Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review.

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.

The mortality analysis of primary prevention patients receiving a cardiac resynchronization defibrillator (CRT-D) or implantable cardioverter-defibrillator (ICD) according to guideline indications in the improve SCA study.

Background: In primary prevention (PP) patients the utilization of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy-defibrillators (CRT-D) remains low in many geographies, despite the proven mortality benefit.

Purpose: The objective of this analysis was to examine the mortality benefit in PP patients by guideline-indicated device type: ICD and CRT-D.

Methods: Improve sudden cardiac arrest was a prospective, nonrandomized, nonblinded multicenter trial that enrolled patients from regions where ICD utilization is low.

Effect of Vericiguat vs Placebo on Quality of Life in Patients With Heart Failure and Preserved Ejection Fraction: The VITALITY-HFpEF Randomized Clinical Trial.

Importance: Patients with heart failure and preserved ejection fraction (HFpEF) are at high risk of mortality, hospitalizations, and reduced functional capacity and quality of life.

Objective: To assess the efficacy of the oral soluble guanylate cyclase stimulator vericiguat on the physical limitation score (PLS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Design, Setting, And Participants: Phase 2b randomized, double-blind, placebo-controlled, multicenter trial of 789 patients with chronic HFpEF and left ventricular ejection fraction 45% or higher with New York Heart Association class II-III symptoms, within 6 months of a recent decompensation (HF hospitalization or intravenous diuretics for HF without hospitalization), and with elevated natriuretic peptides, enrolled at 167 sites in 21 countries from June 15, 2018, through March 27, 2019; follow-up was completed on November 4, 2019.

Selection of human induced pluripotent stem cells lines optimization of cardiomyocytes differentiation in an integrated suspension microcarrier bioreactor.

Background: The production of large quantities of cardiomyocyte is essential for the needs of cellular therapies. This study describes the selection of a human-induced pluripotent cell (hiPSC) line suitable for production of cardiomyocytes in a fully integrated bioprocess of stem cell expansion and differentiation in microcarrier stirred tank reactor.

Methods: Five hiPSC lines were evaluated first for their cardiac differentiation efficiency in monolayer cultures followed by their expansion and differentiation compatibility in microcarrier (MC) cultures under continuous stirring conditions.

Utilization of implantable cardioverter-defibrillators for the prevention of sudden cardiac death in emerging countries: Improve SCA clinical trial.

Background: Implantable cardioverter-defibrillators (ICDs) are underutilized in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA Study is the largest prospective study to evaluate the benefit of ICD therapy in underrepresented geographies. This analysis reports the primary objective of the study.

Clinical safety of the ProMRI implantable cardioverter-defibrillator systems during head and lower lumbar magnetic resonance imaging at 3 T: results of the ProMRI 3T ENHANCED Master study.

Aims: There have been no published studies on the safety of magnetic resonance imaging (MRI) at 3 Tesla (3 T) in patients with MRI-conditional implantable cardioverter-defibrillators (ICDs). The aim of this study was to assess clinical safety of the Biotronik ProMRI ICD system during non-diagnostic head and lower lumbar scans under 3 T MRI conditions.

Methods And Results: The study enrolled 129 patients at 12 sites in Australia, Singapore, and Europe.

Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries: Clinical characteristics and reasons for implantation refusal.

Background: Despite available evidence that implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among patients at risk for sudden cardiac death, utilization of ICDs is low especially in developing countries.

Objective: To summarize reasons for ICD or cardiac resynchronization therapy defibrillator implant refusal by patients at risk for sudden cardiac arrest (Improve SCA) in developing countries.

Methods: Primary prevention (PP) and secondary prevention (SP) patients from countries where ICD use is low were enrolled.

Wenckebach pattern in right bundle branch block - benign or not?

A Mobitz type I block (Wenckebach phenomenon) with narrow QRS complex is almost always due to a lesion in the AV node. In a type I block with wide QRS complex (>0.12sec), the block can be in the His-Purkinje system in 60-70% of the cases.

