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Hokimoto S, Kaikita K, Yasuda S, Tsujita K, Ishihara M, Matoba T, Matsuzawa Y, Mitsutake Y, Mitani Y, Murohara T, Noda T, Node K, Noguchi T, Suzuki H, Takahashi J, Tanabe Y, Tanaka A, Tanaka N, Teragawa H, Yasu T, Yoshimura M, Asaumi Y, Godo S, Ikenaga H, Imanaka T, Ishibashi K, Ishii M, Ishihara T, Matsuura Y, Miura H, Nakano Y, Ogawa T, Shiroto T, Soejima H, Takagi R, Tanaka A, Tanaka A, Taruya A, Tsuda E, Wakabayashi K, Yokoi K, Minamino T, Nakagawa Y, Sueda S, Shimokawa H, Ogawa H. JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (coronary spastic angina) and coronary microvascular dysfunction. J Cardiol 2023; 82:293-341. [PMID: 37597878 DOI: 10.1016/j.jjcc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Affiliation(s)
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, Japan
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Yoshiaki Mitsutake
- Division of Cardiovascular Medicine, Kurume University School of Medicine, Japan
| | - Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Yasuhiko Tanabe
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Nobuhiro Tanaka
- Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Japan
| | - Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Takahiro Imanaka
- Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan
| | | | - Yunosuke Matsuura
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yasuhiro Nakano
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Japan
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | | | - Ryu Takagi
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Japan
| | - Kohei Wakabayashi
- Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital, Japan
| | - Kensuke Yokoi
- Department of Cardiovascular Medicine, Saga University, Japan
| | - Toru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
| | - Shozo Sueda
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Hiroaki Shimokawa
- Graduate School, International University of Health and Welfare, Japan
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Nishimiya K, Takahashi J, Oyama K, Matsumoto Y, Yasuda S, Shimokawa H. Mechanisms of Coronary Artery Spasm. Eur Cardiol 2023; 18:e39. [PMID: 37456775 PMCID: PMC10345984 DOI: 10.15420/ecr.2022.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/22/2023] [Indexed: 07/18/2023] Open
Abstract
Recent clinical trials have highlighted that percutaneous coronary intervention in patients with stable angina provides limited additional benefits on top of optimal medical therapy. This has led to much more attention being paid to coronary vasomotion abnormalities regardless of obstructive or non-obstructive arterial segments. Coronary vasomotion is regulated by multiple mechanisms that include the endothelium, vascular smooth muscle cells (VSMCs), myocardial metabolic demand, autonomic nervous system and inflammation. Over the years, several animal models have been developed to explore the central mechanism of coronary artery spasm. This review summarises the landmark studies on the mechanisms of coronary vasospasm demonstrating the central role of Rho-kinase as a molecular switch of VSMC hypercontraction and the important role of coronary adventitial inflammation for Rho-kinase upregulation in VSMCs.
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Affiliation(s)
- Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Kazuma Oyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
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3
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Lanza GA, Shimokawa H. Management of Coronary Artery Spasm. Eur Cardiol 2023; 18:e38. [PMID: 37456765 PMCID: PMC10345953 DOI: 10.15420/ecr.2022.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/14/2022] [Indexed: 07/18/2023] Open
Abstract
Calcium channel blockers (CCBs) are the first-line treatment for coronary artery spasm (CAS). When CAS-related angina symptoms are not well controlled by CCB therapy, long-acting nitrates or (where available) nicorandil can be added as second-line medications. In the case of CAS refractory to standard treatments, several other alternative drugs and interventions have been proposed, including the Rho-kinase inhibitor fasudil, anti-adrenergic drugs, neural therapies and percutaneous coronary interventions. In patients with syncope or cardiac arrest caused by CAS-related tachyarrhythmias, or even bradyarrhythmias, implantation of an ICD or pacemaker, respectively, should be considered according to the risk of recurrence and efficacy of vasodilator therapy.
