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Objective To evaluate the feasibility of 2D-perfusion angiography (2D-PA) in order to quantify perfusion changes of the lung parenchyma pre- and post-balloon pulmonary angioplasty (BPA). Methods Thirty consecutive interventions in 16 patients with 99 treated pulmonary artery segments were included. To quantify changes in pulmonary blood flow using 2D-PA, the acquired digital subtraction angiographies (DSA) pre- and post-BPA were post-processed. A reference ROI in the treated pulmonary artery and a distal target ROI in the lung parenchyma were placed in corresponding areas on DSA pre- and post-BPA. Time to peak (TTP), peak density (PD) and area under the curve (AUC) were assessed. The ratios reference ROI to target ROI (TTP parenchyma /TTP inflow ; PD parenchyma /PD inflow ; AUC parenchyma /AUC inflow ) were calculated. Relative differences of the 2D-PA parameters were correlated to changes in the pulmonary-flow-grade-score. Results The pulmonary-flow-grade-score improved after BPA (p<0.0001). Likewise, the ratio TTP parenchyma /TTP inflow shortened by 10% (p=0.0002), the PD parenchyma /PD inflow increased by 46% (p<0.0001) and the AUC parenchyma /AUC inflow increased by 36% (p<0.0001). A significant correlation between changes in the pulmonary-flow-grade-score and changes in PD parenchyma /PD inflow (ρ=0.48, p<0.0001) and AUC parenchyma /AUC inflow (ρ=0.31, p=0.0018) was observed. Conclusion Quantification of pulmonary perfusion pre- and post-BPA using 2D-PA is feasible and has the potential to improve monitoring of BPA. Key points • Quantification of BPA results by use of 2D-PA is feasible. • 2D-PA allows objective assessment of changes in lung parenchymal perfusion. • 2D-PA has the potential to optimize BPA.

To investigate the long-term efficacy of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with Takayasu arteritis (TA) and pulmonary artery stenosis and pulmonary hypertension (PH). Data from 183 lesions from 79 surgeries performed on 32 patients with TA and PH were analyzed. Symptoms, laboratory investigation results, World Health Organization (WHO) functional class, 6-min walk distance (6 MWD), hemodynamic parameters, and prognosis were analyzed at baseline and follow-up. The mean (± SD) age of the 32 patients (28 female, 4 male) was 42.8 ± 11.9 years, and the median follow-up was 49.5 months (interquartile range, 26-71 months). Compared with baseline, changes in total bilirubin, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, 6 MWD, and WHO score functional class demonstrated significant differences ( <0.001). Echocardiography findings, right and left ventricular diameter, tricuspid annular plane systolic excursion, and estimated pulmonary artery systolic pressure were all improved ( =0.016, <0.001, <0.001, =0.005, respectively). Importantly, repeat right heart catheterization revealed that mean pulmonary artery pressure, pulmonary vascular resistance, and cardiac index also improved significantly at follow-up ( <0.001, <0.001, and =0.011, respectively). Pulmonary angiography revealed post-procedure restenosis in 64 (35.0%) lesions underwent PTPA within three to six months. Among three patients who underwent stent implantation, one experienced restenosis. Two patients died during the follow-up period, one from aggravation of right heart failure after lung infection, and the other in a traffic accident. Results of this study indicated that PTPA significantly improved clinical symptoms, exercise tolerance, and hemodynamic parameters in patients with TA pulmonary artery stenosis and PH. More importantly, reperfusion pulmonary edema significantly decreased, and no patient died of PTPA-related complications with guidance from the pressure wire.

Purpose To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA). Material and methods Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test). Results The overall intervention time was approximately 2 h in both groups ( p  = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy ( p  = 0.38), while DAP related to DSA was slightly higher in G3D ( p  = 0.048). Overall, DAP was significantly higher in G3D ( p  = 0.002). Conclusions The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions. Key Points • BPA guidance by CACT overlay is feasible and safe . • 2D3D image fusion for BPA guidance is accurate . • Image fusion can reduce patient radiation dose due to repeated BPA sessions .

Background Previous studies have shown that the stress hyperglycemia ratio (SHR), a parameter of relative stress-induced hyperglycemia, is an excellent predictive factor for all-cause mortality and major adverse cardiovascular events (MACEs) among patients with ST-segment elevation myocardial infarction (STEMI). However, its association with pulmonary infection in patients with STEMI during hospitalization remains unclear. Methods Patients with STEMI undergoing percutaneous coronary intervention (PCI) were consecutively enrolled from 2010 to 2020. The primary endpoint was the occurrence of pulmonary infection during hospitalization, and the secondary endpoint was in-hospital MACEs, composed of all-cause mortality, stroke, target vessel revascularization, or recurrent myocardial infarction. Results A total of 2,841 patients were finally included, with 323 (11.4%) developing pulmonary infection and 165 (5.8%) developing in-hospital MACEs. The patients were divided into three groups according to SHR tertiles. A higher SHR was associated with a higher rate of pulmonary infection during hospitalization (8.1%, 9.9%, and 18.0%, P < 0.001) and in-hospital MACEs (3.7%, 5.1%, and 8.6%, P < 0.001). Multivariate logistic regression analysis demonstrated that SHR was significantly associated with the risk of pulmonary infection during hospitalization (odds ratio [OR] = 1.46, 95% confidence interval [CI] 1.06–2.02, P = 0.021) and in-hospital MACEs (OR = 1.67, 95% CI 1.17–2.39, P = 0.005) after adjusting for potential confounding factors. The cubic spline models demonstrated no significant non-linear relationship between SHR and pulmonary infection (P = 0.210) and MACEs (P = 0.743). In receiver operating characteristic curve, the best cutoff value of SHR for pulmonary infection was 1.073. Conclusions The SHR is independently associated with the risk of pulmonary infection during hospitalization and in-hospital MACEs for patients with STEMI undergoing PCI.

