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Franke KB, Montarello NJ, Nelson AJ, Marathe JA, Wong DT, Tavella R, Arstall M, Zeitz C, Worthley MI, Beltrame JF, Psaltis PJ. Tandem lesions associate with angiographic progression of coronary artery stenoses. Int J Cardiol Heart Vasc 2024; 52:101417. [PMID: 38725440 PMCID: PMC11079457 DOI: 10.1016/j.ijcha.2024.101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
Background Although the clinical factors associated with progression of coronary artery disease have been well studied, the angiographic predictors are less defined. Objectives Our objective was to study the clinical and angiographic factors that associate with progression of coronary artery stenoses. Methods We conducted a retrospective analysis of consecutive patients undergoing multiple, clinically indicated invasive coronary angiograms with an interval greater than 6 months, between January 2013 and December 2016. Lesion segments were analysed using Quantitative Coronary Angiography (QCA) if a stenosis ≥ 20 % was identified on either angiogram. Stenosis progression was defined as an increase ≥ 10 % in stenosis severity, with progressor groups analysed on both patient and lesion levels. Mixed-effects regression analyses were performed to evaluate factors associated with progression of individual stenoses. Results 199 patients were included with 881 lesions analysed. 108 (54.3 %) patients and 186 (21.1 %) stenoses were classified as progressors. The median age was 65 years (IQR 56-73) and the median interval between angiograms was 2.1 years (IQR 1.2-3.0). On a patient level, age, number of lesions and presence of multivessel disease at baseline were each associated with progressor status. On a lesion level, presence of a stenosis downstream (OR 3.07, 95 % CI 2.04-4.63, p < 0.001) and circumflex artery stenosis location (OR 1.81, 95 % CI 1.21-2.7, p = 0.004) were associated with progressor status. Other lesion characteristics did not significantly impact progressor status or change in stenosis severity. Conclusion Coronary lesions which have a downstream stenosis may be at increased risk of stenosis progression. Further research into the mechanistic basis of this finding is required, along with its implications for plaque vulnerability and clinical outcomes.
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Affiliation(s)
- Kyle B. Franke
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Nicholas J. Montarello
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Adam J. Nelson
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Jessica A. Marathe
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | | | - Rosanna Tavella
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Margaret Arstall
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Christopher Zeitz
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Matthew I. Worthley
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - John F. Beltrame
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Peter J. Psaltis
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
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2
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Stokes MB, Chan WPA, Worthley MI, Coates PT. Acetazolamide-another tool in the congestion battle? Kidney Int 2023; 103:1012-1014. [PMID: 37210191 DOI: 10.1016/j.kint.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/11/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Michael B Stokes
- South Australian Centre for Advanced Heart and Lung Disease, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Wai Ping Alicia Chan
- South Australian Centre for Advanced Heart and Lung Disease, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew I Worthley
- South Australian Centre for Advanced Heart and Lung Disease, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - P Toby Coates
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
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Lin RZ, Gallagher C, Tu SJ, Pitman BM, Nelson AJ, Roberts-Thomson RL, Worthley MI, Lau DH, Sanders P, Wong CX. Trends in myocardial infarction and coronary revascularisation procedures in Australia, 1993-2017. Heart 2023; 109:283-288. [PMID: 36344268 DOI: 10.1136/heartjnl-2022-321393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Prior data have shown rising acute myocardial infarction (MI) trends in Australia; whether these increases have continued in recent years is not known. This study thus sought to characterise contemporary nationwide trends in MI hospitalisations and coronary procedures in Australia and their associated economic burden. METHODS The primary outcome measure was the incidence and time trends of total MI, ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) hospitalisations from 1993 to 2017. The incidence and time trends of coronary procedures were additionally collected, alongside MI hospitalisation costs. RESULTS Adjusted for population changes, annual MI incidence increased from 216.2 cases per 100 000 to a peak of 270.4 in 2007 with subsequent decline to 218.7 in 2017. Similarly, NSTEMI incidence increased from 68.0 cases per 100 000 in 1993 to a peak of 192.6 in 2007 with subsequent decline to 162.6 in 2017. STEMI incidence decreased from 148.3 cases per 100 000 in 1993 to 56.2 in 2017. Across the study period, there were annual increases in MI hospitalisations of 0.7% and NSTEMI hospitalisations of 5.6%, and an annual decrease in STEMI hospitalisations of 4.8%. Angiography and percutaneous coronary intervention increased by 3.4% and 3.3% annually, respectively, while coronary artery bypass graft surgery declined by 2.2% annually. MI hospitalisation costs increased by 100% over the study period, despite a decreased average length of stay by 45%. CONCLUSIONS The rising incidence of MI hospitalisations appear to have stabilised in Australia. Despite this, associated healthcare expenditure remains significant, suggesting a need for continual implementation of public health policies and preventative strategies.
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Affiliation(s)
- Richard Z Lin
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Celine Gallagher
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Samuel J Tu
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Bradley M Pitman
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Adam J Nelson
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Ross L Roberts-Thomson
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I Worthley
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
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4
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Ong GJ, Sellers A, Mahadavan G, Nguyen TH, Worthley MI, Chew DP, Horowitz JD. 'Bushfire Season' in Australia: Determinants of Increases in Risk of Acute Coronary Syndromes and Takotsubo Syndrome. Am J Med 2023; 136:88-95. [PMID: 36058309 DOI: 10.1016/j.amjmed.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Climate change has resulted in an increase in ambient temperatures during the summer months as well as an increase in risk of associated air pollution and of potentially disastrous bushfires throughout much of the world. The increasingly frequent combination of elevated summer temperatures and bushfires may be associated with acute increases in risks of cardiovascular events, but this relationship remains unstudied. We evaluated the individual and cumulative impacts of daily fluctuations in temperature, fine particulate matter of less than 2.5 µm (PM2.5) pollution and presence of bushfires on incidence of acute coronary syndromes and Takotsubo syndrome. METHODS From November 1, 2019, to February 28, 2020, all admissions with acute coronary syndromes or Takotsubo syndrome to South Australian tertiary public hospitals were evaluated. Univariate and combined associations were sought among each of 1) maximal daily temperature, 2) PM2.5 concentrations, and 3) presence of active bushfires within 200 km of the hospitals concerned. RESULTS A total of 504 patients with acute coronary syndromes and 35 with Takotsubo syndrome were studied. In isolation, increasing temperature was associated (rs = 0.26, P = .005) with increased incidence of acute coronary syndromes, while there were similar, but nonsignificant correlations for PM2.5 and presence of bushfires. Combinations of all these risk factors were also associated with a doubling of risk of acute coronary syndromes. No significant associations were found for Takotsubo syndrome. CONCLUSION The combination of high temperatures, presence of bushfires and associated elevation of atmospheric PM2.5 concentrations represents a substantially increased risk for precipitation of acute coronary syndromes; this risk should be factored into health care planning including public education and acute hospital preparedness.
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Affiliation(s)
- Gao Jing Ong
- Cardiology Research Laboratory, Basil Hetzel Institute for Translational Health Research, Queen Elizabeth Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia; Cardiology Department, Central Adelaide Local Health Network, Adelaide, Australia
| | - Alexander Sellers
- Cardiology Department, Central Adelaide Local Health Network, Adelaide, Australia
| | - Gnanadevan Mahadavan
- Cardiology Department, Central Adelaide Local Health Network, Adelaide, Australia; Cardiology Department, Northern Adelaide Local Health Network, Elizabeth Vale, Adelaide, Australia
| | - Thanh H Nguyen
- Cardiology Research Laboratory, Basil Hetzel Institute for Translational Health Research, Queen Elizabeth Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia
| | - Matthew I Worthley
- University of Adelaide, Adelaide, Australia; Cardiology Department, Central Adelaide Local Health Network, Adelaide, Australia
| | - Derek P Chew
- South Australian Health and Medical Research Institute, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - John D Horowitz
- Cardiology Research Laboratory, Basil Hetzel Institute for Translational Health Research, Queen Elizabeth Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia.
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5
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Baumann AAW, Tavella R, Air TM, Mishra A, Montarello NJ, Arstall M, Zeitz C, Worthley MI, Beltrame JF, Psaltis PJ. Prevalence and real-world management of NSTEMI with multivessel disease. Cardiovasc Diagn Ther 2022; 12:1-11. [PMID: 35282665 PMCID: PMC8898694 DOI: 10.21037/cdt-21-518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/13/2022] [Indexed: 09/09/2023]
Abstract
BACKGROUND Non-ST elevation myocardial infarction (NSTEMI) has higher post-discharge mortality than ST-elevation myocardial infarction (STEMI). Prognosis worsens in those with multivessel coronary disease (MVD). However, information about the prevalence and extent of MVD in NSTEMI is limited, in turn limiting insights into optimal treatment strategies. This study aimed to define the prevalence and extent of MVD, preferred treatment strategies and the predictors of MVD in a real-world NSTEMI population. METHODS The Coronary Angiogram Database of South Australia (CADOSA) was used to identify consecutive patients presenting to major teaching hospitals with NSTEMI between 2012 and 2016. Obtaining clinical and angiographic details, patients were stratified by the number of significantly diseased vessels (0,1,2,3-VD), defined by a stenosis of ≥70%, or ≥50% in the left main coronary artery. Data was analysed retrospectively. RESULTS The prevalence of MVD (2- or 3-VD) was 42% amongst 3,722 NSTEMI presentations. Multivariate logistic regression modelling showed age, male gender, diabetes, dyslipidaemia and prior myocardial infarction predicted MVD over 1-VD or 0-VD. Percutaneous coronary intervention (PCI) was performed in 42% of patients with MVD. This comprised 61% of 2-VD patients and only 22% of 3-VD patients, with 24% and 66% of each group referred for coronary bypass grafting, respectively. Among MVD patients treated with PCI, 76% had their culprit lesion treated alone in the index admission. CONCLUSIONS In this NSTEMI cohort, over 40% had MVD. Notably, a minority of patients with MVD undergoing PCI received multivessel revascularisation. This real-world practice emphasises that further evaluation is required to determine whether complete revascularisation is beneficial in NSTEMI, as reported for STEMI.