A Patient-Specific Computational Fluid Dynamic Model for Hemodynamic Analysis of Left Ventricle Diastolic Dysfunctions.

This work presents a computational fluid dynamic (CFD) model to simulate blood flows through the human heart's left ventricles (LV), providing patient-specific time-dependent hemodynamic characteristics from reconstructed MRI scans of LV. These types of blood flow visualization can be of great asset to the medical field helping medical practitioners better predict the existence of any abnormalities in the patient, hence offer an appropriate treatment. The methodology employed in this work processed geometries obtained from MRI scans of patient-specific LV throughout a cardiac cycle using computer-aided design tool.

Status of radiation protection in various interventional cardiology procedures in the Asia Pacific region.

Objective: Increasing use of interventional procedures in cardiology with unknown levels of radiation protection in many countries of Asia-Pacific region necessitates the need for status assessment. The study was part of an International Atomic Energy Agency (IAEA) project for achieving improved radiation protection in interventional cardiology (IC) in developing countries.

Design: The survey covers 18 cardiac catheterisation laboratories in seven countries (Bangladesh, India, Malaysia, Myanmar, Singapore, Thailand and Vietnam).

Cell delivery and tracking in post-myocardial infarction cardiac stem cell therapy: an introduction for clinical researchers.

Stem cell-based therapy for patients with post-infarct heart failure is a relatively new and revolutionary concept in cardiology. Despite the encouraging results from pre-clinical studies, outcomes from most clinical trials remain moderately positive while the clinical benefits are largely attributed to transplanted cell-associated paracrine effects in stimulating angiogenesis and protecting endogenous cardiomyocytes. This scenario indicates that there may be a considerably protracted iterative process of conceptual and procedural refinement before true clinical benefits can be fully materialized.

Markers of low-grade inflammation and soluble cell adhesion molecules in Chinese patients with coronary artery disease.

Background: Inflammation plays an important role in atherosclerosis. Markers of low-grade chronic inflammation, such as C-reactive protein (CRP) and soluble cell adhesion molecules (sCAMs), have been associated with coronary artery disease (CAD).

Objective: To evaluate the significance of inflammatory markers as novel risk factors for CAD in the Chinese population.

Identification of a novel transcript of human PECAM-1 and its role in the transendothelial migration of monocytes and Ca2+ mobilization.

Platelet-endothelial cell adhesion molecule-1 (PECAM-1) is an integral component of endothelial cells and has been implicated in the transendothelial migration (TEM) of circulating leukocytes mediated by its 1st and 2nd extracellular immunoglobulin (Ig)-like domains and regulation of intracellular Ca(2+) homeostasis with its 6th domain. Up-to-date, little is known about the role of the 5th extracellular (Ig)-like domain. We have discovered a novel human PECAM-1 transcript missing the entire 7th exon, which encodes the 5th extracellular (Ig)-like domain of PECAM-1.

Ethnic differences in utilization of invasive cardiac procedures and in long-term survival following acute myocardial infarction.

Background: Ethnic differences in coronary mortality have been documented, and South Asians from the Indian subcontinent are particularly vulnerable.

Hypothesis: This study sought to determine whether there was a difference in the utilization of invasive cardiac procedures and long-term mortality in survivors of myocardial infarction (MI) among Chinese, Malays, and South Asians in Singapore.

Methods: All MI events in the country were identified and defined by the Singapore Myocardial Infarction Register, which uses modified procedures of the World Health Organization MONICA Project.

Tyrosine kinase inhibitors suppress alpha1-adrenoceptor mediated contraction in human radial, internal mammary arteries and saphenous vein.

The aim of this study is to determine whether the tyrosine kinase plays a role in the contractile response of human radial artery (RA), internal mammary artery (IMA) and saphenous vein (SV) to alpha(1)-adrenoceptor (AR) stimulation. The tyrosine kinase inhibitors, genistein and tyrphostin, significantly inhibited alpha(1)-AR mediated contractile response in a dose-dependent and non-competitive manner. Genistein at 10 microM inhibited 39%, 54% and 72% of PE-induced maximum contraction, and tyrphostin at 50 microM inhibited 41%, 68% and 39% of the contraction in the human RA, IMA and SV respectively.

