Background: The use of mild therapeutic hypothermia (MTH) in patients after out-of-hospital cardiac arrest (OHCA) who are undergoing primary percutaneous coronary intervention (pPCI) can protect patients from thromboembolic complications. The aim of the study was to evaluate the adaptive mechanisms of the coagulation system in MTH-treated comatose OHCA survivors. Methods: Twenty one comatose OHCA survivors with acute coronary syndrome undergoing immediate pPCI were treated with MTH. Quantitative and qualitative analyses of physical clot properties were performed using thromboelastography (TEG). Two analysis time points were proposed: 1) during MTH with in vitro rewarming conditions (37^oC) and 2) after restoration of normothermia (NT) under normal (37^oC) and in vitro cooling conditions (32^oC). Results: During MTH compared to NT, reaction time (R) was lengthened, clot kinetic parameter (α) was significantly reduced, but no effect on clot strength (MA) was observed. Finally, the coagulation index (CI) was significantly reduced with clot fibrinolysis attenuated during MTH. The clot lysis time (CLT) was shortened, and clot stability (LY⁶⁰) was lower compared with those values during NT. In vitro cooling generally influenced clot kinetics and reduced clot stability after treatment. Conclusions: Thromboelastography is a useful method for evaluation of coagulation system dysfunction in OHCA survivors undergoing MTH. Coagulation impairment in hypothermia was associated with a reduced rate of clot formation, increased weakness of clot strength, and disturbances of fibrinolysis. Blood sample analyses performed at 32°C during MTH, instead of the standard 37°C, seems to enhance the accuracy of the evaluation of coagulation impairment in hypothermia. Background: The use of mild therapeutic hypothermia (MTH) in patients after out-of-hospital cardiac arrest (OHCA) who are undergoing primary percutaneous coronary intervention (pPCI) can protect patients from thromboembolic complications. The aim of the study was to evaluate the adaptive mechanisms of the coagulation system in MTH-treated comatose OHCA survivors. Methods: Twenty one comatose OHCA survivors with acute coronary syndrome undergoing immediate pPCI were treated with MTH. Quantitative and qualitative analyses of physical clot properties were performed using thromboelastography (TEG). Two analysis time points were proposed: 1) during MTH with in vitro rewarming conditions (37^oC) and 2) after restoration of normothermia (NT) under normal (37^oC) and in vitro cooling conditions (32^oC). Results: During MTH compared to NT, reaction time (R) was lengthened, clot kinetic parameter (α) was significantly reduced, but no effect on clot strength (MA) was observed. Finally, the coagulation index (CI) was significantly reduced with clot fibrinolysis attenuated during MTH. The clot lysis time (CLT) was shortened, and clot stability (LY⁶⁰) was lower compared with those values during NT. In vitro cooling generally influenced clot kinetics and reduced clot stability after treatment. Conclusions: Thromboelastography is a useful method for evaluation of coagulation system dysfunction in OHCA survivors undergoing MTH. Coagulation impairment in hypothermia was associated with a reduced rate of clot formation, increased weakness of clot strength, and disturbances of fibrinolysis. Blood sample analyses performed at 32°C during MTH, instead of the standard 37°C, seems to enhance the accuracy of the evaluation of coagulation impairment in hypothermia.

Continuous flow left ventricular assist device (LVAD) outflow graft stenosis constitutes a severe complication. Treatment options include surgical pump exchange, transcatheter procedures, or systemic thrombolysis. We present a case of a spontaneous mechanical twisting of the outflow graft at two distinct points, which was treated by a two-step percutaneous stent implantation. Self-expanding stents were used during the first procedure. We also ensured distal bilateral percutaneous neuroprotection against cerebrovascular embolism. During the second, previously unpredicted procedure, we used balloon-expandable bare-metal stents to overcome the torque of the graft, because of their higher radial force. It was assumed that the external, self-expanding layer of the stent might protect the graft from the bare-metal stents. The effects of the treatment were monitored both clinically and through computed tomography angiography. The check-up 12 months later revealed nothing of note. Interventional transcatheter procedures are a safe treatment option for outflow graft stenosis, with good long-term effects. Both self-expanding and balloon-expandable stents can be used for transcatheter intervention. Both the incidence of the graft twisting and the radial force of the implanted stent seem to be critical and robust predictors of the long-term result of percutaneous therapy.

