Publications
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Panoulas VF, Colombo A, Margonato A, et al., 2015, Hybrid coronary revascularization: promising, but yet to take off., J Am Coll Cardiol, Vol: 65, Pages: 85-97
Hybrid coronary revascularization (HCR) combines arterial coronary artery bypass surgery (most commonly minimally invasive) and percutaneous coronary intervention in the treatment of a particular subset of multivessel coronary artery disease. It was first introduced in the mid-1990s, and aspired to bring together the "best of both worlds": the excellent patency rates and survival benefits associated with the durable left internal mammary artery graft to the left anterior descending artery alongside the good patency rates of drug-eluting stents, which outlive saphenous vein grafts to non-left anterior descending vessels. Although in theory this is a very attractive revascularization strategy, several years later, only one small randomized controlled trial comparing HCR with coronary artery bypass grafting has recently emerged in the medical literature, raising concerns regarding HCR's role and generalizability. In the current review, we discuss HCR's rationale, the current evidence behind it, its limitations and procedural challenges.
Panoulas VF, Sato K, Miyazaki T, et al., 2015, Bioresorbable scaffolds for the treatment of complex lesions: Are we there yet?, Interventional Cardiology, Vol: 7, Pages: 35-54, ISSN: 1755-5302
The introduction of bioresorbable vascular scaffolds (BRS) is changing the landscape of percutaneous coronary revascularization and is considered by many the 4th revolution in interventional cardiology. To date, BRS have shown promising short-And long-term results in the treatment of simple de novo lesions. Even though the feasibility, efficacy and safety of BRS implantation for more complex lesion subsets remain unknown, reports are emerging aiming to identify the role of BRS in everyday practice. In the current review we are aiming to summarize the results from 'all-comer' BRS studies and identify strengths and limitations of BRS when tackling specific complex lesion subsets.
Panoulas VF, Figini F, Giustino G, et al., 2015, A case of an occlusive right coronary artery dissection after stent implantation: dilemmas and challenges., J Invasive Cardiol, Vol: 27, Pages: E13-E15
A 53-year-old man with stable angina had a staged percutaneous coronary intervention to a critical focal stenosis of the mid-segment of the right coronary artery (RCA). Two hours after successful RCA stent implantation, the patient re-presented with inferior ST elevation secondary to acute dissection originating at the distal edge of the stent, causing subtotal occlusion of the distal RCA. The patient had TIMI-2 flow in the posterolateral branch and occlusion of the posterior descending artery. This case describes the procedural challenges the operators were faced with and successful use of the "rescue STAR" technique as a last resort.
Colombo A, Panoulas VF, 2015, Diagnostic coronary angiography is getting old!, JACC Cardiovasc Imaging, Vol: 8, Pages: 11-13
Sato K, Panoulas VF, Kawamoto H, et al., 2015, Side branch occlusion after bioresorbable vascular scaffold implantation: lessons from optimal coherence tomography., JACC Cardiovasc Interv, Vol: 8, Pages: 116-118
Miyazaki T, Panoulas VF, Sato K, et al., 2015, In-scaffold restenosis in a previous left main bifurcation lesion treated with bioresorbable scaffold v-stenting., JACC Cardiovasc Interv, Vol: 8, Pages: e7-e10
Miyazaki S, Agricola E, Panoulas VF, et al., 2015, Influence of baseline ejection fraction on the prognostic value of paravalvular leak after transcatheter aortic valve implantation., Int J Cardiol, Vol: 190, Pages: 277-281
BACKGROUND: Moderate or severe paravalvular leak (PVL ≥ moderate) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. The aim of this study was to assess whether the baseline ejection fraction (EF) affects the impact of PVL on mortality after TAVI. METHODS: We analyzed 514 consecutive patients with native severe aortic stenosis who underwent TAVI. Patients were divided into two groups: EF < 40% group (n = 84) and EF ≥ 40% group (n = 430) according to baseline EF. RESULTS: The mean age was 79.5 years and 49% were male. Patients in the EF < 40% group were younger and with higher logistic EuroSCORE compared to patients in the EF ≥ 40% group. Diabetes, coronary artery disease, atrial fibrillation and renal insufficiency were more prevalent in the EF < 40% group. Patients in the EF <40% group had more mitral regurgitation. In-hospital mortality was significantly higher in the EF < 40% group (8.3% vs. 0.9%, p < 0.0001). PVL ≥ moderate was significantly associated with increased 2-year estimated mortality only in the EF <40% group (65% vs. 20%, log-rank p < 0.0001) whereas no difference was seen in the EF ≥40% group (24% vs. 19%, log-rank p = 0.509). Interaction between PVL ≥ moderate and EF < 40% was statistically significant. CONCLUSIONS: The impact of PVL ≥ moderate on mortality after TAVI was significant in the EF <40% group but not in the EF ≥ 40% group in our study. Even though operators should aim to minimize PVL in all TAVI patients, special attention is required for patients with reduced baseline EF.
