Journals
2025 EN
Atlıhan Yusuf Samet · Ün Aleyna Öztüzün · Balaban Hazal Tuzcu
+4 more
ABSTRACT Endotoxin‐induced uveitis (EIU) is a well‐established model for acute ocular inflammation and mimics aspects of human uveitis. Tauroursodeoxycholic acid (TUDCA), a bile acid with known anti‐inflammatory and cytoprotective properties, may attenuate retinal injury by targeting endoplasmic reticulum (ER) stress and apoptosis. This study investigates the protective effects of TUDCA in both in vivo and in vitro EIU models. EIU was induced in male Wistar rats by intravitreal injection of lipopolysaccharide (LPS), with or without prior intraperitoneal TUDCA administration. ARPE‐19 cells were used to model retinal pigment epithelial stress in vitro. Ocular inflammation was assessed clinically and histologically. Immunostaining and immunofluorescence quantified ER stress marker Glucose‐Regulated Protein 78 (GRP78), caspase‐3, caspase‐12, and apoptosis. Caspase‐3 activity and TUNEL assays evaluated apoptotic response. TUDCA pretreatment significantly reduced LPS‐induced ocular inflammation and retinal thickening in rats. In ARPE‐19 cells, TUDCA restored LPS‐compromised viability and mitigated morphological damage. Both models showed reduced expression of GRP78, caspase‐3, and caspase‐12 following TUDCA administration. TUNEL and caspase‐3 activity assays confirmed that TUDCA decreased apoptosis in retinal tissues and cultured cells. The findings demonstrate that TUDCA effectively suppresses ER stress and apoptosis pathways activated during endotoxin‐induced retinal inflammation. Its dual anti‐inflammatory and cytoprotective actions support its therapeutic potential in acute ocular inflammatory conditions. TUDCA attenuates clinical, histological, and molecular manifestations of LPS‐induced uveitis, highlighting its promise as a candidate for adjunctive therapy in inflammatory retinal diseases.
Journals
2025 EN
Çamlı Babayiğit Ezgi · Çağrı Kaya İbrahim · Özgeyik Mehmet
+1 more
ABSTRACT Iatrogenic coronary ostial stenosis (ICOS) is a rare but life‐threatening complication of aortic root surgery. It can occur with the incidence of 0.3%–5% and affect more commonly the left main coronary artery (LMCA) compared to the right coronary artery (RCA). Here, we present a case of non‐ST‐elevation myocardial infarction that occurred after a Bentall aortic root replacement, due to compression of the left main ostium, which was effectively treated with percutaneous coronary intervention.
Journals
2025 EN
Dodoo Sheriff N. · Ibrahim Sammudeen · Osman AbdulFatawu
+13 more
ABSTRACT Background Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are adjunctive intracoronary imaging modalities used to optimize coronary stent implantation. However, the impact of OCT versus IVUS on clinical outcomes and periprocedural complications is unclear. Aims To perform a meta‐analysis of all vetted randomized controlled trials comparing OCT‐guided versus IVUS‐guided percutaneous coronary intervention. Methods We queried MEDLINE, Cochrane Library, Scopus, and clinicalTrials.gov databases from their commencement to February 2024 for all randomized controlled trials that compared OCT‐guided versus IVUS‐guided percutaneous coronary interventions. The primary endpoint was major adverse periprocedural events (MAPE), a composite of stent thrombosis (ST), distal embolization (DE), and distal edge dissection (DED) at 30 days. The secondary endpoints included ST, DE, DED, major adverse cardiac events (MACE)—(a composite of cardiac death, target vessel myocardial infarction TVMI], and target vessel revascularization [TVR]), all‐cause mortality, cardiac death, TVMI, TVR, and nonfatal stroke at 1 year. The odds ratio (OR) with a 95% confidence interval (CI) was analyzed using a random‐effect model. Results Seven randomized controlled trials were included in the analysis, and 4446 patients were enrolled. OCT was associated with lower MAPE (OR: 0.65, CI: 0.47–0.91, p = 0.01) compared to IVUS. ST, DE, and DED were similar between OCT and IVUS at 30 days. There were no significant differences in MACE (OR: 0.86, CI: 0.64–1.16, p = 0.32), all‐cause mortality (OR: 0.83, CI: 0.42–1.66, p = 0.60), Cardiac death (OR:0.62, CI: 0.20–1.89, p = 0.40), TVMI (OR: 0.69, CI: 0.33–1.46, p = 0.33), TVR, (OR: 1.09, CI: 0.70–1.71, p = 0.70), and Nonfatal stroke (OR: 1.82, CI: 0.67–4.95, p = 0.24) 1 year following the index procedure. Conclusion Optical coherence tomographic‐guided PCI was associated with lower MAPE, defined as a composite of ST, DE, and DED, compared to IVUS‐guided PCI at 30 days of the index procedure. However, there was no difference in overall MACE, TVMI, TVR, and nonfatal stroke at 1 year.
