ImportanceIn patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited.ObjectiveTo report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial.Design, Setting, and ParticipantsSURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021.InterventionPatients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis.Main Outcomes and MeasuresThe prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years.ResultsA total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P = .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P < .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm2 vs 1.8 [0.6] cm2; P < .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%]; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%]; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P < .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%]; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention.Conclusions and RelevanceAmong intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.

The incidence of aspirin resistance in the cohort of patients with documented heart disease was 38.1%. Patients with elevated absolute urinary dehydrothomboxane levels (>320 pg/ml) on chronic aspirin therapy constitute a high risk subset for recurrent vascular events.

Historically, higher levels of serum testosterone were presumed deleterious to the cardiovascular system. In the last two decades, studies have suggested that low testosterone levels are associated with increased prevalence of risk factors for cardiovascular disease (CVD), including dyslipidemia and diabetes. This is a cross sectional study. The aim of our study was to determine the relationship between serum testosterone levels and angiographic severity of coronary artery disease (CAD). Serum testosterone levels were also correlated with flow mediated dilation of brachial artery (BAFMD) - an indicator of endothelial function. Consecutive male patients, aged 40-60 years, admitted for coronary angiography (CAG) with symptoms suggestive of CAD, were included in the study. Out of the 92 patients included in the study, 32 patients had normal coronaries and 60 had CAD on coronary angiography. Severity of CAD was determined by Gensini coronary score. The group with CAD had significantly lower levels of total serum testosterone (363±147.1 vs 532.09±150.5ng/dl, p<0.001), free testosterone (7.1215±3.012 vs 10.4419±2.75ng/dl, p<0.001) and bioavailable testosterone (166.17±64.810 vs 247.94±62.504ng/dl, p<0.001) when compared to controls. Adjusting for the traditional risk factors for CAD, a multiple linear regression analysis showed that low testosterone was an independent predictor of severity of CAD (β=-0.007, p<0.001). This study also showed that levels of total, free and bioavailable testosterone correlated positively with BAFMD %.

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CCH is an extremely rare congenital cardiac anomaly. Superior-inferior ventricular relationship often co-exists with CCH, but is not necessarily present in all cases. CCH requires early diagnosis because of its common association with diverse cardiac anomalies.

BackgroundUse of iodinated contrast agents for angiography in patients with renal insufficiency risks further deterioration of renal function and its adverse sequelae.ObjectiveTo study the effectiveness and safety of carbon dioxide (CO2) angiography in guiding percutaneous renal-related interventions in patients with Takayasu arteritis and renal insufficiency.MethodsData on CO2 angiography-guided interventions were obtained from a 23-year database of 692 Takayasu arteritis patients who underwent percutaneous interventions and were analyzed retrospectively. Follow-up data were also obtained. The CO2 angiography system used was developed in-house and was pressure-driven.ResultsSeven patients (6 female, age 16–59 years, baseline serum creatinine 1.62–4.55 mg/dl, estimated glomerular filtration rate 12.2–36.9 ml/min/1.73 m2) underwent CO2 angiography-guided interventions: five underwent angioplasty or stenting to treat six stenotic/occluded renal arteries, one underwent extensive endovascular repair for spontaneous focal abdominal aortic dissection with false lumen aneurysm and aorto-iliac true lumen narrowing, and one underwent balloon dilatation of previously deployed aortic stents used to treat aortic occlusion at two levels. Follow-up (median 5 years, range 2 months–16 years) was obtained in all patients. All the procedures were successful and resulted in relief of symptoms, better blood pressure control, improvement in left ventricular systolic function and recovery or stabilization of renal function. There were no early or late complications related to CO2 angiography. Three renal lesions that had restenosis at follow-up were managed successfully by repeat intervention.ConclusionCO2 angiography-guided renal-related interventions are effective and safe in patients with Takayasu arteritis and renal insufficiency; they significantly improve the care of such patients.

ObjectiveTenecteplase-based pharmacoinvasive percutaneous coronary intervention (PCI) has been shown to yield outcomes comparable to primary PCI in the setting of acute ST elevation myocardial infarction (STEMI). This study was designed to compare the efficacy of pharmacoinvasive PCI following successful thrombolysis with Streptokinase versus primary PCI in patients with STEMI.MethodologyWe conducted a prospective single center observational study in 120 patients with STEMI who underwent primary PCI (n = 60) and Streptokinase-based pharmacoinvasive PCI (n = 60). Patients with Killips class 3 or 4 at presentation, and those with evidence of failed fibrinolysis were excluded. The primary outcome was LV systolic function after angioplasty, as assessed by 2D global longitudinal strain (GLS) using speckle tracking echocardiography (STE), as well as 2D LVEF using Simpson's biplane method.ResultsLV systolic function after PCI was significantly lower in the pharmacoinvasive arm as compared to the primary PCI arm, both by 2D STE (GLS: −9% vs −11%; p = 0.03) and 2D Simpson's biplane method (LVEF: 40.7% vs 45.1%; p = 0.02). TIMI flow in the culprit vessel prior to angioplasty was better in the pharmacoinvasive arm indicating successful thrombolysis, whereas post angioplasty flow was not different. There was no in-hospital mortality in either group. There was a trend toward increased incidence of acute kidney injury in the pharmacoinvasive arm.ConclusionLV systolic function is significantly better after primary angioplasty as compared to pharmacoinvasive PCI following successful thrombolysis with Streptokinase.

Double-chambered left ventricle is a rare cardiac anomaly. We report a case of double-chambered left ventricle in a one-and-half-year-old asymptomatic boy. We depict the use of three-dimensional echocardiography in the demonstration and diagnosis of the condition.