Daily Cardiology Research Analysis

BACKGROUND: Impaired flow following percutaneous coronary intervention (PCI) is a known predictor of adverse outcomes. The pullback pressure gradient (PPG) is a novel physiological metric that differentiates focal from diffuse disease and enables prediction of post-PCI fractional flow reserve (FFR). This post hoc analysis of the PPG Global (NCT04789317) study aimed to evaluate the prognostic performance of a PPG model for predicting post-PCI FFR and to determine whether the predicted physiological outcome is associated with adverse events following PCI. METHODS: Prospective and multicenter study including patients with hemodynamically significant coronary artery disease undergoing PCI. A prediction model based on FFR and PPG was used to estimate post-PCI FFR. Based on the predicted values, vessels were classified as having either optimal or suboptimal post-PCI physiology. The primary end point was target vessel failure at 1 year. Target vessel failure was defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization. RESULTS: A total of 855 patients (890 vessels) were analyzed. The mean difference between predicted and measured post-PCI FFR was 0.001 (limits of agreement, -0.10 to 0.10). There was a strong correlation between predicted and measured delta FFR ( CONCLUSIONS: PPG-predicted post-PCI physiology was associated with target vessel failure at 1 year. These findings extend the role of coronary physiology beyond diagnostic assessment to include risk stratification and outcome prediction following PCI.

BACKGROUND: Calcium scoring from noncontrast computed tomography (CT) is used clinically to adjudicate aortic stenosis severity in patients with discordant echocardiography. OBJECTIVES: The aim of this study was to investigate whether quantification of aortic valve calcium volume from computed tomography angiography (CTA) can provide robust diagnostic discrimination of disease severity and inform risk stratification of patients with aortic stenosis. METHODS: Patients with mild to severe aortic stenosis who underwent concurrent CTA and echocardiography were included in a retrospective international multicenter observational cohort study. Accuracy of aortic valve calcium volume to diagnose severe aortic stenosis in patients with concordant disease on echocardiography was assessed. Association of aortic valve calcium volume with the incidence of aortic valve replacement or all-cause death was investigated. RESULTS: The study included 1,521 patients (mean age: 74 ± 10 years; 44% female; median peak aortic jet velocity: 3.8 m/s [Q1-Q3: 3.1-4.5 m/s]). Indexed aortic valve calcium volume correlated with peak aortic jet velocity (ρ = 0.723; P < 0.001) and noncontrast CT calcium score (ρ = 0.896; P < 0.001). In the derivation cohort (n = 689), sex-specific thresholds for indexed calcium volume (men: 122 mm CONCLUSIONS: In patients with aortic stenosis, indexed aortic valve calcium volume from CTA provides accurate discrimination of disease severity and additive prognostic information. This technique can be easily applied to patients undergoing CTA for transcatheter aortic valve replacement or coronary artery evaluation without the need for a separate noncontrast CT scan.

BACKGROUND: Iron deficiency (ID) is common in patients with heart failure (HF), but optimal use of circulating iron indices as diagnostic criteria and for defining treatment targets remain uncertain. OBJECTIVES: This study sought how to determine how individual iron studies, and different definitions of iron deficiency, relate to functional capacity, hemoglobin levels, and outcomes in the largest study to date of iron repletion in HF. METHODS: The HEART-FID (Ferric Carboxymaltose in Heart Failure with Iron Deficiency) trial evaluated ferric carboxymaltose vs placebo in patients with HF with a left ventricular ejection fraction ≤40% and ID defined as ferritin <100 ng/mL or <300 ng/mL with transferrin saturation (Tsat) <20%. We assessed ferritin levels and alternative definitions of ID (serum iron level <13 μM, Tsat <20% in isolation), and continuous measures of iron indices, in relation to functional capacity, hemoglobin levels, and prognosis by multivariable regression. RESULTS: By trial design, all patients with complete iron studies at baseline (N = 2,951) had ferritin levels <100 or <300 ng/mL with Tsat <20%. Although 89.8% of participants had ferritin <100 ng/mL, only 59.8% had iron <13 μM, 40.5% had Tsat <20%, and 31.1% had ferritin <30 ng/mL. Tsat <20% and iron <13 μM were associated with lower baseline levels of hemoglobin, worse NYHA functional class, shorter 6-minute walk distance (6MWD), and worse outcomes. In contrast, these measures differed minimally within ferritin strata. Tsat and iron levels remained associated with hemoglobin levels and 6MWD after multivariable adjustment and changes in Tsat and iron levels over 6 months related to changes in hemoglobin level and 6MWD. CONCLUSIONS: Patients with HF demonstrate wide variability in fulfillment of various diagnostic criteria for ID. Despite ferritin <100 ng/mL being the most common ID criteria met in HEART-FID, Tsat and iron and their changes over time, more than ferritin, were related to functional capacity, hemoglobin levels, and prognosis. Our results support prioritization of Tsat and iron levels in defining iron deficiency in HF (Randomized Placebo-controlled Trial of FCM as Treatment for Heart Failure With Iron Deficiency and Sub-Study [HEART-FID]; NCT03037931).