Background and ObjectivesThe purposes of this study are 1) to investigate the relationship between resting baseline Pd/Pa, determined by the ratio of the pressures proximal (Pa) and distal (Pd) to the target lesion before, inducing hyperemia and fractional flow reserve (FFR) and 2) to identify a resting baseline Pd/Pa range that might reliably preclude the need for hyperemic induction.Subjects and MethodsA total of 622 pressure wire data sets obtained from intermediate stenotic lesions were analyzed.ResultsThere was a good linear relationship between resting baseline Pd/Pa and FFR (r=0.746, p<0.001). Receiver-operating characteristic curves of the resting baseline Pd/Pa with FFR ≤0.80 as the reference variable showed an area under the curve of 0.89 (95% confidence intervals 0.863-0.914, p<0.001) with a diagnostic accuracy of 82.3% when the resting baseline Pd/Pa was ≤0.92. These results showed that certain cutoff values can reliably predict FFR, whether positive or negative. The resting baseline Pd/Pa >0.95 (n=257, 41.3%) had a negative predictive value (NPV) of 98.1% and a sensitivity of 97.3%. the resting baseline Pd/Pa ≤0.88 (n=65, 10.5%) had a positive predictive value (PPV) of 96.2% and a specificity of 99.8%. These were consistent regardless of coronary vessel, lesion location, lesion length, or degree of stenosis.ConclusionIn intermediate lesions, the resting baseline Pd/Pa was linearly related to FFR. A certain range of the resting baseline Pd/Pa values had an excellent NPV with high sensitivity or excellent PPV with high specificity for determining the lesion significance.

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Purpose: Dissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with a high risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections and subsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novo coronary lesions. Materials and Methods: A total of 227 patients with good distal flow (Thrombolysis in Myocardial Infarction flow grade 3) following DCB treatment were retrospectively enrolled and stratified according to the presence or absence of a non-flow limiting dissection. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization, and target vessel thrombosis). Results: The cohort consisted of 95 patients with and 132 patients without a dissection. There were no between-group differences in LLL (90.8%) returning for angiography at 6 months (0.05±0.19 mm in non-dissection and 0.05±0.30 mm in dissection group, p= 0.886) or in TVF (6.8% in non-dissection and 8.4% in dissection group, p=0.799) at a median follow-up of 3.4 years. In a multivariate analysis, the presence of dissection and its severity were not associated with LLL or TVF. Almost dissections (93.9%) were completely healed, and there was no newly developed dissection at 6-month angiography. Conclusion: The presence of a dissection following successful DCB treatment of a de novo coronary lesion may not be associated with an increased risk of LLL or TVF (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).

Background Dilated cardiomyopathy (DCMP) is characterized by ventricular chamber enlargement and systolic dysfunction which may cause heart failure. Patients with DCMP have overactivation of the renin-angiotensin-aldosterone systems, which can also adversely affect myocardial metabolism in heart failure. The impairment of myocardial metabolism can contribute to the progression of left ventricular remodeling and contractile dysfunction in heart failure. Although angiotensin II receptor blockers (ARBs) have been used to treat patients with DCMP, there has been no direct comparison of the efficacy of these agents. The objective of this study is to compare the effects of olmesartan and valsartan on myocardial metabolism in patients with DCMP. Methods/design The OVOID study (a comparison study of Olmesartan and Valsartan On myocardial metabolism In patients with Dilated cardiomyopathy) is designed as a non-blinded, open-label, parallel-group, prospective, randomized, controlled, multicenter clinical trial. A total of 40 DCMP patients aged between 20 and 85 years will be randomly allocated into the olmesartan or the valsartan group. 18F-fluoro-2-deoxyglucose (FDG) cardiac positron emission tomography (PET) will be performed at baseline and six months after receiving the study agent. The primary endpoint is myocardial glucose consumption per square meter, measured using 18F-FDG PET 6 months after receiving the study agent. Discussion The purpose of this trial is to compare the efficacy between olmesartan and valsartan in improving myocardial metabolism in DCMP patients. This will be the first randomized comparative study investigating the differential effects of ARBs on heart failure. Trial registration ClinicalTrials.govNCT04174456. Registered on 18 November 2019

The combination of coronary arteriovenous fistula to the coronary sinus (CS), dilatation of the entire length of coronary artery, coronary aneurysm and persistent left superior vena cava (PLSVC) is very rare. We present the case of a 63-year-old female admitted for dyspnea on exertion, orthopnea, and facial edema. Echocardiography detected a giant coronary artery with shunt flow, dilated CS and PLSVC and a coronary angiography reaffirmed these findings. The calculated ratio of pulmonary blood flow to systemic blood flow by cardiac catheterization was 1.53. After multidisciplinary review considering old age, hypoactivity due to underlying Parkinsonism and relatively small amount of shunt flow, medical therapy was chosen. The patient remained asymptomatic for 10 months after discharge without intervention.