Multimodal Intravascular Imaging of the Vulnerable Coronary Plaque.

Vulnerable coronary plaques are atherosclerotic lesions which, due to their specific phenotype, are prone to plaque rupture and to cause acute coronary syndromes, with subsequent relevant morbidity and mortality. Strategies to break the chain link between plaque vulnerability and adverse clinical events include optimized pharmacologic prevention and potentially also preemptive percutaneous coronary interventions (previously defined as "plaque sealing" or "plaque passivation"). Various morphologic features of the vulnerable plaques have been described, including aspects regarding the large necrotic lipid content, the thin fibrous cap, the presence and extent of the presence of calcifications with small size and calcification angle, and as well as the large macrophage infiltration within the plaque.

Bismuth Bound to Transition Metals: Visible-Light-Induced Olefin Coordination, Reductive Elimination, and Oxidative Addition.

A series of dibenzobismepinyl (CHBi) substituted transition metal complexes of the type [(CHBi)M(CO)(L)] (M=Mn, Co, Fe) was prepared in salt elimination reactions from a halobismepine and sodium metallates. Irradiation of these complexes with visible light has been investigated, aiming at the elimination of one carbonyl ligand and the concomitant coordination of the bismepine's olefin moiety to the transition metal center. The resulting complexes of the type [{κC,κBi-(CH)Bi}M(CO)(L)] (M=Co, Fe) have been isolated and fully characterized.

Bismuth as a Z-Type Ligand: an Unsupported Pt-Bi Donor-Acceptor Interaction and its Umpolung by Reaction with H.

Establishing unprecedented types of bonding interactions is one of the fundamental challenges in synthetic chemistry, paving the way to new (electronic) structures, physicochemical properties, and reactivity. In this context, unsupported element-element interactions are particularly noteworthy since they offer pristine scientific information about the newly identified structural motif. Here we report the synthesis, isolation, and full characterization of the heterobimetallic Bi/Pt compound [Pt(PCy)(BiMe)(SbF)] (1), bearing the first unsupported transition metal→bismuth donor/acceptor interaction as its key structural motif.

Cyclic Hydrocarbon Frameworks Containing Two Bismuth Atoms: Towards 9,10-Dibismaanthracene.

When bismuth atoms are incorporated into cyclic organic systems, this commonly goes along with strained or distorted molecular geometries, which can be exploited to modulate the physical and chemical properties of these compounds. In six-membered heterocycles, bismuth atoms are often accompanied by oxygen, sulfur or nitrogen as a second hetero-element. In this work, we present the first examples of six-membered rings, in which two CH units are replaced by BiX moieties (X=Cl, Br, I), resulting in dihydro-anthracene analogs.

Chronic kidney disease is related to impaired left ventricular strain as assessed by cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy.

Introduction: Chronic kidney disease (CKD) is an important cardiovascular risk factor. However, the relationship between CKD and myocardial strain as a parameter of myocardial function is still incompletely understood, particularly in patients with ischemic cardiomyopathy (ICM). Cardiac magnetic resonance imaging (CMR) feature tracking allows to analyze myocardial strain with high reproducibility.

Fusing Triphenylbismuth and PnPh (Pn = P-Bi): Synthesis, Isolation, and Characterization of 9-Bisma-10-Pnictatriptycenes.

The first series of 9-bisma-10-pnictatriptycenes Bi(CH)Pn (, Pn = P-Bi; see graphic) has been synthesized in a two-step procedure via suitable tris(2-bromophenyl)pnictanes and characterized in solution as well as in the solid state. DFT calculations suggest preferential interactions between and soft Lewis acids via the lighter pnictogen donor atom. Experimental studies demonstrate that even the weakest Lewis base in the series of , namely the dibismatriptycene , interacts with Lewis acidic [BiMe(SbF)] in solution.

Coronary microvascular dysfunction is a hallmark of all subtypes of MINOCA.

