ABSTRACT Objective There is limited high‐quality data on the factors that contribute to limb loss in patients with diabetes‐related foot disease (DFD) in New Zealand and Australia. Furthermore, wound, ischaemia and foot infection (WIfI) staging has not been validated in the Australasian cohort. The aim of this study was to (1) report on the presentation, management and outcomes of DFD (wound healing, major limb amputation [MLA], amputation‐free survival [AFS] and mortality at 1‐year), and (2) validate the association of WIfI stage on outcomes. Methods This was an observational prospective study of patients with DFD and a wound at three centres in New Zealand and Australia from 2020 to 2022. Data on presentation, management, amputation and mortality at 1‐year was collected. Outcomes were stratified by presenting WIfI stage. Wound healing and survival were assessed with Kaplan–Meier curves, time‐to‐healing with Fine‐Gray competing risks, AFS with logistic regression and survival with Cox proportional hazards. Results Two hundred and seventy‐six patients (384 limbs) were recruited, with WIfI stage 1 (47.9%), 2 (21.1%), 3 (19.5%) and 4 (12.5%). At 1‐year, 71.4% of wounds healed, with WIfI stage associated with healing, p < 0.001. At 1‐year 16.6% of limbs had underwent a MLA, with the proportion increasing by WIfI stage. Poorer AFS was observed with increasing WIfI. Mortality at 1‐year increased with WIfI stage, p < 0.001. Conclusion This study reports on the presentation, management and outcomes from DFD in New Zealand and Australia. WIfI staging appropriately classifies patients with DFD and correlates with healing, MLA, AFS and survival at 1‐year.

OBJECTIVE:There is limited high-quality data on the factors that contribute to limb loss in patients with diabetes-related foot disease (DFD) in New Zealand and Australia. Furthermore, wound, ischaemia and foot infection (WIfI) staging has not been validated in the Australasian cohort. The aim of this study was to (1) report on the presentation, management and outcomes of DFD (wound healing, major limb amputation [MLA], amputation-free survival [AFS] and mortality at 1-year), and (2) validate the association of WIfI stage on outcomes. METHODS:This was an observational prospective study of patients with DFD and a wound at three centres in New Zealand and Australia from 2020 to 2022. Data on presentation, management, amputation and mortality at 1-year was collected. Outcomes were stratified by presenting WIfI stage. Wound healing and survival were assessed with Kaplan-Meier curves, time-to-healing with Fine-Gray competing risks, AFS with logistic regression and survival with Cox proportional hazards. RESULTS:Two hundred and seventy-six patients (384 limbs) were recruited, with WIfI stage 1 (47.9%), 2 (21.1%), 3 (19.5%) and 4 (12.5%). At 1-year, 71.4% of wounds healed, with WIfI stage associated with healing, p < 0.001. At 1-year 16.6% of limbs had underwent a MLA, with the proportion increasing by WIfI stage. Poorer AFS was observed with increasing WIfI. Mortality at 1-year increased with WIfI stage, p < 0.001. CONCLUSION:This study reports on the presentation, management and outcomes from DFD in New Zealand and Australia. WIfI staging appropriately classifies patients with DFD and correlates with healing, MLA, AFS and survival at 1-year.

BACKGROUND:Minor amputations, defined as resection of bone below the ankle, are important procedures for managing diabetes-related foot infections (DFI). The optimal method to determine the presence of residual bone infection is unclear and unplanned reoperation rates are common. Although international guidelines endorse the use of histopathology, this approach has not been universally adopted. PURPOSE:We evaluated the utility of histopathological analysis from samples collected from 'proximal' or 'marginal' bone during minor amputations. STUDY DESIGN:A retrospective, single-center study was conducted at Sir Charles Gairdner Hospital, in Perth, Western Australia. METHODS:The primary outcome of interest was treatment success at six months, defined as being alive and no unplanned reoperation at the original operation site. RESULTS:Of 67 cases, 22 (33 %) had positive histopathology. Patients with positive margins were less likely to have treatment success compared to those with negative margins (50 % versus 82 %; P = 0.006). Antibiotic duration was significantly shorter in patients with negative histopathological margins compared to patients with positive histopathological margins (median 14 vs 42 days; P = 0.0003). The concordance between histopathology and microbiology was 51 %. CONCLUSION:Positive histopathology was associated with lower rates of treatment success, despite receiving longer antibiotic durations. Positive culture from the same samples were not predictive of outcome. Larger, prospective studies are needed to define optimal sampling methods and antibiotic therapy following minor amputation.