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Affiliation(s)
- Angus A. W. Baumann
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Department of Medicine, Alice Springs Hospital, Alice Springs, Australia
| | - Rosanna Tavella
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Tracy M. Air
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Aashka Mishra
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
| | - Nicholas J. Montarello
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
| | - Margaret Arstall
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Northern Adelaide Local Health Network (NALHN), Adelaide, Australia
| | - Chris Zeitz
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Matthew I. Worthley
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - John F. Beltrame
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Peter J. Psaltis
- Department of Cardiology, Central Adelaide Local Health Network (CALHN), Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute, Adelaide, Australia
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6
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Noubiap JJ, Agbaedeng TA, Nyaga UF, Lau DH, Worthley MI, Nicholls SJ, Sanders P. Atrial fibrillation incidence, prevalence, predictors, and adverse outcomes in acute coronary syndromes: A pooled analysis of data from 8 million patients. J Cardiovasc Electrophysiol 2022; 33:414-422. [PMID: 34981859 DOI: 10.1111/jce.15351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To summarize data on the prevalence/incidence, risk factors and prognosis of atrial fibrillation (AF) in patients with acute coronary syndromes (ACS). METHODS MEDLINE, Embase, and Web of Science were searched to identify all published studies providing relevant data through August 23, 2020. Random-effects meta-analysis method was used to pool estimates. RESULTS We included 109 studies reporting data from a pooled population of 8 239 364 patients. The prevalence rates were 5.8% for pre-existing AF, 7.3% for newly diagnosed AF, and 11.3% for prevalent (total) AF, in patients with ACS. Predictors of newly diagnosed AF included age (per year increase) (adjusted odds ratio [aOR]: 1.05), C-reactive protein (aOR: 1.49), left atrial (LA) diameter (aOR: 1.08), LA dilatation (aOR: 2.32), left ventricular ejection fraction <40% (aOR: 1.82), hypertension (aOR: 1.87), and Killip ˃ 1 (aOR: 1.85), p < .01 in all analyzes. Newly diagnosed AF was associated with an increased risk of acute heart failure (adjusted hazard ratio [aHR]: 3.20), acute kidney injury (aHR: 3.09), re-infarction (aHR: 1.96), stroke (aHR: 2.15), major bleeding (aHR: 2.93), and mortality (aHR: 1.80) in the short term; and with an increased risk of heart failure (aHR: 2.21), stroke (aHR: 1.75), mortality (aHR: 1.67), CV mortality (aHR: 2.09), sudden cardiac death (aHR: 1.53), and a composite of major adverse cardiovascular events (aHR: 1.54) in the long term (beyond 1 month), p < .05 in all analyzes. CONCLUSION One in nine patients with ACS has AF, with a high proportion of newly diagnosed AF. AF, in particular newly diagnosed AF, is associated with poor short-term and long-term outcomes in patients with ACS.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas A Agbaedeng
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ulrich F Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victoria Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
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Salehi T, Montarello NJ, Juneja N, Stokes MB, Scherer DJ, Williams KF, King D, Macaulay E, Russell CH, Olakkengil SA, Carroll RP, Faull RJ, Teo KS, McDonald SP, Worthley MI, Coates PT, Rao NN. Long-Term Impact of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients: A 5-Year Follow-Up Observational Cohort Study. Kidney360 2021; 2:1141-1147. [PMID: 35368362 PMCID: PMC8786094 DOI: 10.34067/kid.0000692021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/06/2021] [Indexed: 02/04/2023]
Abstract
Background The long-term effects of arteriovenous fistula (AVF) ligation on cardiovascular structure following kidney transplantation remain uncertain. A prospective randomized, controlled trial (RCT) examined the effect of AVF ligation at 6 months on cardiovascular magnetic resonance imaging (CMR)-derived parameters in 27 kidney transplant recipients compared with 27 controls. A mean decrease in left ventricular mass (LVM) of 22.1 g (95% CI, 15.0 to 29.1) was observed compared with an increase of 1.2 g (95% CI, -4.8 to 7.2) in the control group (P<0.001). We conducted a long-term follow-up observational cohort study in the treated cohort to determine the evolution of CMR-derived parameters compared with those documented at 6 months post-AVF ligation. Methods We performed CMR at long-term follow-up in the AVF ligation observational cohort from our original RCT published in 2019. Results were compared with CMR at 6 months postintervention. The coprimary end point was the change in CMR-derived LVM and LVM index at long-term follow-up from imaging at 6 months postindex procedure. Results At a median of 5.1 years (interquartile range, 4.7-5.5 years), 17 patients in the AVF ligation group were studied with repeat CMR with a median duration to follow-up imaging of 5.1 years (IQR, 4.7-5.5 years). Statistically significant further reductions in LVM (-17.6±23.0 g, P=0.006) and LVM index (-10.0±13.0 g/m2, P=0.006) were documented. Conclusions The benefit of AVF ligation on LVM and LVM index regression appears to persist long term. This has the potential to lead to a significant reduction in cardiovascular mortality.
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Affiliation(s)
- Tania Salehi
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nicholas J. Montarello
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Nishant Juneja
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Michael B. Stokes
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Daniel J. Scherer
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kerry F. Williams
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - David King
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Ewan Macaulay
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Christine H. Russell
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Santosh A. Olakkengil
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Robert P. Carroll
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Randall J. Faull
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen S.L. Teo
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Stephen P. McDonald
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I. Worthley
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Patrick T. Coates
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nitesh N. Rao
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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8
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Montarello NJ, Salehi T, Bate AP, Pisaniello AD, Clayton PA, Teo KS, Worthley MI, Coates PT. Multimodality Tachycardia-Induced Stress Testing Predicts a Low-Risk Group for Early Cardiovascular Mortality After Renal Transplantation. Kidney Int Rep 2020; 6:120-127. [PMID: 33426391 PMCID: PMC7783555 DOI: 10.1016/j.ekir.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Cardiovascular events remain a major cause of death in kidney transplant recipients. The optimal noninvasive workup to prevent peritransplant cardiac mortality remains contentious. Methods We conducted a retrospective analysis to assess the renal transplantation cardiovascular assessment protocol within a single-center population over a 5-year period. Asymptomatic patients aged less than 45 years with no history of cigarette smoking, without diabetes mellitus, and dialysis-dependent for less than 24 months did not undergo cardiac testing before listing. All other asymptomatic patients underwent a noninvasive, tachycardia-induced stress test, where a target heart rate of 85% predicted for age and gender was required. The primary endpoints were rates of acute myocardial infarction (AMI) and cardiovascular death at 30 days after renal transplantation. Results Between 2015 and 2019, 380 recipients underwent cardiac evaluation: 79 (20.8%) were deemed low cardiovascular risk and placed on the renal transplant waitlist without further assessment; 270 (71.1%) underwent a tachycardia-induced stress test; and 31 (8.1%) were deemed high risk and proceeded directly to invasive coronary angiography (ICA). In the 5-year follow-up, 3 patients (0.8%) experienced an AMI 30 days after renal transplantation, all of which occurred in the high-risk “direct to ICA” cohort. No events were documented in the low-risk cohort or in patients who had a negative tachycardia-induced stress test. There were no cardiovascular deaths within 30 days after transplantation. Conclusion A negative tachycardia-induced cardiac stress test, achieving 85% of predicted heart rate, was associated with a 0% AMI rate and no cardiovascular deaths at 30 days after renal transplantation.
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Affiliation(s)
| | - Tania Salehi
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
| | - Alex P. Bate
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | | | - Philip A. Clayton
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
| | - Karen S.L. Teo
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Matthew I. Worthley
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
| | - Patrick T. Coates
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
- Correspondence: Patrick T. Coates, Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
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9
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Baumann AAW, Mishra A, Worthley MI, Nelson AJ, Psaltis PJ. Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine. Ther Adv Chronic Dis 2020; 11:2040622320938527. [PMID: 32655848 PMCID: PMC7331770 DOI: 10.1177/2040622320938527] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022] Open
Abstract
Recent analyses suggest the incidence of acute coronary syndrome is declining in high- and middle-income countries. Despite this, overall rates of non-ST-elevation myocardial infarction (NSTEMI) continue to rise. Furthermore, NSTEMI is a greater contributor to mortality after hospital discharge than ST-elevation myocardial infarction (STEMI). Patients with NSTEMI are often older, comorbid and have a high likelihood of multivessel coronary artery disease (MVD), which is associated with worse clinical outcomes. Currently, optimal treatment strategies for MVD in NSTEMI are less well established than for STEMI or stable coronary artery disease. Specifically, in relation to percutaneous coronary intervention (PCI) there is a paucity of randomized, prospective data comparing multivessel and culprit lesion-only PCI. Given the heterogeneous pathological basis for NSTEMI with MVD, an approach of complete revascularization may not be appropriate or necessary in all patients. Recognizing this, this review summarizes the limited evidence base for the interventional management of non-culprit disease in NSTEMI by comparing culprit-only and multivessel PCI strategies. We then explore how a personalized, precise approach to investigation, therapy and follow up may be achieved based on patient-, disease- and lesion-specific factors.
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Affiliation(s)
- Angus A. W. Baumann
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Aashka Mishra
- Flinders Medical School, Flinders University, Adelaide, South Australia, Australia
| | - Matthew I. Worthley
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, USA
- Vascular Research Centre, Lifelong Health Theme, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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10
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Nelson AJ, Worthley MI. Reply to “Letter to the Editor: Aortic distensibility and coronary blood flow: does cardiac period play a role?”. Am J Physiol Heart Circ Physiol 2019; 317:H1389. [DOI: 10.1152/ajpheart.00636.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Adam J. Nelson
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
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11
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Rao NN, McDonald SP, Worthley MI, Coates PT. Response by Rao et al to Letter Regarding Article, "Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients". Circulation 2019; 140:e806-e807. [PMID: 31738596 DOI: 10.1161/circulationaha.119.043153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nitesh N Rao
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.P.M., M.I.W., P.T.C.).,Central Northern Adelaide Renal and Transplantation Service (N.N.R., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia.,Lyell McEwin Hospital, Northern Adelaide Local Health Network, Australia (N.N.R.)