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Affiliation(s)
- Gaetano Antonio Lanza
- Fondazione Policlinico A Gemelli IRCCS, Department of Cardiovascular Medicine, Università Cattolica del Sacro Cuore Rome, Italy
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4
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Kato T, Momose M, Uemura Y, Naya M, Matsumoto N, Hida S, Yamauchi T, Nakajima T, Suzuki E, Inoko M, Tamaki N. Association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan. J Cardiol 2022; 80:475-481. [PMID: 35835641 DOI: 10.1016/j.jjcc.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is an ongoing controversy regarding the necessity of single-photon emission computed tomography (SPECT) for patients with ischemic heart diseases after the publication of the results of the ISCHEMIA trial. We aimed to evaluate the association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan. METHODS From the data of 2780 patients with stable angina who were enrolled prospectively between January 2006 and March 2008 in Japan and had undergone physician-referrednon-invasive imaging tests (Japanese Coronary-Angiography or Myocardial Imaging for Angina Pectoris Study), 1205 patients managed with SPECT were stratified by 10% myocardial ischemia. Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalization for heart failure, and late revascularization, were followed-up for 1year. RESULTS Patients with ≥10% myocardial ischemia (n=173) were less likely to be women than patients with <10% myocardial ischemia (n=1032) and had a significantly higher 1-year cumulative incidence of MACEs (6.9% vs. 1.8%, p<0.0001). After adjusting for confounders, the risk of ≥10% myocardial ischemia relative to <10% myocardial ischemia for MACEs remained significant [adjusted hazard ratio (95% confidence interval), 2.40 (1.09-5.26), p=0.029]. After adjusting including treatments, the risk of MACEs became insignificant between the ≥10% myocardial ischemia group and the <10% myocardial ischemia group [adjusted hazard ratio (95% confidence interval), 1.04 (0.45-2.45), p=0.92]. CONCLUSION The presence of ≥10% myocardial ischemia at diagnosis was significantly associated with the 1-year risk for MACEs in Japanese patients with suspected coronary artery disease.
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Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Mitsuru Momose
- Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Section, Department of Data Science, Center for Clinical Science, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoya Matsumoto
- Department of Cardiovascular Medicine, Nihon University, Tokyo, Japan
| | - Satoshi Hida
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Takao Yamauchi
- Cardiovascular Medicine, JCHO Sagamino Hospital, Sagamihara, Japan
| | | | - Eriko Suzuki
- Department of Nuclear Medicine, Hokkaido University, Sapporo, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Kitano Hospital, Osaka, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Zhou Y, Yan H, Li T, Xie M, Li X, Zhao C. New use of old medicine: Nifedipine acts on the TRP family and inflammatory proteins in the treatment of chilblain. Burns 2022; 48:372-380. [PMID: 34103198 DOI: 10.1016/j.burns.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022]
Abstract
As a calcium antagonist, the mechanism of nifedipine for treating chilblain has not been reported. In the present study, we established the chilblain model by using -20 ℃ 95% ethanol to freeze the right back foot of SD rats, and investigated the effects of this drug. Hematoxylin-eosin (HE) examination indicated most of pannus in the skin tissue of chilblain rats had disappeared, and the local inflammatory cells were also greatly reduced when given nifedipine at 15.0 mg/kg/d. The enzyme-linked immunosorbent assay (ELISA) revealed that nifedipine inhibited release of inflammatory factors TNF-α, IL-6, IL-1β and VEGF in serum. The RT-PCR analysis showed that nifedipine down regulated mRNA levels of TRPC-6 and VEGF in skin tissue. Furthermore, immunohistochemical examination showed nifedipine inhibited expression of IL-1β, IL-6, and TNF-α inflammatory protein and further inhibited expression of TRP (transient receptor potential) family proteins TRPM-7, TRPC-1, TRPC-3 and TRPC-6 and reduced expression of VEGF in skin and relieved erythema and oedema. This study demonstrated that nifedipine as an old medicine can be new use for the treatment of chilblain by acting on TRPs family and inflammatory proteins.
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Affiliation(s)
- Yongqiang Zhou
- Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China.