Kawamoto H, Panoulas VF, Sato K, et al., 2014, Short-term outcomes following "full-plastic jacket" everolimus-eluting bioresorbable scaffold implantation., Int J Cardiol, Vol: 177, Pages: 607-609
Dimitroulas T, Sandoo A, Hodson J, et al., 2014, Relationship between dimethylarginine dimethylaminohydrolase gene variants and asymmetric dimethylarginine in patients with rheumatoid arthritis, ATHEROSCLEROSIS, Vol: 237, Pages: 38-44, ISSN: 0021-9150
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Sato K, Panoulas VF, Naganuma T, et al., 2014, Optimal duration of dual antiplatelet therapy after implantation of bioresorbable vascular scaffolds: lessons from optical coherence tomography., Can J Cardiol, Vol: 30, Pages: 1460.e15-1460.e17
The current case report demonstrates the interesting finding of incomplete bioresorbable vascular scaffold (BVS) strut coverage at 18 months after implantation for a chronic total occlusion of the left anterior descending coronary artery. In this case, local differences in shear stress could explain the simultaneous presence of well covered and uncovered BVS strut segments in the same optical coherence tomography frame. Even though current standard practice suggests dual antiplatelet therapy for 12 months after BVS implantation, further studies are required to establish optimal duration of dual antiplatelet therapy, particularly when tackling complex lesions.
Taramasso M, Maisano F, Latib A, et al., 2014, Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience., Eur Heart J Cardiovasc Imaging, Vol: 15, Pages: 1161-1167
OBJECTIVES: Paravalvular leaks (PVL) occur in up to 17% of all surgically implanted prosthetic valves. Re-operation is associated with high morbidity and mortality. Transcatheter closure via a surgical transapical approach (TAp) is an emerging alternative for selected high-risk patients with PVL. The aim of this study was to compare the in-hospital outcomes of patients who underwent surgery and TA-closure for PVL in our single-centre experience. METHODS: From October 2000 to June 2013, 139 patients with PVL were treated in our Institution. All the TA procedures were performed under general anaesthesia in a hybrid operative room: in all but one case an Amplatzer Vascular Plug III device was utilized. RESULTS: Hundred and thirty-nine patients with PVL were treated: 122 patients (87.3%) underwent surgical treatment (68% mitral PVL; 32% aortic PVL) and 17 patients (12.2%) underwent a transcatheter closure via a surgical TAp approach (all the patients had mitral PVL; one case had combined mitral and aortic PVLs); in 35% of surgical patients and in 47% of TAp patients, multiple PVLs were present. The mean age was 62.5 ± 11 years; the Logistic EuroScore was 15.4 ± 3. Most of the patients were in New York Heart Association (NYHA) functional class III-IV (57%). Symptomatic haemolysis was present in 35% of the patients, and it was particularly frequent in the TAp (70%). Many patients had >1 previous cardiac operation (46% overall and 82% of TAp patients were at their second of re-operation). Acute procedural success was 98%. In-hospital mortality was 9.3%; no in-hospital deaths occurred in patients treated through a TAp approach. All the patients had less than moderate residual valve regurgitation after the procedure. Surgical treatment was identified as a risk factor for in-hospital death at univariate analysis (OR: 8, 95% CI: 1.8-13; P = 0.05). Overall actuarial survival at follow-up was 39.8 ± 7% at 12 years and it was reduced in patients who had &g
Naganuma T, Latib A, Panoulas VF, et al., 2014, One-year follow-up optical coherence tomography after implantation of bioresorbable vascular scaffolds for a chronic coronary total occlusion., JACC Cardiovasc Interv, Vol: 7, Pages: e157-e159
Naganuma T, Latib A, Panoulas VF, et al., 2014, Why do we need post-dilation after implantation of a bioresorbable vascular scaffold even for a soft lesion?, JACC Cardiovasc Interv, Vol: 7, Pages: 1070-1072
Chambers JC, Abbott J, Zhang W, et al., 2014, The South Asian Genome, PLOS One, Vol: 9, ISSN: 1932-6203
The genetic sequence variation of people from the Indian subcontinent who comprise one-quarter of the world's population, is not well described. We carried out whole genome sequencing of 168 South Asians, along with whole-exome sequencing of 147 South Asians to provide deeper characterisation of coding regions. We identify 12,962,155 autosomal sequence variants, including 2,946,861 new SNPs and 312,738 novel indels. This catalogue of SNPs and indels amongst South Asians provides the first comprehensive map of genetic variation in this major human population, and reveals evidence for selective pressures on genes involved in skin biology, metabolism, infection and immunity. Our results will accelerate the search for the genetic variants underlying susceptibility to disorders such as type-2 diabetes and cardiovascular disease which are highly prevalent amongst South Asians.
