Abstract
OBJECTIVES: The aim of the current study was to estimate adverse event rates while awaiting myocardial revascularization and review criteria for prioritizing patients.
METHODS: A PubMed ...search was performed on 19 January 2015, to identify English-language, original, observational studies reporting adverse events while awaiting coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Rates of death, non-fatal myocardial infarction (MI) and emergency revascularization were calculated as occurrence rates per 1000 patient-weeks and pooled using random-effects models.
RESULTS: The search yielded 1323 articles, of which 22 were included with 66 410 patients and 607 675 patient-weeks on the wait list. When awaiting CABG, rates per 1000 patient-weeks were 1.1 95% confidence interval 0.9–1.3 for death, 1.0 0.6–1.6 for non-fatal MI and 1.8 0.8–4.1 for emergency revascularization. Subgroup analyses demonstrated consistent outcomes, and sensitivity analyses demonstrated comparable event rates with low heterogeneity. Higher urgency of revascularization was based primarily on angiographic complexity, angina severity, left ventricular dysfunction and symptoms on stress testing, and such patients with a semi-urgent status had a higher risk of death than patients awaiting elective revascularization (risk ratio at least 2.8). Individual studies identified angina severity and left ventricular dysfunction as most important predictors of death when awaiting CABG. Adverse rates per 1000 patient-weeks for patients awaiting PCI were 0.1 95% confidence interval 0.0–0.4 for death, 0.4 0.1–1.2 for non-fatal MI and 0.7 0.4–1.4 for emergency revascularization but were based on only a few old studies.
CONCLUSIONS: Rates of death, non-fatal MI and emergency revascularization when awaiting myocardial revascularization are infrequent but higher in specific patients. Countries that not yet have treatment recommendations related to waiting times should consider introducing a maximum to limit adverse events, particularly when awaiting CABG.
The aim of this study was to evaluate and compare the outcomes of transcatheter self-expandable prostheses in patients with small annuli.
Transcatheter aortic heart valves appear to have better ...performance than surgical valves in terms of prosthesis-patient mismatch, especially in patients with aortic stenosis with small aortic annuli.
TAVI-SMALL (International Multicenter Registry to Evaluate the Performance of Self-Expandable Valves in Small Aortic Annuli) is a retrospective registry of patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm
on computed tomography) treated with transcatheter self-expandable valves (n = 859; Evolut R, n = 397; Evolut PRO, n = 84; ACURATE, n = 201; Portico, n = 177). Primary endpoints were post-procedural mean aortic gradient, indexed effective orifice area, and rate of severe prosthesis-patient mismatch.
Pre-discharge gradients were consistently low in every group, with a slight benefit with the Evolut R (8.1 mm Hg; 95% confidence interval CI: 7.7 to 8.5 mm Hg) and Evolut PRO (6.9 mm Hg; 95% CI: 6.3 to 7.6 mm Hg) compared with the ACURATE (9.6 mm Hg; 95% CI: 8.9 to 10.2 mm Hg) and Portico (8.9 mm Hg; 95% CI: 8.2 to 9.6 mm Hg) groups (p < 0.001). Mean indexed effective orifice area was 1.04 cm
/m
(95% CI: 1.01 to 1.08 cm
/m
) with a trend toward lower values with the Portico. No significant differences were reported in terms of severe prosthesis-patient mismatch (overall rate 9.4%; p = 0.134), permanent pacemaker implantation (15.6%), and periprocedural and 1-year adverse events. Pre-discharge more than mild paravalvular leaks were significantly more common with the Portico (19.2%) and less common with the Evolut PRO (3.6%) compared with the Evolut R (11.8%) and ACURATE (9%) groups.
Transcatheter self-expandable valves showed optimal clinical and echocardiographic results in patients with small aortic annuli, although supra-annular functioning transcatheter heart valves seemed to slightly outperform intra-annular functioning ones. The role of transcatheter aortic valve replacement with self-expandable valves for the treatment of aortic stenosis in patients with small annuli needs to be confirmed in larger trials.