Individuals with a family history of premature coronary heart disease (CHD) have increased cardiac morbidity and mortality, which may motivate them to modify their health behaviours. This analysis examines whether patients with self-reported family history of premature CHD experiencing an acute coronary syndrome (ACS) were more likely to have their risk factors and health behaviours under control at 12 months post ACS. Data from the TEXTMEDS study were used to estimate the association between self-reported family history of premature CHD and blood pressure control, LDL cholesterol control, BMI, exercise and smoking status at 12 months post ACS. The study cohort consisted of 1423 participants (mean age 58.0 ± 10.67, 79.2% male), with 556 (39.1%) reporting a family history of premature CHD, while 867 (60.9%) reported no family history. No evidence from this analysis suggests that patients with knowledge of their family history were more likely to achieve better risk factor control. Novel strategies for risk factor control in this high-risk population is required to improve secondary prevention.

Diabetic foot ulcers (DFUs) represent one of the most complex and challenging chronic wounds to manage, carrying a high risk of limb amputation due to the multifactorial comorbidities of hyperglycemia, including peripheral neuropathy, arterial occlusive disease, and immune dysfunction. The current clinical gold standard treatment for DFUs involves surgical debridement, followed by the application of appropriate wound dressings. Although numerous commercial products are available and advanced dressings are currently in research development and clinical trials, most still fail to meet the clinical criteria for an ideal dressing. This Perspective highlights the current focus of DFU wound dressing research and identifies key translational gaps. These include the reliance on oversimplified validation models, the tendency to address only one or two pathological features (e.g., infection or angiogenesis), and limited consideration of dressing and other management needs in post-amputation care. We thenpropose the ideal properties required for the development of proactive, multifunctional, and smart wound dressings that can address a broader spectrum of DFU pathophysiologies. Furthermore, we emphasize that such designs should also prioritize simplicity and manufacturability to meet regulatory requirements and facilitate clinical translation.

The vasa vasorum (VV) have gathered considerable interest over the last decade due to its role in vascular wall biology and pathology; however, while the coronary VV are relatively well studied, the anatomy of peripheral VV, such as those of the aorta, remains poorly described, hampering knowledge of their role in peripheral vascular diseases. Through careful retrieval of the porcine thoracic aorta and successful microthrombi removal, the thoracic aorta was perfused with BriteVu™ followed by micro-computed tomography (micro-CT) scanning to image the VV and obtain a 3D reconstruction. We used commercially available software and its thresholding algorithms. The arterial segments were further dehydrated and stained in an iodine solution to delineate the tunica adventitia and tunica media on imaging. A meticulous technique of harvest, clearing and perfusion of the porcine aorta was developed. BriteVu™ perfusion enabled clear visualization of the VV structure, branching pattern and distribution with a voxel size of 9 μm. Additional iodine staining differentiated VV residing in the tunica media versus the tunica adventitia of the vessel. The technique we have developed allows detailed knowledge of peripheral VV anatomy and distribution to be obtained where previous information was scarce. Detailed anatomical study of the VV and its relation to branches will further our understanding of its relationship to vascular disease processes.