Introduction: Myocardial infarction without obstructive coronary artery disease (MINOCA) is a heterogeneous clinical condition presenting with myocardial necrosis not due to an obstruction of a major coronary artery. Recently, a relevant role of coronary microvascular dysfunction (CMD) in the pathogenesis of MINOCA has been suggested; however, data on this are scarce. Particularly, it is unclear if CMD is equally present in all subtypes of MINOCA or differentially identifies one or more of these conditions.

Bismuth Cations: Fluoride Ion Abstraction, Isocyanide Coordination, and Impact of Steric Bulk on Lewis Acidity.

Invited for the cover of this issue are the groups of Carsten von Hänisch and Crispin Lichtenberg at the Philipps University of Marburg. The image depicts a bismuth kraken, eagerly grabbing Lewis basic substrates, thereby solving scientific puzzles about bismuth-based Lewis acidity. Read the full text of the article at 10.

Bismuth Cations: Fluoride Ion Abstraction, Isocyanide Coordination, and Impact of Steric Bulk on Lewis Acidity.

The molecular compound [BiDipp (SbF )], containing the bulky, donor-free bismuth cation [BiDipp ] has been synthesized and fully characterized (Dipp=2,6-iPr -C H ). Using its methyl analog [BiMe (SbF )] as a second reference point, the impact of steric bulk on bismuth-based Lewis acidity was investigated in a combined experimental (Gutmann-Beckett and modified Gutmann-Beckett methods) and theoretical approach (DFT calculations). Reactivity studies of the bismuth cations towards [PF ] and neutral Lewis bases such as isocyanides C≡NR' revealed facile fluoride ion abstraction and straightforward Lewis pair formation, respectively.

Coronary microvascular dysfunction as assessed by angiography-derived index of microvascular resistance co-localizes with and may explain the presence of ischemia in stress-cardiac magnetic resonance imaging in the absence of coronary artery disease.

Introduction: Ischemia with no obstructive coronary disease (INOCA) is a frequent phenomenon in the cath lab. A possible cause is coronary microvascular dysfunction (CMD), which may be assessed by invasive testing with possible complications; therefore, less invasive approaches have emerged, such as the angiography-derived index of microvascular resistance (aIMR). The aim of our study was to investigate the association of single-vessel aIMR as a measure of CMD with areas of INOCA in stress testing.

Morphological characteristics of lesions with thin cap fibroatheroma-a substudy from the COMBINE (OCT-FFR) trial.

Aims: To study if any qualitative or quantitative optical coherence tomography (OCT) variables in combination with thin cap fibroatheroma (TCFA) patients could improve the identification of lesions at risk for future major adverse cardiac events (MACEs).

Methods And Results: From the combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict adverse event outcomes in diabetes mellitus patients: COMBINE (OCT-FFR) trial database (NCT02989740), we performed a detailed assessment OCT qualitative and quantitative variables in TCFA carrying diabetes mellitus (DM) patients with vs. without MACE during follow-up.

Quantitative Flow Ratio Is Related to Anatomic Left Main Stem Lesion Parameters as Assessed by Intravascular Imaging.

Introduction: Previously, an association between anatomic left main stem (LMS) lesion parameters, as described by intravascular ultrasound (IVUS) and fractional flow reserve (FFR), was shown. Quantitative flow ratio (QFR) is a novel, promising technique which can assess functional stenosis relevance based only on angiography. However, as little is known about the relationship between anatomic LMS parameters and QFR, it was thus investigated in this study.

Outcome of transcatheter edge-to-edge mitral valve repair in patients with diabetes mellitus: Results from a real-world cohort.

Background: There are only limited data on patients with diabetes undergoing transcatheter edge-to-edge repair (TEER) in real-world settings. Previous data indicated patients with diabetes to have a worse prognosis. This study sought to evaluate safety and efficacy of TEER in patients with diabetes in a real-world cohort.

[Mitral valve: When conservative, when surgical, when interventional therapy?].

