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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 August 2023) | Viewed by 15575

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Prof. Dr. Béla Merkely

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Heart and Vascular Center, Semmelweis University, Budapest, Hungary
Interests: CRT implantation; heart failure; sudden cardiac death; sports cardiology

Special Issue Information

Dear Colleagues,

The number of invasive cardiological procedures and structural interventions are increasing. Structural heart disease interventions represent a less invasive treatment method compared with traditional open heart surgery. Ballon valvuloplasty; mitraclip; transcatheter aortic, mitral, and tricuspid valve implantation; tricuspid annuloplasty; and paraprosthetic leak, left atrial appendage, ASD, VSD, and PFO closures are a few examples of such state-of-the-art techniques. Transcatheter aortic valve implantation (TAVI) is one of the most rapidly evolving fields. To date, more than 250000 patients have benefited from TAVI worldwide. Clear recommendations are already implemented in the guidelines regarding optimal patient selection, indications, and timing. Moreover, based on real-world data, TAVI had lower mortality rates and a favorable outcome owing to the unique advantages of these procedures, e.g., small access wounds and conscious sedation. Furthermore, the number of patients eligible for TAVI is increasing, and as a result of rapid technological development, the rate of complications is decreasing and the number of in-hospital stays and days spent at the ICU are decreasing, with faster recoveries and post-procedural periods. At the same time, most of these techniques require complex investigations and decisions during planning and implantation. Thus, multimodal imaging, hybrid solutions, and multidisciplinary decisions are important for interventional cardiologists, heart and vascular surgeons, anesthesiologists.

The aim of this Special Issue is to release the latest results of invasive cardiology, supporting physicians in their everyday clinical practice and showing how patients can be treated by minimally invasive heart valve procedures to optimize the quality of care in a patient-centered approach.

Prof. Dr. Béla Merkely
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

invasive cardiology
heart
vascular
multimodal imaging
hybrid solution
multidisciplinary decision

Published Papers (9 papers)

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Research

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7 pages, 223 KiB

Open AccessArticle

Isovolumetric Contraction as a Marker of Ventricular Performance in Patients with Afterload Mismatch

by Theodoros Sinanis, Eleftherios Markidis, Symeon Evangelos Mavroudeas, Emmanouil Sideras, Evangelos Vittorakis and Eftychios Vittorakis

Diagnostics 2023, 13(8), 1366; https://doi.org/10.3390/diagnostics13081366 - 07 Apr 2023

Viewed by 1042

Abstract

Introduction: The evaluation of myocardial contractility is essential in cardiology practice. The gold standard for this evaluation is the end-systolic elastance, but it the method involved is complex. Echocardiographic measurement of the ejection fraction (EF) is the most commonly used parameter in clinical practice, but it has significant limitations, especially in patients with afterload mismatch. In this study, the area under the curve (AUC) of the isovolumetric contraction was measured to evaluate the myocardial contractility in patients with pulmonary arterial hypertension and severe aortic stenosis. Methods: 110 patients with severe aortic stenosis and pulmonary arterial hypertension were included in this study. The AUC of the isovolumetric contraction was measured using pressure curves of the right ventricle–pulmonary artery and left ventricle–aorta ascendens. This AUC was then correlated with the echocardiographically measured EF, stroke volume (SV), and total ventricular work. Results: The AUC of the isovolumetric contraction showed a statistically significant correlation with the EF of the corresponding ventricle (p < 0.0001). Both the AUC of the isovolumetric contraction and the EF showed a statistically significant correlation with the total work of the ventricle (AUC: R2 0.49, p < 0.001; EF: R2 0.51, p < 0.001). However, the SV only showed a statistically significant correlation with the EF. A statistically significant one-sample t-test could be found for the EF (decreased, p < 0.001) and for the AUC of the isovolumetric contraction (increased, p < 0.001), but not for the total work of the ventricle. Conclusion: The AUC space of the isovolumetric contraction is a useful marker of ventricular performance in patients with afterload mismatch, showing a statistically significant correlation with the EF and the total ventricular work. This method may have potential for use in clinical practice, especially in challenging cardiological cases. However, further studies are needed to evaluate its usefulness in healthy individuals and in other clinical scenarios. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