| | - Helv Yan
- Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Ting Li
- Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Mei Xie
- Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Xiuya Li
- Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Chunli Zhao
- Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
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6
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Wu BT. Percutaneous coronary intervention to refractory left main coronary artery spasm. J Cardiol Cases 2021; 25:300-303. [DOI: 10.1016/j.jccase.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022] Open
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7
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Hao K, Takahashi J, Kikuchi Y, Suda A, Sato K, Sugisawa J, Tsuchiya S, Shindo T, Nishimiya K, Ikeda S, Tsuburaya R, Shiroto T, Matsumoto Y, Miyata S, Sakata Y, Yasuda S, Shimokawa H. Prognostic Impacts of Comorbid Significant Coronary Stenosis and Coronary Artery Spasm in Patients With Stable Coronary Artery Disease. J Am Heart Assoc 2021; 10:e017831. [PMID: 33455423 PMCID: PMC7955295 DOI: 10.1161/jaha.120.017831] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/05/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Stable coronary artery disease is caused by a variable combination of organic coronary stenosis and functional coronary abnormalities, such as coronary artery spasm. Thus, we examined the clinical importance of comorbid significant coronary stenosis and coronary spasm. METHODS AND RESULTS We enrolled 236 consecutive patients with suspected angina who underwent acetylcholine provocation testing for coronary spasm and fractional flow reserve (FFR) measurement. Among them, 175 patients were diagnosed as having vasospastic angina (VSA), whereas the remaining 61 had no VSA (non-VSA group). The patients with VSA were further divided into the following 3 groups based on angiography and FFR: no organic stenosis (≤50% luminal stenosis; VSA-alone group, n=110), insignificant stenosis of FFR>0.80 (high-FFR group, n=36), and significant stenosis of FFR≤0.80 (low-FFR group, n=29). The incidence of major adverse cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, urgent percutaneous coronary intervention, and hospitalization attributed to unstable angina was evaluated. All patients with VSA received calcium channel blockers, and 28 patients (95%) in the low-FFR group underwent a planned percutaneous coronary intervention. During a median follow-up period of 656 days, although the incidence of major adverse cardiovascular events was low and comparable among non-VSA, VSA-alone, and high-FFR groups, the low-FFR group had an extremely poor prognosis (non-VSA group, 1.6%; VSA-alone group, 3.6%; high-FFR group, 5.6%; low-FFR group, 27.6%) (P<0.001). Importantly, all 8 patients with major adverse cardiovascular events in the low-FFR group were appropriately treated with percutaneous coronary intervention and calcium channel blockers. CONCLUSIONS These results indicate that patients with VSA with significant coronary stenosis represent a high-risk population despite current guideline-recommended therapies, suggesting the importance of routine coronary functional testing in this population.
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Affiliation(s)
- Kiyotaka Hao
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Jun Takahashi
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yoku Kikuchi
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Akira Suda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Koichi Sato
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Jun Sugisawa
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Tsuchiya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Tomohiko Shindo
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Kensuke Nishimiya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Shohei Ikeda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Ryuji Tsuburaya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Takashi Shiroto
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yasuharu Matsumoto
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Miyata
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yasuhiko Sakata
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Yasuda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Hiroaki Shimokawa
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
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Sawano M, Katsuki T, Kitai T, Tamita K, Obunai K, Ikegami Y, Yamane T, Ueda I, Endo A, Maekawa Y, Kawamura A, Fukuda K, Kohsaka S. Beta blockers versus calcium channel blockers for provocation of vasospastic angina after drug-eluting stent implantation: a multicentre prospective randomised trial. Open Heart 2020; 7:openhrt-2020-001406. [PMID: 33087441 PMCID: PMC7580072 DOI: 10.1136/openhrt-2020-001406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background Drug-eluting stent-induced vasospastic angina (DES-VSA) has emerged as a novel complication in the modern era of percutaneous coronary intervention (PCI). Although beta blockers (BBs) are generally recommended for coronary heart disease, they may promote incidence of DES-VSA. This study aimed to compare the effects of calcium channel blockers (CCBs) perceived to be protective against DES-VSA and BBs on subsequent coronary events after second-generation drug-eluting stent implantation. Methods In this multicentre prospective, randomised study, 52 patients with coronary artery disease who underwent PCI for a single-vessel lesion with everolimus-eluting stent placement were randomised into post-stenting BB (N=26) and CCB (N=26) groups and followed for 24 months to detect any major cardiovascular events (MACE). A positive result on acetylcholine provocation testing during diagnostic coronary angiography (CAG) at 9 months was the primary endpoint for equivalence. MACE included all-cause death, non-fatal myocardial infarction, unstable angina, cerebrovascular disease or coronary revascularisation for stable coronary artery disease after index PCI. Results At 9 months, 42 patients (80.8%) underwent diagnostic coronary angiography and acetylcholine provocation testing. Among them, seven patients in each group were diagnosed with definite vasospasm (intention-to-treat analysis 26.9% vs 26.9%, risk difference 0 (−0.241, 0.241)). Meanwhile, the secondary endpoint, 24-month MACE, was higher in the CCB group (19.2%) than in the BB group (3.8%) (p=0.01). In detail, coronary revascularisation for stable coronary artery disease was the predominant endpoint that contributed to the greater proportion of MACE in the CCB group (CCB (19.2%) vs BB (3.8%), p=0.03). Conclusions The incidence of acetylcholine-induced coronary artery spasms did not differ between patients receiving BBs or CCBs at 9 months after PCI. However, a higher incidence of 2-year MACE was observed in the CCB group, suggesting the importance of BB administration. Trial registration number This study was registered at the Japanese University Hospital Medical Information Network (UMIN) Clinical Trial Registry (The Prospective Randomized Trial for Optimizing Medical Therapy After Stenting: Calcium-Beta Trial; UMIN000008321, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009536).
