Amirali Masoumi

BackgroundInterventricular interactions may be responsible for the decline in ventricular performance observed in various disease states that primarily affect the contralateral ventricle.ObjectivesThis study sought to quantify the impact of such interactions on right ventricular (RV) size and function using clinically stable individuals with left ventricular assist devices (LVADs) as a model for assessing RV hemodynamics while LV loading conditions were acutely manipulated by changing device speed during hemodynamic optimization studies (ie, ramp tests).MethodsThe investigators recorded RV pressure-volume loops with a conductance catheter at various speeds during ramp tests in 20 clinically stable HeartMate3 recipients.ResultsWith faster LVAD speeds and greater LV unloading, indexed RV end-diastolic volume increased (72.28 ± 15.07 mL at low speed vs 75.95 ± 16.90 at high speed; P = 0.04) whereas …

BackgroundHigh-risk percutaneous coronary intervention (PCI) with mechanical circulatory support (MCS) has been associated with varying rates of bleeding due to variable bleeding definitions, incomplete data relative to site-specific bleeding, and inclusion of variable patient populations.Study Design and ObjectivesSAFE-MCS (NCT05077657) is a multicenter, single-arm, open-label study designed to evaluate the safety of complex high-risk PCI using Impella and surveillance with the Saranas Early Bird Bleed Monitoring System (EBBMS). The study aims to enroll 184 evaluable subjects at up to 15 US centers. The primary clinical end point is the incidence of access-site related BARC type III or V bleeding. Secondary clinical end points include the incidence of each of the Saranas EBBMS level 1, 2, and 3 indicators and the incidence of all BARC type III or V bleeding. Enrollment is anticipated to complete in …

PurposeLeft ventricular (LV) unloading and reduced LV pressure generation with LV assist device (LVAD) are possible causes of post-LVAD right ventricular (RV) failure. To better understand interventricular interactions in LVAD recipients, we performed RV pressure-volume (PV) analysis in HeartMate 3 recipients.MethodsWe prospectively enrolled 20 patients at 2 sites undergoing hemodynamic speed optimization studies. Speeds were ramped from 4,800 to 6,400 rpm, 200 rpm at a time with RV PV loops generated using a high-fidelity conductance catheter. Patients were divided by median value of RAP/ PCWP, which was 0.5. Interventricular interactions were assessed by plotting changes in RV morphologic and hemodynamic parameters by LVAD speed.ResultsNineteen patients had data used for analysis. The average age was 67 years (IQR 59-69.5), 80% were male, and the median duration from LVAD …

We applied the Society for Cardiovascular Angiography and Interventions (SCAI) schema to cardiogenic shock (CS) patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to assess performance in this high acuity group of patients.

Background Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions …

Background There is limited data on the impact of a second attending operator on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes. Methods We analyzed the association between multiple operators (MOs) (>1 attending operator) and procedural outcomes of 9296 CTO PCIs performed between 2012 and 2021 at 37 centers. Results CTO PCI was performed by a single operator (SO) in 85% of the cases and by MOs in 15%. Mean patient age was 64.4 ± 10 years and 81% were men. SO cases were more complex with higher Japan‐CTO (2.38 ± 1.29 vs. 2.28 ± 1.20, p = 0.005) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention scores (1.13 ± 1.01 vs. 0.97 ± 0.93, p < 0.001) compared with MO cases. Procedural time (131 [87, 181] vs. 112 [72, 167] min, p < 0.001), fluoroscopy time (49 [31, 76] vs. 42 [25, 68] min, p < 0.001), air …

(1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support between 2000 and 2019 at the Department of Cardiac Surgery (Vienna General Hospital, Austria) were included in this retrospective analysis. Blood samples were collected at several timepoints (baseline, postoperative day (POD) 1–7, POD 14 and 30). Patients were categorized according to the relative AP drop (<60% vs. ≥60%) and ECMO duration (<5 days vs. ≥5 days). (3) Overall, 44.4% reached the baseline AP values within 5 days—this was only the case for 28.6% with a higher AP drop (compared to 62.7% with a lower drop; p = 0.000). A greater AP drop was associated with a significantly higher need for renal replacement therapy (40.9% vs. 61.9%; p = 0.002) and an impaired 1-year survival (51.4% vs. 66.0%; p = 0.031). (4) CPB exceeds the negative impact of VA-ECMO; still, ECMO seems to delay alkaline phosphatase recovery. A greater initial AP drop bears the risk of higher morbidity and mortality.