Journals
2025 EN
Tekin Meltem · Güler Gamze Babur · Çiçek Mehmet
+9 more
ABSTRACT Background Clinically significant paravalvular leak (PVL) may complicate both surgical and transcatheter valve implantation. Percutaneous PVL closure (PPVLC) is becoming an increasingly attractive alternative to redo surgery, with demonstrated lower mortality and morbidity rates. Echocardiographic techniques are crucial for accurate diagnosis, defect sizing, and determining the appropriate size of the sealing devices. Aims There is no consensus on the optimal imaging modality for PVLs. We aimed to compare transthoracic and transesophageal echocardiographic measurements to accurately determine defect size and estimate device size. Methods We reviewed hospital records to identify patients diagnosed with moderate to severe and severe PVL from 2018 to 2024. A total of 81 patients who underwent PPVLC were evaluated. Eight of these patients were excluded due to unsuccessful PPVLC, leaving 73 patients who were successfully treated. The defect size for all patients was evaluated using 2D transthoracic echocardiography (TTE), 2D transesophageal echocardiography (TEE), direct 3D TEE cropped volume rendering vena contracta (VC) measurement, and 3D TEE multiplanar reconstruction (3D TEE MPR). Results Among the 73 patients, 42 underwent aortic PPVLC and 31 underwent mitral PPVLC. Proportional odds logistic regression analysis identified 3D TEE MPR measurement as the strongest predictor of device size accuracy, both overall and within the aortic/mitral subgroups. In the mitral subgroup, the predictive power of direct 3D TEE cropped volume rendering VC measurement and 3D TEE MPR measurement were similar. Furthermore, a cut‐off value of 7 mm was identified for hemodynamically significant jets as measured by 3D methods. Conclusion Our findings suggest that using 3D TEE MPR significantly improves the accuracy of device size selection in both mitral and aortic PVL. Additionally, direct 3D TEE cropped volume rendering VC measurement can serve as a viable alternative for patients with mitral PVL.
Journals
2025 EN
Ibrahim Ahmed · Shalabi Laila · Zreigh Sofian
+8 more
ABSTRACT Background Left atrial appendage occlusion (LAAO) is an alternative to chronic oral anticoagulation (OAT) for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients with contraindications to OAT. Postprocedure antithrombotic therapy (ATT) is essential to reduce the risk of device‐related thrombosis (DRT), but the optimal regimen remains uncertain. Aims This study aims to compare the safety and efficacy of low‐dose direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT) following LAAO. Methods A comprehensive search of PubMed, Scopus, Cochrane, and Web of Science was conducted in August 2024. Studies comparing low‐dose DOACs and DAPT post‐LAAO were included. The primary outcomes were a composite efficacy endpoint (DRT, strokes, and systemic embolism [SE]) and major bleeding events as the safety endpoint. Secondary outcomes included all bleeding events, all‐cause mortality, and a composite of efficacy and safety endpoints. Results Four studies with 727 patients were included. Low‐dose DOACs were associated with lower rates of the primary composite efficacy endpoint compared to DAPT (OR = 0.36; 95% CI [0.16, 0.85], p = 0.01). No significant difference in major bleeding events was observed (OR = 0.36; 95% CI [0.11, 1.18]; p = 0.091; I ² = 0%). Compared to DAPT, low‐dose DOACs were also associated with lower rates of DRT events (OR = 0.36; 95% CI [0.16, 0.79], p = 0.011). Conclusion Low‐dose DOACs effectively reduce thromboembolic events post‐LAAO without increasing bleeding risk. These findings support their use as a viable ATT option, but larger trials are needed to confirm optimal regimens.
Journals
2025 EN
Hoek Roel · Winter Ruben W. · Peters Rens T.