Sato K, Latib A, Panoulas VF, et al., 2014, A case of true left main bifurcation treated with bioresorbable everolimus-eluting stent v-stenting., JACC Cardiovasc Interv, Vol: 7, Pages: e103-e104
Panoulas VF, Montorfano M, Figini F, et al., 2014, Unanticipated pseudocoarctation highlights the importance of visualizing aortic arch anatomy before transfemoral transcatheter aortic valve implantation., Circ Cardiovasc Interv, Vol: 7, Pages: 631-633
Giustino G, Montorfano M, Chieffo A, et al., 2014, Tardive coronary obstruction by a native leaflet after transcatheter aortic valve replacement in a patient with heavily calcified aortic valve stenosis., JACC Cardiovasc Interv, Vol: 7, Pages: e105-e107
Naganuma T, Latib A, Panoulas VF, et al., 2014, Delayed disruption of a bioresorbable vascular scaffold., JACC Cardiovasc Imaging, Vol: 7, Pages: 845-847
Miyazaki T, Panoulas VF, Sato K, et al., 2014, Bioresorbable vascular scaffolds for left main lesions; a novel strategy to overcome limitations., Int J Cardiol, Vol: 175, Pages: e11-e13
Sato K, Panoulas VF, Naganuma T, et al., 2014, Bioresorbable vascular scaffold strut disruption after crossing with an optical coherence tomography imaging catheter., Int J Cardiol, Vol: 174, Pages: e116-e119
Miyazaki T, Panoulas VF, Sato K, et al., 2014, Acute stent thrombosis of a bioresorbable vascular scaffold implanted for ST-segment elevation myocardial infarction., Int J Cardiol, Vol: 174, Pages: e72-e74
Panoulas VF, Colombo A, 2014, Interventional cardiology: Outcomes in coronary stent trials--1 year is not enough., Nat Rev Cardiol, Vol: 11, Pages: 318-320
Sato K, Latib A, Costopoulos C, et al., 2014, A case of Kawasaki's disease with extensive calcifications needing rotational atherectomy with a 2.5mm burr., Cardiovasc Revasc Med, Vol: 15, Pages: 248-251
This case report demonstrates a unique strategy requiring a 2.5 mm burr to treat in-stent restenosis of an originally underexpanded stent, implanted in a heavily calcified lesion within a giant aneurysm by Kawasaki disease. Despite our procedural success, it should be emphasized that stent implantation in undilatable lesions should be avoided. When an angiographically calcified lesion within an ectatic segment is observed in a patient with Kawasaki disease, it is recommended that the operator evaluates in detail the severity and location of calcification using intravascular ultrasound imaging and pays meticulous attention to lesion preparation.