Background Percutaneous coronary intervention (PCI) can be complicated by major adverse cardiovascular events (MACE; death, myocardial infarction [MI], and target vessel revascularization). Statistical models facilitated by machine learning (ML) can improve prediction of MACE compared with conventional models. However, two key challenges impair ML performance: (1) class imbalance in outcome distributions; and (2) bias affecting fairness across social subgroups. These challenges are amplified in small datasets. Additionally, no published ML model specifically addresses the influence of social determinants of health (SDoH) on PCI outcomes. We hypothesized that random oversampling would improve sensitivity and fairness when assessing the effect of SDoH on select PCI-associated MACE in a small dataset. Methods We employed multivariable logistic regression to predict 180-day MACE and new MI following urgent PCI in a small dataset ( N  = 481). Three SDoH were pre-specified variables: race, marital status, and socioeconomic status at extremes of the spectrum (uninsured and Medicaid versus private insurance). Random oversampling was applied to the SDoH and outcomes while maintaining a consistent ratio between positive and negative outcomes. Results In the imbalanced dataset, the logistic regression revealed no significant association between SDoH and 180-day MACE or new MI (minimum P-value = 0.47). Although sensitivity for event detection was low (≤ 0.26), other metrics-including positive predictive value (PPV)-were commendable (≥ 0.80). ML classifiers trained on oversampled data for race and marital status showed increased sensitivity but decreased PPV as the ratio of adverse-to-favorable outcome increased. Other performance metrics remained stable. Equalized odds disparity decreased with increasing oversampling ratio, indicating improved fairness. However, for socioeconomic-extremes status, the low numbers of adverse events and small sub-group size limited the effectiveness of oversampling. The optimal oversampling ratio cut-point across all outcomes and SDoH was 0.30-0.40 (sensitivity-0.50; PPV-0.52). Conclusions In small, imbalanced datasets, random oversampling can improve sensitivity and fairness of ML classifiers when evaluating PCI outcomes across race and marital status. However, this improvement comes at the expense of decreased PPV. The decrease in equalized odds disparity indicates improved balance in the performance of the classifiers across these two subgroups.

Coronary artery involvements occur rarely both during cardiac repair and in the late period after surgery, and it may result in myocardial ischaemia and infarction. We present six cases who underwent percutaneous transluminal coronary balloon angioplasty for coronary artery stenosis in the late period after surgery. The patients included four boys and two girls. Post-operative states involving anomalous origin of the left coronary artery from the pulmonary artery and d-transposition of the great arteries were observed in two patients each. Two patients with univentricular heart had coronary artery injuries during surgery. The age at the angioplasty ranged from 1 month to 14 years, with a median of 3 years. The interval from the operation to angioplasty ranged from 37 days to 14 years (median 8 months). The interval from the angioplasty to follow-up coronary angiography ranged from 2 months to 14 years (median 11 months). The follow-up period ranged from 2 months to 20 years (median 8 years). One patient underwent a stent implantation because of post-procedure recoil. Coronary artery stenosis improved immediately after procedure in the six patients without complication, and restenosis occurred post-procedure in one patient. Five patients had no cardiac events. Although the angioplasty’s initial effect may not be dramatic, it can improve late after the procedure. It was considered that the optimal balloon-reference vessel ratio to obtain a minimal effective lumen diameter was about 1.0. Angioplasty post-surgery for CHD in children was feasible and without complications.

