Publikacje naukowe

Advancements in artificial intelligence-driven techniques for interventional cardiology

Zofia Rudnicka, Agnieszka Pręgowska, Kinga Glądys, Mark Perkins, Klaudia Proniewska

This paper aims to thoroughly discuss the impact of artificial intelligence (AI) on clinical practice in interventional cardiology (IC) with special recognition of its most recent advancements. Thus, recent years have been exceptionally abundant in advancements in computational tools, including the development of AI. The application of AI development is currently in its early stages, nevertheless new technologies have proven to be a promising concept, particularly considering IC showing great impact on patient safety, risk stratification and outcomes during the whole therapeutic process. The primary goal is to achieve the integration of multiple cardiac imaging modalities, establish online decision support systems and platforms based on augmented and/or virtual realities, and finally to create automatic medical systems, providing electronic health data on patients. In a simplified way, two main areas of AI utilization in IC may be distinguished, namely, virtual and physical. Consequently, numerous studies have provided data regarding AI utilization in terms of automated interpretation and analysis from various cardiac modalities, including electrocardiogram, echocardiography, angiography, cardiac magnetic resonance imaging, and computed tomography as well as data collected during robotic-assisted percutaneous coronary intervention procedures. Thus, this paper aims to thoroughly discuss the impact of AI on clinical practice in IC with special recognition of its most recent advancements.

The 3D Operating Room with Unlimited Perspective Change and Remote Support

Proniewska Klaudia, Dolega-Dolegowski Damian, Kolecki Radek, Osial Magdalena, Pregowska Agnieszka

The proposed XR-based solution enables the preview and registration of performed medical procedures without restrictions resulting from the camera settings and the recorded perspective, i.e. unlimited perspective...

The ΔWaveECG: The differences to the normal 12‑lead ECG amplitudes

Proniewska Klaudia K.,  Abacherli Roger , van Dam Peter M.

Creation of a normal ECG amplitude distribution to enable the distinction by non-ECG experts of normal from abnormal waveforms of the standard 12‑lead ECG.

A New Computer-Aided Solution for the Automatic Detection of Metal Stent Struts in Follow-up Evaluation in OCT Images

Schneider Zofia, Pociask Elżbieta, Proniewska Klaudia, Kolecki Radek

Stenting is commonly used in the treatment of corona

Information and Communication Technologies Combined with Mixed Reality as Supporting Tools in Medical Education

Pregowska Agnieszka, Osial Magdalena, Dolega-Dolegowski Damian, Kolecki Radek, Proniewska Klaudia

The dynamic COVID-19 pandemic has destabilized education and...

Application of holography and augmented reality based technology to visualize the internal structure of the dental root - a proof of concept

Dolega-Dolegowski Damian, Proniewska Klaudia, Dolega-Dolegowska Magdalena, Pregowska Agnieszka, Hajto-Bryk Justyna, Trojak Mariusz, Chmiel Jakub, Walecki Piotr, Fudalej Piotr S.

Application of HoloLens-based Augmented Reality and three-dimensional printed anatomical tooth reference models in dental education

Grad Piotr, Przeklasa-Bierowiec Anna M., Malinowski Krzysztof P., Witowski Jan, Proniewska Klaudia, Tatoń Grzegorz

Tooth anatomy is fundamental knowledge used in everyday dental practice to reconstruct the occlusal surface during cavity fillings...

Assessment of the utility of Mixed Reality in medical education

Kolecki Radek, Pregowska Agnieszka, Dąbrowa Julianna, Skuciński Jerzy, Pulanecki Tomasz, Walecki Piotr, van Dam Peter M., Dudek Dariusz, Richter Piotr, Proniewska Klaudia

MR technology can be a valuable resource that supports traditional medical education, especially via 3D...

Zaawansowane techniki obrazowania i modelowania 3D w anatomicznej strukturze serca

Jakub Jucha

Ostatnie lata były wyjątkowo obfite pod względem postępów w trójwymiarowym (3D) obrazowaniu i modelowaniu. Te techniki znacznie przyczyniły się do naszego zrozumienia struktury anatomicznej serca, umożliwiając precyzyjniejszy proces diagnozowania i strategie leczenia. Zaawansowane techniki obrazowania 3D, takie jak: tomografia komputerowa (TK), angiografia, rezonans magnetyczny o wysokiej rozdzielczości (HR-MRI), mogą pomóc lekarzom w lepszym zrozumieniu różnych aspektów wizualizacji anatomii serca. Dane uzyskane za pomocą tych metod można przekształcić za pomocą różnych technik modelowania 3D w fizyczne modele z dokładnymi wirtualnymi reprezentacjami serca i poprawnymi cechami anatomicznymi. Modele te okazały się wartościowe przy planowaniu operacji i minimalizowaniu ryzyka podczas operacji. Jednakże istnieją pewne wyzwania związane z szerokim zastosowaniem tych technik. Przede wszystkim możliwości technologiczne, takie jak konieczność specjalistycznego oprogramowania i sprzętu, w połączeniu z zawsze obecnymi artefaktami obrazu, mogą nie pozwolić na takie uogólnione zastosowanie. Ponadto integracja i migracja danych mogą prowadzić do różnych problemów, w tym niekompatybilności między pewnymi platformami oprogramowania. Ponadto obecna liczba wysoko wykwalifikowanych specjalistów z wystarczającym doświadczeniem w zarządzaniu tego rodzaju danymi nie jest wystarczająco wysoka, aby umożliwić stosowanie tych technik na co dzień. Podsumowując, zaawansowane techniki obrazowania i modelowania 3D zapewniają kompleksową i szczegółową reprezentację anatomicznej struktury serca. Wykorzystanie tych metod ma znaczny potencjał w szerokim spektrum zaburzeń, ale ostatecznie będzie się różnić między punktami opieki, w zależności od sprzętu i personelu. Poprzez rozwiązanie istniejących wyzwań i promowanie współpracy międzydziedzinowej, możemy ułatwić przyszłość, w której te innowacyjne techniki stają się rutynowymi narzędziami w dziedzinie kardiologii.

Restriction in supra-annular transcatheter heart valve leaflet mobility during coronary access after valve-in-valve TAVI

Khokhar Arif A., Zlahoda-Huzior Adriana, Giannini Francesco, Dudek Dariusz

Coronary access after transcatheter aortic valve implantation (TAVI) can be challenging or unfeasible due to interactions between coronary catheters and elements of the transcatheter heart valve (THV) frames1-3. Catheters may also interact with THV leaflets, which, in the extreme case of leaflet pinning, may lead to acute haemodynamic compromise. However, to date, the interaction between THV leaflets and catheters during coronary cannulation has not been visualized or evaluated.

Hybrid step-by-step approach to perform a Robotic DK Crush PCI

Khokhar Arif A., Zelias Aleksander, Giannini Francesco, Zlahoda-Huzior Adriana, Dudek Dariusz

View the case of this 65-year-old male patient who was staged for R-PCI of a Medina 1,1,1 distal left main lesion, and discover how the authors used a hybrid robotic and manual approach to perform a DK crush procedure using the second-generation R-PCI device.

Coronary access after chimney stenting during valve-in-valve TAVI for failed surgical bioprosthetic valves : impact of valve design

Ruggiero Rossella, Khokhar Arif, Zlahoda-Huzior Adriana, Mangieri Antonio, Dudek Dariusz, Giannini Francesco

We developed advanced computed tomography–based 3-dimensional (3D) models to demonstrate how transcatheter valve design may affect future coronary access in aortic valve implantation patients. Transcatheter aortic valve-in-valve implantation (ViV-TAVI) for failed surgical bioprosthetic valves is associated with an increased risk of coronary artery obstruction. 1 Multiple strategies have been developed to avoid this complication.

Robotic control of a 0.035 guide-wire : initial feasibility and first-in-human experience.

Ruggiero Rossella, Khokhar Arif A., Cocco Marta, Chandra Kailash, Toselli Marco, Zlahoda-Huzior Adriana, Zelias Aleksander, Giannini Francesco, Dudek Dariusz

Robotic procedures represent a new frontier for interventional cardiology. 1 The latest generation robotic platform is the CorPath GRX System (Corindus Inc, Waltham, MA), which is composed of an interventional cockpit and a single-use cassette incorporated within a robotic arm. The cassette has a dedicated “wire track” to control 0.014-inch or 0.018-inch wires and a dedicated “device track” to advance and retrieve balloons and stents (Fig. 1A). One limitation of the current cassette is the absence of a specific “track” designed for the commonly used 0.035-inch wire. 2 The possibility of controlling this wire is important, particularly for peripheral endovascular procedures, in which the 0.035-inch wire is commonly used to advance catheters, balloons, and stents.

European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic : part 1-epidemiology, pathophysiology, and diagnosis

Baigent Colin, Dudek Dariusz, Guzik Tomasz, Williams Bryan

Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19.

Coronary access after ACURATE neo2 implantation for valve-in-valve TAVR : insights from ex vivo simulations.