Context: As quantum technologies advance with innovations in cardiovascular medicine, it can be challenging to distinguish genuine clinical progress from mere ideas. There will also be difficult transitions involved in moving technology from proof of concept demonstrated in the lab. This transition is complicated by the excitement and hype that comes with any new technology. Aim: This work aims to assess what quantum technologies are available in cardiovascular medicine for real-world use, to identify which applications are closer to clinically relevant translation, and to differentiate realistic advances from advanced-not-yet realities. Methods: A narrative review was conducted using PubMed, EMBASE, Scopus, Web of Science, IEEE Xplore, and arXiv. While real-world use of technologies was prioritized, we included all theoretical literature, regardless of date of publication. Search terms were a combination of the vocabulary of quantum technologies and the vocabulary of cardiovascular medicine. Peer-reviewed publications included primary research, reviews, theoretical works, and conference proceedings. Two reviewers independently screened all citations, and any disagreements were resolved through consensus discussion. Results: We identified three core application areas: (1) quantum sensing, such as cardiac magnetometry, where there is potential for SQUID magnetocardiography to be used for detecting cardiomyopathy; (2) quantum computing for cardiovascular risk prediction, and (3) next-generation quantum sensors for mobile cardiac imaging. Conclusions: Quantum technology in cardiovascular medicine represents modest promise in select applications, most notably, magnetocardiography. To go from “hype to hope”, clinical trials will be required to identify application domains where quantum technologies outweigh the challenges of implementation in clinical practice.

Background: Mild therapeutic hypothermia (MTH) is believed to reduce the effectiveness of antiplatelet drugs. Effective dual-antiplatelet therapy after percutaneous coronary intervention (PCI) is mandatory to avoid acute stent thrombosis (ST). The effectiveness of ticagrelor in MTH-treated out-of-hospital cardiac arrest (OHCA) survivors is still a matter of debate. The aim of the study was to evaluate the impact of MTH on the platelet-inhibitory effect of ticagrelor in comatose survivors of OHCA treated with primary PCI. Methods: Eighteen comatose survivors of OHCA with acute coronary syndrome undergoing immediate PCI treated with MTH were compared with 14 patients with uncomplicated primary myocardial infarction after PCI, matched for gender and age, in a prospective, single-center, observational study. Platelet aggregation was evaluated using VerifyNow P₂Y₁₂ point-of-care testing at 3 time points: admission (T₀), during MTH (T₁), and 48–72 h after rewarming (T₂). Results: Ticagrelor effectively inhibits platelet aggregation in OHCA patients subjected to MTH and in all patients in the control group. The effectiveness of ticagrelor did not differ between the MTH group and the control group (p = 0.581). In 2 cases in the MTH population, the platelet response to ticagrelor was inadequate, and in one of them it remained insufficient during the re-warming phase. There was no stent thrombosis in these patients. Conclusions: The present study confirmed the effectiveness of ticagrelor to inhibit platelets in myocardial infarction patients after OHCA treated with primary PCI undergoing hypothermia. The use of cooling was not associated with an increased risk of stent thrombosis. Background: Mild therapeutic hypothermia (MTH) is believed to reduce the effectiveness of antiplatelet drugs. Effective dual-antiplatelet therapy after percutaneous coronary intervention (PCI) is mandatory to avoid acute stent thrombosis (ST). The effectiveness of ticagrelor in MTH-treated out-of-hospital cardiac arrest (OHCA) survivors is still a matter of debate. The aim of the study was to evaluate the impact of MTH on the platelet-inhibitory effect of ticagrelor in comatose survivors of OHCA treated with primary PCI. Methods: Eighteen comatose survivors of OHCA with acute coronary syndrome undergoing immediate PCI treated with MTH were compared with 14 patients with uncomplicated primary myocardial infarction after PCI, matched for gender and age, in a prospective, single-center, observational study. Platelet aggregation was evaluated using VerifyNow P₂Y₁₂ point-of-care testing at 3 time points: admission (T₀), during MTH (T₁), and 48–72 h after rewarming (T₂). Results: Ticagrelor effectively inhibits platelet aggregation in OHCA patients subjected to MTH and in all patients in the control group. The effectiveness of ticagrelor did not differ between the MTH group and the control group (p = 0.581). In 2 cases in the MTH population, the platelet response to ticagrelor was inadequate, and in one of them it remained insufficient during the re-warming phase. There was no stent thrombosis in these patients. Conclusions: The present study confirmed the effectiveness of ticagrelor to inhibit platelets in myocardial infarction patients after OHCA treated with primary PCI undergoing hypothermia. The use of cooling was not associated with an increased risk of stent thrombosis.