| | - Stephen P McDonald
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.P.M., M.I.W., P.T.C.).,Central Northern Adelaide Renal and Transplantation Service (N.N.R., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia.,Australia & New Zealand Dialysis and Transplant Registry (S.P.M.), South Australian Health and Medical Research Institute, Adelaide
| | - Matthew I Worthley
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.P.M., M.I.W., P.T.C.).,Department of Cardiology (M.I.W.), Central Adelaide Local Health Network, Australia.,Heart Health Theme (M.I.W.), South Australian Health and Medical Research Institute, Adelaide
| | - P Toby Coates
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.P.M., M.I.W., P.T.C.).,Central Northern Adelaide Renal and Transplantation Service (N.N.R., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
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12
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Nelson AJ, Puri R, Nicholls SJ, Dundon BK, Richardson JD, Sidharta SL, Teo KS, Worthley SG, Worthley MI. Aortic distensibility is associated with both resting and hyperemic coronary blood flow. Am J Physiol Heart Circ Physiol 2019; 317:H811-H819. [DOI: 10.1152/ajpheart.00067.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A large body of evidence demonstrates an independent association between arterial stiffness and prospective risk of cardiovascular events. A reduction in coronary perfusion is presumed to underscore this association; however, studies confirming this are lacking. This study compared invasive measures of coronary blood flow (CBF) with cardiac magnetic resonance (CMR)-derived aortic distensibility (AD). Following coronary angiography, a Doppler FloWire and infusion microcatheter were advanced into the study vessel. Average peak velocity (APV) was acquired at baseline and following intracoronary adenosine to derive coronary flow velocity reserve (CFVR = hyperemic APV/resting APV) and CBF [π × (diameter)2 × APV × 0.125]. Following angiography, patients underwent CMR to evaluate distensibility at the ascending aorta (AA), proximal descending aorta (PDA) and distal descending aorta (DDA). Fifteen participants (53 ± 13 yr) with minor epicardial disease (maximum stenosis <30%) were enrolled. Resting CBF was 44.1 ± 11.9 mL/min, hyperemic CBF was 143.8 ± 37.4 mL/min, and CFVR was 3.15 ± 0.48. AD was 3.89 ± 1.72·10−3mmHg−1 at the AA, 4.08 ± 1.80·10−3mmHg−1 at the PDA, and 4.42 ± 1.67·10−3mmHg−1 at the DDA. All levels of distensibility correlated with resting CBF ( R2 = 0.350–0.373, P < 0.05), hyperemic CBF ( R2 = 0.453–0.464, P < 0.01), and CFVR ( R2 = 0.442–0.511, P < 0.01). This study demonstrates that hyperemic and, to a lesser extent resting CBF, are significantly associated with measures of aortic stiffness in patients with only minor angiographic disease. These findings provide further in vivo support for the observed prognostic capacity of large artery function in cardiovascular event prediction. NEW & NOTEWORTHY Cardiac magnetic resonance-derived aortic distensibility is associated with invasive measures of coronary blood flow. Large artery function is more strongly correlated with hyperemic than resting blood flow. Increased stiffness may represent a potential target for novel antianginal medications.
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Affiliation(s)
- Adam J. Nelson
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Rishi Puri
- Department of Cardiovascular Medicine, and Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland Clinic, Cleveland, Ohio
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Benjamin K. Dundon
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - James D. Richardson
- Northern General Hospital, Sheffield Teaching Hospitals National Health Service, Sheffield, United Kingdom
| | - Samuel L. Sidharta
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
- GenesisCare, HeartCare, Adelaide, Australia
| | - Karen S. Teo
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Stephen G. Worthley
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
- GenesisCare, HeartCare, Adelaide, Australia
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13
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Takata K, Honda S, Sidharta SL, Duong M, Shishikura D, Kim SW, Andrews J, Di Bartolo BA, Psaltis PJ, Bursill CA, Worthley MI, Nicholls SJ. Associations of ABCG1-mediated cholesterol efflux capacity with coronary artery lipid content assessed by near-infrared spectroscopy. Cardiovasc Diagn Ther 2019; 9:310-318. [PMID: 31555535 DOI: 10.21037/cdt.2018.11.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Although high-density lipoprotein (HDL) has atheroprotective properties, the association of HDL functionality with coronary plaques remains unclear. Methods We investigated the association between HDL-mediated cholesterol efflux capacity (CEC) and coronary lipid burden in 74 patients who underwent near-infrared spectroscopy (NIRS) imaging for acute coronary syndrome (ACS) or stable ischemic symptoms. We measured baseline HDL-mediated CEC, distinguishing the specific pathways, and stratified patients according to their median CEC values. Coronary lipid burden was assessed as lipid core burden index (LCBI) using NIRS at baseline (n=74) and on serial imaging (n=47). Results Patients with baseline ATP-binding cassette transporter G1 (ABCG1)-mediated CEC > median had a greater baseline LCBI {74 [20, 128] vs. 32 [5, 66]; P=0.04} or change in LCBI {-30 [-89, 0] vs. -3 [-16, 0]; P=0.048}. In addition to a negative association between baseline LCBI and change in LCBI (standardized β=-0.31; P=0.02), multivariable analysis demonstrated a significant interaction effect between clinical presentation of coronary artery disease (CAD) and baseline ABCG1-mediated CEC on change in LCBI (P=0.003), indicating that baseline ABCG1-mediated CEC was inversely associated with change in LCBI in patients with ACS (standardized β=-0.79, P=0.003), but not in those with stable ischemic symptoms (P=0.52). Conclusions In this study, ABCG1-mediated CEC, but not ATP-binding cassette transporter A1 and scavenger receptor B type I, was associated with regression of coronary artery lipid content, especially in patients with high-risk phenotype. Further studies are required to determine the roles of ABCG1 pathway in the development coronary plaques.
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Affiliation(s)
- Kohei Takata
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Satoshi Honda
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Samuel L Sidharta
- Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - MyNgan Duong
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Daisuke Shishikura
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Susan W Kim
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Jordan Andrews
- South Australian Health & Medical Research Institute, Adelaide, Australia
| | | | - Peter J Psaltis
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Christina A Bursill
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Matthew I Worthley
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Stephen J Nicholls
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
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14
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Rao NN, Stokes MB, Rajwani A, Ullah S, Williams K, King D, Macaulay E, Russell CH, Olakkengil S, Carroll RP, Faull RJ, Teo KS, McDonald SP, Worthley MI, Coates PT. Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients. Circulation 2019; 139:2809-2818. [DOI: 10.1161/circulationaha.118.038505] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Nitesh N. Rao
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Lyell McEwin Hospital, Northern Adelaide Local Health Network, Australia (N.N.R.)
| | - Michael B. Stokes
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - Adil Rajwani
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
- Department of Cardiology, Royal Perth Hospital, Australia (A.R.)
| | - Shahid Ullah
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Australia and New Zealand Dialysis and Transplant Registry 1 (S.U., S.P.M.), South Australian Health and Medical Research Institute, Adelaide
| | - Kerry Williams
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - David King
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Department of Vascular Surgery (D.K., E.M.), Central Adelaide Local Health Network, Australia
| | - Ewan Macaulay
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Department of Vascular Surgery (D.K., E.M.), Central Adelaide Local Health Network, Australia
| | - Christine H. Russell
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Santosh Olakkengil
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Robert P. Carroll
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Randall J. Faull
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Karen S.L. Teo
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - Stephen P. McDonald
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Australia and New Zealand Dialysis and Transplant Registry 1 (S.U., S.P.M.), South Australian Health and Medical Research Institute, Adelaide
| | - Matthew I. Worthley
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
- Heart Health Theme (M.I.W.), South Australian Health and Medical Research Institute, Adelaide
| | - P. Toby Coates
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
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15
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Shishikura D, Sidharta SL, Honda S, Takata K, Kim SW, Andrews J, Montarello N, Delacroix S, Baillie T, Worthley MI, Psaltis PJ, Nicholls SJ. The relationship between segmental wall shear stress and lipid core plaque derived from near-infrared spectroscopy. Atherosclerosis 2018; 275:68-73. [PMID: 29864607 DOI: 10.1016/j.atherosclerosis.2018.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Wall shear stress (WSS) has an important role in the natural history of coronary atherosclerosis. The aim of this study is to investigate the relationship between WSS and the lipid content of atherosclerotic plaques as assessed by near-infrared spectroscopy (NIRS). METHODS We performed serial NIRS and intravascular ultrasound (IVUS) upon Doppler coronary flow guidewire of coronary plaques at baseline and after 12-18 months in 28 patients with <30% angiographic stenosis, who presented with coronary artery disease. Segmental WSS, plaque burden and NIRS-derived lipid rich plaque (LRP) were evaluated at both time-points in 482 consecutive 2-mm coronary segments. RESULTS Segments with LRP at baseline (n = 106) had a higher average WSS (1.4 ± 0.6 N/m2), compared to those without LRP (n = 376) (1.2 ± 0.6 N/m2, p<0.001). In segments without baseline LRP, WSS was higher in those who subsequently developed new LRP (n = 35) than those who did not (n = 341) (1.4 ± 0.8 vs. 1.1 ± 0.6 N/m2, p=0.002). Conversely, in segments with baseline LRP, WSS was lower in those who had regression of lipid content (n = 41) than those who did not (n = 65) (1.2 ± 0.4 vs. 1.6 ± 0.7 N/m2, p=0.007). Segments with the highest tertile of WSS displayed greater progression of LCBI irrespective of baseline lipid content (p<0.001). Multivariate analysis revealed that baseline WSS (p=0.017), PAV (p<0.001) and LCBI (p<0.001) were all independent predictors of change in LCBI over time. CONCLUSIONS Coronary segments with high WSS associate with progression of lipid content over time, which may indicate transformation to a more vulnerable phenotype.
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Affiliation(s)
- Daisuke Shishikura
- Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute, Australia
| | - Samuel L Sidharta
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; Cardiovascular Investigation Unit, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Satoshi Honda
- Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute, Australia
| | - Kohei Takata
- Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute, Australia
| | - Susan W Kim
- Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute, Australia
| | - Jordan Andrews
- Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute, Australia
| | - Natalie Montarello
- Cardiovascular Investigation Unit, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Sinny Delacroix
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Timothy Baillie
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Matthew I Worthley
- Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia; Cardiovascular Investigation Unit, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia; Cardiovascular Investigation Unit, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Stephen J Nicholls
- Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia; Cardiovascular Investigation Unit, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
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16
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Hammett CJ, Amerena J, Brieger D, Sindone A, Thompson PL, Worthley MI, Aylward PE. Preventing recurrent events in survivors of acute coronary syndromes in Australia: consensus recommendations using the Delphi process. Curr Med Res Opin 2018; 34:551-558. [PMID: 29243497 DOI: 10.1080/03007995.2017.1418175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE There remain substantial gaps in implementation of evidence-based care in patients with acute coronary syndromes (ACS) in Australia, which contribute to high recurrent event rates. Improved translation of evidence into effective action is a key health-care priority. We engaged cardiovascular experts from across Australia to develop straightforward, easily actionable recommendations on key medications to use following ACS. METHODS An eight-person steering committee (SC) reviewed the published evidence and developed an initial set of statements to be developed into consensus recommendations using a modified Delphi technique. A panel of 21 expert cardiologists in the ACS field (including the SC) voted on their level of agreement with the statements using a 6 point Likert scale. Statements that did not reach consensus (≥80% agreement) were reviewed by the SC, modified as appropriate based on input from the panel and circulated for re-voting. RESULTS Twenty-eight statements were developed by the SC across six classes of medication: low-density lipoprotein (LDL) cholesterol lowering agents, aspirin, dual antiplatelet therapy, renin-angiotensin-aldosterone system inhibitors, beta blockers and "other". Twenty-six recommendations were endorsed by the voting panel; two statements did not reach consensus. CONCLUSIONS Despite the extensive evidence base and detailed guidelines outlining best practice post ACS, there remain considerable gaps in translating these into everyday care. We used an internationally recognized technique to develop practical consensus recommendations on medical treatment following ACS. These simple, up-to-date recommendations aim to improve evidence-based medication use and thereby reduce the risk of future cardiovascular events for Australian patients with ACS.
