A final dilatation of the stent only in the MV proximal to the SB with a balloon sized according to the mother vessel is suggested to prevent stent malapposition and optimise stent deployment in bifurcation stenting.

When conventional NC balloons fail, the new OPN NC dedicated high-pressure balloon provides an effective and safe alternative strategy for the dilatation of resistant coronary lesions.

Optical coherence tomography (OCT) has higher resolution than IVUS (approximately 10 times), with the potential to precisely measure lumen diameters in the variable geometry of a bifurcational lesion and to identify superficial lipid laden plaques and calcium, relevant to confirm the severity of the lumen obstruction before treatment and guide location and diameter of the stent. In addition, OCT produces fewer strut-induced artifacts and offers precise evaluation of strut apposition in a real-life clinical setting. The increase in the speed of image acquisition consequent to the introduction of frequency domain OCT allows rapid pull-back at a speed of 2 cm/sec, minimising the amount of contrast required to clear blood during image acquisition, with an average injection of 10-18 ml required for the maximal length currently available of 5.6 cm. This allows serial OCT acquisitions, typically before treatment if the lesion is not very severe and flow is expected to be present around the OCT catheter, after predilatation and to assess and guide stent expansion. Repeated OCT examinations at follow-up may help to detect presence and characteristics of strut coverage, a potential predictor of late stent thrombosis. These applications are of particular interest in the context of bifurcational lesion treatment because this condition is still associated with a higher number of malapposed stent struts and frequent impairment of stent expansion, explaining the higher incidence of stent thrombosis and restenosis. In this article, all potential applications of OCT for bifurcational lesion treatment are explored. The use of OCT to characterise plaque components, and to optimise stent expansion and strut apposition are first discussed in detail. The conclusion of the article highlights some future research and technological developments that promise to expand the role of OCT further still.

No abstract

Background: The first admission for acute heart failure with preserved ejection fraction (HFpEF) drastically influences the short-term prognosis. Baseline characteristics may predict repeat hospitalization or death in these patients. Methods: A 103 patient-cohort, admitted for the first acute HFpEF episode, was monitored for six months. Baseline characteristics were recorded and their relation to the primary outcome of heart failure readmission (HFR) and secondary outcome of all-cause mortality was assessed. Results: We identified six independent determinants for HFR: estimated glomerular filtration rate (eGFR) (p = 0.07), hemoglobin (p = 0.04), left ventricle end-diastolic diameter (LVEDD) (p = 0.07), E/e’ ratio (p = 0.004), left ventricle outflow tract velocity-time integral (LVOT VTI) (p = 0.045), and diabetes mellitus (p = 0.06). Three of the variables were used to generate a risk score for HFR: LVEDD, E/e’, LVOT VTI -DEI Score = − 28.763 + 4.558 × log (LVEDD (mm)) + 1.961 × log (E/e’ ratio) + 1.759 × log (LVOT VTI (cm)). Our model predicts a relative amount of 20.50% of HFR during the first 6 months after the first acute hospitalization within the general population with HFpEF with a DEI Score over −0.747. Conclusions: We have identified three echocardiographic parameters (LVEDD, E/e’, and LVOT VTI) that predict HFR following an initial acute HFpEF hospitalization. The prognostic DEI score demonstrated good accuracy.