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Affiliation(s)
- Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.,Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Toshiomi Katsuki
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koichi Tamita
- Department of Cardiology, Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, Hyogo, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Ichikawa, Japan
| | - Yukinori Ikegami
- Department of Cardiology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ayaka Endo
- Department of Cardiology, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare Faculty of Medicine Graduate School of Medicine, Narita, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Crea F, Bairey Merz CN, Beltrame JF, Berry C, Camici PG, Kaski JC, Ong P, Pepine CJ, Sechtem U, Shimokawa H. Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization. Eur Heart J 2020; 40:2455-2462. [PMID: 30608528 DOI: 10.1093/eurheartj/ehy857] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/09/2018] [Accepted: 11/28/2018] [Indexed: 01/09/2023] Open
Abstract
Persistence or recurrence of angina after a percutaneous coronary intervention (PCI) may affect about 20-40% of patients during short-medium-term follow-up. This appears to be true even when PCI is 'optimized' using physiology-guided approaches and drug-eluting stents. Importantly, persistent or recurrent angina post-PCI is associated with a significant economic burden. Healthcare costs may be almost two-fold higher among patients with persistent or recurrent angina post-PCI vs. those who become symptom-free. However, practice guideline recommendations regarding the management of patients with angina post-PCI are unclear. Gaps in evidence into the mechanisms of post-PCI angina are relevant, and more research seems warranted. The purpose of this document is to review potential mechanisms for the persistence or recurrence of angina post-PCI, propose a practical diagnostic algorithm, and summarize current knowledge gaps.
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Affiliation(s)
- Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Roma, Italy
| | - Cathleen Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 San Vicente Blvd, Los Angeles, CA, USA
| | - John F Beltrame
- Discipline of Medicine, Ward 5B, The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville South, Adelaide, South Australia, Australia
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow, UK
| | - Paolo G Camici
- Department of Cardiology, Vita Salute University and San Raffaele Hospital, Via Olgettina 60, Milano, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, UK
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, Stuttgart, Germany
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Departmant of Medicine, College of Medicine, University of Florida, 1600 SW Archer Rd, Box 100288, Gainesville, FL, USA
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, Stuttgart, Germany
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Japan
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Pathak MP, Das A, Patowary P, Chattopadhyay P. Contentious role of 'Good Adiponectin' in pulmonary and cardiovascular diseases: Is adiponectin directed therapy a boon or a bane? Biochimie 2020; 175:106-119. [PMID: 32473183 DOI: 10.1016/j.biochi.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 11/24/2022]
Abstract
After two decades of its discovery, numerous facts of adiponectin (APN) biology has been uncovered, yet, APN remains an elusive adipokine. Findings from clinical studies and animal models established APN's ameliorative role in cardiovascular disease (CVD) and pulmonary disease (PD) but the same condition is prognostic for mortality in the same set of patients which cornered APN towards a dubious state. A repertoire of mechanisms associated with the positive association of APN in both lean/cachectic or obese CVD and PD patients from past publications are evaluated. Newer pharmacological agent may be explored to regulate elevated blood APN concentration in COPD or CHF patients whereas administration of recombinant APN as well as growth hormone may augment blood APN concentration in obese subjects associated with low blood and intracellular APN concentration. However, some APN directed therapy in clinical as well as in pre-clinical setup has pronounced some contentious effects. After reviewing the mechanisms of the contentious role of APN functioning in pathologic conditions of CVD and PD in both lean and obese conditions, the authors came to conclusion that APN directed therapy may be utilized with caution keeping in mind the different age group, sex and the different CVD as well as pulmonary diseases they are suffering from.
