Addressing Frailty in Cardiology: Identifying Barriers Faced by Cardiologists and Health Care Professionals in Asia.

Background: Preventing frailty is crucial for improving outcomes in aging populations at heightened cardiovascular risk, yet implementation in real-world practice remains challenging. The authors previously reported low use of frailty strategies among cardiologists in Asia.

Objectives: The aim of this study was to explore the barriers to frailty implementation among cardiologists, other physicians, and nurses.

Body Mass Index and Outcomes After Transcatheter Aortic Valve Replacement: Insights From the Transpacific-TAVR Registry.

Background: Whereas some studies suggest an "obesity paradox" with improved outcomes in obese patients following transcatheter aortic valve replacement (TAVR), the impact of pre-TAVR body mass index (BMI) and post-TAVR BMI changes on clinical and echocardiographic outcomes remains unclear.

Objectives: This study sought to evaluate the influence of BMI at the time of TAVR and subsequent BMI changes on clinical and echocardiographic outcomes in patients undergoing TAVR.

Methods: We included 1,339 patients with severe, native aortic stenosis from 2015 to 2019, stratified by BMI according to World Health Organization classifications, from an international registry.

Temporal modulation of antiplatelet therapy in high-risk patients undergoing complex percutaneous coronary intervention: the TAILORED-CHIP randomized clinical trial.

Background And Aims: Limited data exist on optimal antiplatelet strategies for high-risk patients undergoing complex percutaneous coronary intervention (PCI). This study aimed to investigate the efficacy and safety of tailored antiplatelet treatment with temporal modulation of the intensity of platelet inhibition in patients undergoing complex high-risk PCI.

Methods: We randomly assigned 2018 patients with high-risk anatomical or clinical characteristics undergoing complex PCI to a tailored antiplatelet strategy with early escalation (low-dose ticagrelor at 60 mg twice daily plus aspirin <6 months) and late de-escalation (clopidogrel monotherapy >6 months) or dual antiplatelet therapy (clopidogrel plus aspirin for 12 months).

Effect of cerebral embolic protection device on new cerebral embolism during transcatheter aortic valve replacement: A prospective sentinel registry.

Background: Cerebral embolization is a common complication following transcatheter aortic valve replacement (TAVR). Cerebral embolic protection (CEP) devices have the potential to reduce embolic burden to the cerebral circulation; however, their effectiveness in real-world patients at high risk of stroke remains insufficiently studied.

Methods: As part of imaging study of the prospective Sentinel registry (NCT05217888), we evaluated the effect of CEP on new cerebral embolism as determined by brain magnetic resonance imaging (MRI) in patients undergoing transfemoral TAVR who were considered at high risk for stroke.

Delayed Mitral Prosthesis Dehiscence Following Transcatheter Aortic Valve Replacement.

Background: The presence of preexisting mitral prosthesis in transcatheter aortic valve replacement (TAVR) raises concerns about potential valve interaction; however, this issue remains insufficiently explored.

Case Summary: A 79-year-old man presented with hemolysis 8 months post-TAVR. He had a history of mitral valve replacement 16 years prior.

Totally Endoscopic Approach for TAVR Explantation and Subsequent Surgical AVR Using a 3D Endoscope System.

Objectives: Surgical aortic valve replacement (SAVR) after transcatheter aortic valve replacement (TAVR) has a higher mortality rate than standard SAVR. We present a successful minimally invasive TAVR explantation and SAVR using the lasso technique in conjunction with a 3D endoscope.

Key Steps: 1) Aortotomy was performed where the nitinol frame was easily palpable.

Single vs. dual antithrombotic therapy in patients with oral anticoagulation and stabilized coronary artery disease: a systematic review and meta-analysis of randomized-controlled trials.

Aims: Despite consistent recommendations from clinical guidelines, data from randomized trials on a long-term antithrombotic treatment strategy for patients with oral anticoagulation (OAC) and stabilized coronary artery disease (CAD) are still limited and underpowered for ischaemic events. Therefore, we investigated the safety and efficacy of single vs. dual antithrombotic therapy (SAT vs.

Preventive percutaneous coronary intervention for non-flow-limiting vulnerable atherosclerotic coronary plaques in diabetes: the PREVENT trial.

Background And Aims: The efficacy and safety of preventive percutaneous coronary intervention (PCI) for treating vulnerable plaques in diabetic patients remain unclear.

Methods: The PREVENT (Preventive Coronary Intervention on Stenosis with Functionally Insignificant Vulnerable Plaque) trial was a randomized clinical trial that compared preventive PCI plus optimal medical therapy with optimal medical therapy alone in patients with non-flow-limiting (fractional flow reserve >0.80) vulnerable plaques identified via intracoronary imaging.