Aim To evaluate the safety and efficacy of FreeFlow percutaneous atrial septal shunt device (manufactured by AOLIU Medical Technology Co., Ltd, Shanghai, China) in patients with refractory pulmonary arterial hypertension (PAH) for the first time. Methods The study enrolled adult patients diagnosed with refractory pulmonary arterial hypertension (PAH) at the Department of Cardiology, Zhongshan Hospital, Fudan University, between Oct 2021 and Oct 2023. The patients were treated with the FreeFlow percutaneous atrial septal shunt device and underwent follow-up immediately after operation, as well as before and after discharge (at 1, 3, 6, 12 months post-operation). The primary endpoints of the study included the rate of major cardiovascular and cerebrovascular adverse events (MACCEs), serious adverse events (SAEs), and serious device-related adverse events (SADEs) within 12 months of shunt implantation. Data analysis was conducted using SAS 9.3. Results A total of 12 patients were enrolled in the study and successfully completed the operation. 10 subjects had completed 12 months’ follow-up after operation, while two subjects had died. The incidence of MACCE was 0%, and the incidence of SAEs was 33%, which was unrelated to the treatment with this device. No systemic or instrumental embolizations occurred during the follow-up period. All ten subjects exhibited a stable right-to-left shunt after the operation (100% success rate). Seven patients’ New York Heart Association (NYHA) functional classification improved from grade III to grade II. The Short Form-36 (SF-36) score and the 6-minute walking distance (6MWD) at 12 months post-operation were significantly improved compared to baseline, with scores of 47.6 ± 19.5 versus 64.7 ± 24.6 ( P  = 0.029) and distances of 239.5 ± 137.8 m versus 401.7 ± 129.6 m ( P  = 0.045), respectively. Similarly, the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and right heart diameter (RAD) also decreased significantly, from 3236 ± 1590.3 pg/mL to 1787.3 ± 703.7 pg/mL ( P  = 0.039) and from 59.1 ± 10.6 mm to 46.3 ± 7.5 mm ( P  = 0.046), respectively. Conclusions The results of this clinical study demonstrate that the product can attain the anticipated performance under typical conditions of use. The risks associated with the product are deemed acceptable when weighed against its potential benefits. All preclinical and clinical evaluations have furnished definitive and rational scientific evidence supporting the safety and efficacy of the percutaneous atrial septal shunt. Clinical trial number Not applicable.

Background The ACEF score (age, creatinine, and left ventricular ejection fraction) and the triglyceride-glucose (TyG) index have been identified as robust risk prediction models for adverse outcomes post-percutaneous coronary intervention (PCI) in coronary atherosclerotic heart disease (CHD) patients. This study aimed to assess whether incorporating the TyG index enhances the predictive ability of the ACEF score and enhances risk stratification for CHD patients undergoing PCI. Methods This observational cohort study enrolled 1248 patients diagnosed with CHD who underwent PCI at the Third People’s Hospital of Chengdu, China, between May 2018 and December 2022. Receiver operating characteristic (ROC) curves were employed to establish the optimal cutoff values for the TyG index and ACEF score. The primary endpoint event was defined as major adverse cardiac and cerebrovascular events (MACCEs). Cumulative survival curves were plotted using the Kaplan–Meier method. Univariable and multivariable Cox regression analyses were conducted to identify predictors of MACCEs. The predictive ability of the ACEF score and the TyG index was assessed using the area under the ROC curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results Over a median follow-up period of 30.60 months, 214 patients experienced MACCEs. Kaplan-Meier survival analysis demonstrated a significant association between elevated ACEF score (> 1.27) and TyG index levels (> 8.82) with a heightened incidence of MACCEs (HR = 2.018, 95%CI 1.593–2.789; HR = 2.057, 95%CI 1.572–2.691; Log-Rank test, both P  < 0.001). Multivariable Cox regression analysis revealed that even after adjusting for multiple confounders, both the ACEF score and TyG index remained as predictors of MACCEs (HR = 1.702, 95%CI 1.210–2.394, P  = 0.002; HR = 1.575, 95%CI 1.296–1.916, P  < 0.001). Additionally, the addition of the ACEF score and TyG index into the conventional risk model significantly improved the ability to predict MACCEs, as evidenced by the increase in the C-statistic value from 0.664 to 0.703, along with notable improvements in continuous NRI (0.391), categorical NRI (0.107), and IDI (0.033) (all P  < 0.001). Conclusion The combination of the TyG index and the ACEF score enhances the predictive ability for long-term MACCEs in patients with CHD undergoing PCI.

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a major contributor to cardiovascular mortality, yet reliable tools for individualized mortality prediction remain limited. Machine learning offers the potential to enhance prognostic accuracy in this high-risk population. A total of 1,495 patients with NSTE-ACS who underwent percutaneous coronary intervention (PCI) were retrospectively analyzed. Eight clinical and laboratory variables were selected through univariate and multivariate logistic regression. Five machine learning models-logistic regression, random forest, XGBoost, LightGBM, and naïve Bayes-were constructed. Model performance was evaluated using area under the curve (AUC) and calibration curves. Age, diabetes mellitus, and ejection fraction were identified as independent predictors of all-cause mortality. Among all models, LightGBM achieved the highest AUC (0.847), followed by XGBoost (0.822), both of which demonstrated superior discrimination and calibration compared to traditional logistic regression and other algorithms. Calibration analysis showed excellent agreement between predicted and observed mortality in both training and test cohorts. Gradient boosting models, particularly LightGBM and XGBoost, significantly improve mortality prediction in NSTE-ACS patients after PCI. These models may facilitate more accurate risk stratification and guide personalized post-procedural management strategies in clinical practice.