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Affiliation(s)
- Manash Pratim Pathak
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur, India; Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, India
| | - Aparoop Das
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, India
| | - Pompy Patowary
- Division of Pharmaceutical Technology, Defence Research Laboratory, Tezpur, India; Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, India
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11
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Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41:407-477. [PMID: 31504439 DOI: 10.1093/eurheartj/ehz425] [Citation(s) in RCA: 3586] [Impact Index Per Article: 896.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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12
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Ohyama K, Matsumoto Y, Takanami K, Ota H, Nishimiya K, Sugisawa J, Tsuchiya S, Amamizu H, Uzuka H, Suda A, Shindo T, Kikuchi Y, Hao K, Tsuburaya R, Takahashi J, Miyata S, Sakata Y, Takase K, Shimokawa H. Coronary Adventitial and Perivascular Adipose Tissue Inflammation in Patients With Vasospastic Angina. J Am Coll Cardiol 2019; 71:414-425. [PMID: 29389358 DOI: 10.1016/j.jacc.2017.11.046] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/22/2017] [Accepted: 11/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies suggested that perivascular components, such as perivascular adipose tissue (PVAT) and adventitial vasa vasorum (VV), play an important role as a source of various inflammatory mediators in cardiovascular disease. OBJECTIVES The authors tested their hypothesis that coronary artery spasm is associated with perivascular inflammation in patients with vasospastic angina (VSA) using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). METHODS This study prospectively examined 27 consecutive VSA patients with acetylcholine-induced diffuse spasm in the left anterior descending artery (LAD) and 13 subjects with suspected angina but without organic coronary lesions or coronary spasm. Using CT coronary angiography and electrocardiogram-gated 18F-FDG PET/CT, coronary PVAT volume and coronary perivascular FDG uptake in the LAD were examined. In addition, adventitial VV formation in the LAD was examined with optical coherence tomography, and Rho-kinase activity was measured in circulating leukocytes. RESULTS Patient characteristics were comparable between the 2 groups. CT coronary angiography and ECG-gated 18F-FDG PET/CT showed that coronary PVAT volume and coronary perivascular FDG uptake significantly increased in the VSA group compared with the non-VSA group. Furthermore, optical coherence tomography showed that adventitial VV formation significantly increased in the VSA group compared with the non-VSA group, as did Rho-kinase activity. Importantly, during the follow-up period with medical treatment, both coronary perivascular FDG uptake and Rho-kinase activity significantly decreased in the VSA group. CONCLUSIONS These results provide the first evidence that coronary spasm is associated with inflammation of coronary adventitia and PVAT, where 18F-FDG PET/CT could be useful for disease activity assessment. (Morphological and Functional Change of Coronary Perivascular Adipose Tissue in Vasospastic Angina [ADIPO-VSA Trial]; UMIN000016675).
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Affiliation(s)
- Kazuma Ohyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirokazu Amamizu
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hironori Uzuka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuji Tsuburaya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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13
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Rodriguez-Granillo GA, Capunay C, Deviggiano A, De Zan M, Carrascosa P. Regional differences of fat depot attenuation using non-contrast, contrast-enhanced, and delayed-enhanced cardiac CT. Acta Radiol 2019; 60:459-467. [PMID: 30060671 DOI: 10.1177/0284185118787356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Regional fat density assessed by computed tomography (CT) has been suggested as a marker of perivascular adipose tissue inflammation. Dual energy CT (DECT) allows improved tissue characterization compared to conventional CT. PURPOSE To explore whether DECT might aid regional fat density discrimination. MATERIAL AND METHODS We included patients who had completed a non-enhanced cardiac CT scan, CT coronary angiography (CTCA), and a delayed enhancement CT. Attenuation levels (Hounsfield units [HU]) were assessed at the epicardial, paracardial, visceral, and subcutaneous fat. The number of coronary segments with disease (SIS) was calculated. RESULTS A total of 36 patients were included in the analysis. Twenty-six (72%) patients had evidence of obstructive disease at CCTA and 25 (69%) patients had evidence of previous myocardial infarction. At non-contrast CT, we did not identify significant attenuation differences between epicardial, paracardial, subcutaneous, and visceral fat depots (-110.8 ± 9 HU, vs. -113.7 ± 9 HU, vs. -114.7 ± 8 HU, vs. -113.8 ± 11 HU, P = 0.36). Significant attenuation differences were detected between fat depots at mid and low energy levels, both at CTCA and delayed-enhancement scans ( P < 0.05 for all). Epicardial fat showed the least negative attenuation, irrespective of the acquisition mode; epicardial fat evaluated at 40 keV was related to the SIS (r = 0.37, P = 0.03). CONCLUSIONS In this study, regional fat depots amenable to examination during thoracic CT scans have distinctive regional attenuation values. Furthermore, such differences were better displayed using contrast-enhanced monochromatic imaging at low energy levels.