Khokhar Arif A., Giannini Francesco, Zlahoda-Huzior Adriana, Mikhail Ghada, Dudek Dariusz

The expansion of transcatheter aortic valve replacement (TAVR) toward lower-risk often younger populations makes coronary access (CA) an increasingly relevant issue for the lifetime management of aortic stenosis.1 CA can be challenging or unfeasible due to anatomical, procedural, or transcatheter heart valve (THV)-related factors.2-4 Prior studies have reported more challenging CA following use of supra-annular self-expandable valves (SA-SEV) due to the taller stent frame, higher leaflet position, and commissural posts.2, 3 Dedicated cannulation techniques have been described to help operators achieve CA following the implantation of SA-SEVs.5, 6 However, to date, these techniques have only been described for the Corevalve/Evolut SA-SEV (Medtronic). The ACURATE neo2 (Boston Scientific) is another SA-SEV with a different design philosophy that consists of a short lower-stent frame connected to open upper stabilization arches. The potential impact of this different design on cannulation techniques, particularly in the challenging setting of valve-in-valve TAVR (ViV-TAVR) procedures has not yet been evaluated.

Monocyte exposure to fine particulate matter results in miRNA release : a link between air pollution and potential clinical complication

Konduracka Ewa, Krawczyk Krzysztof, Surmiak Marcin, Pudełek Maciej, Malinowski Krzysztof Piotr, Mastalerz Lucyna, Zimnoch Mirosław, Samek Lucyna, Styszko Katarzyna, Furman Leszek, Gałkowski Michał, Nessler Jadwiga, Różański Kazimierz, Sanak Marek

Chronic exposure to PM2.5 contributes to the pathogenesis of numerous disorders, although the underlying mechanisms remain unknown. The study investigated whether exposure of human monocytes to PM2.5 is associated with alterations in miRNAs. Monocytes were exposed in vitro to PM2.5 collected during winter and summer, followed by miRNA isolation from monocytes. Additionally, in 140 persons chronically exposed to air pollution, some miRNA patterns were isolated from serum seasonally. Between-season differences in chemical PM2.5 composition were observed. Some miRNAs were expressed both in monocytes and in human serum. MiR-34c-5p and miR-223-5p expression was more pronounced in winter. Bioinformatics analyses showed that selected miRNAs were involved in the regulation of several pathways. The expression of the same miRNA species in monocytes and serum suggests that these cells are involved in the production of miRNAs implicated in the development of disorders mediated by inflammation, oxidative stress, proliferation, and apoptosis after exposure to PM2.5.

EAPCI Presidential criss-cross

Barbato Emanuele, Dudek Dariusz

The transition between the European Association for Percutaneous Cardiovascular Interventions (EAPCI) 20-22 Board, under the presidency of Prof. Dariusz Dudek, and the 22-24 Board, under the presidency of Prof. Emanuele Barbato, took place this past May in Paris at EuroPCR. This is a consolidated tradition that has taken place for more than 14 years, with a turnover of 8 EAPCI Presidents. The main objective of the event is to report on the results achieved and to reflect on the challenges and opportunities that arose during the most recent term in order to positively inject the incoming Board with new activities, scientific projects, ...

Definitions and standardized endpoints for treatment of coronary bifurcations

Lunardi Mattia, Louvard Yves, Lefevre Thierry, Stankovic Goran, Burzotta Francesco, Kassab Ghassan S., Lassen Jens F., Darremont Olivier, Garg Scot, Koo Bon-Kwon, Holm Niels R., Johnson Thomas W., Pan Manuel, Chatzizisis Yiannis S., Banning Adrian, Chieffo Alaide, Dudek Dariusz, Hildick-Smith David, Garot Jerome, Henry Timothy D., Dangas George, Stone Gregg W., Krucoff Mitchell W., Cutlip Donald, Mehran Roxana, Wijns William, Sharif Faisal, Serruys Patrick W., Onuma Yoshinobu

The Bifurcation Academic Research Consortium (Bif-ARC) project originated from the need to overcome the paucity of standardization and comparability between studies involving bifurcation coronary lesions. This document is the result of a collaborative effort between academic research organizations and the most renowned interventional cardiology societies focused on bifurcation lesions in Europe, the United States, and Asia. This consensus provides standardized definitions for bifurcation lesions; the criteria to judge the side branch relevance; the procedural, mechanistic, and clinical endpoints for every type of bifurcation study; and the follow-up methods. Considering the complexity of bifurcation lesions and their evaluation, detailed instructions and technical aspects for site and core laboratory analysis of bifurcation lesions are also reported. The recommendations included within this consensus will facilitate pooled analyses and the effective comparison of data in the future, improving the clinical relevance of trials in bifurcation lesions, and the quality of care in this subset of patients.

Coronary access techniques following ACURATE neo2 implantation in surgical bioprosthesis

Khokhar Arif A., Ponticelli Francesco, Zlahoda-Huzior Adriana, Zakrzewski Pawel, Mikhail Ghada, Dudek Dariusz, Giannini Francesco

Coronary access after transcatheter aortic valve implantation (TAVI) procedures can be challenging due to anatomical, procedural or valve-related factors12. This challenge is further augmented during valve-in-valve (ViV) procedures due to the additional presence of transcatheter or surgical valve frames and leaflets3. Dedicated valve-specific cannulation techniques are required for operators to achieve coronary access, particularly in challenging scenarios24. To date, specific coronary cannulation techniques have only been described for the CoreValve/Evolut (Medtronic) and SAPIEN (Edwards Lifesciences) valve platforms following native aortic valve TAVI24. Therefore, we performed ex vivo simulations of coronary access in a computed tomography-derived patient-specific pulsatile ...

Ticagrelor with and without aspirin in patients with a prior coronary artery bypass graft undergoing percutaneous coronary intervention : the TWILIGHT-CABG study

Sardella Gennaro, Beerkens Frans J., Dangas George, Cao Davide, Baber Usman, Sartori Samantha, Cohen David J., Briguori Carlo, Gil Robert, Nicolas Johny, Zhang Zhongjie, Dudek Dariusz, Kunadian Vijay, Kornowski Ran, Weisz Giora, Claessen Bimmer, Marx Steven O., Escaned Javier, Huber Kurt, Collier Timothy, Moliterno David J., Ohman E. Magnus, Krucoff Mitchell W., Kastrati Adnan, Steg Philippe Gabriel, Angiolillo Dominick J., Mehta Shamir R., Shlofmitz Richard, Sharma Samin, Pocock Stuart, Gibson Charles Michael, Mehran Roxana

Prior coronary artery bypass graft surgery (CABG) patients undergoing percutaneous coronary intervention (PCI) are often older and present with multiple comorbidities. Ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) has emerged as an effective bleeding-avoidance strategy among high-risk patients.

Percutaneous treatment options for acute pulmonary embolism : a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions

Pruszczyk Piotr, Klok Frederikus A., Kucher Nils, Roik Marek, Meneveau Nicolas, Sharp Andrew S.P., Nielsen-Kudsk Jens Erik, Obradovic Slobodan, Barco Stefano, Giannini Francesco, Stefanini Giulio, Tarantini Giuseppe, Konstantinides Stavros, Dudek Dariusz

There is a growing clinical and scientific interest in catheter-directed therapy (CDT) of acute pulmonary embolism (PE). Currently, CDT should be considered for patients with high-risk PE, in whom thrombolysis is contraindicated or has failed. Also, CDT is a treatment option for initially stable patients in whom anticoagulant treatment fails, i.e., those who experience haemodynamic deterioration despite adequately dosed anticoagulation. However, the definition of treatment failure (primary reperfusion therapy or anticoagulation alone) remains an important area of uncertainty. Moreover, several techniques for CDT are available without evidence supporting one over the other, and variation in practice with regard to periprocedural anticoagulation is considerable. The aim of this position paper is to describe the currently available CDT approaches in PE patients and to standardise patient selection, the timing and technique of the procedure itself as well as anticoagulation regimens during CDT. We discuss several clinical scenarios of the clinical evaluation of the “efficacy” of thrombolysis and anticoagulation, including treatment failure with haemodynamic deterioration and treatment failure based on a lack of improvement. This clinical consensus statement serves as a practical guide for CDT, complementary to the formal guidelines.

How the on-going conflict in Ukraine is impacting cardiovascular health

Beattie James M., Baruah Resham, Dudek Dariusz, Vinereanu Dragos, McDonagh Theresa A.

Following the outbreak of war in Ukraine on 24 February 2022, we are witnessing a conflict that has led to many civilian, military, and volunteer civil defence force casualties. Those civilians living in a theatre of war are directly exposed to combat-attributable trauma and risks from explosive ordnance. The United Nations Office for the High Commissioner for Human Rights (UNHCR) reported that by 4th September, there had been 13 917 confirmed casualties in the non-combatant civilian population with 5718 deaths1; these figures are likely to be significant underestimates. It is believed that ∼18 million people have been directly impacted by the hostilities with more than 8 million internally displaced. Given the widespread destruction of housing and civil infrastructure, including the disconnection of basic utilities, initial activity to aid those affected has focused on ensuring safe shelter with humanitarian support in the form of clean water, nutrition, sanitation, and clothing.

Morphological characteristics of lesions with thin cap fibroatheroma - a substudy from the COMBINE (OCT-FFR) trial

Roleder-Dylewska Magda, Gasior Pawel, Hommels Tobias M., Roleder Tomasz, Berta Balasz, Ang Hui Ying, Ng Jaryl Chen Koon, Hermanides Renicus S., Fabris Enrico, Jsselmuiden Alexander J.J.I, Kauer Floris, Alfonso Fernando, von Birgelen Clemens, Escaned Javier, Camaro Cyril, Kennedy Mark W., Pereira Bruno, Magro Michael, Nef Holger, Reith Sebastian, Malinowski Krzysztof, De Luca Giuseppe, Garcia Garcia Hector M., Granada Juan F., Wojakowski Wojciech, Kedhi Elvin

Aims To study if any qualitative or quantitative optical coherence tomography (OCT) variables in combination with thin cap fibroatheroma (TCFA) patients could improve the identification of lesions at risk for future major adverse cardiac events (MACEs).