+10 more
ABSTRACT Background Revascularization decision‐making for saphenous vein grafts (SVGs) relies on angiographic lesion severity estimation, as studies on fractional flow reserve (FFR) for detecting ischemia in SVGs are scarce. Aims To compare FFR and quantitative coronary angiography (QCA) of SVGs against myocardial perfusion imaging (MPI) and to establish an optimal FFR threshold for SVGs. Methods This cross‐sectional registry study included symptomatic patients with prior coronary artery bypass grafting who underwent single‐photon emission computed tomography, positron emission tomography, or stress perfusion cardiac magnetic resonance imaging and had FFR measurements of ≥ 1 SVGs. We matched the myocardial territory supplied by the SVGs to ischemia on MPI. The optimal FFR threshold for SVGs was determined using the Youden index. Diagnostic performance measures were calculated and compared for FFR (0.80 and the optimal threshold) and for QCA (diameter stenosis ≥ 50%). Results This study included 80 patients (mean age 73 ± 7 years, 68 [85%] male) with 94 SVGs, of which 38 (40%) supplied ischemic myocardium. Areas under the curve between FFR and QCA were comparable (0.73 vs. 0.65, p = 0.181). The optimal cutoff value of FFR was 0.94. FFR ≤ 0.94 showed higher sensitivity (63%) and negative predictive value (75%) compared to FFR ≤ 0.80 (32% [ p < 0.001] and 64% [ p = 0.007]) and QCA (37% [ p = 0.002] and 65% [ p = 0.021]), but with lower specificity (75%) than FFR ≤ 0.80 (84%, p = 0.021). Positive predictive value and overall accuracy were similar across all methods. Conclusions FFR and QCA had comparable moderate diagnostic performance for detecting SVG failure determined by MPI. The optimal FFR cutoff in SVGs is higher than 0.80, resulting in higher sensitivity and negative predictive value compared to FFR ≤ 0.80 and QCA, at the expense of reduced specificity.
Journals
2025 EN
Hoek Roel · Porouchani Sina · Winter Ruben W.
+11 more
ABSTRACT Background The relationship between height differences related to graft anatomy and physiological pressure indices in coronary bypass grafts has not been studied. We sought to study the impact of hydrostatic pressure on fractional flow reserve (FFR) in saphenous vein grafts (SVGs). Methods Included were 66 symptomatic patients (76 SVGs) with prior coronary artery bypass grafting who underwent coronary computed tomography angiography (CCTA) preceding invasive coronary angiography with FFR interrogation of ≥ 1 SVGs. The graft course and height excursion were reconstructed based on CCTA images. The impact of hydrostatic pressure on FFR (corrected FFR) was calculated by adding or subtracting 0.077 mmHg to the distal coronary pressure for every millimeter height difference in a supine position between the SVG ostium and the pressure wire tip position. Results The height difference (mm) between the SVG ostium and pressure wire tip position was largest for single SVGs to the circumflex artery (Cx; −55.1 ± 17.0), followed by sequential SVGs to the Cx (−51.8 ± 17.3) and the right coronary artery (RCA; −36.7 ± 21.6). The correlation between height difference and uncorrected FFR was −0.59 ( p < 0.001). Corrected FFR was lower as compared to uncorrected FFR in the overall cohort (0.86 ± 0.17 vs. 0.88 ± 0.18), in single SVGs to Cx (0.85 ± 0.17 vs. 0.90 ± 0.18), and in sequential SVGs to Cx (0.92 ± 0.14 vs. 0.96 ± 0.15) and RCA (0.82 ± 0.17 vs. 0.85 ± 0.21) ( p < 0.001 for all). Conclusions Hydrostatic pressure related to height differences along the course anatomy of SVGs can impact FFR measurements, with corrected FFR being significantly lower in SVGs to the Cx and sequential SVGs to the RCA.
