Studies investigating clinical outcomes of patients with or without endothelial disfunction (ED) treated with percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) using second generation drug eluting stents (DES) are lacking.
Methods: We prospectively collected data from 109 patients undergoing PCI with second generation DES due to stable CAD between December 2014 and September 2016. ED was evaluated evaluating the flow mediated dilation (FMD) at the brachial artery level and defined by an FMD < 7 %.
Article Synopsis
- Simple visual estimation of coronary angiography has limitations in accurately classifying coronary lesions, making it less reliable for diagnosis.
- Fractional flow reserve (FFR) is a more effective tool for evaluating coronary stenoses, showing better outcomes by identifying which lesions lead to myocardial ischemia.
- Despite some studies supporting FFR-guided revascularization over standard angiography, recent randomized clinical trials have produced inconsistent findings, prompting a review of current data and study methodologies.