Smartphone and wearable detected atrial arrhythmias in older adults : results of a fully digital European case finding study

Fabritz L., Connolly D.L., Czarnecki E., Dudek D[ariusz], Guasch E., Haase D., Huebner T., Zlahoda-Huzior A., Jolly K., Kirchhof P., Obergassel J., Schotten U., Vettorazzi E., Winkelmann S.J., Zapf A., Schnabel R.B.

Aims Simplified detection of atrial arrhythmias via consumer-electronics would enable earlier therapy in at-risk populations. Whether this is feasible and effective in older populations is not known. Methods and results The fully remote, investigator-initiated Smartphone and wearable detected atrial arrhythmia in Older Adults Case finding study (Smart in OAC—AFNET 9) digitally enrolled participants ≥65 years without known atrial fibrillation, not receiving oral anticoagulation in Germany, Poland, and Spain for 8 weeks. Participants were invited by media communications and direct contacts. Study procedures adhered to European data protection. Consenting participants received a wristband with a photoplethysmography sensor to be coupled to their smartphone. The primary outcome was the detection of atrial arrhythmias lasting 6 min or longer in the first 4 weeks of monitoring. Eight hundred and eighty-two older persons (age 71 ± 5 years, range 65–90, 500 (57%) women, 414 (47%) hypertension, and 97 (11%) diabetes) recorded signals. Most participants (72%) responded to adverts or word of mouth, leaflets (11%) or general practitioners (9%). Participation was completely remote in 469/882 persons (53%). During the first 4 weeks, participants transmitted PPG signals for 533/696 h (77% of the maximum possible time). Atrial arrhythmias were detected in 44 participants (5%) within 28 days, and in 53 (6%) within 8 weeks. Detection was highest in the first monitoring week [incidence rates: 1st week: 3.4% (95% confidence interval 2.4–4.9); 2nd–4th week: 0.55% (0.33–0.93)].

Percutaneous coronary intervention vs. coronary artery bypass grafting for treating in-stent restenosis in unprotected-left main : LM-DRAGON-Registry

Wańha Wojciech, Bil Jacek, Kołodziejczak Michalina, Kowalówka Adam, Kowalewski Mariusz, Hudziak Damian, Gocoł Radosław, Januszek Rafał, Figatowski Tomasz, MIlewski Marek, Tomasiewicz Brunon, Kubler Piotr, Hrymniak Bruno, Desperak Piotr, Kuźma Łukasz, Milewski Krzysztof, Góra Bartłomiej, Łoś Andrzej, Kulczycki Jan, Włodarczak Adrian, Skorupski Wojciech, Grygier Marek, Lesiak Maciej, D'Ascenzo Fabrizio, Andres Marek, Kleczyński Paweł, Litwinowicz Radosław, Borin Andrea, Smolka Grzegorz, Reczuch Krzysztof, Gruchała Marcin, Gil Robert J., Jaguszewski Miłosz, Bartuś Krzysztof, Suwalski Piotr, Dobrzycki Sławomir, Dudek Dariusz, Bartuś Stanisław, Gąsior Mariusz, Ochała Andrzej, Lansky Alexandra J., Deja Marek, Legutko Jacek, Kedhi Elvin, Wojakowski Wojciech.

Background Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce. Objectives This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR. Methods Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke. Results A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95%CI 1.01–11.8, p = 0.04). At a median of 3.5 years [interquartile range (IQR) 1.3–5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (HR 0.82, 95%CI 0.52–1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95%CI 0.81–3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95%CI 0.15–1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95%CI 0.45–7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%CI 0.15–0.85, p = 0.02).

Coronary access following ACURATE neo implantation for transcatheter aortic valve-in-valve implantation : Ex vivo analysis in patient-specific anatomies

Khokhar Arif A., Ponticelli Francesco, Zlahoda-Huzior Adriana, Chandra Kailash, Ruggiero Rossella, Toselli Marco, Gallo Francesco, Cereda Alberto, Sticchi Alessandro, Laricchia Alessandra, Regazzoli Damiano, Mangieri Antonio, Reimers Bernhard, Biscaglia Simone, Tumscitz Carlo, Campo Gianluca, Mikhail Ghada W., Kim Won-Keun, Colombo Antonio, Dudek Dariusz, Giannini Francesco.

Background Coronary access after transcatheter aortic valve implantation (TAVI) with supra-annular self-expandable valves may be challenging or un-feasible. There is little data concerning coronary access following transcatheter aortic valve-in-valve implantation (ViV-TAVI) for degenerated surgical bioprosthesis. Aims To evaluate the feasibility and challenge of coronary access after ViV-TAVI with the supra-annular self-expandable ACURATE neo valve. Materials and methods Sixteen patients underwent ViV-TAVI with the ACURATE neo valve. Post-procedural computed tomography (CT) was used to create 3D-printed life-sized patient-specific models for bench-testing of coronary cannulation. Primary endpoint was feasibility of diagnostic angiography and PCI. Secondary endpoints included incidence of challenging cannulation for both diagnostic catheters (DC) and guiding catheters (GC). The association between challenging cannulations with aortic and transcatheter/surgical valve geometry was evaluated using pre and post-procedural CT scans. Results Diagnostic angiography and PCI were feasible for 97 and 95% of models respectively. All non-feasible procedures occurred in ostia that underwent prophylactic “chimney” stenting. DC cannulation was challenging in 17% of models and was associated with a narrower SoV width (30 vs. 35 mm, p < 0.01), STJ width (28 vs. 32 mm, p < 0.05) and shorter STJ height (15 vs. 17 mm, p < 0.05). GC cannulation was challenging in 23% of models and was associated with narrower STJ width (28 vs. 32 mm, p < 0.05), smaller transcatheter-to-coronary distance (5 vs. 9.2 mm, p < 0.05) and a worse coronary-commissural overlap angle (14.3° vs. 25.6o, p < 0.01). Advanced techniques to achieve GC cannulation were required in 22/64 (34%) of cases.

Paroxysmal sustained ventricular tachycardia with cardiac arrest and myocardial infarction in 29-year-old man addicted to medical marijuana-it never rains but it pours

Wiliński Jerzy, Skwarek Anna, Chrzan Iwona, Zeliaś Aleksander, Borek Radosław, Dykla Dominika Elżbieta, Bober-Fotopoulos Maria, Dudek Dariusz.

This article presents the case of a 29-year-old male patient, addicted to prescribed medical marijuana administered for mixed anxiety and depressive disorder and without classic cardiovascular risk factors and history of myocarditis, suffering from episodes of paroxysmal hemodynamically unstable ventricular tachycardia. Cardiovascular magnetic resonance imaging of the heart revealed disseminated non-ischemic myocardial injury lesions of subepicardial and intramuscular location. Additionally, the individual experienced myocardial infarction without ST segment elevation following marijuana intake. Treatment required implantation of a cardioverter-defibrillator and ablation of the myocardial areas responsible for the origin of the arrhythmia, as well as appropriate pharmacotherapy and marijuana addiction treatment.

Knowledge and prevalence of risk factors for coronary artery disease in patients after percutaneous coronary intervention and coronary artery bypass grafting.

Matysek Mikołaj, Wójcicki Krzysztof, Tokarek Tomasz, Dziewierz Artur, Rakowski Tomasz, Bartuś Stanisław, Dudek Dariusz.

Background: Percutaneous coronary intervention (PCI) is associated with a short hospital stay and fast recovery. However, it might be related to insufficient implementation of lifestyle changes after the procedure. Conversely, coronary artery bypass grafting (CABG) is a highly invasive technique that requires a prolonged hospital stay and long rehabilitation with more opportunities for education. This study aimed to evaluate the impact of CABG on adherence to lifestyle modifications and knowledge about coronary artery disease (CAD) in comparison with PCI. We also evaluated the level of education and tried to define groups of patients that might require targeted education. Methods: Data was collected using a self-designed 56-item questionnaire. Questions assessed the knowledge of CAD risk factors and the level of their control. Results: The study group consisted of 155 consecutive patients admitted to the Cardiology Department. Patients with a history of PCI (68%) (at least 8 weeks before) were included in the prior-PCI group, and patients with previous surgical revascularization (also at least 8 weeks before) were assigned to the prior-CABG group (32%). The knowledge score was higher in the prior-CABG group. The median (IQR) results in the prior-PCI vs. prior-CABG group were, respectively: 20 (12–24) vs. 22 (19–25) [points, per 31 max.]; p = 0.01. Similar results were obtained in the level of risk control (prior-PCI vs. prior-CABG, respectively: 6 (4–7) vs. 7 (6–8) [points, per 15 max.]; p = 0.002). Conclusions: The method of treatment of CAD might impact the implementation of lifestyle modifications after the procedure. More effort is required to improve secondary prevention, especially in PCI patients.

Bleeding and ischemic outcomes with ticagrelor monotherapy according to Body Mass Index.