Rheumatic heart diseases in pregnancy.

Acute rheumatic fever and rheumatic valvular disease remain prevalent in many parts of the world, and are probably the most common cause of heart disease in pregnancy. Mitral stenosis is the most frequently encountered rheumatic valvular lesion. A variety of pregnancy-associated cardiovascular changes often exacerbate the signs and symptoms of valvular lesions.

Effects of molybdenum, silicon and nickel on alpha1-adrenoceptor-induced constriction of rat isolated aorta.

1. To determine the effects of trace elements on alpha1-adrenoceptor-mediated vasoconstriction, we studied the effects of molybdenum (Mo), silicon (Si) and nickel (Ni) on vasoconstrictor response to an alpha1-adrenoceptor agonist in rat aorta. 2.

Effects of micromolar concentrations of manganese, copper, and zinc on alpha1-adrenoceptor-mediating contraction in rat aorta.

To determine the influences of the Mn, Cu, and Zn on alpha1-adrenoceptor (AR)-mediated vasoconstriction, we investigated their effects on vasoconstriction produced by the alpha1-AR agonist phenylephrine in isolated rings of rat thoracic aorta. The cumulative concentration-contraction curves for phenylephrine were obtained in the absence and presence of Mn (0.3, 1, 3 microM), Cu (1, 10, 16 microM), and Zn (0.

Early and mid-term angiographic and clinical results after intracoronary duet stent placement.

The Duet stent (Guidant/Advanced Cardiovascular Systems) is a new stent with a corrugated ring design and very limited data on its short- and mid-term performance. Accordingly, in this study we sought to determine the early and mid-term clinical and angiographic outcomes in a moderate-sized series of 86 consecutive patients who underwent placement of 108 premounted Duet stents in 98 coronary lesions. Procedural success, accomplished in all patients, was accompanied by a significant reduction in lesion severity from 89% +/- 11% before to 5% +/- 3% diameter stenosis after the procedure (P = 0.

Clinical and angiographic outcome after angiography-guided stent placement in small coronary vessels.

Background: Although it is widely accepted that stenting confers favorable angiographic and clinical results in coronary arteries >/=3.0 mm in diameter, the outcome of stent placement in smaller vessels remains largely unclear.

Methods And Results: We sought to specifically determine the early and long-term clinical outcomes in a large series of 197 consecutive patients who underwent stent placement in 207 vessels <3.

Immediate and mid-term results after MultiLink stent implantation in native coronary arteries.

Different stent designs have widely disparate characteristics that may exert a positive or negative impact on their early and mid-term outcomes. The MultiLink stent (Guidant/Advanced Cardiovascular Systems, Santa Clara, CA) is a new coronary stent with only very limited data. In this report, we examined the results of 50 consecutive patients treated with 57 premounted sheathless MultiLink stents in 53 native coronary arteries with reference diameter > or =2.

Angiographic restenosis rate in patients with chronic total occlusions and subtotal stenoses after initially successful intracoronary stent placement.

The 5-month angiographic in-stent restenosis rate did not differ between patients with chronic total occlusions (n = 43) and subtotal stenoses (n = 43) equally matched for diabetes status, exact stent design, final expanded stent diameter, stent length, and residual percent diameter stenosis after stent placement; it was 32.5% and 27.9% for those with chronic total occlusions and subtotal stenoses, respectively (p = 0.

Early experience with the NIR intracoronary stent.

Immediate and midterm results of 61 NIR stent placement attempts in 55 native coronary vessels in 52 patients demonstrate a high clinical success rate of 98%, no early stent thrombosis, and a 5-month angiographic restenosis rate of 23%. The frequency of in-stent restenosis was significantly heightened in small vessel sizes and in diabetic patients.