BACKGROUND:Endovascular technologies continue to evolve to meet the large and growing burden of peripheral arterial disease. The overall quality of published RCTs in endovascular treatments for peripheral arterial disease is low, resulting in uncertainty over treatment effectiveness. The aim of this study was to develop a framework to improve the design, conduct, and reporting of future clinical trials for infrainguinal endovascular treatments of peripheral arterial disease. METHODS:The authors undertook the design, development, and pilot testing of a novel framework. The study comprised four distinct phases. Phase 1 represented the development of a preliminary framework using content analysis of endovascular interventions described in previously published RCTs. Phase 2 consisted of focus groups with key stakeholders to further develop, revise, and achieve initial consensus on the framework. Phase 3 corresponded to the creation of a modified Delphi questionnaire to achieve final consensus on the framework. Phase 4 included cognitive interviews with professionals designing or undertaking endovascular lower limb trials to pilot test the framework. RESULTS:Content analysis of 228 endovascular interventions from 112 RCTs identified six key themes, relevant to endovascular peripheral arterial disease interventions, for the framework: expertise; setting; anaesthesia; imaging; intervention components (access; crossing lesion; treating lesion (lesion preparation; intervention; intervention optimization; bailout intervention; and treatment of non-target lesions); and closure of artery); and pharmacological interventions. Further refinements were made to the framework as a result of feedback from three focus groups and a Delphi questionnaire. The framework deconstructs an endovascular intervention into its component parts. The final framework can be accessed at www.endo-star.com. Pilot testing evaluated comprehension, clarity, and completeness of interpretation. CONCLUSION:The Endo-STAR framework deconstructs endovascular interventions into their key component parts and has been designed and pilot tested to enhance the quality of RCTs of endovascular interventions in peripheral arterial disease. It may be used to assist in developing future trial protocols, the standardization of infrainguinal endovascular interventions, the monitoring of adherence to the trial protocol, and as a standardized reporting guideline.

BACKGROUND AND AIMS:Randomized trials of colchicine in secondary prevention of atherosclerotic cardiovascular disease have shown mixed results. METHODS:A systematic review and study-level meta-analysis of randomized controlled trials was performed comparing colchicine vs no colchicine in a secondary-prevention atherosclerotic cardiovascular disease population. A fixed-effect inverse variance model was applied using the intention-to-treat population from the included trials. The primary outcome was the composite of cardiovascular death, myocardial infarction, or stroke. RESULTS:Nine trials, including 30 659 patients (colchicine 15 255, no colchicine 15 404) with known coronary artery disease or stroke, were included. Compared with no colchicine, patients randomized to colchicine had a relative risk (RR) of 0.88 [95% confidence interval (CI) 0.81-0.95, P = .002] for the primary composite outcome, including a RR of 0.94 for cardiovascular death (95% CI 0.78-1.13, P = .5), a RR of 0.84 for myocardial infarction (95% CI 0.73-0.97, P = .016), and a RR of 0.90 for stroke (95% CI 0.80-1.02, P = .09). Colchicine was associated with a RR of 1.35 for hospitalization for gastrointestinal events (95% CI 1.10-1.66, P = .004) with no increase in hospitalization for pneumonia, newly diagnosed cancers, or non-cardiovascular death. CONCLUSIONS:In patients with prior coronary disease or stroke, colchicine reduced the composite of cardiovascular death, myocardial infarction, or stroke by 12%.

Chronic inflammation plays a key role in the development and progression of atherosclerotic cardiovascular disease (ASCVD) and its complications. Despite the use of blood pressure-, lipid-, and glucose-lowering therapies as well as antithrombotic agents, the lifetime residual cardiovascular (CV) risk in patients with ASCVD remains high. Because chronic inflammation remains an unaddressed risk factor, anti-inflammatory therapy has the potential to further lower residual CV risk in these patients. Low-dose colchicine (0.5 mg daily) has emerged as a promising low-cost oral anti-inflammatory therapy for this indication. In patients with chronic coronary syndrome (CCS), low-dose colchicine was well-tolerated and reduced the risk of myocardial infarction, stroke, coronary revascularization, and CV death. However, trials in patients with acute coronary syndrome (ACS) yielded conflicting results, and two trials in patients with ischemic stroke did not show a benefit. In patients with peripheral artery disease (PAD), preliminary observational data suggested a potential benefit, and a randomized trial is currently underway to examine its efficacy in reducing CV and limb events. The long-term safety data for low-dose colchicine in ASCVD are reassuring. Although pooled data from trials in ASCVD show a small (0.55%) absolute increase in the risk of hospitalization for gastrointestinal events, adverse signals were not observed for serious infection, cancer, or severe myotoxicity. In this article, we review the clinical studies of colchicine that examined its risk-benefit for the prevention of CV events in patients with ASCVD, discuss clinical and research implications, and highlight knowledge gaps.