11 pages, 1544 KiB

Open AccessArticle

Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve Stenosis

by Clemens Eckel, Johannes Blumenstein, Oliver Husser, Dagmar Sötemann, Christina Grothusen, Judith Schlüter, Marc Becher, Holger Nef, Albrecht Elsässer, Georg Nickenig, Helge Möllmann and Vedat Tiyerili

Diagnostics 2023, 13(7), 1357; https://doi.org/10.3390/diagnostics13071357 - 06 Apr 2023

Viewed by 1516

Abstract

Objectives: This study examined the prognostic value of the get-with-the-guidelines heart-failure risk score (GWTG-HF) on mortality in patients with low-flow–low-gradient aortic valve stenosis (LFLG-AS) after transcatheter aortic valve implantation (TAVI). Background: Data on feasibility of TAVI and mortality prediction in the LFLG-AS population are scarce. Clinical risk assessment in this particular population is difficult, and a score has not yet been established for this purpose. Methods: A total of 212 heart failure (HF) patients with real LFLG-AS were enrolled. Patients were classified into low-risk (n = 108), intermediate-risk (n = 90) and high-risk (n = 14) groups calculated by the GWTG-HF score. Clinical outcomes of cardiovascular events according to Valve Academic Research Consortium (VARC-2) recommendations and composite endpoint of death and hospitalization for heart failure (HHF) were assessed at discharge and 1 year of follow-up. Results: Baseline parameters of the groups showed a median age of 81.0 years [77.0; 84.0] (79.0 vs. 82.0 vs. 86.0, respectively p < 0.001), median EuroSCORE II of 6.6 [4.3; 10.7] (5.5 vs. 7.2 vs. 9.1, p = 0.004) and median indexed stroke volume of 26.7 mL/m² [22.0; 31.0] (28.2 vs. 25.8 vs. 25.0, p = 0.004). The groups significantly differed at follow-up in terms of all-cause mortality (10.2 vs. 21.1 vs. 28.6%; p < 0.035). There was no difference in intrahospital event rate (VARC). Postprocedural mean gradients were lower in high-risk group (7.0 vs. 7.0 vs. 5.0 mmHg, p = 0.011). No differences in postprocedural aortic valve area (1.9 vs. 1.7 vs. 1.9 cm², p = 0.518) or rate of device failure (5.6 vs. 6.8 vs. 7.7%, p = 0.731) could be observed. After adjustment for known predictors, the GWTG score (HR 1.07 [1.01–1.14], p = 0.030) as well as pacemaker implantation (HR 3.97 [1.34–11.75], p = 0.013) turned out to be possible predictors for mortality. An increase in stroke volume index (SVI) was, in contrast, protective (HR 0.90 [0.83–0.97]; p = 0.006). Conclusions: The GWTG score may predict mortality after TAVI in LFLG-AS HF patients. Interestingly, all groups showed similar intrahospital event and mortality rates, independent of calculated mortality risk. Low SVI and new conduction disturbances associated with PPI after THV implantation had negative impact on mid-term outcome in post-TAVI HF-patients. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

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11 pages, 1068 KiB

Open AccessArticle

Carotid Artery Stenting Using Five-French Distal Radial Vascular Access

by Giuseppe Di Gioia, Luigi Salemme, Marco Ferrone, Angelo Cioppa, Grigore Popusoi, Armando Pucciarelli, Sebastiano Verdoliva, Michele Franzese, Simion Marga, Emanuele Barbato and Tullio Tesorio

Diagnostics 2023, 13(7), 1266; https://doi.org/10.3390/diagnostics13071266 - 27 Mar 2023