Epidemiology of Valvular Heart Disease in Asia Pacific Region.

Valvular heart disease poses a significant health burden in the Asia-Pacific region, with its epidemiology varying widely across countries caused by diverse socioeconomic and health care situations. Rheumatic heart disease remains prevalent, especially in low- to middle-income areas, while degenerative valvular diseases are emerging in developed regions caused by an aging population. Significant disparities in access to health care and intervention result in variable clinical outcomes.

Long-term outcomes of intravascular ultrasound-guided percutaneous coronary intervention versus coronary artery bypass grafting for multivessel coronary artery disease.

Background: Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) has been shown to improve outcomes in complex coronary artery disease compared with angiography-guided PCI. However, long-term comparisons between IVUS-guided PCI and coronary artery bypass grafting (CABG) for multivessel disease (MVD) remain limited.

Methods: This post hoc analysis of the Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment Extended Follow-up study included 880 patients with MVD, excluding 15 patients who received medical therapy.

Automated, Standardized, Quantitative Analysis of Cardiovascular Borders on Chest X-Rays Using Deep Learning.

Background: The analysis of cardiovascular borders (CVBs) in chest x-rays (CXRs) traditionally relied on subjective assessment and does not have established normal ranges.

Objectives: The authors aimed to develop a deep learning-based method for quantifying CVBs on CXRs and to explore its clinical utility.

Methods: This study used a prevalidated deep learning to analyze CVBs.

Proportion and Clinical Impact of Stent Optimization During Imaging-Guided Percutaneous Coronary Intervention: The OCTIVUS Trial.

Background: Data regarding the proportion and clinical impact of achieving stent optimization by intravascular ultrasound (IVUS)- or optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) remain limited.

Objectives: The authors assessed the proportion and cardiovascular outcomes in patients with and without stent optimization using imaging guidance.

Methods: This secondary analysis of the OCTIVUS (Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention) trial classified patients into optimized (meeting all prespecified optimization criteria) or nonoptimized groups.

Potassium-competitive acid blocker vs proton-pump inhibitor in patients receiving antithrombotic therapy who are at high risk for gastrointestinal bleeding: Rationale and design of the randomized PROTECT- HBR trial.

Background: Concomitant use of proton pump inhibitor (PPI) is recommended in patients receiving chronic antithrombotic therapy who are at high risk of gastrointestinal (GI) bleeding. However, long-term safety and efficacy of chronic PPI use have been concerned. Potassium-competitive acid blocker (P-CAB) is a novel class of acid suppressants, providing more acid stability, rapid onset of action, less variability with CYP2C19 polymorphisms, and longer duration of action than PPI.

Enhancing quantitative coronary angiography (QCA) with advanced artificial intelligence: comparison with manual QCA and visual estimation.

Artificial intelligence-based quantitative coronary angiography (AI-QCA) was introduced to address manual QCA's limitations in reproducibility and correction process. The present study aimed to assess the performance of an updated AI-QCA solution (MPXA-2000) in lesion detection and quantification using manual QCA as the reference standard, and to demonstrate its superiority over visual estimation. This multi-center retrospective study analyzed 1,076 coronary angiography images obtained from 420 patients, comparing AI-QCA and visual estimation against manual QCA as the reference standard.

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis.

Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis (AS) and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exist a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomic variations, disparity in healthcare resources and infrastructure, and the lack of consensus on the optimal management of AS in the Asia-Pacific region.

Artificial Intelligence-Based Fully Automated Quantitative Coronary Angiography vs Optical Coherence Tomography-Guided PCI: The FLASH Trial.

Background: Recently developed artificial intelligence-based coronary angiography (AI-QCA, fully automated) provides real-time, objective, and reproducible quantitative analysis of coronary angiography without requiring additional time or labor.

Objectives: This study aimed to evaluate the efficacy of AI-QCA-assisted percutaneous coronary intervention (PCI) compared to optical coherence tomography (OCT)-guided PCI in terms of post-PCI results.

Methods: This trial enrolled 400 patients with significant coronary artery disease undergoing PCI from 13 participating centers in South Korea.

Contemporary State-of-the-Art PCI of Left Main Coronary Artery Disease.

The left main coronary artery (LMCA) supplies over 70% of the myocardium, and significant LMCA disease is associated with high morbidity and mortality. With remarkable advances in percutaneous coronary intervention (PCI), including stent technology, antithrombotic agents, and evolving procedural techniques, PCI has become an important treatment option in clinical practice guidelines for the revascularization of LMCA disease. In contemporary clinical practice, a heart-team approach to shared decision-making, considering clinical/anatomic factors along with patient preferences, is emphasized for patients with significant LMCA disease requiring myocardial revascularization.