Abstract
A previous Task Force of the European Society of Cardiology (ESC) and European Association of Percutaneous Cardiovascular Interventions (EAPCI) provided a report on recommendations for the ...non-clinical and clinical evaluation of coronary stents. Following dialogue with the European Commission, the Task Force was asked to prepare an additional report on the class of devices known as bioresorbable scaffolds (BRS). Five BRS have CE-mark approval for use in Europe. Only one device—the Absorb bioresorbable vascular scaffold—has published randomized clinical trial data and this data show inferior outcomes to conventional drug-eluting stents (DES) at 2–3 years. For this reason, at present BRS should not be preferred to conventional DES in clinical practice. The Task Force recommends that new BRS devices should undergo systematic non-clinical testing according to standardized criteria prior to evaluation in clinical studies. A clinical evaluation plan should include data from a medium sized, randomized trial against DES powered for a surrogate end point of clinical efficacy. Manufacturers of successful devices receive CE-mark approval for use and must have an approved plan for a large-scale randomized clinical trial with planned long-term follow-up.
Background:
Recent measurements of fusion cross sections for the
28
Si
+
28
Si system revealed a rather
unsystematic behavior; i.e., they drop faster near the barrier than at lower energies. This was ...tentatively attributed
to the large oblate deformation of
28
Si because coupled-channels (CC) calculations largely underestimate the
28
Si
+
28
Si cross sections at low energies, unless a weak imaginary potential is applied, probably simulating
the deformation.
30
Si has no permanent deformation and its low-energy excitations are of a vibrational nature.
Previous measurements of this system reached only 4 mb, which is not sufficient to obtain information on effects
that should show up at lower energies.
Purpose:
The aim of the present experiment was twofold: (i) to clarify the underlying fusion dynamics by
measuring the symmetric case
30
Si
+
30
Si in an energy range from around the Coulomb barrier to deep sub-barrier
energies, and (ii) to compare the results with the behavior of
28
Si
+
28
Si involving two deformed nuclei.
Methods:
30
Si beams from the XTU tandem accelerator of the Laboratori Nazionali di Legnaro of the Istituto
Nazionale di Fisica Nucleare were used, bombarding thin metallic
30
Si targets (50
µ
g
/
cm
2
) enriched to 99
.
64%
in mass 30. An electrostatic beam deflector allowed the detection of fusion evaporation residues (ERs) at very
forward angles, and angular distributions of ERs were measured.
Results:
The excitation function of
30
Si
+
30
Si was measured down to the level of a few microbarns. It has a
regular shape, at variance with the unusual trend of
28
Si
+
28
Si. The extracted logarithmic derivative does not
reach the
L
CS
limit at low energies, so that no maximum of the
S
factor shows up. CC calculations were performed
including the low-lying 2
+
and 3
-
excitations.
Conclusions:
Using a Woods-Saxon potential the experimental cross sections at low energies are overpredicted,
and this is a clear sign of hindrance, while the calculations performed with a M3Y + repulsion potential nicely
fit the data at low energies, without the need of an imaginary potential. The comparison with the results for
28
Si
+
28
Si strengthens the explanation of the oblate shape of
28
Si being the reason for the irregular behavior of
that system.
Peer Reviewed
In this contribution, we discuss the modeling of cylindrical Huygens metasurfaces wrapping linear antennas through the array antenna theory. In particular, it is shown that the circular array pattern ...synthesis can be efficiently exploited to model conformal metasurfaces used for wavefront manipulation in view of beamforming applications. By considering the metasurface unit-cells as the equivalent radiating sources of a circular array, the shape of the emerging radiation pattern is accurately predicted. The proposed approach is validated through several examples where the radiation patterns are modified acting on the excitation phases of the equivalent circular array sources, and are compared with full-wave numerical simulations considering ideal coating metasurfaces designed with conventional techniques. This innovative design strategy allows to further expands the possibility enabled by metasurface coatings in radiation pattern manipulation, potentially improving the functionality of metasurfaces through full control over the radiation characteristics.
Recent measurements of fusion cross sections for the 28Si + 28Si system revealed a rather unsystematic behavior; i.e., they drop faster near the barrier than at lower energies. This was tentatively ...attributed to the large oblate deformation of 28Si because coupled-channels (CC) calculations largely underestimate the 28Si + 28Si cross sections at low energies, unless a weak imaginary potential is applied, probably simulating the deformation. 30Si has no permanent deformation and its low-energy excitations are of a vibrational nature. Here, previous measurements of this system reached only 4 mb, which is not sufficient to obtain information on effects that should show up at lower energies.