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Affiliation(s)
| | - Carlos Capunay
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina
| | - Alejandro Deviggiano
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina
| | - Macarena De Zan
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina
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14
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Kubo S, Ohya M, Kuwayama A, Shimada T, Miura K, Amano H, Hyodo Y, Otsuru S, Habara S, Tada T, Tanaka H, Fuku Y, Goto T, Kadota K. Difference in clinical presentations and related angiographic findings among early, late, and very late sirolimus-eluting stent failures requiring target lesion revascularization. Int J Cardiol 2017; 243:116-120. [PMID: 28545849 DOI: 10.1016/j.ijcard.2017.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/07/2017] [Accepted: 05/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUNDS The difference in clinical presentations (acute coronary syndrome [ACS] and stable coronary artery disease [SCAD]) and related angiographic morphologies of sirolimus-eluting stent (SES) failure requiring target lesion revascularization (TLR) during early-term (<1year), late-term (1-5years), and very late-term periods (>5years) remains unknown. METHODS Among 4484 lesions undergoing SES implantation, clinically-driven TLR was performed on 105 lesions during early-term, 169 lesions during late-term, and 147 lesions during very late-term period. Angiographic morphological patterns were divided into focal or non-focal patterns and stent-edge or stent-body patterns. RESULTS The proportion of ACS substantially increased in very late TLR lesions (57.1%) from early (40.0%, p=0.01) and late TLR lesions (36.7%, p<0.001). The proportions of both stent-edge and non-focal patterns were higher in very late TLR lesions than in early and late TLR lesions. Although the stent-edge pattern tended to be more prevalent in SCAD lesions than in ACS lesions during the early- and late-term periods, it was more frequently observed in ACS lesions than in SCAD lesions during the very late-term period (65.5% vs. 47.6%, p=0.04). The non-focal pattern was more frequent in ACS lesions than in SCAD lesions during all 3 periods. However, the proportion of the non-focal pattern in ACS lesions was extremely high during the very late-term (90.5%) compared with the early- (47.6%, p<0.001) and late-term periods (48.4%, p<0.001). CONCLUSIONS Stent-related ACS became more common beyond 5years after SES implantation. Stent-edge and non-focal patterns were the main angiographic morphologies of very late SES failure, particularly causing ACS.
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Affiliation(s)
- Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akimune Kuwayama
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takenobu Shimada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Katsuya Miura
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hidewo Amano
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yusuke Hyodo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Suguru Otsuru
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Seiji Habara
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tsuyoshi Goto
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
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Ohyama K, Matsumoto Y, Amamizu H, Uzuka H, Nishimiya K, Morosawa S, Hirano M, Watabe H, Funaki Y, Miyata S, Takahashi J, Ito K, Shimokawa H. Association of Coronary Perivascular Adipose Tissue Inflammation and Drug-Eluting Stent–Induced Coronary Hyperconstricting Responses in Pigs. Arterioscler Thromb Vasc Biol 2017; 37:1757-1764. [DOI: 10.1161/atvbaha.117.309843] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/11/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Kazuma Ohyama
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Yasuharu Matsumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Hirokazu Amamizu
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Hironori Uzuka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Kensuke Nishimiya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Susumu Morosawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Michinori Hirano
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Hiroshi Watabe
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Yoshihito Funaki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Kenta Ito
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.O., Y.M., H.A., H.U., K.N., S. Morosawa, M.H., S. Miyata, J.T., K.I., H.S.); and Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (H.W., Y.F.)