Cited by 2 | Viewed by 1369

Abstract

Carotid artery stenting (CAS) is usually performed through a femoral vascular access using 6–9 Fr guiding catheters. We investigated whether a systematic distal radial approach using 5 Fr guiding sheaths was a safe and effective alternative to transfemoral approach for CAS. From July 2020 to October 2022, two operators at our center systematically performed CAS using a 5 Fr distal radial approach in consecutive patients. The main endpoints of the study were procedural success via distal radial and via proximal or distal radial access. The learning curve was evaluated by comparing the first half of patients versus the second half of patients enrolled. Procedural data and 30-day clinical outcomes were collected. Fifty-one patients were prospectively enrolled. CAS was effectively performed via distal radial access in 45 patients (88%). Overall radial artery success was 92%. Distal radial CAS was successfully performed in 20 out of the first 25 patients enrolled (80%), and in 25 of the last 26 patients enrolled (96%; p = 0.07). Significantly less contrast was administered in the last 26 patients compared to the first 25 enrolled (110 (70, 140) mL vs. 120 (107, 150) mL; p = 0.045). Radial artery occlusion was reported in 1 patient (2%). Only 1 minor stroke (2%) was reported in-hospital and at 30-day follow-up. In conclusion, distal radial CAS using 5 Fr catheters was a safe procedure with a high success rate. The procedure had a relatively short learning curve in operators familiar with transfemoral CAS. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

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11 pages, 4511 KiB

Open AccessArticle

Long-Term Results of Below-The-Knee Bypass Using a Prosthetic Graft with a Distal Arteriovenous Fistula Interposition

by Francesco Spinelli, Giuseppe Roscitano, David Barillà, Graziana Derone, Antonio Nenna, Nunzio Montelione, Vincenzo Catanese, Andrea Cutrupi, Martina Maria Giambra, Alessandra Varrà, Pier Francesco Veroux and Francesco Stilo

Diagnostics 2023, 13(7), 1246; https://doi.org/10.3390/diagnostics13071246 - 26 Mar 2023

Cited by 1 | Viewed by 1519

Abstract

Surgical bypass is the gold standard treatment in patients affected by chronic limb-threatening ischemia in advanced GLASS stages, according to the Global Vascular Guidelines. For patients in whom an autologous graft is not available, a prosthesis could be used with the adjunct of a distal arteriovenous fistula interposition. The aim of this study was to examine the long-term results of below-the-knee surgical revascularization using a prosthesis with the distal adjunct mentioned above. From 2010 to 2020, we performed 159 lower limb below-the-knee surgical revascularizations using a prosthesis with the creation of an arteriovenous fistula interposition on the distal anastomosis. The GLASS stage was 3 in 100% of patients. The primary patency rates were as follows: 86.7% at 1 year, 57.2% at 3 years, and 12.6% at 5 years. The graft thrombosis rates were 17.4% at 1 year, 42.1% at 3 years, and 64.5% at 5 years. The amputation-free survival rates were 79% at 1 year, 76% at 3 years, and 64% at 5 years. PTFE prosthetic bypass for below-the-knee arteries using an arteriovenous fistula interposition is a good solution in patients without an autologous conduit. This technique offers reasonable graft patency and limb salvage rates. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

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13 pages, 5844 KiB

Open AccessArticle

Factors Associated with Impaired Resistive Reserve Ratio and Microvascular Resistance Reserve

by Tatsuro Yamazaki, Yuichi Saito, Daichi Yamashita, Hideki Kitahara and Yoshio Kobayashi

Diagnostics 2023, 13(5), 950; https://doi.org/10.3390/diagnostics13050950 - 02 Mar 2023