Kunadian Vijay, Baber Usman, Pivato Carlo A., Cao Davide, Dangas George, Sartori Samantha, Zhang Zhongjie, Angiolillo Dominick J., Briguori Carlo, Cohen David J., Collier Timothy, Dudek Dariusz, Gibson Michael, Gil Robert, Huber Kurt, Kaul Upendra, Kornowski Ran, Krucoff Mitchell W., Dehghani Payam, Mehta Shamir, Moliterno David J., Ohman E. Magnus, Escaned Javier, Sardella Gennaro, Sharma Samin K., Shlofmitz Richard, Weisz Giora, Witzenbichler Bernhard, Dzavik Vladimir, Gurbel Paul, Hamm Christian W., Henry Timothy, Kastrati Adnan, Marx Steven O., Oldroyd Keith, Steg P. Gabriel, Pocock Stuart, Mehran Roxana.

Background There is a paucity of data regarding the safety and efficacy of different antiplatelet regimens according to standardized body mass index (BMI) categories. Objectives The aim of this study was to investigate bleeding and ischemic outcomes according to BMI in the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial. Methods The TWILIGHT trial randomized high-risk patients to ticagrelor plus aspirin or ticagrelor plus placebo at 3 months after percutaneous coronary intervention. In this secondary analysis, patients were stratified by standard BMI categories, as recommended by the European Society of Cardiology Working Group on Thrombosis (normal weight [BMI 18.5-24.99 kg/m2], overweight [BMI 25-29.99 kg/m2], and obese [BMI ≥30 kg/m2]) and by median BMI, as prespecified in the protocol. Results Among 7,038 patients randomized and with available BMI, 1,807 (25.7%) were normal weight, 2,927 (41.6%) were overweight, and 2,304 (32.7%) were obese. In normal-weight, overweight, and obese patients, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced the primary endpoint of Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (normal weight: HR: 0.48 [95% CI: 0.32-0.73]; overweight: HR: 0.57 [95% CI: 0.41-0.78]; obese: HR: 0.63 [95% CI: 0.44-0.91]; P for interaction = 0.627), without any increase in the composite ischemic endpoint of all-cause death, myocardial infarction, or stroke (normal weight: HR: 1.36 [95% CI: 0.84-2.19]; overweight: HR: 0.92 [95% CI: 0.63-1.35]; obese: HR: 0.84 [95% CI: 0.56-1.25]; P for interaction = 0.290). These findings were consistent with the prespecified analysis by median BMI.

Coronary access and PCI after chimney stenting during self-expanding transcatheter aortic valve replacement in surgical bioprosthesis.

Giannini Francesco, Khokhar Arif A., Curio Jonathan, Zlahoda-Huzior Adriana, Mikhail Ghada, Dudek Dariusz.

Prophylactic stenting with the chimney technique has been developed to maintain coronary ostial patency during transcatheter aortic valve replacement (TAVR) for degenerated surgical bioprosthesis.1 However, the feasibility to re-engage the neo-ostium and to perform percutaneous coronary intervention (PCI) following chimney stenting has never been investigated.

Combining imaging-based with simulation-based techniques to evaluate coronary access.

Khokhar Arif A., Curio Jonathan, Beneduce Alessandro, Giannini Francesco, Dudek Dariusz.

The expansion of transcatheter aortic valve replacement (TAVR) towards younger populations with longer life expectancies has highlighted the importance of coronary access (CA) when considering the optimal heart valve journey. Multiple, predominantly imaging-based, approaches have been utilized to define the feasibility and challenge of CA following TAVR-in-TAVR, ranging from pre- or postimplantation computed tomography (CT) scans to computer simulations or photography.1,2

Diabetes mellitus is still a strong predictor of periprocedural outcomes of primary percutaneous coronary interventions in patients presenting with ST-segment elevation myocardial infarction (from the ORPKI Polish National Registry).

Dziewierz Artur, Zdzierak Barbara, Malinowski Krzysztof P., Siudak Zbigniew, Zasada Wojciech, Tokarek Tomasz, Zabojszcz Michał, Dolecka-Ślusarczyk Magdalena, Dudek Dariusz, Bartuś Stanisław, Surdacki Andrzej, Rakowski Tomasz.Dziewierz Artur, Zdzierak Barbara, Malinowski Krzysztof P., Siudak Zbigniew, Zasada Wojciech, Tokarek Tomasz, Zabojszcz Michał, Dolecka-Ślusarczyk Magdalena, Dudek Dariusz, Bartuś Stanisław, Surdacki Andrzej, Rakowski Tomasz.

first_pagesettingsOrder Article Reprints Open AccessArticle Diabetes Mellitus Is Still a Strong Predictor of Periprocedural Outcomes of Primary Percutaneous Coronary Interventions in Patients Presenting with ST-Segment Elevation Myocardial Infarction (from the ORPKI Polish National Registry) by Artur Dziewierz 1,2,Barbara Zdzierak 2,Krzysztof P. Malinowski 3,4,Zbigniew Siudak 5,Wojciech Zasada 2ORCID,Tomasz Tokarek 6,7ORCID,Michał Zabojszcz 5ORCID,Magdalena Dolecka-Ślusarczyk 5,Dariusz Dudek 1,4,6,Stanisław Bartuś 1,2ORCID,Andrzej Surdacki 1,2ORCID andTomasz Rakowski 1,2,* 1 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland 3 Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 31-008 Krakow, Poland 4 Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-008 Krakow, Poland 5 Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland 6 Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland 7 Center for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland * Author to whom correspondence should be addressed. J. Clin. Med. 2022, 11(21), 6284; https://doi.org/10.3390/jcm11216284 Submission received: 12 September 2022 / Revised: 21 October 2022 / Accepted: 22 October 2022 / Published: 25 October 2022 (This article belongs to the Special Issue New Frontiers in the Diagnostics and Clinical Management of Coronary Artery Disease) Downloadkeyboard_arrow_down Browse Figures Versions Notes Abstract The impact of diabetes mellitus (DM) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was confirmed by several studies. However, it is unclear whether this effect is still present in large groups of unselected patients undergoing up-to-date treatment. Thus, we sought to assess the impact of DM on periprocedural outcomes of primary PCI in STEMI using data from the Polish National Registry of PCI. Data on 150,782 STEMI patients undergoing primary PCI were collected. Of them, 26,360 (17.5%) patients had DM. Patients with DM were higher-risk individuals who experienced longer reperfusion delays and were less likely to have closed infarct-related artery at baseline (TIMI 0 + 1 flow: 73.2% vs. 72.0%; p < 0.0001) and achieve optimal reperfusion after PCI (TIMI 3 flow: 91.8% vs. 88.5%; p < 0.0001). The periprocedural mortality (1.1% vs. 1.9%; p < 0.0001) was higher in patients with DM and DM was identified as an independent predictor of periprocedural death. In conclusion, despite continuous progress in STEMI treatment, DM remains a strong predictor of periprocedural mortality. However, this detrimental effect of DM may be partially explained by the overall higher risk profile of diabetic patients.

Definitions and standardized endpoints for treatment of coronary bifurcations.

Lunardi Mattia, Louvard Yves, Lefevre Thierry, Stankovic Goran, Burzotta Francesco, Kassab Ghassan S., Lassen Jens F., Darremont Olivier, Garg Scot, Koo Bon-Kwon, Holm Niels R., Johnson Thomas W., Pan Manuel, Chatzizisis Yiannis S., Banning Adrian, Chieffo Alaide, Dudek Dariusz, Hildick-Smith David, Garot Jerome, Henry Timothy D., Dangas George, Stone Gregg W., Krucoff Mitchell W., Cutlip Donald, Mehran Roxana, Wijns William, Sharif Faisal, Serruys Patrick W., Onuma Yoshinobu.

The Bifurcation Academic Research Consortium (Bif-ARC) project originated from the need to overcome the paucity of standardization and comparability between studies involving bifurcation coronary lesions. This document is the result of a collaborative effort between academic research organizations and the most renowned interventional cardiology societies focused on bifurcation lesions in Europe, the United States, and Asia. This consensus provides standardized definitions for bifurcation lesions; the criteria to judge the side branch relevance; the procedural, mechanistic, and clinical endpoints for every type of bifurcation study; and the follow-up methods. Considering the complexity of bifurcation lesions and their evaluation, detailed instructions and technical aspects for site and core laboratory analysis of bifurcation lesions are also reported. The recommendations included within this consensus will facilitate pooled analyses and the effective comparison of data in the future, improving the clinical relevance of trials in bifurcation lesions, and the quality of care in this subset of patients.

Risk factors of contrast induced nephropathy in patients with acute coronary syndromes

Rakowski Tomasz, Dziewierz Artur, Węgiel Michał, Siudak Zbigniew, Zasada Wojciech, Jąkała Jacek, Dykla Dominika, Matysek Jerzy, Surdacki Andrzej, Bartuś Stanisław, Dudek Dariusz, Wojdyła Roman.

Background: Patients with acute coronary syndrome (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization, higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed. Aims: We aimed to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment. Methods: A total of 2638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 μmol/l) increase in the absolute value. Results: Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referred for other treatment strategies (P < 0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was an independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P < 0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN.

Impact of diabetes mellitus on the diagnostic performance of fractional flow reserve in patients with severe aortic stenosis

Dziewierz Artur, Rzeszutko Łukasz, Dudek Dariusz, Legutko Jacek, Kleczyński Paweł.