BACKGROUND: Low-dose combinations are a promising intervention for improving blood pressure (BP) control but their effects on therapeutic inertia are uncertain. METHODS: Analysis of 591 patients randomized to an ultra-low-dose quadruple pill or initial monotherapy. The episode of therapeutic inertia was defined as a patient visit with a BP of >140/90 mm Hg without intensification of antihypertensive treatment. We compared the frequency of therapeutic inertia episodes between Quadpill and initial monotherapy as a proportion of the total population (intention-to-treat analysis with the denominator being all participants randomized) and as a proportion of people with uncontrolled BP (with the denominator being participants with uncontrolled BP). RESULTS: Therapeutic inertia occurred in fewer participants randomized to Quadpill compared with monotherapy. For example, among the 390 participants with a 6-month follow-up, therapeutic inertia according to unattended BP was 21/192 (11%) versus 45/192 (23%), P =0.002. There were similar rates of therapeutic inertia among those with uncontrolled unattended BP in each group (all P >0.4). Consistent observations were seen with the use of attended office BP measures. The major determinants of not intensifying treatment during follow-up were BP readings that were close to target and large improvements in BP compared with the previous visit. CONCLUSIONS: Among all treated individuals, low-dose Quadpill reduced the number of therapeutic inertia episodes compared with initial monotherapy. After the first follow-up visit, most high BP values did not lead to treatment intensification in both groups. Education is needed about the importance of treatment intensification despite a significant improvement in BP or BP being close to target. REGISTRATION: URL: XXX; Unique identifier: ACTRN12616001144404

INTRODUCTION:Sutton-Kadir Syndrome (SKS) describes true inferior pancreaticoduodenal artery (IPDA) aneurysms in the setting of coeliac artery (CA) stenosis or occlusion. Although rare, SKS aneurysms can rupture and cause morbidity. Due to its rarity and lack of controlled treatment data, correct treatment for the CA lesion is currently unknown. Our aim was to assess if endovascular embolisation alone was safe and effective in treatment of SKS aneurysms, in emergent and elective settings. Secondary objectives were to describe presentation and imaging findings.METHODS:A retrospective cohort study of patients treated at Sir Charles Gairdner Hospital between January 2014 and December 2021 was done. Data on presentation, diagnostics, aneurysm characteristics, CA lesion aetiology, treatment and outcomes were extracted from chart review.RESULTS:Twenty-four aneurysms in 14 patients were identified. Rupture was seen in 7/15 patients. Most aneurysms (22/24) were in the IPDA or one of its anterior or posterior branches. Median arcuate ligament (MAL) compression was identified in all. There was no difference in median (IQR) maximal transverse diameter between ruptured and non-ruptured aneurysms (6 mm (9), 12 mm (6), P = 0.18). Of ruptures, 6/7 had successful endovascular embolisation and 1/7 open surgical ligation. Of non-ruptures, 6/7 had successful endovascular embolisation, 1/7 open MAL division then endovascular CA stenting and aneurysm embolisation. No recurrences or new aneurysms were detected with computed tomography or magnetic resonance angiography over a median (IQR) follow-up period of 30 (10) months in 12 patients.CONCLUSION:Endovascular embolisation of SKS aneurysms without treatment of MAL compression is safe and effective in both the emergent and elective settings.

3D printing technologies have the potential to revolutionize the manufacture of heart valves through the ability to create bespoke, complex constructs. In light of recent technological advances, we review the progress made towards 3D printing of heart valves, focusing on studies that have utilised these technologies beyond manufacturing patient-specific moulds. We first overview the key requirements of a heart valve to assess functionality. We then present the 3D printing technologies used to engineer heart valves. By referencing International Organisation for Standardisation (ISO) Standard 5840 (Cardiovascular implants - Cardiac valve prostheses), we provide insight into the achieved functionality of these valves. Overall, 3D printing promises to have a significant positive impact on the creation of artificial heart valves and potentially unlock full complex functionality.