Cited by 2 | Viewed by 1957

Abstract

Coronary microvascular dysfunction (CMD) is described as an important subset of ischemia with no obstructive coronary artery disease. Resistive reserve ratio (RRR) and microvascular resistance reserve (MRR) have been proposed as novel physiological indices evaluating coronary microvascular dilation function. The aim of this study was to explore factors associated with impaired RRR and MRR. Coronary physiological indices were invasively evaluated in the left anterior descending coronary artery using the thermodilution method in patients suspected of CMD. CMD was defined as a coronary flow reserve <2.0 and/or index of microcirculatory resistance ≥25. Of 117 patients, 26 (24.1%) had CMD. RRR (3.1 ± 1.9 vs. 6.2 ± 3.2, p < 0.001) and MRR (3.4 ± 1.9 vs. 6.9 ± 3.5, p < 0.001) were lower in the CMD group. In the receiver operating characteristic curve analysis, RRR (area under the curve 0.84, p < 0.001) and MRR (area under the curve 0.85, p < 0.001) were both predictive of the presence of CMD. In the multivariable analysis, previous myocardial infarction, lower hemoglobin, higher brain natriuretic peptide levels, and intracoronary nicorandil were identified as factors associated with lower RRR and MRR. In conclusion, the presence of previous myocardial infarction, anemia, and heart failure was associated with impaired coronary microvascular dilation function. RRR and MRR may be useful to identify patients with CMD. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

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8 pages, 1010 KiB

Open AccessArticle

Comparison of Safety of RADial comPRESSion Devices: A Multi-Center Trial of Patent Hemostasis following Percutaneous Coronary Intervention from Conventional Radial Access (RAD-PRESS Trial)

by Balazs T. Nemeth, Istvan Hizoh, Fanni Nowotta, Zoltan Ruzsa, Tibor Szuk, Peter Kulyassa, Gabor A. Fulop, Fanni E. Szablics, David Becker, Bela Merkely and Istvan F. Edes

Diagnostics 2023, 13(1), 143; https://doi.org/10.3390/diagnostics13010143 - 01 Jan 2023

Viewed by 2567

Abstract

Although radial access is the current gold standard for the implementation of percutaneous coronary interventions (PCI), post-procedural radial compression devices are seldom compared with each other in terms of safety or efficacy. Our group aimed to compare a cost effective and potentially green method to dedicated radial compression devices, with respect to access site complications combined in a device oriented complex endpoint (DOCE), freedom from which served as our primary endpoint. Patients undergoing PCI were randomized to receive either the cost effective or a dedicated device, either of which were removed using patent hemostasis. Twenty-four hours after the procedure, radial artery ultrasonography was performed to evaluate the access site. The primary endpoint was assessed using a non-inferiority framework with a non-inferiority margin of five percentage points, which was considered as the least clinically meaningful difference. The cost-effective technique and the dedicated devices were associated with a comparably low rate of complications (freedom from DOCE: 83.3% vs. 70.8%, absolute risk difference: 12.5%, one-sided 95% confidence interval (CI): 1.11%). Composition of the DOCE (i.e., no complication, hematoma, pseudoaneurysm, and radial artery occlusion) and compression time were also assessed in superiority tests as secondary endpoints. Both the cost-effective technique and the dedicated devices were associated with comparably low rates of complications: p = 0.1289. All radial compression devices performed similarly when considering the time to complete removal of the respective device (120.0 (inter-quartile range: 100.0–142.5) for the vial vs. 120.0 (inter-quartile range: 110.0–180) for the dedicated device arm, with a median difference of [95% CI]: 7.0 [−23.11 to 2.00] min, p = 0.2816). In conclusion, our cost-effective method was found to be non-inferior to the dedicated devices with respect to safety, therefore it is a safe alternative to dedicated radial compression devices, as well as seeming to be similarly effective. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

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Review

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13 pages, 1053 KiB

Open AccessReview

Hemodynamic Performance of Transcatheter Aortic Valves: A Comprehensive Review

by Domenico Angellotti, Rachele Manzo, Domenico Simone Castiello, Maddalena Immobile Molaro, Andrea Mariani, Cristina Iapicca, Dalila Nappa, Fiorenzo Simonetti, Marisa Avvedimento, Attilio Leone, Mario Enrico Canonico, Carmen Anna Maria Spaccarotella, Anna Franzone, Federica Ilardi, Giovanni Esposito and Raffaele Piccolo

Diagnostics 2023, 13(10), 1731; https://doi.org/10.3390/diagnostics13101731 - 13 May 2023