Journals
2025 EN
Antoun Ibrahim · Helal Ayman · Wassef Nancy
+1 more
ABSTRACT Headache is a rare yet clinically significant presentation of ischaemic heart disease (IHD). While chest pain is the hallmark symptom of myocardial ischaemia (MI), some patients present with atypical symptoms, such as headaches, which lead to diagnostic challenges and potential delays in treatment. This case series highlights the diagnostic complexity and clinical significance of headache‐predominant presentations of both acute and chronic coronary syndromes, emphasizing the need for a comprehensive differential diagnosis in patients with cardiovascular risk factors. We present two cases where headache was the primary symptom of MI. The first case describes an acute ischaemic event wherein the headache preceded the onset of classic cardiac symptoms, leading to the identification of an occluded obtuse marginal artery. This was the second case in our institution where a previous patient presented with exertion‐induced headaches, ultimately diagnosed as a chronic total occlusion of the left anterior descending (LAD) artery, which was successfully revascularised. Two years later, the same patient re‐presented with acute coronary syndrome secondary to disease in a different coronary artery and his presentation was solely with headache. Both cases were successfully managed with percutaneous revascularisation, resulting in the resolution of symptoms and reinforcing the link between headache and CAD. These cases underscore the importance of considering ACS and chronic stable angina in patients presenting with unexplained headaches, particularly when symptoms are exertional or pressure‐like. Early cardiac assessment, including ECG and further imaging when indicated, is essential for timely intervention. Raising the awareness of exertional headache as a potential ischaemic symptom may facilitate earlier diagnosis and prevent adverse outcomes. Further research is required to elucidate the mechanisms underlying headaches in MI and refine diagnostic approaches for atypical cardiac presentations.
Journals
2025 EN
Ali Momen · Helal Ayman · ElDin Mohammad
+1 more
ABSTRACT Kounis syndrome (KS) is a rare condition characterized by acute coronary syndrome (ACS) triggered by an allergic reaction. This report presents a case of high‐risk ACS associated with a food allergy. A 53‐year‐old male with no prior medical history presented to the emergency department with itching, facial swelling, chest tightness, shortness of breath, and presyncope after consuming peanut butter and grapefruit juice. His past medical history included an allergy to codeine/paracetamol, causing angioedema. Initial vitals were stable, and examination revealed minimal lip swelling, a pruritic rash, and clear auscultation. A baseline electrocardiogram (ECG) demonstrated subtle ST‐segment depression with T‐wave inversion in inferior leads, which progressed to significant ST depression and deep T‐wave inversion. Serial troponin levels showed a significant rise (20.2 to 39.2 ng/L). Coronary angiography revealed no significant coronary artery disease. Cardiac magnetic resonance (CMR) excluded myocardial infarction or fibrosis. The patient was diagnosed with KS based on clinical presentation, dynamic ECG changes, and elevated troponins in the absence of obstructive coronary artery disease. Management included antihistamines, steroids, nitroglycerin, and standard acute coronary syndrome treatment. He was discharged on oral antihistamines after a brief coronary care unit observation.
Journals
2025 EN
Asfour Ahmed Mohamed Shawky · Ibrahim Mohamed Osman · Mashhour Karim Salem
+2 more
ABSTRACT Background Myocardial infarction (MI) is a major global cause of morbidity and mortality. Reperfusion therapy in acute MI reduces mortality, but microvascular obstruction (MVO) may persist. Tirofiban improves myocardial perfusion by inhibiting platelet aggregation. Aims This study aims to compare intracoronary tirofiban delivery via guiding catheter versus aspiration catheter on MVO and myocardial salvage in ST‐segment elevation MI (STEMI) patients undergoing PCI. Methods In this randomized study, 118 STEMI patients were classified into two groups: Group A ( n = 56) received tirofiban via guiding catheter, and Group B ( n = 62) via aspiration catheter. Cardiac MRI assessed MVO%, myocardial salvage index, and left ventricular function. Major adverse cardiovascular events (MACE) were monitored for 6 months. Results Patients receiving tirofiban via aspiration catheter had a significantly lower median MVO (0.8% vs. 2.5%, p < 0.001) and a higher myocardial salvage index (56.1% ± 8.1% vs. 44.8% ± 5.9%, p < 0.001) compared to the other group. No significant difference was reported between both groups regarding MACE (10.7 vs. 4.8, p = 0.305). Minor bleeding occurred at similar rates in both groups (10.7% vs. 9.7%, p = 0.852). Multivariate linear regression analysis confirmed that tirofiban administration via aspiration catheter was a significant predictor of reduced MVO% ( B = −1.303, p < 0.001) and increased myocardial salvage index ( B = 4.669, 95%, p = 0.001). Conclusions Intracoronary tirofiban delivery via aspiration catheter significantly reduces MVO and improves myocardial salvage in STEMI patients undergoing PCI compared to the guiding catheter method, without increasing the risk of bleeding or MACE.