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Affiliation(s)
- Christopher J Hammett
- a Department of Cardiology , Royal Brisbane and Women's Hospital , Brisbane , QLD , Australia
| | - John Amerena
- b Geelong Cardiology Research Centre , Barwon Health , Deakin University , VIC , Australia
| | - David Brieger
- c Cardiology Department , Concord Hospital and Sydney Medical School, The University of Sydney , Sydney , NSW , Australia
| | - Andrew Sindone
- d Cardiology Department , Concord Hospital and Sydney Medical School, The University of Sydney , Sydney , NSW , Australia
| | - Peter L Thompson
- e Heart Research Institute, Sir Charles Gairdner Hospital and Harry Perkins Institute of Medical Research, University of Western Australia , Perth , WA , Australia
| | - Matthew I Worthley
- f University of Adelaide, Royal Adelaide Hospital, and South Australian Health and Medical Research Institute , Adelaide , SA , Australia
| | - Philip E Aylward
- g South Australian Health and Medical Research Institute, and Flinders University and Medical Centre , Adelaide , SA , Australia
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17
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Sidharta SL, Baillie TJ, Howell S, Nicholls SJ, Montarello N, Honda S, Shishikura D, Delacroix S, Kim S, Beltrame JF, Psaltis PJ, Worthley SG, Worthley MI. Evaluation of human coronary vasodilator function predicts future coronary atheroma progression. Heart 2018; 104:1439-1446. [DOI: 10.1136/heartjnl-2017-312579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 11/03/2022] Open
Abstract
ObjectiveCoronary vasodilator function and atherosclerotic plaque progression have both been shown to be associated with adverse cardiovascular events. However, the relationship between these factors and the lipid burden of coronary plaque remains unknown. These experiments focus on investigating the relationship between impaired coronary vasodilator function (endothelium dependent (salbutamol) and endothelium independent (glyceryl trinitrate)) and the natural history of atheroma plaque progression and lipid burden using dual modality intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging.Methods33 patients with stable chest pain or acute coronary syndrome underwent serial assessment of coronary vasodilator function and intracoronary plaque IVUS and NIRS imaging. Coronary segmental macrovascular response (% change segmental lumen volume (ΔSLV)), plaque burden (per cent atheroma volume (PAV)), lipid core (lipid-rich plaque (LRP) and lipid core burden index (LCBI)) were measured at baseline and after an interval of 12–18 months (n=520 segments).ResultsLipid-negative coronary segments which develop into LRP over the study time period demonstrated impaired endothelial-dependent function (−0.24±2.96 vs 5.60±1.47%, P=0.04) and endothelial-independent function (13.91±4.45 vs 21.19±3.19%, P=0.036), at baseline. By multivariate analysis, endothelial-dependent function predicted ∆LCBI (β coefficient: −3.03, 95% CI (−5.81 to −0.25), P=0.033) whereas endothelial-independent function predicted ∆PAV (β coefficient: 0.07, 95% CI (0.04 to 0.10), P<0.0001).ConclusionsEpicardial coronary vasodilator function is a determinant of future atheroma progression and composition irrespective of the nature of clinical presentation.Trial registration numberACTRN12612000594820, Post-results.
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18
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Baillie TJ, Sidharta S, Steele PM, Worthley SG, Willoughby S, Teo K, Sanders P, Nicholls SJ, Worthley MI. Noninvasive Assessment of Cardiopulmonary Reserve: Toward Early Detection of Pulmonary Vascular Disease. Am J Respir Crit Care Med 2017; 195:398-401. [PMID: 28145761 DOI: 10.1164/rccm.201607-1366le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Timothy J Baillie
- 1 Royal Adelaide Hospital Adelaide, South Australia, Australia.,2 University of Adelaide Adelaide, South Australia, Australia and
| | - Samuel Sidharta
- 1 Royal Adelaide Hospital Adelaide, South Australia, Australia.,2 University of Adelaide Adelaide, South Australia, Australia and
| | - Peter M Steele
- 1 Royal Adelaide Hospital Adelaide, South Australia, Australia
| | - Stephen G Worthley
- 1 Royal Adelaide Hospital Adelaide, South Australia, Australia.,2 University of Adelaide Adelaide, South Australia, Australia and
| | - Scott Willoughby
- 3 South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
| | - Karen Teo
- 1 Royal Adelaide Hospital Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- 1 Royal Adelaide Hospital Adelaide, South Australia, Australia.,2 University of Adelaide Adelaide, South Australia, Australia and
| | - Stephen J Nicholls
- 1 Royal Adelaide Hospital Adelaide, South Australia, Australia.,2 University of Adelaide Adelaide, South Australia, Australia and.,3 South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
| | - Matthew I Worthley
- 1 Royal Adelaide Hospital Adelaide, South Australia, Australia.,2 University of Adelaide Adelaide, South Australia, Australia and
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19
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Honda S, Sidharta SL, Shishikura D, Takata K, Di Giovanni GA, Nguyen T, Janssan A, Kim SW, Andrews J, Psaltis PJ, Worthley MI, Nicholls SJ. High-density lipoprotein cholesterol associated with change in coronary plaque lipid burden assessed by near infrared spectroscopy. Atherosclerosis 2017; 265:110-116. [DOI: 10.1016/j.atherosclerosis.2017.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/21/2017] [Accepted: 08/18/2017] [Indexed: 11/29/2022]
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20
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Azarisman SM, Shirazi M, Bradley J, Teo KS, Worthley MI, Worthley SG. Assessment of diastolic dysfunction in patients with acute coronary syndrome and preserved systolic function: comparison between Doppler transthoracic echocardiography and velocity-encoded cardiac magnetic resonance. Acta Cardiol 2017. [DOI: 10.1080/ac.71.4.3159695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shah M. Azarisman
- Department of Medicine, University of Adelaide, Adelaide, South Australia
- Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, South Australia
- Department of Internal Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Mitra Shirazi
- Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, South Australia
| | - Julie Bradley
- Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, South Australia
| | - Karen S. Teo
- Department of Medicine, University of Adelaide, Adelaide, South Australia
- Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, South Australia
| | - Matthew I. Worthley
- Department of Medicine, University of Adelaide, Adelaide, South Australia
- Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, South Australia
| | - Stephen G. Worthley
- Department of Medicine, University of Adelaide, Adelaide, South Australia
- Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, South Australia
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Abstract
Chest pain is an important presenting symptom. However, few cases of chest pain
are diagnosed as acute coronary syndrome (ACS) in the acute setting. This
results in frequent inappropriate discharge and major delay in treatment for
patients with underlying ACS. The conventional methods of assessing ACS, which
include electrocardiography and serological markers of infarct, can take time to
manifest. Recent studies have investigated more sensitive and specific imaging
modalities that can be used. Diastolic dysfunction occurs early following
coronary artery occlusion and its detection is useful in confirming the
diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic
resonance provides a single imaging modality for comprehensive evaluation of
chest pain in the acute setting. In particular, cardiac magnetic resonance has
many imaging techniques that assess diastolic dysfunction post-coronary artery
occlusion. Techniques such as measurement of left atrial size, mitral inflow,
and mitral annular and pulmonary vein flow velocities with phase-contrast
imaging enable general assessment of ventricular diastolic function. More novel
imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and
myocardial tagging, allow early determination of regional diastolic dysfunction
and oedema. These findings may correspond to specific infarcted arteries that
may be used to tailor eventual percutaneous coronary artery intervention.
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Affiliation(s)
- Shah M. Azarisman
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
- Department of Internal Medicine,
International Islamic University Malaysia, Pahang, Malaysia
- Shah M Azarisman, Professor of Medicine,
International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar
InderaMahkota, 25200 Kuantan, Pahang, Malaysia.
| | - Karen S Teo
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
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22
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Baillie TJ, Sidharta S, Steele PM, Worthley SG, Willoughby S, Teo K, Sanders P, Nicholls SJ, Worthley MI. The predictive capabilities of a novel cardiovascular magnetic resonance derived marker of cardiopulmonary reserve on established prognostic surrogate markers in patients with pulmonary vascular disease: results of a longitudinal pilot study. J Cardiovasc Magn Reson 2017; 19:3. [PMID: 28065166 PMCID: PMC5220614 DOI: 10.1186/s12968-016-0316-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND No unified method exists to effectively predict and monitor progression of pulmonary arterial hypertension (PAH). We assessed the longitudinal relationship between a novel marker of cardiopulmonary reserve and established prognostic surrogate markers in patients with pulmonary vascular disease. METHODS AND RESULTS Twenty participants with confirmed (n = 14) or at high risk (n = 6) for PAH underwent cardiovascular magnetic resonance (CMR) at baseline and after ~6 months of guideline-appropriate management. Ten PAH participants underwent RHC within 48 h of each CMR. RHC (mean pulmonary arterial pressure, mPAP; pulmonary vascular resistance index, PVRI; cardiac index, CI) and phase-contrast CMR (mean pulmonary arterial blood flow velocity, meanPAvel) measurements were taken at rest and during continuous adenosine infusion (70/140/210 mcg/kg/min). Initial meanPAvel's (rest and hyperemic) were correlated with validated surrogate prognostic parameters (CMR: RV ejection fraction, RVEF; RV end systolic volume indexed, RVESVI; RHC: PVRI, CI; biomarker: NT-pro brain natriuretic peptide, NTpBNP; clinical: 6-min walk distance, 6MWD), a measure of pulmonary arterial stiffness (elastic modulus) and volumetric estimation of RV ventriculoarterial (VA) coupling. Changes in meanPAvel's were correlated with changes in comparator parameters over time. At initial assessment, meanPAvel at rest correlated significantly with PVRI (inversely), CI (positively) and elastic modulus (inversely) (R 2 > 0.37,P < 0.05 for all), whereas meanPAvel at peak hyperemia correlated significantly with PVRI, RVEF, RVESVI, 6MWD, elastic modulus and VA coupling (R 2 > 0.30,P < 0.05 for all). Neither resting or hyperemia-derived meanPAvel correlated with NTpBNP levels. Initial meanPAvel at rest correlated significantly with RVEF, RVESVI, CI and VA coupling at follow up assessment (R 2 > 0.2,P < 0.05 for all) and initial meanPAvel at peak hyperemia correlated with RVEF, RVESVI, PVRI and VA coupling (R 2 > 0.37,P < 0.05 for all). Change in meanPAvel at rest over time did not show statistically significant correlation with change in prognostic parameters, while change in meanPAvel at peak hyperemia did show a significant relationship with ΔRVEF, ΔRVESVI, ΔNTpBNP and ΔCI (R 2 > 0.24,P < 0.05 for all). CONCLUSION MeanPAvel during peak hyperemia correlated with invasive, non-invasive and clinical prognostic parameters at different time points. Further studies with predefined clinical endpoints are required to evaluated if this novel tool is a marker of disease progression in patients with pulmonary vascular disease.
