Annapoorna Kini

Background: Percutaneous coronary interventions (PCI) expose patients and operators to ionizing radiation, posing risks of deterministic effects such as skin injury and stochastic effects including malignancy. Although real‐time dosimetry and dose alerts have been associated with radiation‐dose reductions in prior reports, the level of patient radiation reduction associated with implementing a formal, multifaceted radiation reduction program has not previously been reported in a high‐volume catheterization laboratory. Objectives: To evaluate the impact of a substantial radiation dose level (SRDL) protocol on patient radiation exposure during PCI. Methods: This retrospective study analyzed 19,249 PCI procedures at a tertiary center from July 2012 to December 2021. Patients were stratified into a pre‐protocol cohort (Phase 1: 17,332 procedures) and a post‐protocol cohort (Phase 2: 1917 procedures following implementation in November 2019). The SRDL protocol included real‐time radiation monitoring, alert thresholds at 5 Gy air kerma, and structured follow‐up for high‐dose cases. Study outcomes included air kerma ( K _a,r ) dose‐area product (DAP), contrast volume, and fluoroscopy time. Results: The study cohort (mean age 66.3 years; 28.5% female) demonstrated significant reductions in radiation exposure after implementing the protocol. Median air kerma declined from 2.6 to 2.0 Gy (23% reduction; p < 0.0001), and median DAP decreased from 158 to 125 Gy·cm ² (20.8% reduction; p < 0.0001). Contrast volume was reduced by 15 mL (11.1% reduction; p < 0.0001), while fluoroscopy time remained unchanged (18.1 vs. 18.3 min; p = 0.094). Despite increased procedural complexity in Phase 2 (multivessel PCI: 69.5% vs. 65.2%; p < 0.001), radiation reduction remained significant. Conclusions: Implementation of an SRDL protocol was associated with significant reductions in patient radiation exposure during PCI without increasing procedure time, supporting its use as a safety intervention in high‐volume catheterization laboratories.

Structured Objectives: Mitral regurgitation (MR) evolution after transcatheter aortic valve replacement (TAVR) in low-flow aortic stenosis (LFAS) is poorly characterized. We evaluated MR trajectories across LFAS phenotypes, predictors of MR worsening, and associations with clinical outcomes. Methods: We retrospectively studied 614 LFAS patients undergoing TAVR: low-flow high-gradient (LFHG; n=153, 24.9%), classical low-flow low-gradient (cLFLG; n=155, 25.2%), and paradoxical low-flow low-gradient (pLFLG; n=306, 49.8%). MR severity was abstracted from clinical echocardiography reports using a 6-level ordinal scale. MR worsening was defined as a ≥1-grade increase from baseline MR at ∼30 days or ∼1 year. Multivariable logistic models identified predictors of MR worsening. Kaplan–Meier and Cox models evaluated associations of MR trajectory and LFAS subtype with all-cause death, heart failure hospitalization (HFH), and their composite. Results: Among 614 LFAS patients, 443 had 30-day and 290 had 1-year echocardiographic follow up. At 30 days, MR trajectory differed significantly across LFAS phenotypes, with the highest rate of worsening in cLFLG and the lowest in LFHG. At 1 year, unadjusted MR trajectory distributions did not differ significantly across phenotypes. In adjusted logistic models, cLFLG remained independently associated with MR worsening at both timepoints. MR worsening was associated with worse unadjusted outcomes at 30 days but was not independently associated with the composite endpoint after multivariable adjustment. LFAS phenotype, particularly cLFLG, remained the dominant predictor of adverse clinical outcomes. Conclusions: MR evolution after TAVR is phenotype-specific: cLFLG patients have the highest risk of MR worsening and lowest event-free survival, supporting phenotype-informed post-TAVR surveillance.

Preparing patients for cardiac catheterization requires critical but repetitive tasks. We conducted a prospective evaluation of the AI voice assistant, Sofiya, for pre-procedural calls in our center. A customized Large Language Model was trained on medical knowledge and deployed on an agentic AI framework with conversational AI. Sofiya called patients to provide instructions, collect clinical data, and answer questions or redirect the patient to a nurse. The study consisted of a 90-day stabilization period with collaboration between clinicians and developers (Phase I), followed by a 90-day real-world application led by nurses (Phase II). The primary outcome was the overall rate of successfully completed calls reaching the end of the script with all patients answering all clinical questions. From January 16, 2025, to July 17, 2025, 1431 patients received 1606 calls from Sofiya. Phase I had 806 calls whose completion rate gradually improved, reaching an average of 86.4%. High completed call rate (87.9%) was maintained in Phase II with an additional 800 calls. AI system errors were observed in 48 (6.0%) calls during Phase I and 24 (2.6%) in Phase II. A voice-based AI assistant can successfully augment routine tasks of pre-procedural patient preparation, allowing nurses to focus on clinical aspects of patient care.

Background and Aims: Calcified nodules (CNs) contribute to 3-5% of acute coronary syndromes (ACS). Identifying peri-calcific lipid-rich areas is challenging with conventional imaging but feasible using near-infrared spectroscopy (NIRS). This YELLOW III substudy investigated the impact of maximal lipid-lowering on CN morphology and lipid content over 26 weeks. Methods: Patients with stable CAD and lipid-rich, non-obstructive plaques (lipid arc >90°, FCT <120 µm on OCT) received Evolocumab (140 mg biweekly) plus maximally tolerated statins. Lesions were evaluated at baseline and 26 weeks using combined NIRS-IVUS and OCT. Exploratory endpoints were the maximum 4 mm lipid core burden index (LCBI) in segments containing CNs (maxLCBI4mm-CN) and morphological changes in CN. Linear mixed-effects models were used to evaluate temporal changes and group interactions. Peripheral blood mononuclear cell (PBMC) transcriptomics were analyzed. Results: Among 110 patients, 43 (39.1%) had CNs. A total of 73 paired CNs were analyzed for morphology, of which 65 CNs were≥4mm. CNs with lipid signal (CNLS) demonstrated a significant reduction in maxLCBI4mm-CN from 176.8 to 113.3 (β = −63.51 ± 17.63; p < 0.001), whereas no change was observed in dense CNs (p = 0.317). Morphological parameters remained largely unchanged in both groups. A modest increase in the surrounding calcium arc was observed in CNLS (p = 0.018), while depth showed a differential change between groups (pinteraction = 0.012). Transcriptomic analysis demonstrated baseline enrichment of neutrophil degranulation pathways in CN patients, which diminished at follow-up. Conclusions: Intensive lipid-lowering significantly reduces peri-calcific lipid burden without measurable short-term changes in CN morphology. The clinical implications of LCBI reduction in CNs warrant further investigation.