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16
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Uzuka H, Matsumoto Y, Nishimiya K, Ohyama K, Suzuki H, Amamizu H, Morosawa S, Hirano M, Shindo T, Kikuchi Y, Hao K, Shiroto T, Ito K, Takahashi J, Fukuda K, Miyata S, Funaki Y, Ishibashi-Ueda H, Yasuda S, Shimokawa H. Renal Denervation Suppresses Coronary Hyperconstricting Responses After Drug-Eluting Stent Implantation in Pigs In Vivo Through the Kidney-Brain-Heart Axis. Arterioscler Thromb Vasc Biol 2017; 37:1869-1880. [PMID: 28818859 DOI: 10.1161/atvbaha.117.309777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/02/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Drug-eluting stent-induced coronary hyperconstricting responses remain an important issue. The adventitia harbors a variety of components that potently modulate vascular tone, including sympathetic nerve fibers (SNF) and vasa vasorum. Catheter-based renal denervation (RDN) inhibits sympathetic nerve activity. We, thus, examined whether RDN suppresses drug-eluting stent-induced coronary hyperconstricting responses, and if so, what mechanisms are involved. APPROACH AND RESULTS Protocol 1: pigs implanted with everolimus-eluting stents into the left coronary arteries underwent coronary angiography at 1 month after implantation for assessment of coronary vasomotion and adventitial SNF formation. Drug-eluting stent-induced coronary hyperconstricting responses were significantly enhanced associated with enhanced coronary adventitial SNF and vasa vasorum formation. Protocol 2: pigs implanted with everolimus-eluting stents were randomly assigned to the RDN or sham group. The RDN group underwent renal ablation. At 1 month, RDN significantly caused marked damage of the SNF at the renal arteries without any stenosis, thrombus, or dissections. Notably, RDN significantly upregulated the expression of α2-adrenergic receptor-binding sites in the nucleus tractus solitarius, attenuated muscle sympathetic nerve activity, and decreased systolic blood pressure and plasma renin activity. In addition, RDN attenuated coronary hyperconstricting responses to intracoronary serotonin at the proximal and distal stent edges associated with decreases in SNF and vasa vasorum formation, inflammatory cell infiltration, and Rho-kinase expression/activation. Furthermore, there were significant positive correlations between SNF and vasa vasorum and between SNF and coronary vasoconstricting responses. CONCLUSIONS These results provide the first evidence that RDN ameliorates drug-eluting stent-induced coronary hyperconstricting responses in pigs in vivo through the kidney-brain-heart axis.
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Affiliation(s)
- Hironori Uzuka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuharu Matsumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kensuke Nishimiya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuma Ohyama
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Suzuki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hirokazu Amamizu
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Susumu Morosawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michinori Hirano
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomohiko Shindo
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoku Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kiyotaka Hao
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenta Ito
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Fukuda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihito Funaki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hatsue Ishibashi-Ueda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan.
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Abstract
PURPOSE OF REVIEW Adiponectin is an adipokine with anti-inflammatory, antioxidant, antiatherogenic, pro-angiogenic, vasoprotective and insulin-sensitizing properties. Several factors may influence adiponectin levels, such as genetic polymorphisms, obesity / body fat distribution, diet and exercise as well as cardiovascular risk factors such as sleep deprivation and smoking as well as medications. Adiponectin has been proposed as a potential prognostic biomarker and a therapeutic target in patients with cardiometabolic diseases. RECENT FINDINGS This narrative review discusses the associations of adiponectin with obesity-related metabolic disorders (metabolic syndrome, nonalcoholic fatty liver disease, hyperuricaemia and type 2 diabetes mellitus). We also focus on the links between adiponectin and lipid disorders and with coronary heart disease and noncardiac vascular diseases (i.e. stroke, peripheral artery disease, carotid artery disease, atherosclerotic renal artery stenosis, abdominal aortic aneurysms and chronic kidney disease). Further, the effects of lifestyle interventions and drug therapy on adiponectin levels are briefly reviewed. SUMMARY Based on available data, adiponectin represents a multifaceted biomarker that may beneficially affect atherosclerosis, inflammation and insulin resistance pathways. However, there are conflicting results with regard to the associations between adiponectin levels and the prevalence and outcomes of cardiometabolic diseases. Further research on the potential clinical implications of adiponectin in the diagnosis and treatment of such diseases is needed.
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Affiliation(s)
- Niki Katsiki
- aSecond Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece bDivision of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA cDepartment of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Chen D, Jepson N. Coronary stent technology: a narrative review. Med J Aust 2016; 205:277-81. [DOI: 10.5694/mja16.00444] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
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Lüscher TF. An update on interventional cardiology: management of CTO, performance of absorbable scaffolds, coronary vasomotion after DES, and antithrombotics. Eur Heart J 2016; 37:2681-3. [PMID: 27678182 DOI: 10.1093/eurheartj/ehw412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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