Diabetes-related foot disease (DFD) is a common, costly, and severe complication of diabetes mellitus. DFD is associated with high rates of morbidity and mortality and poses a significant burden on patients, healthcare systems and society. While the detrimental impact of DFD is widely recognised, the precise financial implications of its management in Australia remain unclear due to inconsistent and inconclusive contemporary data. Therefore, the aim of this review was to identify, summarise and synthesise existing evidence to estimate the costs associated with DFD management in Australia. Searches were conducted in MEDLINE, Embase, AMED, CINAHL, Joanna Briggs Institute EBP, and the Cochrane Library from November 2011 to July 2023. Australian studies investigating costs associated with DFD management were eligible for inclusion. Two independent reviewers performed the study selection, data extraction and quality assessment steps. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist was used to assess study quality. A descriptive analysis was performed due to limited existing evidence and large heterogeneity between study populations to conduct meta-analyses. Three economic evaluations were included in the review. One study was rated as ‘poor’, one as ‘very good’ and one as ‘excellent’ when assessed against the CHEERS checklist. The estimated cost of DFD management varied between studies and comparisons were not possible due to the different methodological approaches and data sources. The studies were unable to provide an overall cost of DFD with respect to all aspects of care as they did not capture the multi-faceted level of care throughout the entire patient journey between sectors and over time. There is limited contemporary evidence for the costs associated with DFD management within Australia, particularly related to direct costs and resource utilisation. Further research into the economic impact of DFD management is needed to inform optimisation of national service delivery and improve health outcomes for individuals with DFD in Australia. Integrating real-world data on impact of clinical interventions with parallel economic evaluation could be a valuable approach for future research, which would offer a more comprehensive understanding of the clinical and economic outcomes beyond solely model-based evaluations. PROSPERO Registration No. CRD42022290910.