Chandra N, Bastiaenen R, Papadakis M, et al., 2014, Prevalence of electrocardiographic anomalies in young individuals: relevance to a nationwide cardiac screening program., J Am Coll Cardiol, Vol: 63, Pages: 2028-2034
OBJECTIVES: This study sought to investigate the prevalence of potentially abnormal electrocardiographic (ECG) patterns in young individuals to assess the implications for a nationwide screening program for conditions causing sudden cardiac death (SCD). BACKGROUND: The Italian experience suggests that pre-participation screening with ECG reduces the incidence of SCD in athletes. However, the majority of SCDs occur in nonathletes. In the United Kingdom, screening for cardiac disorders is confined to symptomatic individuals or those with a family history of inherited cardiac conditions or premature cardiac death. METHODS: Between 2008 and 2012, 7,764 nonathletes ages 14 to 35 years underwent ECG screening. Electrocardiograms were analyzed for group 1 (training-related) and group 2 (potentially pathological) patterns presented in the 2010 European Society of Cardiology position paper, which advocates further evaluation for individuals with group 2 ECG patterns. Results were compared with 4,081 athletes. RESULTS: Group 1 patterns occurred in 49.1% of nonathletes and 87.4% of athletes (p < 0.001). Group 2 patterns occurred in 21.8% of nonathletes and 33% of athletes (p < 0.001). In nonathletes, QTc interval abnormalities comprised the majority (52%) of group 2 changes, whereas T-wave inversions constituted 11%. Male sex and African/Afro-Caribbean ethnicity demonstrated the strongest association with group 2 ECG patterns. CONCLUSIONS: The study demonstrates that 1 in 5 young people have group 2 ECG patterns. The low incidence of SCD in young people suggests that in most instances such patterns are non-specific. These findings have significant implications on the feasibility and cost-effectiveness of nationwide screening programs for cardiovascular disease in young nonathletes and athletes alike, on the basis of current guidelines.
Ielasi A, Latib A, Naganuma T, et al., 2014, Early results following everolimus-eluting bioresorbable vascular scaffold implantation for the treatment of in-stent restenosis., Int J Cardiol, Vol: 173, Pages: 513-514
Panoulas VF, Miyazaki T, Sato K, et al., 2014, Hybrid percutaneous coronary revascularisation for a patient with left main bifurcation and extensive, diffuse coronary artery disease., Int J Cardiol, Vol: 173, Pages: e20-e22
Panoulas VF, Colombo A, 2014, Is "the bigger the better" still valid for drug-eluting stents?, Catheter Cardiovasc Interv, Vol: 83, Pages: 879-880
Colombo A, Panoulas VF, 2014, After 3 decades, at long last, a new device to deal with calcific lesions., JACC Cardiovasc Interv, Vol: 7, Pages: 519-520
Naganuma T, Latib A, Ielasi A, et al., 2014, No more metallic cages: an attractive hybrid strategy with bioresorbable vascular scaffold and drug-eluting balloon for diffuse or tandem lesions in the same vessel., Int J Cardiol, Vol: 172, Pages: 618-619
Panoulas VF, Toms TE, Douglas KMJ, et al., 2014, Prolonged QTc interval predicts all-cause mortality in patients with rheumatoid arthritis: an association driven by high inflammatory burden., Rheumatology (Oxford), Vol: 53, Pages: 131-137
OBJECTIVE: RA associates with an increased rate of sudden cardiac death (SCD). A prolonged QTc interval has been associated with arrhythmogenic and SCD in patients with long QT syndrome. Despite the previously reported contemporary association of CRP with SCD, thus far no studies have examined the association of QTc with mortality in RA, a condition characterized by high inflammatory burden. The aim of this study was to examine the role of electrocardiography (QT corrected interval) in predicting all-cause mortality in patients with RA who have an increased rate of SCD and a high inflammatory burden. METHODS: Three hundred and fifty-seven RA patients with detailed baseline clinical characterization and 12-lead ECGs were followed up for a mean of 73.0 (S.D. 18.3) months. Linear and Cox regression analyses were used to identify variables that associate with QTc and examine its association with all-cause mortality. RESULTS: The patients' mean age was 60.6 (S.D. 12.0) years, 267 (74.8%) were females and 54 (15.1%) died during the follow-up period. Age (β = 0.231, P < 0.001), gender (β = 0.137, P = 0.008) and CRP (β = 0.144, P = 0.006) associated independently with QTc in RA patients. The crude hazard ratio (HR) for total mortality per 50-ms increase in QTc was 2.17 (95% CI 1.21, 3.90). This association remained significant [HR = 2.18 (95% CI 1.09, 4.35)] after adjustment for identified confounders (cardiovascular and RA specific), but was lost [HR = 1.73 (95% CI 0.83, 3.62)] when CRP was included in the model. CONCLUSION: A 50-ms increase in QTc interval associates with a doubling of the hazard for all-cause mortality in patients with RA. The observed contemporary association of QTc with CRP levels indicates a potentially hazardous interplay between inflammation and arrhythmogenesis. Future studies are needed to confirm the above findings and explore underlying mechanisms.
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