Background: The validity of functional assessment of coronary artery disease with fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR) in patients with severe aortic stenosis (AS) might be affected by AS per se and other factors, including diabetes mellitus. Aims: We aimed to evaluate the impact of diabetic status on FFR performance in severe AS. Methods: The functional significance of 416 stenoses of intermediate angiographic severity in 221 patients with severe AS was assessed with iFR and FFR. Patients treated with insulin or oral hypoglycemic agents were classified as diabetic patients. Results: Of 221 enrolled patients, 68 (32.1%) patients were diabetic. A total of 128 (30.8%) lesions in patients with and 288 in patients without diabetes mellitus were assessed. The mean (SD) FFR was 0.85 (0.07), and iFR was 0.90 (0.04) with no difference between nondiabetic and diabetic patients. Good agreement between iFR and FFR was confirmed for non-diabetic (ICC, 0.83 [95% confidence interval, CI, 0.79–0.86]) and diabetic (ICC, 0.82 [95% CI, 0.76–0.87]) patients. Among patients without diabetes mellitus, the optimal cutoff value for FFR to detect iFR ≤0.89 was 0.81 with sensitivity and specificity of 96.6% and 100.0%. The optimal cutoff value for FFR to detect iFR ≤0.89 for diabetic patients was 0.83 with sensitivity and specificity of 98.0% and 100.0%. Conclusions: In patients with severe AS, FFR correlates well with iFR. However, the optimal threshold for FFR to identify significant ischemia (iFR ≤0.89) in those patients may differ from the standard threshold of FFR ≤0.80 and might be affected by the diabetic status.

Strategies for renal protection in cardiovascular interventions.

Ali Ziad A., Escaned Javier, Dudek Dariusz, Radhakrishnan Jai, Karimi Galougahi Keyvan.

Contrast-associated acute kidney injury (CA-AKI), a potential complication of cardiovascular interventions that require radiocontrast administration, is associated with increased morbidity, mortality, and length of hospital admission. CA-AKI is particularly prevalent among patients with chronic kidney disease and comorbidities such as advanced age and diabetes. This review briefly discusses the evidence-based strategies to minimize CA-AKI. In addition, technical details of procedures to minimize the contrast volume, i.e., ultra-low contrast angiography and zero contrast percutaneous intervention, along with several illustrative cases are presented.

Prevention and management of peri-procedural TAVR complications

Khokhar Arif A., Ruggiero Rossella, Chandra Kailash, DAgostino Alessandro, Toselli Marco, Mangieri Antonio, Dudek Dariusz, Colombo Antonio, Giannini Francesco.

Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment strategy for severe aortic stenosis. However, peri-procedural complications can have a significant impact on acute and longer-term morbidity and mortality. Therefore, this review article provides a practical overview on how to prevent and manage the common and also rare but life-threatening peri-procedural TAVR complications.

Sources of patients' knowledge about cardiovascular disease prevention in Poland - a pilot study.

Kowalewska Ewa, Komnacka Katarzyna, Wójcicki Krzysztof, Dziewierz Artur, Dudek Dariusz, Tokarek Tomasz.

Patients’ knowledge of coronary heart disease and prevention is insufficient. Thus, we sought to identify sources of patients’ knowledge about cardiovascular prevention. Patients perceive physicians as the most reliable and trusted source of knowledge regardless of sociodemographic and clinical factors. Patients with higher education more often obtain their knowledge from books and the internet, whereas patients with lower levels of education more often rely on their cardiologist for their knowledge.

Dissections after bioresorbable vascular scaffold implantation in the POLAR ACS Registry

Zasada Wojciech, Dziewierz Artur, Partyka Łukasz, Wegiel Michal, Bobrowska Beata, Depukat Rafal, Rakowski Tomasz, Dudek Dariusz, Bartuś Stanisław, Rzeszutko Łukasz.

Taking into account the angiographic characteristics of the treated lesions, as well as the treatment strategy, several significant differences were observed between the studied groups, while one independent risk factor for dissection was identified: the presence of at least moderate calcifications in the treated segment. The clinical complication rate observed in the 12-month follow-up was very low in the whole group, allowing for the conclusion that the occurrence of significant dissection can be effectively treated, and the good angiographic results of this treatment immediately after the initial procedure translate into good clinical results in longer, 1-year follow-up.

CT in transcatheter-delivered treatment of valvular heart disease

Rudzinski Piotr Nikodem, Leipsic Jonathon A., Schoepf U. Joseph, Dudek Dariusz, Schwarz Florian, Andreas Martin, Zlahoda-Huzior Adriana, Thilo Christian, Renker Matthias, Burt Jeremy R., Emrich Tilman, Varga-Szemes Akos, Amoroso Nicholas S., Steinberg Daniel H., Pukacki Piotr, Demkow Marcin, Kepka Cezary, Bayer Richard R..

Minimally invasive strategies to treat valvular heart disease have emerged over the past 2 decades. The use of transcatheter aortic valve replacement in the treatment of severe aortic stenosis, for example, has recently expanded from high- to low-risk patients and became an alternative treatment for those with prohibitive surgical risk. With the increase in transcatheter strategies, multimodality imaging, including echocardiography, CT, fluoroscopy, and cardiac MRI, are used. Strategies for preprocedural imaging strategies vary depending on the targeted valve. Herein, an overview of preprocedural imaging strategies and their postprocessing approaches is provided, with a focus on CT. Transcatheter aortic valve replacement is reviewed, as well as less established minimally invasive treatments of the mitral and tricuspid valves. In addition, device-specific details and the goals of CT imaging are discussed. Future imaging developments, such as peri-procedural fusion imaging, machine learning for image processing, and mixed reality applications, are presented.

Quantitative flow ratio for evaluation of borderline coronary lesions in patients with severe aortic stenosis.

Kleczynski Pawel, Dziewierz Artur, Rzeszutko Lukasz, Dudek Dariusz, Legutko Jacek.

Quantitative flow ratio (QFR) is a novel noninvasive method for evaluating coronary physiology. However, data on the QFR in patients with aortic stenosis (AS) and coronary artery disease are scarce. Thus, we compared the diagnostic performance of the QFR with that of the resting distal to aortic coronary pressure (Pd/Pa) ratio, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR), as well as angiographic indices.

Assessment of the utility of Mixed Reality in medical education

Kolecki Radek, Pregowska Agnieszka, Dąbrowa Julianna, Skuciński Jerzy [A.], Pulanecki Tomasz, Walecki Piotr, van Dam Peter M., Dudek Dariusz, Richter Piotr, Proniewska Klaudia.

Immersive technologies like Mixed Reality (MR), Virtual Reality (VR) and Augmented Reality (AR) are becoming increasingly popular and gain user trust across various fields, particularly in medicine. In this paper we will use the general term Mixed Reality (MR) to refer to the various virtual reality methods, namely VR and AR. These new immersive technologies require varying degrees of instruction, both in their practice use, as well as in how to adjust to interacting with 3D virtual spaces. This study assesses the pedagogical value of these immersive technologies in medical education.

Gender-related and PUFA-related differences in lipoprotein-associated phospholipase a2 levels in patients with type 2 diabetes and atherosclerotic cardiovascular disease

Hanarz Maksymilian, Siniarski Aleksander, Gołębiowska-Wiatrak Renata, Nessler Jadwiga, Malinowski Krzysztof Piotr, Gajos Grzegorz.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) may play an important role in the development of atherosclerotic cardiovascular disease (ASCVD). Increased plasma levels of Lp-PLA2 may predict future cardiovascular (CV) events in type 2 diabetes (T2D). The potential beneficial effects of polyunsaturated fatty acids (PUFA) on ASCVD have been widely investigated. However, the impact of different PUFA concentrations on Lp-PLA2 remains uncertain.

The application of mixed reality in root canal treatment

Dolega-Dolegowski Damian, Dolega-Dolegowska Magdalena, Pregowska Agnieszka, Malinowski Krzysztof, Proniewska Klaudia.

The priority of modern dentistry is to keep patients’ teeth for as long as possible. Tooth extraction is a procedure performed as a last resort when conservative methods and endodontic surgery procedures have not brought the expected results. As a consequence, the number of patients in dental offices, who require first and repeated endodontic treatment, is increasing. Thus, the development of new technologies in the medical industry, including microscopy, computer tomography (CT), as well as diode and neodymium-YAG-erbium lasers, enables dentists to increase the percentage of successful treatments. Moreover, mixed reality (MR) is a very new technology, in which the 3D view can help plan or simulate various types of tasks before they will be carried out in real life. In dentistry, 3D holography can be applied to display CT data to plan endodontic treatment. The most important element in effective root canal treatment is the precise imaging of the root canal. The CT scans allow dentists to view the anatomy of the patient’s tooth with much higher precision and understanding than using 2D radiography (RTG-radiographic photo) pictures. Recently, the development of new 3D technologies allows dentists to obtain even more data from existing CT scans. In this paper, the CT scan data were applied to generate patient teeth in 3D and simulate the view of the root canal’s anatomy in MR devices, i.e., Microsoft HoloLens 2. Using DICOM RAW data from the CT exam, we generated a 3D model of the jaw with a tooth. In the next step, the crown of the tooth was removed in a similar way to how a dentist would do this using a dental handpiece. Furthermore, all root canals were cleaned of everything inside. This way we achieved empty tunnels, namely root canals. Finally, we added appropriate lighting, similar to the type of lighting that dentists use. The proposed approach enables to display of the root canals in the same way as during the endodontic procedure using a microscope. It allows for the visualization of the root canal and changing its direction, in which dimensional accuracy is crucial. It turns out that mixed reality can be considered a complementary method to the traditional approach, which reduces the amount of time for the root canal treatment procedure by up to 72.25%, depending on the complexity of the case, and increases its effectiveness. Thus, the mixed reality-based system can be considered an effective tool for planning dental treatment.

Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions in collaboration with the ESC Working Group on Cardiovascular Surgery

Tarantini Giuseppe, Tang Gilbert, Nai Fovino Luca, Blackman David, Van Mieghem Nicolas M., Kim Won-Keun, Karam Nicole, Carrilho-Ferreira Pedro, Fournier Stephane, Pręgowski Jerzy, Fraccaro Chiara, Vincent Flavien, Campante Teles Rui, Mylotte Darren, Wong Ivan, Bieliauskas Gintautas, Czerny Martin, Bonaros Nikolaos, Parolari Alessandro, Dudek Darius, Tchetche Didier, Eltchaninoff Helene, De Backer Ole, Stefanini Giulio, Sondergaard Lars.

Significant coronary artery disease (CAD) is a frequent finding in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), and the management of these two conditions becomes of particular importance with the extension of the procedure to younger and lower-risk patients. Yet, the preprocedural diagnostic evaluation and the indications for treatment of significant CAD in TAVI candidates remain a matter of debate. In this clinical consensus statement, a group of experts from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery aims to review the available evidence on the topic and proposes a rationale for the diagnostic evaluation and indications for percutaneous revascularisation of CAD in patients with severe aortic stenosis undergoing transcatheter treatment. Moreover, it also focuses on commissural alignment of transcatheter heart valves and coronary re-access after TAVI and redo-TAVI.

Radiation protection for healthcare professionals working in catheterisation laboratories during pregnancy : a statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the ESC Regulatory Affairs Committee and Women as One.

Manzo-Silberman Stephane, Velazquez Maite, Burgess Sonya, Sahni Sheila, Best Patricia, Mehran Roxana, Piccaluga Emanuela, Vitali-Serdoz Laura, Sarma Amy, Barbash Israel Moshe, Mauri Josepa, Szymański Piotr, Hinterbuchner Lynne, Stefanini Giulio, Gimelli Alessia, Maurovich-Horvat Pal, Boersma Lucas, Buchanan Gill Louise, Pontone Gianluca, Holmvang Lene, Karam Nicole, Neylon Antoinette, Morice Marie-Claude, Leclercq Christophe, Tarantini Giuseppe, Dudek Dariusz, Chieffo Alaide.

The European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the European Society of Cardiology (ESC) Regulatory Affairs Committee and Women as One support continuous review and improvement, not only in the practice of assuring patients a high quality of care but also in providing health professionals with support documents to help them in their career and enhance gender equity. Recent surveys have revealed that radiation exposure is commonly reported as the primary barrier for women pursuing a career in interventional cardiology or cardiac electrophysiology (EP). The fear of foetal exposure to radiation during pregnancy may lead to a prolonged interruption in their career. Accordingly, this joint statement aims to provide a clear statement on radiation risk and the existing data on the experience of radiation-exposed cardiologists who continue to work in catheterisation laboratories (cath labs) throughout their pregnancies. In order to reduce the barrier preventing women from accessing these careers, increased knowledge in the community is warranted. Finally, by going beyond simple observations and review of the literature, our document suggests proposals for improving workplace safety and for encouraging equity.

Computed tomographic angiography in coronary artery disease

Serruys Patrick W., Kotoku Nozomi, Norgaard Bjarne L., Garg Scot, Nieman Koen, Dweck Marc R., Bax Jeroen J., Knuuti Juhani, Narula Jagat, Perera Divaka, Taylor Charles A., Leipsic Jonathon A., Nicol Edward D., Piazza Nicolo, Schultz Carl J., Kitagawa Kakuya, de Bruyne Bernard, Collet Carlos, Tanaka Kaoru, Mushtaq Saima, Belmonte Marta, Dudek Darius, Zlahoda-Huzior Adriana, Tu Shengxian, Wijns William, Sharif Faisal, Budoff Matthew J., de Mey Johan, Andreini Daniele, Onuma Yoshinobu.

Coronary computed tomographic angiography (CCTA) is becoming the first-line investigation for establishing the presence of coronary artery disease and, with fractional flow reserve (FFRCT), its haemodynamic significance. In patients without significant epicardial obstruction, its role is either to rule out atherosclerosis or to detect subclinical plaque that should be monitored for plaque progression/regression following prevention therapy and provide risk classification. Ischaemic non-obstructive coronary arteries are also expected to be assessed by non-invasive imaging, including CCTA. In patients with significant epicardial obstruction, CCTA can assist in planning revascularisation by determining the disease complexity, vessel size, lesion length and tissue composition of the atherosclerotic plaque, as well as the best fluoroscopic viewing angle; it may also help in selecting adjunctive percutaneous devices (e.g., rotational atherectomy) and in determining the best landing zone for stents or bypass grafts.

Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology

Escaned Javier, Berry Colin, de Bruyne Bernard, Shabbir Asad, Collet Carlos, Lee Joo Myung, Appelman Yolande, Barbato Emanuele, Biscaglia Simone, Buszman Piotr P., Campo Gianluca, Chieffo Alaide, Colleran Róisín, Collison Damien, Davies Justin E., Giacoppo Daniele, Holm Niels R., Jeremias Allen, Paradies Valeria, Piróth Zsolt, Raposo Luís, Roguin Ariel, Rudolph Tanja, Sarno Giovanna, Sen Sayan, Toth Gabor G., Van Belle Eric, Zimmermann Frederick M., Dudek Dariusz, Stefanini Giulio, Tarantini Giuseppe.

The clinical value of fractional flow reserve and non-hyperaemic pressure ratios are well established in determining an indication for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). In addition, over the last 5 years we have witnessed a shift towards the use of physiology to enhance procedural planning, assess post-PCI functional results, and guide PCI optimisation. In this regard, clinical studies have reported compelling data supporting the use of longitudinal vessel analysis, obtained with pressure guidewire pullbacks, to better understand how obstructive CAD contributes to myocardial ischaemia, to establish the likelihood of functionally successful PCI, to identify the presence and location of residual flow-limiting stenoses and to predict long-term outcomes. The introduction of new functional coronary angiography tools, which merge angiographic information with fluid dynamic equations to deliver information equivalent to intracoronary pressure measurements, are now available and potentially also applicable to these endeavours. Furthermore, the ability of longitudinal vessel analysis to predict the functional results of stenting has played an integral role in the evolving field of simulated PCI. Nevertheless, it is important to have an awareness of the value and challenges of physiology-guided PCI in specific clinical and anatomical contexts. The main aim of this European Association of Percutaneous Cardiovascular Interventions clinical consensus statement is to offer up-to-date evidence and expert opinion on the use of applied coronary physiology for procedural PCI planning, disease pattern recognition and post-PCI optimisation.

Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Barbato Emanuele, Azizi Michel, Schmieder Roland E., Lauder Lucas, Bohm Michael, Brouwers Sofie, Bruno Rosa Maria, Dudek Dariusz, Kahan Thomas, Kandzari David E., Luscher Thomas F., Parati Gianfranco, Pathak Atul, Ribichini Flavio L., Schlaich Markus P., Sharp Andrew S.P., Sudano Isabella, Volpe Massimo, Tsioufis Costas, Wijns William, Mahfoud Felix.

Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient’s global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.

CineECG analysis provides new insights into Familial ST-segment Depression Syndrome

Frosted Rasmus, Paludan-Muller Christian, Vad Oliver Bundgaard, Olesen Morten Salling, Bundgaard Henning, van Dam Peter, Christensen Alex Horby.

Familial ST-segment Depression Syndrome (Fam-STD) is a novel inherited cardiac disease associated with arrhythmias and sudden cardiac death. This study aimed at investigating the cardiac activation pathway in patients with Fam-STD, modelling the electrocardiogram (ECG) phenotype, and performing in-depth ST-segment analyses.

Management strategies for heavily calcified coronary stenoses : an EAPCI clinical consensus statement in collaboration with the EURO4C-PCR group

Barbato Emanuele, Gallinoro Emanuele, Abdel-Wahab Mohamed, Andreini Daniele, Carrié Didier, Di Mario Carlo, Dudek Dariusz, Escaned Javier, Fajadet Jean, Guagliumi Giulio, Hill Jonathan, McEntegart Margaret, Mashayekhi Kambis, Mezilis Nikolasos, Onuma Yoshinobu, Reczuch Krzyszstof, Shlofmitz Richard, Stefanini Giulio, Tarantini Giuseppe, Toth Gabor G., Vaquerizo Beatriz, Wijns William, Ribichini Flavio.

Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators’ confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications and the importance of adequate training and education.

Merging virtual and physical experiences : extended realities in cardiovascular medicine

Tsai Tsung-Ying, Onuma Yoshinobu, Złahoda-Huzior Adriana, Kageyama Shigetaka, Dudek Dariusz, Wang Qingdi, Lim Ruth P., Garg Scot, Poon Eric K.W., Puskas John, Ramponi Fabio, Jung Christian, Sharif Faisal, Khokhar Arif A., Serruys Patrick W..

Technological advancement and the COVID-19 pandemic have brought virtual learning and working into our daily lives. Extended realities (XR), an umbrella term for all the immersive technologies that merge virtual and physical experiences, will undoubtedly be an indispensable part of future clinical practice. The intuitive and three-dimensional nature of XR has great potential to benefit healthcare providers and empower patients and physicians. In the past decade, the implementation of XR into cardiovascular medicine has flourished such that it is now integrated into medical training, patient education, pre-procedural planning, intra-procedural visualization, and post-procedural care. This review article discussed how XR could provide innovative care and complement traditional practice, as well as addressing its limitations and considering its future perspectives.