BackgroundThere is limited data on the impact of a second operator on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes.MethodsWe analyzed the association between multiple operators (MO)(> 1 attending operator), and procedural outcomes of 9,296 CTO PCIs performed between 2012 and 2021 at 37 centers.ResultsCTO PCI was performed by a single operator (SO) in 85% of the cases and by MO in 15%. Mean patient age was 64.4±10 years and 81% were men. SO cases were more complex with higher Japan-CTO (2.38±1.29 vs. 2.28±1.20, p= 0.005) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores (1.13±1.01 vs. 0.97±0.93, p< 0.001) compared with cases performed by MO. Procedural times (131 [87, 181] vs. 112 [72, 167] min, p< 0.001), fluoroscopy times (49 [31, 76] vs. 42 [25, 68] min, p< 0.001), air kerma (2.32 …

ObjectiveWe sought to compare the clinical outcomes with provisional versus double-stenting strategy for left main (LM) bifurcation percutaneous coronary intervention (PCI).BackgroundDespite two recent randomized controlled trials (RCTs) and several observational reports, the optimal LM bifurcation PCI technique remains controversial.MethodsPubMed, Cochrane Central Register of Controlled-Trials (CENTRAL), Clinicaltrials.gov, International Clinical Trial Registry Platform were leveraged for studies comparing PCI bifurcation techniques for LM coronary lesions using second-generation drug eluting stents (DES). The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes of interest were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), target vessel or lesion revascularization, and stent thrombosis.ResultsTwo RCTs and 10 observational studies with …

PurposeData supporting the hypothesis that interventricular interaction contribute to right ventricular (RV) failure after left ventricular assist device (LVAD) implantation are lacking.MethodsPatients underwent a protocolized hemodynamic ramp test where RV pressure-volume (PV) loops were recorded with a conductance catheter. The end-systolic PV relationship was characterized by the ratio of end-systolic pressure and volume (Res). The end-diastolic PV relationship (EDPVR) was characterized by the V10 index (i.e., the volume at which the EDPVR reaches a pressure of 10 mmHg). ΔRes and ΔV10 (i.e., the maximal change across the range of tested LVAD speeds) were used to compare systolic and diastolic function between patients.ResultsSix adult males with HeartMate3 LVADs completed the study protocol (Fig. 1). ΔRes and ΔV10 both exhibited minimal changes in 3 subjects (mean ΔRes=7.24%, mean ΔV …

Background Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with increased risk of periprocedural complications. Estimating the risk of complications facilitates risk-benefit assessment and procedural planning. Objectives This study sought to develop risk scores for in-hospital major adverse cardiovascular events (MACE), mortality, pericardiocentesis, and acute myocardial infarction (MI) in patients undergoing CTO PCI. Methods The study analyzed the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; NCT02061436) and created risk scores for MACE, mortality, pericardiocentesis, and acute MI. Logistic regression prediction modeling was used to identify independently associated variables, and models were internally validated with bootstrapping. Results The incidence of periprocedural complications among 10,480 CTO …

Right ventricular pressure-volume (PV) analysis characterizes ventricular systolic and diastolic properties independent of loading conditions like volume status and afterload. While long-considered the gold-standard method for quantifying myocardial chamber performance, it was traditionally only performed in highly specialized research settings. With recent advances in catheter technology and more sophisticated approaches to analyze PV data, it is now more commonly used in a variety of clinical and research settings. Herein, we review the basic techniques for PV loop measurement, analysis, and interpretation with the aim of providing readers with a deeper understanding of the strengths and limitations of PV analysis. In the second half of the review, we detail key scenarios in which right ventricular PV analysis has influenced our understanding of clinically relevant topics and where the technique can be applied …

BackgroundThe characteristics and procedural outcomes of balloon undilatable lesions in chronic total occlusion percutaneous coronary intervention (CTO PCI) have received limited study.MethodsWe examined the clinical characteristics and procedural outcomes of balloon undilatable lesions in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436).ResultsOf the 6,151 CTO PCIs performed at 38 centers between 2012 and 2021, 538 (8.7%) lesions were balloon undilatable. The mean age was 67±10, 80% were men, 54% had diabetes mellitus, 71% had prior PCI, 51% had prior myocardial infarction, and 44% had prior coronary artery bypass graft surgery (Table). The CTO lesion length was estimated to be 34±23 mm, J-CTO score (2.3±1.3). Overall, cutting balloon was used in 27% with scoring balloon (14%), laser (15%), rotational atherectomy (28%), orbital …

Background An upfront (primary) retrograde strategy is often used in complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We examined the clinical, angiographic characteristics, and procedural outcomes of CTO PCIs that were approached with a primary retrograde strategy in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS‐CTO, NCT02061436). Results Of 10,286 CTO PCIs performed between 2012 and 2022, a primary retrograde strategy was used in 1329 (13%) with an initial technical success of 66%, and a final success of 83%. Patients who underwent successful versus unsuccessful primary retrograde cases had similar characteristics: age (65 ± 10 vs. 65 ± 9, years, p = 0.203), men (83% vs. 87%, p = 0.066), prior PCI (71% vs. 71%, p = 0.809), and prior coronary artery bypass graft surgery (52% vs. 53%, p = 0.682). The …