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Affiliation(s)
- Timothy J Baillie
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
- University of Adelaide, Adelaide, Australia.
| | - Samuel Sidharta
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
| | - Peter M Steele
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Stephen G Worthley
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
| | - Scott Willoughby
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Karen Teo
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Prashanthan Sanders
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen J Nicholls
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Matthew I Worthley
- Cardiovascular Investigational Unit, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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23
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Azarisman SM, Shirazi M, Bradley J, Teo KS, Worthley MI, Worthley SG. Assessment of diastolic dysfunction in patients with acute coronary syndrome and preserved systolic function: comparison between Doppler transthoracic echocardiography and velocity-encoded cardiac magnetic resonance. Acta Cardiol 2016; 71:425-34. [PMID: 27594358 DOI: 10.2143/ac.71.4.3159695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Puri R, Leong DP, Nicholls SJ, Liew GYL, Nelson AJ, Carbone A, Copus B, Wong DT, Beltrame JF, Worthley SG, Worthley MI. Coronary artery wall shear stress is associated with endothelial dysfunction and expansive arterial remodelling in patients with coronary artery disease. EUROINTERVENTION 2016; 10:1440-8. [PMID: 24425248 DOI: 10.4244/eijv10i12a249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To investigate in vivo relationships between segmental wall shear stress (WSS), endothelium-dependent vasoreactivity and arterial remodelling. METHODS AND RESULTS Twenty-four patients with minor angiographic coronary arterial disease (≤30% stenosis severity) underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound (IVUS)-upon-Doppler guidewire imaging. Macrovascular response (change in segmental lumen volume [SLV] at baseline and following IC salbutamol), plaque burden (percent atheroma volume [PAV]), remodelling indices (RI), eccentricity indices (EI) and WSS were evaluated in 179 consecutive 5 mm coronary segments. Baseline WSS was directly related to endothelium-dependent epicardial coronary vasomotion (% change SLV, coefficient 17.2, p=0.004), and inversely related to RI (coefficient -0.23, p=0.02) and EI (coefficient -10.0, p=0.001). Baseline WSS was lower in segments displaying endothelial dysfunction (defined as any change in SLV ≤0) compared with preserved function (0.66±0.33 vs. 0.71±0.22 N/m2, p=0.046). Independent of plaque burden, segments with the lowest tertile of WSS displayed less vasodilatation, or vasoconstriction, than segments with the highest tertile of WSS. Higher plaque burden segments harbouring the lowest tertiles of WSS displayed vasoconstriction, expansive arterial remodelling and greater plaque eccentricity. CONCLUSIONS In patients with stable coronary syndromes and minor angiographic coronary disease, coronary segments with lower in vivo WSS values display functional and morphological features of plaque vulnerability.
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Affiliation(s)
- Rishi Puri
- Discipline of Medicine, Cardiovascular Research Centre, University of Adelaide, Adelaide, Australia
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25
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Affiliation(s)
- Nitesh N. Rao
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | - Benjamin K. Dundon
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Victoria Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Randall J. Faull
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
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26
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Tsioufis CP, Papademetriou V, Dimitriadis KS, Kasiakogias A, Tsiachris D, Worthley MI, Sinhal AR, Chew DP, Meredith IT, Malaiapan Y, Thomopoulos C, Kallikazaros I, Tousoulis D, Worthley SG. Catheter-based renal denervation for resistant hypertension: Twenty-four month results of the EnligHTN I first-in-human study using a multi-electrode ablation system. Int J Cardiol 2015; 201:345-50. [PMID: 26301677 DOI: 10.1016/j.ijcard.2015.08.069] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Long term safety and efficacy data of multi-electrode ablation system for renal denervation (RDN) in patients with drug resistant hypertension (dRHT) are limited. METHODS AND RESULTS We studied 46 patients (age: 60 ± 10 years, 4.7 ± 1.0 antihypertensive drugs) with drug resistant hypertension (dRHT). Reduction in office BP at 24 months from baseline was -29/-13 mmHg, while the reduction in 24-hour ambulatory BP and in home BP at 24 months were -13/-7 mmHg and -11/-6 mmHg respectively (p<0.05 for all). A correlation analysis revealed that baseline office and ambulatory BP were related to the extent of office and ambulatory BP drop. Apart from higher body mass index (33.3 ± 4.7 vs 29.5 ± 6.2 kg/m(2), p<0.05), there were no differences in patients that were RDN responders defined as ≥10 mmHg decrease (74%, n=34) compared to non-responders. Stepwise logistic regression analysis revealed no prognosticators of RDN response (p=NS for all). At 24 months there were no new serious device or procedure related adverse events. CONCLUSIONS The EnligHTN I study shows that the multi-electrode ablation system provides a safe method of RDN in dRHT accompanied by a clinically relevant and sustained BP reduction.
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Affiliation(s)
- Costas P Tsioufis
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece.
| | - Vasilios Papademetriou
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece; Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Dimitrios Tsiachris
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece
| | | | - Ajay R Sinhal
- The Department of Cardiology, Flinders University, Bedford Park, Australia
| | - Derek P Chew
- The Department of Cardiology, Flinders University, Bedford Park, Australia
| | - Ian T Meredith
- The Monash Heart and Monash University, Melbourne, Australia
| | - Yuvi Malaiapan
- The Monash Heart and Monash University, Melbourne, Australia
| | - Costas Thomopoulos
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece
| | - Ioannis Kallikazaros
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, University of Athens, Hippocration Hospital, Athens, Greece
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27
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Sheikh AR, Sidharta S, Worthley MI, Yeend R, Di Fiore DP, Beltrame JF. The importance of evaluating patients with MINOCA (myocardial infarction with non-obstructive coronary arteries). Int J Cardiol 2015; 199:386-8. [PMID: 26247794 DOI: 10.1016/j.ijcard.2015.07.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Abdul Rauf Sheikh
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5011, Australia; Cardiology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, South Australia 5011, Australia
| | - Samuel Sidharta
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5011, Australia; Cardiology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, North Terrace, Adelaide, SA 5000, Australia
| | - Matthew I Worthley
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5011, Australia; Cardiology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, North Terrace, Adelaide, SA 5000, Australia
| | - Richard Yeend
- Cardiology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, North Terrace, Adelaide, SA 5000, Australia
| | - David P Di Fiore
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5011, Australia; Cardiology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, South Australia 5011, Australia
| | - John F Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5011, Australia; Cardiology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, South Australia 5011, Australia.
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28
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Lim HS, Willoughby SR, Schultz C, Alasady M, Rangnekar G, Dang J, Gan C, Lau DH, Roberts-Thomson KC, Young GD, Worthley MI, Sanders P. Thrombogenic Risk in Patients With Atrial Fibrillation. JACC Clin Electrophysiol 2015; 1:210-217. [DOI: 10.1016/j.jacep.2015.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/17/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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29
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Dundon BK, Pisaniello AD, Nelson AJ, Maia M, Teo KS, Worthley SG, Coates PT, Russ GR, Faull RJ, Bannister K, Worthley MI. Dobutamine Stress Cardiac MRI for Assessment of Coronary Artery Disease Prior to Kidney Transplantation. Am J Kidney Dis 2015; 65:808-9. [DOI: 10.1053/j.ajkd.2015.02.319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/10/2015] [Indexed: 11/11/2022]
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30
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Dundon BK, Torpey K, Nelson AJ, Wong DT, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI. The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study. Int J Nephrol Renovasc Dis 2014; 7:337-45. [PMID: 25258554 PMCID: PMC4172192 DOI: 10.2147/ijnrd.s66390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim Arteriovenous fistula-formation remains critical for the provision of hemodialysis in end-stage renal failure patients. Its creation results in a significant increase in cardiac output, with resultant alterations in cardiac stroke volume, systemic blood flow, and vascular resistance. The impact of fistula-formation on cardiac and vascular structure and function has not yet been evaluated via “gold standard” imaging techniques in the modern era of end-stage renal failure care. Methods A total of 24 patients with stage 5 chronic kidney disease undergoing fistula-creation were studied in a single-arm pilot study. Cardiovascular magnetic resonance imaging was undertaken at baseline, and prior to and 6 months following fistula-creation. This gold standard imaging modality was used to evaluate, via standard brachial flow-mediated techniques, cardiac structure and function, aortic distensibility, and endothelial function. Results At follow up, left ventricular ejection fraction remained unchanged, while mean cardiac output increased by 25.0% (P<0.0001). Significant increases in left and right ventricular end-systolic volumes (21% [P=0.014] and 18% [P<0.01]), left and right atrial area (11% [P<0.01] and 9% [P<0.01]), and left ventricular mass were observed (12.7% increase) (P<0.01). Endothelial-dependent vasodilation was significantly decreased at follow up (9.0%±9% vs 3.0%±6%) (P=0.01). No significant change in aortic distensibility was identified. Conclusion In patients with end-stage renal failure, fistula-formation is associated with an increase in cardiac output, dilation of all cardiac chambers and deterioration in endothelial function.
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Affiliation(s)
- Benjamin K Dundon
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia ; Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Kim Torpey
- Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Adam J Nelson
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Dennis Tl Wong
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Rae F Duncan
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Randall J Faull
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Stephen G Worthley
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Matthew I Worthley
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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31
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Papademetriou V, Tsioufis CP, Sinhal A, Chew DP, Meredith IT, Malaiapan Y, Worthley MI, Worthley SG. Catheter-Based Renal Denervation for Resistant Hypertension. Hypertension 2014; 64:565-72. [DOI: 10.1161/hypertensionaha.114.03605] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Renal denervation has emerged as a novel approach for the treatment of patients with drug-resistant hypertension. To date, only limited data have been published using multielectrode radiofrequency ablation systems. In this article, we present the 12-month data of EnligHTN I, a first-in-human study using a multielectrode ablation catheter. EnligHTN I enrolled 46 patients (average age, 60±10 years; on average 4.7±1.0 medications) with drug-resistant hypertension. Eligible patients were on ≥3 antihypertensive medications and had a systolic blood pressure (BP) ≥160 mm Hg (≥150 mm Hg for diabetics). Bilateral renal artery ablation was performed using a percutaneous femoral approach and standardized techniques. The average baseline office BP was 176/96 mm Hg, average 24-hour ambulatory BP was 150/83 mm Hg, and average home BP was 158/90 mm Hg. The average reductions (mm Hg) at 1, 3, 6, and 12 months were as follows: office: −28/−10, −27/−10, −26/−10, and −27/−11 mm Hg (
P
<0.001 for all); 24-hour ambulatory: −10/−5, −10/−5, −10/−6 (
P
<0.001 for all), and −7/−4 for 12 months (
P
<0.0094). Reductions in home measurements (based on 2-week average) were −9/−4, −8/−5,−10/−7, and −11/−6 mm Hg (
P
<0.001 at 12 months). At 12 months, there were no signals of worsening renal function and no new serious or life-threatening adverse events. One patient with baseline nonocclusive renal artery stenosis progressed to 75% diameter stenosis, requiring renal artery stenting. The 12-month data continue to demonstrate safety and efficacy of the EnligHTN ablation system in patients with drug-resistant hypertension. Home BP measurements parallel measurements obtained with 24-hour ambulatory monitoring.
