Fractional flow reserve-guided PCI in patients with and without left ventricular hypertrophy: a DANAMI-3-PRIMULTI substudy.
- 作者列表："Sabbah M","Nepper-Christensen L","Lønborg J","Helqvist S","Køber L","Høfsten DE","Ahtarovski KA","Göransson C","Kyhl K","Schoos MM","Vejlstrup N","Kelbæk H","Engstrøm T
AIMS:The aim of this substudy was to investigate the correlation between fractional flow reserve (FFR) and diameter stenosis in patients with STEMI with and without left ventricular hypertrophy (LVH), and the influence of LVH on complete FFR-guided revascularisation versus culprit only, in terms of risk of clinical outcome. METHODS AND RESULTS:In this DANAMI-3-PRIMULTI substudy, 279 patients with STEMI had cardiac magnetic resonance (CMR) imaging for assessment of left ventricular mass index. Ninety-six patients had FFR evaluation of a non-culprit lesion. Diameter stenosis of the non-culprit lesion was determined with two-dimensional quantitative coronary analysis. The diameter stenosis (56.9% vs 54.3%, p=0.38) and FFR value (0.83 vs 0.85, p=0.34) were significantly correlated in both groups (Spearman's ρ=-0.40 and -0.41 without LVH and with LVH, respectively; p<0.001) but were not different between patients without and with LVH (p for interaction=0.87). FFR-guided complete revascularisation was associated with reduced risk of death, myocardial infarction or ischaemia-driven revascularisation both for patients without LVH (HR 0.42, 95% CI: 0.20-0.85) and for patients with LVH (HR 0.50, 95% CI: 0.17-1.47), with no interaction between the FFR-guided complete revascularisation and LVH (p for interaction=0.82). CONCLUSIONS:LVH did not interact with the correlation between diameter stenosis and FFR and did not modify the impact of complete revascularisation on the occurrence of subsequent clinical events.
目的: 本子研究的目的是研究伴有和不伴有左心室肥厚 (LVH) 的STEMI患者的血流储备分数 (FFR) 和直径狭窄之间的相关性，以及LVH对FFR指导下的完全血运重建的影响，而不是仅对罪犯的影响。 方法和结果: 在这项DANAMI-3-PRIMULTI的子研究中，279例STEMI患者使用心脏磁共振 (CMR) 成像评估左心室质量指数。96名患者对非罪魁祸首病变进行了FFR评估。通过二维定量冠状动脉分析确定非罪犯病变的直径狭窄。两组的直径狭窄 (56.9% vs 54.3%，p = 0.38) 和FFR值 (0.83 vs 0.85，p = 0.34) 显著相关 (Spearman ρ =-0.40和-0.41，无LVH和有LVH; p<0.001) 但在没有LVH和有LVH的患者之间没有差异 (交互作用p = 0.87)。FFR指导下的完全血运重建与无LVH患者 (HR 0.42，95% CI: 0.20-0.85) 和LVH患者 (HR 0.50，95% CI: 0.17-1.47) 的死亡、心肌梗死或缺血驱动的血运重建风险降低相关，FFR指导的完全血运重建与LVH之间无相互作用 (相互作用p = 0.82)。 结论: LVH不与直径狭窄和FFR之间的相关性相互作用，也不改变完全血运重建对后续临床事件发生的影响。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.