Overcoming professional barriers encountered by women in interventional cardiology : an EAPCI statement

Buchanan Gill Louise, Paradies Valeria, Karam Nicole, Holmvang Lene, Mamas Mamas A., Mehilli Julinda, Capodanno Davide, Capranzano Piera, Appelman Yolande, Manzo-Silberman Stephane, Kunadian Vijay, Mauri Josepa, Shuepke Stefanie, Petronio Anna Sonia, Kaluzna-Oleksy Marta, Gilard Martine, Morice Marie Claude, Barbato Emanuele, Dudek Dariusz, Chieffo Alaide.

Despite the increasing proportion of female medical and nursing students, there is still a significant under-representation of women working as healthcare providers in interventional cardiology, with very few of them reaching senior leadership, academic positions, or acting principal investigators, as well as actively involved in company advisory boards. In this position paper, we will describe the current status of women working in interventional cardiology across Europe. We will also provide an overview of the most relevant determinants of the under-representation of women at each stage of the interventional cardiology career path and offer practical suggestions for overcoming these challenges.

Ticagrelor with or without aspirin in high-risk patients with anemia undergoing percutaneous coronary intervention : a subgroup analysis of the TWILIGHT trial

Spirito Alessandro, Kastrati Adnan, Cao Davide, Baber Usman, Sartori Samantha, Angiolillo Dominick J., Briguori Carlo, Cohen David J., Dangas George, Dudek Dariusz, Escaned Javier, Gibson Michael, Zhang Zhongjie, Huber Kurt, Kaul Upendra, Kornowski Ran, Kunadian Vijay, Han Ya-Ling, Mehta Shamir R., Sardella Gennaro, Sharma Samin, Shlofmitz Richard A., Vogel Birgit, Collier Timothy, Pocock Stuart, Mehran Roxana.

The aim of this study was to assess the effect of ticagrelor monotherapy among high-risk patients with anaemia undergoing percutaneous coronary intervention (PCI).

Virtual reality-assisted heart team consultation for complex structural heart intervention.

Złahoda-Huzior Adriana, Januska Jaroslav, Hecko Jan, Khokhar Arif, Dudek Dariusz.

A 52-year-old male was referred with dizziness and found to have a haemodynamically significant atrial septal defect (ASD). Trans-esophageal echocardiography (TEE) (Panel A) revealed a complex ASD with multiple fenestrations (white arrows) and two separate tissue arcades (green stars) on the left atrial side. Due to the complex morphology, a 4D multi-slice computed tomography (MSCT) was performed (Panel B; see Supplementary material online, Video S1), which confirmed the presence and position of the arcades covering the ASD (red arrow).

Elevated factor XIa as a modulator of plasma fibrin clot properties in coronary artery disease

Paszek Elżbieta, Malinowski Krzysztof P., Ząbczyk Michał, Butenas Saulius, Undas Anetta.

Patients with coronary artery disease (CAD) display a prothrombotic fibrin clot phenotype, involving low permeability and resistance to lysis. The determinants of this phenotype remain elusive. Circulating tissue factor (TF) and activated factor XI (FXIa) are linked to arterial thromboembolism. We investigated whether detectable active TF and FXIa influence fibrin clot properties in CAD.

The application of the preoperative image-guided 3D visualization supported by machine learning to the prediction of organs reconstruction during pancreaticoduodenectomy via a head-mounted displays

Proniewska Klaudia, Kolecki Radek, Grochowska Anna, Popiela Tadeusz [J.], Rogula Tomasz, Malinowski Krzysztof, Dołęga-Dołęgowski Damian, Kenig Jakub, Richter Piotr, Dąbrowa Julianna, Mortada Jafar, van Dam Peter, Pregowska Agnieszka.

Early pancreatic cancer diagnosis and therapy drastically increase the chances of survival. Tumor visualization using CT scan images is an important part of these processes. In this paper, we apply Mixed Reality (MR) and Artificial Intelligence, in particular, Machine Learning (ML) to prepare image-guided 3D models of pancreatic cancer in a population of oncology patients. Object detection was based on the convolution neural network, i.e. the You Only Look Once (YOLO) version 7 algorithm, while the semantic segmentation has been done with the 3D-UNET algorithm. Next, the 3D holographic visualization of this model as an interactive, MR object was performed using the Microsoft HoloLens2. The results indicated that the proposed MR and ML-based approach can precisely segment the pancreas along with suspected lesions, thus providing a reliable tool for diagnostics and surgical planning, especially when considering organ reconstruction during pancreaticoduodenectomy.

Impact of COVID-19 pandemic on patients with ST-segment-elevation myocardial infarction complicated by out-of-hospital cardiac arrest

Tokarek Tomasz, Dziewierz Artur, Zeliaś Aleksander, Malinowski Krzysztof Piotr, Rakowski Tomasz, Dudek Dariusz, Siudak Zbigniew.

Patients with ST-segment-elevation myocardial infarction (STEMI) treated during the COVID-19 pandemic might experience prolonged time to reperfusion. The delayed reperfusion may potentially aggravate the risk of out-of-hospital cardiac arrest (OHCA) in those patients. Limited access to healthcare, more reluctant health-seeking behaviors, and bystander readiness to render life-saving interventions might additionally contribute to the suggested change in the risk of OHCA in STEMI. Thus, we sought to explore the effects of the COVID-19 outbreak on treatment delay and clinical outcomes of patients with STEMI with OHCA. Overall, 5,501 consecutive patients with STEMI complicated by OHCA and treated with primary percutaneous coronary intervention with stent implantation were enrolled. A propensity score matching was used to obviate the possible impact of non-randomized design. A total of 740 matched pairs of patients with STEMI and OHCA treated before and during the COVID-19 pandemic were compared. A similar mortality and prevalence of periprocedural complications were observed in both groups. However, patients treated during the COVID-19 outbreak experienced longer delays from first medical contact to angiography (88.8 (±61.5) vs. 101.4 (±109.8) [minutes]; p = 0.006). There was also a trend toward prolonged time from pain onset to angiography in patients admitted to the hospital in the pandemic era (207.3 (±192.8) vs. 227.9 (±231.4) [minutes]; p = 0.06). In conclusion, the periprocedural outcomes in STEMI complicated by OHCA were comparable before and during the COVID-19 era. However, treatment in the COVID-19 outbreak was associated with a longer time from first medical contact to reperfusion.

Randomized controlled trial of conventional versus MicroNet-covered stent in carotid artery revascularization : 12-month outcomes

Karpenko Andrey, Bugurov Savr, Ignatenko Pavel, Starodubtsev Vladimir, Popova Irina, Malinowski Krzysztof, Musialek Piotr.

The aim of this study was to compare procedure-related ipsilateral cerebral embolism with a conventional (Acculink, Abbott Vascular) versus a MicroNet-covered (CGuard, InspireMD) stent in carotid artery stenting (CAS).

Single versus dual-operator approaches for percutaneous coronary interventions within chronic total occlusion - an analysis of 27,788 patients

Januszek Rafał, De Luca Giuseppe, Siłka Wojciech, Bryniarski Leszek, Malinowski Krzysztof Piotr, Surdacki Andrzej, Wańcha Wojciech, Bartuś Stanisław, Piotrowska Aleksandra, Bartuś Krzysztof, Pytlak Kamil, Siudak Zbigniew.

Since the treatment of chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) is associated with high procedural complexity, it has been suggested to use a multi-operator approach. This study was aimed at evaluating the procedural outcomes of single (SO) versus dual-operator (DO) CTO-PCI approaches

Factors affecting self-reported bleeding acceptance in acute ischemic stroke survivors on various types of antithrombotic therapy

Rusin Gabriela, Kubica Jadwiga, Malinowski Krzysztof Piotr, Słowik Agnieszka, Undas Anetta.

Prior ischemic cerebrovascular event and younger age have been shown to increase bleeding acceptance among anticoagulated outpatients with atrial fibrillation (AF). We sought to determine factors affecting bleeding acceptance in acute ischemic stroke (AIS) survivors on various types of antithrombotic therapy.

Low bleeding acceptance is associated with increased death risk in patients with atrial fibrillation on oral anticoagulation

Rusin Gabriela, Konieczyńska Małgorzata, Natorska Joanna, Malinowski Krzysztof Piotr, Undas Anetta.