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Affiliation(s)
- Vasilios Papademetriou
- From the Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.); The First Cardiology Clinic, University of Athens, Ippokration Hospital, Athens, Greece (V.P., C.P.T.); Department of Cardiology, Flinders University, Bedford Park, Australia (A.S., D.P.C.); Monash Heart and Monash University, Melbourne, Australia (I.T.M., Y.M.); Royal Adelaide Hospital, Adelaide, Australia (M.I.W.); and University of Adelaide, Adelaide, Australia (S.G.W.)
| | - Costas P. Tsioufis
- From the Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.); The First Cardiology Clinic, University of Athens, Ippokration Hospital, Athens, Greece (V.P., C.P.T.); Department of Cardiology, Flinders University, Bedford Park, Australia (A.S., D.P.C.); Monash Heart and Monash University, Melbourne, Australia (I.T.M., Y.M.); Royal Adelaide Hospital, Adelaide, Australia (M.I.W.); and University of Adelaide, Adelaide, Australia (S.G.W.)
| | - Ajay Sinhal
- From the Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.); The First Cardiology Clinic, University of Athens, Ippokration Hospital, Athens, Greece (V.P., C.P.T.); Department of Cardiology, Flinders University, Bedford Park, Australia (A.S., D.P.C.); Monash Heart and Monash University, Melbourne, Australia (I.T.M., Y.M.); Royal Adelaide Hospital, Adelaide, Australia (M.I.W.); and University of Adelaide, Adelaide, Australia (S.G.W.)
| | - Derek P. Chew
- From the Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.); The First Cardiology Clinic, University of Athens, Ippokration Hospital, Athens, Greece (V.P., C.P.T.); Department of Cardiology, Flinders University, Bedford Park, Australia (A.S., D.P.C.); Monash Heart and Monash University, Melbourne, Australia (I.T.M., Y.M.); Royal Adelaide Hospital, Adelaide, Australia (M.I.W.); and University of Adelaide, Adelaide, Australia (S.G.W.)
| | - Ian T. Meredith
- From the Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.); The First Cardiology Clinic, University of Athens, Ippokration Hospital, Athens, Greece (V.P., C.P.T.); Department of Cardiology, Flinders University, Bedford Park, Australia (A.S., D.P.C.); Monash Heart and Monash University, Melbourne, Australia (I.T.M., Y.M.); Royal Adelaide Hospital, Adelaide, Australia (M.I.W.); and University of Adelaide, Adelaide, Australia (S.G.W.)
| | - Yuvi Malaiapan
- From the Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.); The First Cardiology Clinic, University of Athens, Ippokration Hospital, Athens, Greece (V.P., C.P.T.); Department of Cardiology, Flinders University, Bedford Park, Australia (A.S., D.P.C.); Monash Heart and Monash University, Melbourne, Australia (I.T.M., Y.M.); Royal Adelaide Hospital, Adelaide, Australia (M.I.W.); and University of Adelaide, Adelaide, Australia (S.G.W.)
| | - Matthew I. Worthley
- From the Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.); The First Cardiology Clinic, University of Athens, Ippokration Hospital, Athens, Greece (V.P., C.P.T.); Department of Cardiology, Flinders University, Bedford Park, Australia (A.S., D.P.C.); Monash Heart and Monash University, Melbourne, Australia (I.T.M., Y.M.); Royal Adelaide Hospital, Adelaide, Australia (M.I.W.); and University of Adelaide, Adelaide, Australia (S.G.W.)
| | - Stephen G. Worthley
- From the Veterans Affairs and Georgetown University Medical Centers, Washington, DC (V.P.); The First Cardiology Clinic, University of Athens, Ippokration Hospital, Athens, Greece (V.P., C.P.T.); Department of Cardiology, Flinders University, Bedford Park, Australia (A.S., D.P.C.); Monash Heart and Monash University, Melbourne, Australia (I.T.M., Y.M.); Royal Adelaide Hospital, Adelaide, Australia (M.I.W.); and University of Adelaide, Adelaide, Australia (S.G.W.)
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32
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Lim HS, Willoughby SR, Schultz C, Chakrabarty A, Alasady M, Lau DH, Roberts-Thomson KC, Worthley MI, Young GD, Sanders P. Successful catheter ablation decreases platelet activation and improves endothelial function in patients with atrial fibrillation. Heart Rhythm 2014; 11:1912-8. [PMID: 25068571 DOI: 10.1016/j.hrthm.2014.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Nonvalvular atrial fibrillation (AF) confers a five-fold increased risk of stroke. Whether catheter ablation (CA) subsequently decreases prothrombotic risk is unknown. OBJECTIVE The purpose of this study was to assess the long-term effects of CA for AF on prothrombotic risk. METHODS Fifty-seven patients undergoing CA for AF were prospectively studied. Platelet activation (CD62P [platelet P-selectin] and PAC-1 [glycoprotein IIb/IIIa] expression) and endothelial function (asymmetric dimethylarginine [ADMA] levels) were measured at baseline and 6-months postablation. RESULTS Thirty-seven (65%) patients remained in sinus rhythm (SR group) and 20 (35%) sustained AF recurrence (AF recurrence group) at 6-months. Patients with AF-recurrence were older, had a higher proportion of hypertension and long-standing persistent AF. There were no significant differences in CD62P (P = .3), PAC-1 (P = .1) and ADMA (P = .7) levels at baseline between the two groups. In the SR group, markers of platelet activation decreased significantly at 6-month follow-up compared to baseline; log CD62P % 0.79 ± 0.28 vs 1.03 ± 0.27 (P <.05) and log PAC-1 % 0.22 ± 0.58 vs 0.89 ± 0.31 (P <.01). This was not significant in the AF-recurrence group (P = .8, log CD62P; P = .1, log PAC-1). For endothelial function, ADMA levels decreased significantly at 6-months compared to baseline in the SR group (log ADMA μM/L 0.15 ± 0.02 vs 0.17 ± 0.04; P <.05), but did not alter significantly in the AF-recurrence group (P = .4, log ADMA). CONCLUSION Catheter ablation and successful maintenance of SR leads to a decrease in platelet activation and improvement in endothelial function in patients with AF. These findings suggest that AF is an important determinant of the prothrombotic state and that this may be reduced by successful catheter ablation.
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Affiliation(s)
- Han S Lim
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Scott R Willoughby
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Carlee Schultz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adhiraj Chakrabarty
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Muayad Alasady
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Matthew I Worthley
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Glenn D Young
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), and University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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Puri R, Nicholls SJ, Brennan DM, Andrews J, King KL, Liew GY, Carbone A, Copus B, Nelson AJ, Kapadia SR, Tuzcu EM, Beltrame JF, Worthley SG, Worthley MI. Left main coronary arterial endothelial function and heterogenous segmental epicardial vasomotor reactivity in vivo: novel insights with intravascular ultrasonography. Eur Heart J Cardiovasc Imaging 2014; 15:1270-80. [PMID: 25024410 DOI: 10.1093/ehjci/jeu133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS While the relationship between epicardial coronary vasomotor reactivity and cardiovascular events is well established, this observation has yet to be evaluated within the left main coronary artery (LMCA) in humans in vivo. Our aims were to test the endothelium-dependent vasomotor properties of the LMCA, and to compare these responses to downstream epicardial segments. METHODS AND RESULTS Thirty patients referred for coronary angiography underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound imaging within a non-critically diseased, left-sided conduit vessel. Macrovascular vasomotor response [change in average lumen area (LA) at baseline and following 5 min of 0.30 µg/min IC salbutamol] and percent atheroma volume (PAV) were evaluated in 30 LMCA, 42 proximal, 109 mid, and 132 distal epicardial coronary segments. In comparison with all other segments, the LMCA had the greatest lumen and vessel areas (P < 0.001), yet the proximal epicardial segments contained the greatest PAV (P < 0.02). The mid and distal epicardial segments displayed significant endothelium-dependent vasodilatation from baseline (P = 0.017 and <0.001, respectively); however, the proximal epicardial and LMCA segments did not (P = 0.45 and 0.16, respectively). Significant segmental vasomotor heterogeneity was noted in all 30 patients, with opposing vasomotor responses between adjacent LMCA and epicardial segments. Across all segments, baseline LA inversely correlated with the % change in LA (r = -0.16, P = 0.0005). CONCLUSION Endothelium-dependent vasomotor reactivity is heterogenous within the conduit coronary system. Vascular dynamic responses were less prominent in the larger calibre LMCA and proximal epicardial segments. This may, in part, relate to higher shear stress in smaller, distal segments and yet also may explain the propensity for culprit plaques to cluster proximally.
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Affiliation(s)
- Rishi Puri
- Discipline of Medicine, University of Adelaide, Adelaide, Australia Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA C5Research, Cleveland Clinic, Cleveland, OH, USA
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Jordan Andrews
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Gary Y Liew
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Angelo Carbone
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Barbara Copus
- Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Adam J Nelson
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Emin Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - John F Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Stephen G Worthley
- Discipline of Medicine, University of Adelaide, Adelaide, Australia Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia Department of Medicine, Cardiovascular Research Centre, Royal Adelaide Hospital, Level 6, Theatre Block, North Terrace, Adelaide, SA 5000, Australia
| | - Matthew I Worthley
- Discipline of Medicine, University of Adelaide, Adelaide, Australia Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia Department of Medicine, Cardiovascular Research Centre, Royal Adelaide Hospital, Level 6, Theatre Block, North Terrace, Adelaide, SA 5000, Australia
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Dundon BK, Torpey DK, Nelson AJ, Wong DTL, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI. Beneficial cardiovascular remodeling following arterio-venous fistula ligation post-renal transplantation: a longitudinal magnetic resonance imaging study. Clin Transplant 2014; 28:916-25. [DOI: 10.1111/ctr.12402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin K. Dundon
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - David K. Torpey
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Adam J. Nelson
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Dennis T. L. Wong
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Rae F. Duncan
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Ian T. Meredith
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Randall J. Faull
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Stephen G. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome. World J Cardiol 2014; 6:405-414. [PMID: 24976912 PMCID: PMC4072830 DOI: 10.4330/wjc.v6.i6.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/10/2014] [Accepted: 04/19/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently, advances in monitoring, revascularisation and pharmacotherapy have resulted in a reduction in mortality. However, although mortality rates have declined, the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia, acute coronary syndrome (ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually. It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS, aid in the risk stratification of de novo coronary artery disease and avail incremental information of prognostic value such as viability which cardiovascular magnetic resonance (CMR) allows. Despite its manifold benefits, there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols, CMR could be made less cumbersome, its imaging protocols less lengthy, the technology more inexpensive and easily applied in routine clinical practice.