Viewed by 1171

Abstract

Transcatheter aortic valve implantation (TAVI) is a widely adopted treatment option for patients with severe aortic stenosis. Its popularity has grown significantly in recent years due to advancements in technology and imaging. As TAVI use is increasingly expanded to younger patients, the need for long-term assessment and durability becomes paramount. This review aims to provide an overview of the diagnostic tools to evaluate the hemodynamic performance of aortic prosthesis, with a special focus on the comparison between transcatheter and surgical aortic valves and between self-expandable and balloon-expandable valves. Moreover, the discussion will encompass how cardiovascular imaging can effectively detect long-term structural valve deterioration. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

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11 pages, 921 KiB

Open AccessReview

High Non-Cardiac Death Incidence Should Be a Limitation of Drug-Eluting Stents Implantation? Insights from Recent Randomized Data

by Alfredo E. Rodriguez, Carlos Fernandez-Pereira, Juan Ramon Mieres and Alfredo Matias Rodriguez-Granillo

Diagnostics 2023, 13(7), 1321; https://doi.org/10.3390/diagnostics13071321 - 02 Apr 2023

Cited by 2 | Viewed by 1817

Abstract

Despite the introduction of drug-eluting stents (DES) significantly improved the efficacy and safety of percutaneous coronary interventions (PCI), particularly in a high-risk group of patients, the gap between PCI with his competitor’s coronary artery bypass surgery (CABG) and/or optimal medical treatment alone was not reduced. In this revision, we highlighted the fact that in recent years landmark randomized studies reported at mid and long-term follow-ups a high incidence of non-cardiac death, cancer incidence, or both in the DES group of patients. The overall incidence of non-cardiac death was significantly higher in the DES vs. the comparator arm: 5.5% and 3.8%, respectively, p = 0.000018, and non-cardiac death appears to be more divergent between DES vs. the comparator at the extended follow-up to expenses of the last one. One of these trials reported five times greater cancer incidence in the DES arm at late follow-up, 5% vs. 0.7% p < 0.0018. We review the potential reason for these unexpected findings, although we can discard that DES biology could be involved in it. Until all these issues are resolved, we propose that DES implantation should be tailored accorded patient age, life expectancy, and lesion complexity. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

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Other

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13 pages, 5117 KiB

Open AccessCase Report

Use of Autotransfusion following Percutaneous Thrombectomy for Cardiogenic Shock Due to Pulmonary Embolism in a Single Session—A Case Report

by Franz Haertel, Laura Baez, Marcus Franz, Jurgen Bogoviku, Friederike Klein, Gudrun Dannberg, P. Christian Schulze and Sven Möbius-Winkler

Diagnostics 2023, 13(8), 1392; https://doi.org/10.3390/diagnostics13081392 - 11 Apr 2023

Viewed by 1318

Abstract

A 64-year-old male patient was admitted to the catheterization laboratory with a suspected myocardial infarction and in cardiogenic shock. Upon further investigation, a massive bilateral pulmonary embolism with signs of right heart dysfunction was discovered, leading to a decision to perform a direct interventional treatment with a thrombectomy device for thrombus aspiration. The procedure was successful in removing almost the entirety of the thrombotic material from the pulmonary arteries. The patient’s hemodynamics stabilized and oxygenation improved instantly. The procedure required a total of 18 aspiration cycles. Each aspiration contained approx. 60 mL blood amounting to a total of approx. 1080 mL of blood. During the procedure, a mechanical blood salvage system was used to resupply 50% of the blood via autotransfusion that would otherwise have been lost. The patient was transferred to the intensive care unit for post-interventional care and monitoring. A CT angiography of the pulmonary arteries after the procedure confirmed the presence of only minor residual thrombotic material. The patient’s clinical, ECG, echocardiographic, and laboratory parameters returned to normal or near normal ranges. The patient was discharged shortly after in stable conditions on oral anticoagulation. Full article

(This article belongs to the Special Issue New Techniques in Interventional Cardiology)

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