HomeCirculationVol. 148, No. 4Effect of Initial Treatment With a Single Pill Containing Quadruple Combination of Quarter Doses of Blood Pressure Medicines Versus Standard Dose Monotherapy in Patients With Hypertension on Ambulatory Blood Pressure Indices: Results From the QUARTET Study No AccessResearch ArticleRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessResearch ArticleRequest AccessFull TextEffect of Initial Treatment With a Single Pill Containing Quadruple Combination of Quarter Doses of Blood Pressure Medicines Versus Standard Dose Monotherapy in Patients With Hypertension on Ambulatory Blood Pressure Indices: Results From the QUARTET Study Janis M. Nolde, Emily Atkins, Simone Marschner, Graham S. Hillis, John Chalmers, Laurent Billot, Mark R. Nelson, Christopher M. Reid, Peter Hay, Michael Burke, Shirley Jansen, Tim Usherwood, Anthony Rodgers, Clara K. Chow and Markus P. Schlaich Janis M. NoldeJanis M. Nolde https://orcid.org/0000-0001-6864-8514 Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth (J.M.N., M.P.S.). *J.M. Nolde, E. Atkins, C.K. Chow, and M.P. Schlaich contributed equally. Search for more papers by this author , Emily AtkinsEmily Atkins *J.M. Nolde, E. Atkins, C.K. Chow, and M.P. Schlaich contributed equally. Search for more papers by this author , Simone MarschnerSimone Marschner https://orcid.org/0000-0002-5484-9144 Westmead Applied Research Centre, University of Sydney, Australia, and Department of Cardiology, Westmead Hospital, Sydney, Australia (F.A., S.M., T.U., C.K.C.). Search for more papers by this author , Graham S. HillisGraham S. Hillis https://orcid.org/0000-0003-2417-4673 Department of Cardiology, Royal Perth Hospital, Perth, Australia, and School of Medicine, The University of Western Australia, Perth (G.S.H., M.PS.). Search for more papers by this author , John ChalmersJohn Chalmers https://orcid.org/0000-0002-9931-0580 The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.). Search for more papers by this author , Laurent BillotLaurent Billot https://orcid.org/0000-0002-4975-9793 The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.). Search for more papers by this author , Mark R. NelsonMark R. Nelson https://orcid.org/0000-0001-9941-7161 Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.R.N.). Search for more papers by this author , Christopher M. ReidChristopher M. Reid https://orcid.org/0000-0001-9173-3944 School of Public Health & Preventive Medicine Monash University, School of Population Health, Curtin University, Perth, Australia (C.M.R.). Search for more papers by this author , Peter HayPeter Hay Castle Hill Medical Centre Sydney, Australia (P.H.). Search for more papers by this author , Michael BurkeMichael Burke School of Medicine, Western Sydney University, Australia (M.B.). Search for more papers by this author , Shirley JansenShirley Jansen https://orcid.org/0000-0001-7781-4748 Sir Charles Gairdner Hospital, Perth, Australia (S.J.). Search for more papers by this author , Tim UsherwoodTim Usherwood The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.). Westmead Applied Research Centre, University of Sydney, Australia, and Department of Cardiology, Westmead Hospital, Sydney, Australia (F.A., S.M., T.U., C.K.C.). Search for more papers by this author , Anthony RodgersAnthony Rodgers https://orcid.org/0000-0003-1282-1896 The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.). Search for more papers by this author , Clara K. ChowClara K. Chow Clara K. Chow, PhD, Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Level 6, Block K, Entrance 10, Westmead Hospital, Hawkesbury Rd, Westmead, NSW 2145, Australia, Email E-mail Address: [email protected] https://orcid.org/0000-0003-4693-0038 The George Institute for Global Health, University of New South Wales, Sydney, Australia (F.A., J.C., L.B., T.U., A.R., C.K.C.). Westmead Applied Research Centre, University of Sydney, Australia, and Department of Cardiology, Westmead Hospital, Sydney, Australia (F.A., S.M., T.U., C.K.C.). *J.M. Nolde, E. Atkins, C.K. Chow, and M.P. Schlaich contributed equally. Search for more papers by this author and Markus P. SchlaichMarkus P. Schlaich Correspondence to: Markus P. Schlaich, MD, Medical School, Royal Perth Hospital Unit, The University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth Western Australia 6000, Australia, Email E-mail Address: [email protected] https://orcid.org/0000-0002-1765-0195 Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth (J.M.N., M.P.S.). Department of Cardiology, Royal Perth Hospital, Perth, Australia, and School of Medicine, The University of Western Australia, Perth (G.S.H., M.PS.). Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M.P.S.). *J.M. Nolde, E. Atkins, C.K. Chow, and M.P. Schlaich contributed equally. Search for more papers by this author Originally published24 Jul 2023https://doi.org/10.1161/CIRCULATIONAHA.123.064964Circulation. 2023;148:375–377Footnotes*J.M. Nolde, E. Atkins, C.K. Chow, and M.P. Schlaich contributed equally.Registration: URL: https://www.australianclinicaltrials.gov.au; Unique identifier: ACTRN12616001144404.The podcast and transcript are available as Supplemental Material at https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.123.064964.For Sources of Funding and Disclosures, see page 377.Circulation is available at www.ahajournals.org/journal/circCorrespondence to: Markus P. Schlaich, MD, Medical School, Royal Perth Hospital Unit, The University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth Western Australia 6000, Australia, Email markus.schlaich@uwa.edu.auClara K. Chow, PhD, Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Level 6, Block K, Entrance 10, Westmead Hospital, Hawkesbury Rd, Westmead, NSW 2145, Australia, Email clara.chow@sydney.edu.auREFERENCES1. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, Ramirez A, Schlaich M, Stergiou GS, Tomaszewski M, et al. 2020 International Society of Hypertension global hypertension practice guidelines.J Hypertens. 2020; 38:982–1004. doi: 10.1097/HJH.0000000000002453CrossrefMedlineGoogle Scholar2. Chow CK, Atkins ER, Hillis GS, Nelson MR, Reid CM, Schlaich MP, Hay P, Rogers K, Billot L, Burke M, et al. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial.Lancet. 2021; 398:1043–1052. doi: 10.1016/s0140-6736(21)01922-xCrossrefMedlineGoogle Scholar3. Chow CK, Atkins ER, Billot L, Chalmers J, Hillis GS, Hay P, Neal B, Nelson M, Patel A, Reid CM, et al. Ultra-low-dose quadruple combination blood pressure–lowering therapy in patients with hypertension: The QUARTET randomized controlled trial protocol.Am Heart J. 2021; 231:56–67. doi: 10.1016/j.ahj.2020.09.017CrossrefMedlineGoogle Scholar4. Nolde JM, Hillis GS, Atkins E, Von Huben A, Marschner S, Chan J, Reid CM, Nelson MR, Figtree G, Chalmers J, et al. Impact of various night-time period definitions on nocturnal ambulatory blood pressure.J Hypertens. 2022; 40:2271–2279. doi: 10.1097/HJH.0000000000003255CrossrefMedlineGoogle Scholar5. de La Sierra A, Banegas JR, Segura J, Gorostidi M, Ruilope LM; CARDIORISC Event Investigators. Ambulatory blood pressure monitoring and development of cardiovascular events in high-risk patients included in the Spanish ABPM registry: the CARDIORISC Event study.J Hypertens. 2012; 30:713–719. doi: 10.1097/HJH.0b013e328350bb40CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails July 25, 2023Vol 148, Issue 4 Advertisement Circulation on the Run: July 25, 2023 July 24, 2023 Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.123.064964PMID: 37486996 Originally publishedJuly 24, 2023 PDF download Advertisement