The management of severe symptomatic mitral regurgitation is in contrast to the aortic-valve-intervention more challenging due to the complex mitral-valve anatomy. In primary mitral regurgitation surgical therapy is recommended, whereas there are various therapeutic options in secondary mitral regurgitation. Besides the established mitral-valve Transcatheter Edge-to-Edge-Repair (M-TEER) and the interventional annuloplasty - devices dynamic developments have recently been made in the field of Transcatheter Mitral Valve Replacement-therapy (TMVR).

Between imide, imidyl and nitrene - an imido iron complex in two oxidation states.

Imidyl and nitrene metal species play an important role in the -functionalisation of unreactive C-H bonds as well as the aziridination of olefines. We report on the synthesis of the trigonal imido iron complexes [Fe(NMes)L] (L = -N{Dipp}SiMe); Dipp = 2,6-diisopropyl-phenyl; Mes = (2,4,6-trimethylphenyl) reaction of mesityl azide (MesN) with the linear iron precursors [FeL]. UV-vis-, EPR-, Fe Mössbauer spectroscopy, magnetometry, and computational methods suggest for the reduced form an electronic structure as a ferromagnetically coupled iron(ii) imidyl radical, whereas oxidation leads to mixed iron(iii) imidyl and electrophilic iron(ii) nitrene character.

Thin-Cap Fibroatheroma Rather Than Any Lipid Plaques Increases the Risk of Cardiovascular Events in Diabetic Patients: Insights From the COMBINE OCT-FFR Trial.

Background: Autopsy studies have established that thin-cap fibroatheromas (TCFAs) are the most frequent cause of fatal coronary events. In living patients, optical coherence tomography (OCT) has sufficient resolution to accurately differentiate TCFA from thick-cap fibroatheroma (ThCFA) and not lipid rich plaque (non-LRP). However, the impact of OCT-detected plaque phenotype of nonischemic lesions on future adverse events remains unknown.

Quantitative Flow Ratio Is Associated with Extent and Severity of Ischemia in Non-Culprit Lesions of Patients with Myocardial Infarction.

Quantitative flow ratio (QFR) is a novel method to assess the relevance of coronary stenoses based only on angiographic projections. We could previously show that QFR is able to predict the hemodynamic relevance of non-culprit lesions in patients with myocardial infarction. However, it is still unclear whether QFR is also associated with the extent and severity of ischemia, which can effectively be assessed with imaging modalities such as cardiac magnetic resonance (CMR).

Cobalt and Iron Stabilized Ketyl, Ketiminyl and Aldiminyl Radical Anions.

Carbonyl and iminyl based radical anions are reactive intermediates in a variety of transformations in organic synthesis. Herein, the isolation of ketyl, and more importantly unprecedented ketiminyl and aldiminyl radical anions coordinated to cobalt and iron complexes is presented. Insights into the electronic structure of these unusual metal bound radical anions is provided by X-Ray diffraction analysis, NMR, IR, UV/Vis and Mössbauer spectroscopy, solid and solution state magnetometry, as well as a by a detailed computational analysis.

Lesion Geometry as Assessed by Optical Coherence Tomography Is Related to Myocardial Ischemia as Determined by Cardiac Magnetic Resonance Imaging.

Introduction: Although the relationship between the geometry of coronary stenosis and the presence of myocardial ischemia is well known, the association between stenosis geometry and severity and/or extent of ischemia is still unexplored. Thus, we investigated this relationship using optical coherence tomography (OCT) to assess stenosis parameters and cardiac magnetic resonance imaging (CMR) to determine both extent and severity of ischemia.

Methods: We analyzed 55 lesions from 51 patients with stable angina.

Effects of Transcatheter Mitral Valve Repair Using MitraClip Device on Sleep Disordered Breathing in Patients with Mitral Valve Regurgitation.

Sleep disordered breathing (SDB) is common among patients with valvular heart disease, and successful valve surgery could reduce SDB severity. However, data about the effects of transcatheter mitral valve repair on SDB are scarce. Therefore, mitral regurgitation (MR) patients undergoing MitraClip-placement were prospectively enrolled.