Objective: We investigated the effect of proximal optimization technique (POT) on coronary bifurcation stent failure (BSF) in cross-over stenting by comparing with the kissing balloon technique (KBT) in a multicenter randomized PROPOT trial.
The current version (ver. 7.3) of the popular quantitative coronary analysis system QAngio XA (Medis Medical Imaging System BV, Leiden, the Netherlands) is widely used without evaluating the agreement between the current and older versions in relation to a change of algorithms. The purpose of this study was to assess the equivalence of averages between QAngio XA versions 7.3 and 6.0. Based on the calculated sample size, angiographic images of 100 patients who underwent percutaneous coronary intervention of a single target lesion were randomly selected from two published studies (OUCH-TL: 154 lesions; OUCH-PRO: 160 lesions). The primary endpoint was the minimum lumen diameter (MLD), and the secondary endpoints were the reference diameter (RefD) and length of the stenotic lesion (LL). Two independent analysts measured the same frame using both previous and current versions of QAngio XA. Version-order for each lesion was randomly determined per coronary locations targeted. Data were analysed by using a mixed model that includes random lesion effects and fixed rater effects and reading-order effects. A Bland-Altman plot of parameters showed no large differences between the versions. Differences in parameters were estimated by the mixed model, and the 95% confidence interval of the MLD, RefD, and LL estimates was from -0.045 to -0.0001 mm, from -0.040 to 0.006 mm, and from -1.08 to 0.46 mm, respectively, compared with the predefined non-inferiority margin of ±0.2 mm. Measurements of MLD and RefD using QAngio XA showed no major systematic differences between versions.
Edge restenosis has gained attention as a main cause of restenosis after first-generation drug-eluting stent (DES) implantation. The aim of this study was to assess the incidence of edge restenosis and identify the predictors of edge restenosis after second-generation DES implantation. Data were obtained from several postmarketing surveillance (PMS) studies on a cobalt-chromium everolimus-eluting stent (CoCr-EES; Xience V/ PROMUS, Xience Prime, Xience Prime SV, and Xience Expedition SV), a second-generation DES, in Japan. Angiographic analysis was conducted at the baseline and after eight months on the following subsegments: instent region, proximal edge, and distal edge. Restenosis was defined as !50% diameter stenosis (DS) at followup. We used multivariate logistic regression (with lesions as a random effect) to compare the instances of restenosis between the proximal and the distal edges. Univariate and multivariate analyses of the risk factors for restenosis were performed for each subsegment. We analyzed 1,966 lesions in 1,687 patients. The restenosis rates at the in-stent region, proximal edge, and distal edge were 4.4%, 3.0%, and 1.1%, respectively. The risk of restenosis at the distal edge was significantly lower than that at the proximal edge, when adjusted for 13 variables. The predictors of restenosis were postprocedural % diameter stenosis (%DS), postprocedural reference diameter, !45°bending, stent overlap at the proximal edge, and postprocedural %DS at the distal edge. Our analysis of eight-month angiographic outcomes from CoCr-EES PMS demonstrated that postprocedural %DS is a major predictor of edge restenosis. Edge restenosis is more likely attributable to postprocedural angiographic results than to the patient's background.
Background
Increased body mass index (BMI) is a major risk factor for heart failure with preserved ejection fraction (HFpEF), and HFpEF is more prevalent in elderly females than males. We hypothesized that there may be gender differences in the association between BMI and echocardiographic left ventricular (LV) diastolic parameters.
Methods
We enrolled 456 subjects (243 males) without overt cardiac diseases, all of whom underwent a health checkup. Early (E) and late (A) diastolic transmitral flow velocity, early diastolic mitral annular velocity (e′), and left atrial (LA) volume index were measured by echocardiography to assess LV diastolic function. To examine gender differences in the association between BMI and LV diastolic function, we analyzed the interaction effects of gender on the association between BMI and echocardiographic LV diastolic parameters.
Results
Although there were significant gender differences in the association between BMI and E/A and e′ in the crude model (interaction effect 0.037 and 0.173, respectively; P = .006 and .022, respectively), these differences were not statistically significant after adjustment for factors related to LV diastolic function. On the other hand, there were significant associations between BMI and LV diastolic parameters in each gender, even after adjustment.
Conclusions
Our findings suggest there is no gender difference in the association between BMI and echocardiographic LV diastolic parameters. However, the association between BMI and LV diastolic parameters was significant in both genders. Controlling body weight might be beneficial for both women and men to prevent progression of LV diastolic dysfunction and development of HFpEF.
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