Three-dimensional (3D) printing plays an important role in cardiovascular disease through the use of personalised models that replicate the normal anatomy and its pathology with high accuracy and reliability. While 3D printed heart and vascular models have been shown to improve medical education, preoperative planning and simulation of cardiac procedures, as well as to enhance communication with patients, 3D bioprinting represents a potential advancement of 3D printing technology by allowing the printing of cellular or biological components, functional tissues and organs that can be used in a variety of applications in cardiovascular disease. Recent advances in bioprinting technology have shown the ability to support vascularisation of large-scale constructs with enhanced biocompatibility and structural stability, thus creating opportunities to replace damaged tissues or organs. In this review, we provide an overview of the use of 3D bioprinting in cardiovascular disease with a focus on technologies and applications in cardiac tissues, vascular constructs and grafts, heart valves and myocardium. Limitations and future research directions are highlighted.

Synchrotron-radiation-computed tomography (SRCT) allows more accurate calcified plaque and coronary stenosis assessment as a result of its superior spatial resolution; however, typical micro-computed tomography (micro-CT) systems have even higher resolution. The purpose of this study was to compare the performance of high-resolution micro-CT with SRCT in the assessment of calcified plaques and a previously published dataset of coronary stenosis assessment. This experimental study involved micro-CT scanning of three-dimensional printed coronary artery models with calcification in situ used in our previously published SRCT study on coronary stenosis assessment. Measurements of coronary stenosis utilizing both modalities were compared using a paired sample t-test. The degrees of stenosis measured on all but one micro-CT dataset were statistically significantly lower than the corresponding SRCT measurements reported in our previous paper (p < 0.0005–0.05). This indicates that the superior spatial resolution of micro-CT was able to further reduce over-estimation of stenosis caused by extensive calcification of coronary arteries and, hence, false positive results. Our results showed that the high-resolution micro-CT used in this study outperformed the Australian Synchrotron SRCT in both calcified plaque and coronary stenosis assessment. These findings will become clinically important for cardiovascular event prediction and enable reclassification of individuals with low and intermediate risk into appropriate risk categories when the technical challenges of micro-CT in clinical practice such as the small field of view and demanding on image processing power are addressed.