Bleeding is the most feared complication of anticoagulation. We sought to investigate whether the bleeding risk acceptance has a prognostic value during long-term follow-up in the era of direct oral anticoagulants (DOACs) among patients with atrial fibrillation (AF). We studied 167 consecutive AF outpatients [aged 68.8 SD 10.6 years; 141 (84.4%) on DOACs]. The bleeding acceptance was assessed based on the Bleeding Ratio defined as the declared maximum number of major bleedings that a patient would be willing to accept to prevent one major stroke. We recorded cerebrovascular ischemic events, major or clinically relevant non-major bleeds (CRNMB), and mortality. A median Bleeding Ratio was 4 (IQR 2–5). During follow-up of 946 patient-years, cerebrovascular ischemic events and/or death were observed in 28 patients (3.3%/ year) and major bleeding or CRNMB in 33 (4.6%/ year). The Bleeding Ratio was lower in patients who experienced cerebrovascular events or death (p = 0.004), but not bleeding. Patients with the Bleeding Ratio 0–3 were more often non-persistent to the OAC therapy, and more likely to have cerebrovascular event or die than those with higher bleeding acceptance (odds ratio 2.55; 0.95% CI 1.08–6.02) which was driven by the impact on mortality. The multiple Cox proportional hazards model showed that lower Bleeding Ratio, higher CHA2DS2-VASc score, and older age predicted cerebrovascular events or death during follow-up. AF patients who are willing to accept fewer serious bleedings to avoid major stroke during anticoagulation are more likely to experience death and/or cerebrov

Thrombus containing lesions strategies during primary percutaneous coronary interventions in ST-segment elevation myocardial infarction : insights from ORPKI National Registry

Rakowski Tomasz, Węgiel Michał, Malinowski Krzysztof P., Siudak Zbigniew, Zasada Wojciech, Zdzierak Barbara, Tokarek Tomasz, Rzeszutko Łukasz, Dudek Dariusz, Bartuś Stanisław, Surdacki Andrzej, Dziewierz Artur.

In the era of potent P2Y12 inhibitors, according to current guidelines, treatment with glycoprotein IIb/IIIa inhibitors (GPIs) should be limited to bail-out and/or highly thrombotic situations. Similarly, the recommendation for aspiration thrombectomy (AT) is downgraded to very selective use. We examine the prevalence, and predictors of GPI and AT use in STEMI patients referred to primary percutaneous coronary intervention (PCI). Data on 116,873 consecutive STEMI patients referred to primary PCI in Poland between 2015 and 2020 were analyzed. GPIs were administered in 29.3%, AT was used in 11.6%, and combined treatment with both in 6.1%. There was a mild trend toward a decrease in GPI and AT usage during the analyzed years. On the contrary, there was a rapid growth of the ticagrelor/prasugrel usage rate from 6.5 to 48.1%. Occluded infarct-related artery at baseline and no-reflow during PCI were the strongest predictors of GPI administration (OR 2.3; 95% CI 2.22–2.38 and OR 3.47; 95% CI 3.13–3.84, respectively) and combined usage of GPI and AT (OR 4.4; 95% CI 4.08–4.8 and OR 3.49; 95% CI 3.08–3.95 respectively) in a multivariate logistic regression model. Similarly, the administration of ticagrelor/prasugrel was an independent predictor of both adjunctive treatment strategies. In STEMI patients in Poland, GPIs are selectively used in one in four patients during primary PCI, and the combined usage of GPI and AT is marginal. Despite the rapid growth in potent P2Y12 inhibitors usage in recent years, GPIs are selectively used at a stable rate during PCI in highly thrombotic lesions.

Transcatheter aortic valve implantation for failed surgical and transcatheter prostheses. Expert Opinion of the Association of Percutaneous Cardiovascular Interventions of the Polish Cardiac Society

Huczek Zenon, Protasiewicz Marcin, Dąbrowski Maciej, Parma Radosław, Hudziak Damian, Olszówka Piotr, Targoński Radosław, Grodecki Kajetan, Frank Marek, Ścisło Piotr, Kralisz Paweł, Trębacz Jarosław, Sacha Jerzy, Wilczek Krzysztof, Walczak Andrzej, Smolka Grzegorz, Kleczyński Paweł, Milewski Krzysztof, Hawranek Michał, Kochman Janusz, Lesiak Maciej, Dudek Dariusz, Witkowski Adam, Legutko Jacek, Bartuś Stanisław, Wilimski Radosław, Wojakowski Wojciech, Grygier Marek.

Over 15 years of clinical experience and multiple large-scale observational studies followed by guidelines show good safety and efficacy of valve-in-valve transcatheter aortic valve implantation TAVI (ViV-TAVI), which reduces the need for re-do surgical aortic valve replacement (SAVR) in high-risk patients. The number of procedures in Poland, estimated as ca. 2% of all TAVIs in 2020, is expected to rise. This article aims to review specific challenges of the ViV-TAVI procedure including proper pre-procedural planning to achieve best possible hemodynamic results and mitigate coronary occlusion risk. It also provides a preliminary review and guidelines on repeat TAVI (re-do TAVI) in patients presenting with a failed transcatheter aortic bioprosthesis.

Safety and efficacy of repeated balloon aortic valvuloplasty in patients with symptomatic severe aortic stenosis

Sorysz Danuta, Dziewierz Artur, Rzeszutko Łukasz, Wiktorowicz Agata, Wojakowski Wojciech, Parma Radosław, Skoczyńska Agnieszka, Kleczyński Paweł, Stąpór Maciej, Dudek Dariusz, Legutko Jacek, Bartuś Stanisław.

Background: Long-term outcomes of balloon aortic valvuloplasty (BAV) in patients with severe symptomatic aortic stenosis (AS) are poor, and this procedure needs to be repeated in selected cases.Aims: We aimed to investigate the safety and efficacy of repeated BAV (reBAV).Methods: We included consecutive patients who underwent reBAV in three Polish centers between 2010 and 2019. Baseline clinical, echocardiographic, procedural, and outcome data were analyzed.Results: Thirty-five patients (median age 81.5 years, 57.1% women) who underwent reBAV were enrolled. In 42.9% of the patients, index BAV was considered a palliative treatment, and in 54.3% a bridge to definitive treatment. Index BAV decreased peak aortic valve gradient (pAVG) from a median of 78.0 mm Hg to 46.0 mm Hg (P <0.001). After a mean of 255.8 days, reBAV was performed. In most cases (71.4%), the reason for reBAV was the worsening of heart failure symptoms and in 54.3% of patients, reBAV was still considered a palliative option. A decrease in pAVG max from a median of 73.0 mm Hg to 45.0 mm Hg (P <0.001), comparable to index BAV, was observed. The frequency of complications were numerically higher for repeated procedures. During the median (IQR) follow-up of 403.0 (152.0–787.0) days from the index procedure, 80.0% of the patients died.Conclusions: Acute hemodynamic results of reBAV are comparable to those achieved during index BAV. However, reBAV may carry an increased risk of complications. Moreover, mortality is high due to unfavorable risk profiles or delays in receiving definitive therapy.

Stepwise relationship between delay to percutaneous coronary intervention and long-term mortality in patients with non-ST-segment elevation myocardial infarction

Bujak Kamil, Gąsior Mariusz, Tajstra Mateusz, Pres Damian, Gierlotka Marek, Wilczek Krzysztof, Feusette Piotr, Liszka Radosław, Cieśla Daniel, Trzeciak Przemysław, Lesiak Maciej, Witkowski Adam, Legutko Jacek, Wojakowski Wojciech, Dudek Dariusz, Budaj Andrzej.

Current guidelines recommend coronary catheterization in patients with non-ST- -segment elevation myocardial infarction (NSTEMI) within 24 hours of hospital admission. However, whether there is a stepwise relationship between the time to percutaneous coronary intervention (PCI) and long-term mortality in patients with NSTEMI treated invasively within 24 hours of admission has not been established yet.

Unusual rapid progression of TAVI valve degeneration confirmed by PET-CT scan treated with Valve in Valve procedure followed by early valve thrombosis

Sorysz Danuta, Dziewierz Artur, Staszczak Anna, Trębacz Jarosław, Dudek Dariusz.

Transcatheter aortic valve implantation (TAVI) has become a standard treatment in severe aortic stenosis (AS).1 However, the major limitations of TAVI remain valve degeneration and thrombosis, which may affect long-term outcomes.2-4

Computed tomography and transthoracic echocardiography for assessment of left ventricle geometry in patients with aortic valve stenosis

Krawczyk-Ożóg Agata, Batko Jakub, Koziej Mateusz, Tokarek Tomasz, Sorysz Danuta, Siudak Zbigniew, Dudek Dariusz, Bartuś Stanisław, Surdacki Andrzej, Hołda Mateusz K..

Standard transthoracic echocardiography (TTE) often is not sufficient to properly visualize the geometry of the left ventricle. One of the clinical imaging modalities that can be used for this purpose is contrast-enhanced, electrocardiologically gated cardiac computed tomography (CT).

Interventional cardiology in Poland in 2022. Annual summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and Jagiellonian University Medical College

Siudak Zbigniew, Hawranek Michał, Kleczyński Paweł, Bartuś Stanisław, Kusa Jacek, Milewski Krzysztof, Opolski Maksymilian P., Pawłowski Tomasz, Protasiewicz Marcin, Smolka Grzegorz, Malinowski Krzysztof P., Dudek Dariusz, Grygier Marek.

The ORPKI database is endorsed by AISN PTK and is daily operated by the Jagiellonian University Medical College, with currently 154 interventional cardiology centers in Poland reporting. On 31 December 2022 there were 620 PCI operators certified by AISN PTK in Poland [1–3]. According to the current analysis of the ORPKI database, in comparison to 2021, there was a substantial (6%) increase in the total number of coronary angiography (CAG) procedures in Poland in 2022 [1]. There were 152,739 CAGs, which corresponds to 3967 per 1 million inhabitants per year in 2022. The distribution of primary diagnoses as indications for CAG was: 10% ST-elevation myocardial infarction (STEMI), 12% non-ST-elevation myocardial infarction (NSTEMI), 25% unstable angina (UA), and 53% stable angina. The radial approach was utilized in 89% of all CAG cases, which is similar to 2020 and 2021. Complications of coronary angiography in 2022 were rare and corresponded to the rates reported in previous years (Table I).