The aim of this study was to assess the performance of a self-expanding valve in bicuspid aortic valve (BAV) stenosis.
An international registry included a total of 712 patients with aortic stenosis ...treated with the ACURATE neo in bicuspid (n=54; 7.5%) or tricuspid (n=658; 92.4%) anatomy. The overall mean age was 81±5.6 years. At baseline, no significant differences were found between the two groups. BAV more frequently required both predilatation (94.4% vs. 78.1%, p=0.004) and post-dilation (57.4% vs. 38.7%, p=0.007). Moderate perivalvular regurgitation was more frequently found in patients with BAV (7.4% vs. 3.18%, p=0.0001). After propensity score matching (PSM), the rate of predilation and post-dilation was confirmed to be higher in the BAV group (94.4% vs. 66.6%, p=0.001, and 57.4% vs. 37.1%, p=0.034, respectively), while the incidence of moderate perivalvular regurgitation was similar between the two groups (BAV 3.1% vs. 5.5% in tricuspid anatomy, p=0.734). In unmatched cohorts, the 30-day outcome showed a higher rate of stroke in the BAV group (7.4% vs. 1.8%, p=0.001). After adjustment for PSM quintiles, the rate of stroke resulted in being similar (odds ratioadj 1.20, 95% confidence interval CI: 0.81-1.76, p=0.819). The other 30-day clinical endpoints were similar between the two populations.
This preliminary analysis shows that the use of the ACURATE neo in bicuspid aortic valves is feasible and has acceptable 30-day outcomes. Larger studies are needed to confirm our preliminary findings.
Measurements of the excitation function for the fusion of Mg-24 + Si-30 (Q = 17.89 MeV)have been extended toward lower energies with respect to previous experimental data. The S-factor maximum ...observed in this large, positive-Q-value system is the most pronounced among such systems studied thus far. The significance and the systematics of an S-factor maximum in systems with positive fusion Q values are discussed. This result would strongly impact the extrapolated cross sections and reaction rates in the carbon and oxygen burnings and, thus, the study of the history of stellar evolution.
Heart failure (HF) encompasses a diverse clinical spectrum, including instances of transient HF or HF with recovered ejection fraction, alongside persistent cases. This dynamic condition exhibits a ...growing prevalence and entails substantial healthcare expenditures, with anticipated escalation in the future. It is essential to classify HF patients into three groups based on their ejection fraction: reduced (HFrEF), mid-range (HFmEF), and preserved (HFpEF), such as for diagnosis, risk assessment, treatment choice, and the ongoing monitoring of heart failure. Nevertheless, obtaining a definitive prediction poses challenges, requiring the reliance on echocardiography. On the contrary, an electrocardiogram (ECG) provides a straightforward, quick, continuous assessment of the patient's cardiac rhythm, serving as a cost-effective adjunct to echocardiography. In this research, we evaluate several machine learning (ML)-based classification models, such as K-nearest neighbors (KNN), neural networks (NN), support vector machines (SVM), and decision trees (TREE), to classify left ventricular ejection fraction (LVEF) for three categories of HF patients at hourly intervals, using 24-hour ECG recordings. Information from heterogeneous group of 303 heart failure patients, encompassing HFpEF, HFmEF, or HFrEF classes, was acquired from a multicenter dataset involving both American and Greek populations. Features extracted from ECG data were employed to train the aforementioned ML classification models, with the training occurring in one-hour intervals. To optimize the classification of LVEF levels in coronary artery disease (CAD) patients, a nested cross-validation approach was employed for hyperparameter tuning. HF patients were best classified using TREE and KNN models, with an overall accuracy of 91.2% and 90.9%, and average area under the curve of the receiver operating characteristics (AUROC) of 0.98, and 0.99, respectively. Furthermore, according to the experimental findings, the time periods of midnight-1 am, 8-9 am, and 10-11 pm were the ones that contributed to the highest classification accuracy. The results pave the way for creating an automated screening system tailored for patients with CAD, utilizing optimal measurement timings aligned with their circadian cycles.
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