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Wong DTL, Leong DP, Weightman MJ, Richardson JD, Dundon BK, Psaltis PJ, Leung MCH, Meredith IT, Worthley MI, Worthley SG. Magnetic resonance-derived circumferential strain provides a superior and incremental assessment of improvement in contractile function in patients early after ST-segment elevation myocardial infarction. Eur Radiol 2014; 24:1219-28. [PMID: 24723232 DOI: 10.1007/s00330-014-3137-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/28/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND We evaluate whether circumferential strain derived from grid-tagged CMR is a better method for assessing improvement in segmental contractile function after STEMI compared to late gadolinium enhancement (LGE). METHODS STEMI patients post primary PCI underwent baseline CMR (day 3) and follow-up (day 90). Cine, grid-tagged and LGE images were acquired. Baseline LGE infarct hyperenhancement was categorised as ≤25 %, 26-50 %, 51-75 % and >75 % hyperenhancement. The segmental baseline circumferential strain (CS) and circumferential strain rate (CSR) were calculated from grid-tagged images. Segments demonstrating an improvement in wall motion of ≥1 grade compared to baseline were regarded as having improved segmental contractile-function. RESULTS Forty-five patients (aged 58 ± 12 years) and 179 infarct segments were analysed. A baseline CS cutoff of -5 % had sensitivity of 89 % and specificity of 70 % for detection of improvement in segmental-contractile-function. On receiver-operating characteristic analysis for predicting improvement in contractile function, AUC for baseline CS (0.82) compared favourably to LGE hyperenhancement (0.68), MVO (0.67) and baseline-CSR (0.74). On comparison of AUCs, baseline CS was superior to LGE hyperenhancement and MVO in predicting improvement in contractile function (P < 0.001). On multivariate-analysis, baseline CS was the independent predictor of improvement in segmental contractile function (P < 0.001). CONCLUSION Grid-tagged CMR-derived baseline CS is a superior predictor of improvement in segmental contractile function, providing incremental value when added to LGE hyperenhancement and MVO following STEMI. KEY POINTS Baseline CS predicts contractile function recovery better than LGE and MVO following STEMI. Baseline CS predicts contractile function recovery better than baseline CSR following STEMI. Baseline CS provides incremental value to LGE and MVO following STEMI.
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Affiliation(s)
- Dennis T L Wong
- Discipline of Medicine, University of Adelaide, Adelaide, Australia,
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37
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Richardson JD, Psaltis PJ, Frost L, Paton S, Carbone A, Bertaso AG, Nelson AJ, Wong DT, Worthley MI, Gronthos S, Zannettino AC, Worthley SG. Incremental benefits of repeated mesenchymal stromal cell administration compared with solitary intervention after myocardial infarction. Cytotherapy 2014; 16:460-70. [DOI: 10.1016/j.jcyt.2013.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/16/2013] [Accepted: 07/29/2013] [Indexed: 12/11/2022]
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Pisaniello AD, Dundon B, Maia M, Teo KSL, Worthley SG, Bannister K, Faull R, Coates PT, Russ G, Worthley MI. PW301 Dobutamine stress cardiac MRI reliably predicts significant coronary disease in renal transplant candidates. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Willoughby SR, Luu LJ, Cameron JD, Nelson AJ, Schultz CD, Worthley SG, Worthley MI. Clopidogrel improves microvascular endothelial function in subjects with stable coronary artery disease. Heart Lung Circ 2014; 23:534-41. [PMID: 24529502 DOI: 10.1016/j.hlc.2014.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/27/2013] [Accepted: 01/10/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Clopidogrel therapy has recently been shown to reduce cardiovascular events in patients with stable vascular disease. This benefit may be due to effects not exclusively related to platelet aggregation. The aim of this study was to evaluate the effect of clopidogrel therapy on microvascular endothelial function in subjects with stable coronary artery disease (CAD). METHODS AND RESULTS Forty subjects with stable CAD were randomised to clopidogrel therapy (75mg/day) or control. Blood and endothelial function testing occurred at baseline, one week and three months following randomisation. Microvascular endothelial function was assessed via reactive hyperaemic index (RHI). Platelet function was assessed by adenosine diphosphate (ADP)-induced whole blood aggregation and the VerifyNow™ system. Plasma markers of endothelial function (asymmetric dimethylarginine, ADMA) and oxidative stress (myeloperoxidase, MPO) were also tested. The primary endpoint was endothelial function assessment (RHI) at three months. At one week RHI increased by 20±10% in the clopidogrel group; this effect was maintained at three months (21±9% increase from baseline; P<0.01). A significant decrease in ADP-induced platelet aggregation and P2Y12 reaction units was observed in the clopidogrel therapy group (P<0.01). There was no correlation between endothelial function and platelet function testing in the clopidogrel therapy group. CONCLUSION Clopidogrel therapy is associated with improved microvascular endothelial function in patients with stable CAD. This effect is independent of its effects on ADP-induced platelet reactivity.
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Affiliation(s)
- Scott R Willoughby
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Lee-Jen Luu
- Monash Cardiovascular Research Centre, MonashHeart and Monash University, Melbourne, Australia; Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, MonashHeart and Monash University, Melbourne, Australia
| | - Adam J Nelson
- Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia
| | - Carlee D Schultz
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia.
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Lim HS, Schultz C, Dang J, Alasady M, Lau DH, Brooks AG, Wong CX, Roberts-Thomson KC, Young GD, Worthley MI, Sanders P, Willoughby SR. Time course of inflammation, myocardial injury, and prothrombotic response after radiofrequency catheter ablation for atrial fibrillation. Circ Arrhythm Electrophysiol 2014; 7:83-9. [PMID: 24446024 DOI: 10.1161/circep.113.000876] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammation has been linked to the genesis of stroke in atrial fibrillation (AF) and is implicated in early recurrent arrhythmia after AF ablation. We aimed to define the time course of inflammation, myocardial injury, and prothrombotic markers after radiofrequency ablation for AF and its relation to AF recurrence. METHODS AND RESULTS Ninety consecutive AF patients (53% paroxysmal) undergoing radiofrequency ablation were recruited. High-sensitivity C-reactive protein (hs-CRP), Troponin-T, creatine kinase-MB, fibrinogen, and D-Dimer concentrations were measured at baseline, at 1, 2, 3, 7 days, and at 1 month after ablation. AF recurrence was documented at 3 days and at 1, 3, and 6 months follow-up. Troponin-T and creatine kinase-MB peaked at day 1 after procedure (both P<0.05). Hs-CRP peaked at day 3 after procedure (P<0.05). Fibrinogen (P<0.05) and D-Dimer (P<0.05) concentrations were significantly elevated at 1 week after procedure. Ln hs-CRP elevation correlated with Ln Troponin-T and fibrinogen elevation. The extent of Ln hs-CRP, Ln Troponin-T, and fibrinogen elevation predicted early AF recurrence within 3 days after procedure (P<0.05, respectively), but not at 3 and 6 months. CONCLUSIONS Patients undergoing radiofrequency ablation for AF exhibit an inflammatory response within 3 days. The extent of inflammatory response predicts early AF recurrence but not late recurrence. Prothrombotic markers are elevated at 1 week after ablation and may contribute to increased risk of early thrombotic events after AF ablation.
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Affiliation(s)
- Han S Lim
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide & Royal Adelaide Hospital, Adelaide, Australia
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Pisaniello AD, Dundon BK, Maia M, Teo KS, Worthley SG, Bannister K, Faull R, Coates PT, Russ GR, Worthley MI. Dobutamine stress cardiac MRI reliably predicts significant coronary disease in renal transplant candidates. J Cardiovasc Magn Reson 2014. [PMCID: PMC4043329 DOI: 10.1186/1532-429x-16-s1-p181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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42
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Richardson JD, Bertaso AG, Psaltis PJ, Frost L, Carbone A, Paton S, Nelson AJ, Wong DTL, Worthley MI, Gronthos S, Zannettino ACW, Worthley SG. Impact of timing and dose of mesenchymal stromal cell therapy in a preclinical model of acute myocardial infarction. J Card Fail 2013; 19:342-53. [PMID: 23663817 DOI: 10.1016/j.cardfail.2013.03.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/22/2013] [Accepted: 03/26/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although mesenchymal stem/stromal cells (MSC) have shown therapeutic promise after myocardial infarction (MI), the impact of cell dose and timing of intervention remains uncertain. We compared immediate and deferred administration of 2 doses of MSC in a rat model of MI. METHODS AND RESULTS Sprague-Dawley rats were used. Allogeneic prospectively isolated MSC ("low" dose 1 × 10(6) or "high" dose 2 × 10(6) cells) were delivered by transepicardial injection immediately after MI ("early-low," "early-high"), or 1 week later ("late-low," "late-high"). Control subjects received cryopreservant solution alone. Left ventricular dimensions and ejection fraction (EF) were assessed by cardiac magnetic resonance. All 4 MSC-treatment cohorts demonstrated higher EF than control animals 4 weeks after MI (P values <.01 to <.0001), with function most preserved in the early-high group (absolute reduction in EF from baseline: control 39.1 ± 1.7%, early-low 26.5 ± 3.2%, early-high 7.9 ± 2.6%, late-low 19.6 ± 3.5%, late-high 17.9 ± 4.0%). Cell treatment also attenuated left ventricular dilatation and fibrosis and augmented left ventricular mass, systolic wall thickening (SWT), and microvascular density. Although early intervention selectively increased SWT and vascular density in the infarct territory, delayed treatment caused greater benefit in remote (noninfarct) myocardium. All outcomes demonstrated dose dependence for early MSC treatment, but not for later cell administration. CONCLUSIONS The nature and magnitude of benefit from MSC after acute MI is strongly influenced by timing of cell delivery, with dose dependence most evident for early intervention. These novel insights have potential implications for cell therapy after MI in human patients.
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Affiliation(s)
- James D Richardson
- Cardiovascular Research Centre, Royal Adelaide Hospital and Department of Medicine, University of Adelaide, Adelaide, Australia
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Li A, Azarisman SM, Teo KSL, Worthley MI, Sidharta S, Glenie T, Samaraie L, Chua SK, Bailie TJ, Stuklis R, Worthley SG. The innocent bystander: papillary fibroelastoma. Am J Med 2013; 126:964-5. [PMID: 24157287 DOI: 10.1016/j.amjmed.2013.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 07/08/2013] [Accepted: 07/23/2013] [Indexed: 11/20/2022]
Affiliation(s)
- Andrew Li
- Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia; Department of Medicine, Ruttonjee Hospital, Wan Chai, Hong Kong.