BackgroundThe use of retrograde crossings in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) provides higher technical success rates in CTO-PCI. However, the use of epicardial collaterals carries a higher complication risk.Methods and resultsIn this study, we aimed to investigate the temporal trends in retrograde crossing of epicardial collaterals, introduction of new guidewires, in-hospital major adverse cardiovascular events (MACE), and technical success rates in a large, multinational registry. We demonstrate that technical success rates increased substantially from about 5%-10% to 76% in the past decade without a concomitant increase in MACE rate (~ 3% to 4%), likely associated with increased operator experience and introduction of new guidewires. In addition, we show that while high-volume centers have higher technical success, they also have higher perforation rates.

BackgroundThere are numerous risk-prediction models applied to acute myocardial infarction–related cardiogenic shock (AMI-CS) patients to determine a more accurate prognosis and to assist in patient triage. There is wide heterogeneity among the risk models including the nature of predictors evaluated and their specific outcome measures. The aim of this analysis was to evaluate the performance of 20 risk-prediction models in AMI-CS patients.MethodsPatients included in our analysis were admitted to a tertiary care cardiac intensive care unit with AMI-CS. Twenty risk-prediction models were computed utilizing vitals assessments, laboratory investigations, hemodynamic markers, and vasopressor, inotropic and mechanical circulatory support available from within the first 24 ​hours of presentation. Receiver operating characteristic curves were used to assess the prediction of 30-day mortality. Calibration was …

Ischaemic papillary muscle rupture causing acute severe mitral regurgitation (MR) has a dramatic presentation and a very high mortality. Emergent surgical repair improves outcomes, which necessitates robust preoperative stabilisation. Here we discuss a patient with cardiogenic shock with an acute severe MR that was deemed very high risk for emergent valve replacement due to haemodynamic instability and respiratory failure. A percutaneous left ventricular assist device Impella 2.5 (Abiomed, Danvers, MA) drastically improved clinical status, and the patient underwent a successful surgical mitral valve replacement soon after placement of the temporary assist device. Our case highlights that percutaneous ventricular assist devices may help to stabilise patients with severe acute ischaemic MR, and it can serve as a bridge to surgery in high risk patients.

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) following acute myocardial infarction with cardiogenic shock (AMI-CS) is increasing, but the ability to predict favorable outcomes with support remains limited. We retrospectively reviewed all patients with AMI-CS supported with VA-ECMO between December 2008 and June 2018. One hundred twenty-six patients received VA-ECMO for AMI-CS during the study period; of these, 39 (31.0%) experienced ventricular recovery and were discharged while 87 (69.0%) did not recover, with 71 (56.3%) dying in the hospital and 16 (12.7%) surviving to discharge with either left ventricular assist device or heart transplant. TIMI 3 flow in culprit artery (OR, 4.01; 95% CI, 1.25–12.77; p= 0.02), serum lactate (OR, 0.89; 95% CI, 0.80–0.99; p= 0.04), and prompt revascularization (OR, 3.39; 95% CI, 1.18–9.81; p= 0.02) were independent predictors of ventricular …

MethodsWe analyzed the association between IVUS utilization and procedural outcomes of 8,983 CTO PCIs performed in 8,771 patients between 2012 and January 2022 at 39 centers.ResultsOverall, IVUS was used in 44.5% of the cases, for crossing in 11.5% and for stent optimization in 33.1%. Mean patient age was 64.4±10 years and 81% were men. IVUS for stent optimization was used more often for complex lesions with higher prevalence of calcification (51.2% vs. 34.3%, p< 0.001) and in-stent restenosis (19.2% vs. 15.1%, p< 0.001) and was associated with longer procedure time (138 [95, 195] vs. 102 [66, 151] min, p< 0.001) lower air kerma radiation dose (1.78 [1.00, 3.09] vs. 2.30 (1.35, 3.91) min, p< 0.001) and contrast volume (190 [138, 258] vs. 220 [160, 300] ml, p< 0.001). Among cases with successful guidewire crossing, those that used IVUS for stent optimization had higher technical (99.3% vs. 96.3 …

Background:In patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF), surgical revascularization improves survival and cardiovascular (CV) outcomes compared to medical treatment only. We evaluated the effect of multivessel percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on change in global longitudinal strain (GLS) and left ventricular ejection fraction (EF).Methods:Patients with baseline EF< 45% and multivessel CAD who underwent either CABG or PCI were retrospectively analyzed. Those with prior CABG, or without pre-and post-procedure echocardiograms were excluded. Primary efficacy endpoints were change in GLS and EF at follow-up echo within 1 year. Primary safety endpoints were five-year rates of CV mortality and target vessel revascularization (TVR).Results:A total of 83 PCI and 98 CABG patients were included. The …