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Puri R, Nicholls SJ, Nissen SE, Brennan DM, Andrews J, Liew GY, Nelson AJ, Carbone A, Copus B, Tuzcu EM, Beltrame JF, Worthley SG, Worthley MI. Coronary Endothelium-Dependent Vasoreactivity and Atheroma Volume in Subjects With Stable, Minimal Angiographic Disease Versus Non–ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2013; 6:674-82. [DOI: 10.1161/circimaging.113.000460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Epicardial plaque burden and endothelial function are recognized predictors of coronary events. We aimed to investigate mechanistic relationships between atheroma volume and endothelial function in patients with non–ST-segment–elevation myocardial infarction (NSTEMI) using intravascular ultrasound.
Methods and Results—
In coronary vessels of patients with near-normal or minimal angiographic disease (n=23) and NSTEMI (n=24), intravascular ultrasound-derived measures (percent atheroma volume), arterial remodeling index, and segmental lumen volumes were performed in contiguous 5-mm epicardial segments. Repeat intravascular ultrasound imaging was performed after consecutive 5-minute intracoronary infusions (vehicle solution, 0.30 μg/min and 0.60 μg/min intracoronary salbutamol) to measure changes in segmental lumen volume (endothelium-dependent function). Male sex, diabetes mellitus, smoking, higher triglycerides, and lower high-density lipoprotein cholesterol were more prevalent in the NSTEMI group. Patients with NSTEMI demonstrated greater segmental percent atheroma volume (40.4±12 versus 27.5±14%, P<0.001), remodeling index (1.2 [1.0–1.5] versus 1.0 [0.9–1.0], P<0.001), and displayed less endothelium-dependent vasomotion (% change segmental lumen volume: 2.1±0.89 versus 5.1±0.89%, P=0.02) compared to patients with minimal angiographic disease. No significant difference in endothelial function between both groups was observed when controlling for plaque burden. Multivariate analysis for change in segmental lumen volume identified percent atheroma volume (β=−0.18, P=0.0004), high-sensitivity C-reactive protein >2 mg/L (β=−3.1, P=0.03), diabetes mellitus (β=−6.9, P<0.0001), low-density lipoprotein cholesterol levels (β=−0.04, P=0.01), and smoking (β=–3.2, P=0.01) as independent associates.
Conclusions—
Although coronary endothelial vasoreactivity is blunted in the setting of NSTEMI, this is a reflection of the greater volume of atherosclerosis and cardiovascular risk factors. Thus, the relationship between coronary endothelium-dependent vasomotor reactivity and atheroma volume remains constant irrespective of the nature of the clinical presentation.
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Affiliation(s)
- Rishi Puri
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Stephen J. Nicholls
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Steven E. Nissen
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Danielle M. Brennan
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Jordan Andrews
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Gary Y. Liew
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Adam J. Nelson
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Angelo Carbone
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Barbara Copus
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - E. Murat Tuzcu
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - John F. Beltrame
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Stephen G. Worthley
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
| | - Matthew I. Worthley
- From the Discipline of Medicine, University of Adelaide, South Australia (R.P., S.J.N., G.Y.L., A.J.N., A.C., J.F.B., S.G.W., M.I.W.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (R.P., S.E.N., E.M.T.); South Australian Health and Medical Research Institute, University of Adelaide, South Australia (S.J.N.); C5Research, Cleveland Clinic, OH (D.M.B., J.A.); and Cardiovascular Investigation Unit, Royal Adelaide Hospital, South Australia (B.C., S.G.W., M.I.W.)
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Bertaso AG, Richardson JD, Wong DT, Cunnington MS, Nelson AJ, Tayeb H, Williams K, Chew DP, Worthley MI, Teo KS, Worthley SG. Prognostic value of adenosine stress perfusion cardiac MRI with late gadolinium enhancement in an intermediate cardiovascular risk population. Int J Cardiol 2013; 167:2055-60. [DOI: 10.1016/j.ijcard.2012.05.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 02/09/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022]
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Alasady M, Shipp NJ, Brooks AG, Lim HS, Lau DH, Barlow D, Kuklik P, Worthley MI, Roberts-Thomson KC, Saint DA, Abhayaratna W, Sanders P. Myocardial infarction and atrial fibrillation: importance of atrial ischemia. Circ Arrhythm Electrophysiol 2013; 6:738-45. [PMID: 23873140 DOI: 10.1161/circep.113.000163] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is associated with the development of atrial fibrillation (AF). We aimed to characterize the atrial abnormalities because of MI and determine the role of ischemia to the AF substrate. METHODS AND RESULTS Forty-four sheep were studied. MI was induced by occlusion of the left circumflex artery (LCX) or left anterior descending artery (LAD). Excluding 11 with fatal arrhythmias, equal groups of animals (LCX; LAD; and sham-operated) underwent sequential electrophysiology study for 45 minutes to determine atrial effective refractory periods, conduction velocity, conduction heterogeneity index, and AF inducibility. Postmortem evaluation was performed with 2,3,5 triphenyl tetrazolium chloride staining. MI resulted in greater left ventricular dysfunction (P<0.05), LA pressure (P<0.0003), and reduction in atrial effective refractory periods (P<0.0001) compared with control. 2,3,5 triphenyl tetrazolium chloride staining demonstrated that the left circumflex artery, and not the LAD, group had atrial infarction. The left circumflex artery group demonstrated the following compared with the LAD or control groups: greater slowing in atrial conduction velocity (P<0.0001 and P<0.001); increased absolute range of conduction phase delay (P<0.001 and P<0.001); increased conduction heterogeneity index (P<0.0001 and P<0.001); greater AF vulnerability (P<0.05 for both); and longer AF duration (P<0.05 for both). LAD group had modest but significant slowing in conduction velocity (P<0.01) but no change in conduction heterogeneity index or AF duration compared with control. CONCLUSIONS Left ventricular infarction, which is known to result in atrial stretch, hemodynamic change, and neurohumoral activation, contributes partially to the atrial abnormalities in MI. Atrial ischemia/infarction results in greater atrial electrophysiological changes and propensity for AF forming the dominant substrate for AF in MI.
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Richardson JD, Bertaso AG, Frost L, Psaltis PJ, Carbone A, Koschade B, Wong DT, Nelson AJ, Paton S, Williams K, Azarisman S, Worthley MI, Teo KS, Gronthos S, Zannettino ACW, Worthley SG. Cardiac magnetic resonance, transthoracic and transoesophageal echocardiography: a comparison of in vivo assessment of ventricular function in rats. Lab Anim 2013; 47:291-300. [PMID: 23836849 DOI: 10.1177/0023677213494373] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In vivo assessment of ventricular function in rodents has largely been restricted to transthoracic echocardiography (TTE). However 1.5 T cardiac magnetic resonance (CMR) and transoesophageal echocardiography (TOE) have emerged as possible alternatives. Yet, to date, no study has systematically assessed these three imaging modalities in determining ejection fraction (EF) in rats. Twenty rats underwent imaging four weeks after surgically-induced myocardial infarction. CMR was performed on a 1.5 T scanner, TTE was conducted using a 9.2 MHz transducer and TOE was performed with a 10 MHz intracardiac echo catheter. Correlation between the three techniques for EF determination and analysis reproducibility was assessed. Moderate-strong correlation was observed between the three modalities; the greatest between CMR and TOE (intraclass correlation coefficient (ICC) = 0.89), followed by TOE and TTE (ICC = 0.70) and CMR and TTE (ICC = 0.63). Intra- and inter-observer variations were excellent with CMR (ICC = 0.99 and 0.98 respectively), very good with TTE (0.90 and 0.89) and TOE (0.87 and 0.84). Each modality is a viable option for evaluating ventricular function in rats, however the high image quality and excellent reproducibility of CMR offers distinct advantages even at 1.5 T with conventional coils and software.
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Affiliation(s)
- J D Richardson
- Cardiovascular Research Centre, Royal Adelaide Hospital and Department of Medicine, University of Adelaide, South Australia, Australia
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Worthley SG, Tsioufis CP, Worthley MI, Sinhal A, Chew DP, Meredith IT, Malaiapan Y, Papademetriou V. Safety and efficacy of a multi-electrode renal sympathetic denervation system in resistant hypertension: the EnligHTN I trial. Eur Heart J 2013; 34:2132-40. [PMID: 23782649 PMCID: PMC3717311 DOI: 10.1093/eurheartj/eht197] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 02/06/2023] Open
Abstract
AIMS Catheter-based renal artery sympathetic denervation has emerged as a novel therapy for treatment of patients with drug-resistant hypertension. Initial studies were performed using a single electrode radiofrequency catheter, but recent advances in catheter design have allowed the development of multi-electrode systems that can deliver lesions with a pre-determined pattern. This study was designed to evaluate the safety and efficacy of the EnligHTN(™) multi-electrode system. METHODS AND RESULTS We conducted the first-in-human, prospective, multi-centre, non-randomized study in 46 patients (67% male, mean age 60 years, and mean baseline office blood pressure 176/96 mmHg) with drug-resistant hypertension. The primary efficacy objective was change in office blood pressure from baseline to 6 months. Safety measures included all adverse events with a focus on the renal artery and other vascular complications and changes in renal function. Renal artery denervation, using the EnligHTN system significantly reduced the office blood pressure from baseline to 1, 3, and 6 months by -28/10, -27/10 and -26/10 mmHg, respectively (P < 0.0001). No acute renal artery injury or other serious vascular complications occurred. Small, non-clinically relevant, changes in average estimated glomerular filtration rate were reported from baseline (87 ± 19 mL/min/1.73 m2) to 6 months post-procedure (82 ± 20 mL/min/1.73 m2). CONCLUSION Renal sympathetic denervation, using the EnligHTN multi-electrode catheter results in a rapid and significant office blood pressure reduction that was sustained through 6 months. The EnligHTN system delivers a promising therapy for the treatment of drug-resistant hypertension.
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Affiliation(s)
- Stephen G Worthley
- Cardiovascular Research Centre, c/o The Cardiovascular Investigational Unit, Level 6 Theatre Block, University of Adelaide, Royal Adelaide Hospital, Adelaide 5000, Australia.
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Duncan RF, Dundon BK, Nelson AJ, Williams K, Carbone A, Worthley MI, Zaman A, Worthley SG. 1029“MRI phase-encoded tissue velocity mapping for the
non-invasive estimation of left ventricular diastolic filling pressure: A
MRI-cardiac catheterisation comparison study”. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet070ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wong DT, Leung MC, Das R, Liew GY, Teo KS, Chew DP, Meredith IT, Worthley MI, Worthley SG. Intracoronary ECG during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction predicts microvascular obstruction and infarct size. Int J Cardiol 2013; 165:61-6. [DOI: 10.1016/j.ijcard.2011.07.078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 06/23/2011] [Accepted: 07/25/2011] [Indexed: 11/24/2022]
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