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Esenboga K, Kurtul A, Yamanturk YY, Kozluca V, Tutar E. Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion. Arq Bras Cardiol 2024; 121:e20230765. [PMID: 38597538 DOI: 10.36660/abc.20230765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/03/2023] [Accepted: 11/28/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. OBJECTIVE To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. METHODS A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. RESULTS The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. CONCLUSION The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.
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Affiliation(s)
- Kerim Esenboga
- Ankara University Faculty of Medicine - Cardiology, Ankara - Turquia
| | - Alparslan Kurtul
- Mustafa Kemal University Tayfur Ata Sokmen Faculty of Medicine - Department of Cardiology, Hatay - Turquia
| | | | - Volkan Kozluca
- Ankara University Faculty of Medicine - Cardiology, Ankara - Turquia
| | - Eralp Tutar
- Ankara University Faculty of Medicine - Cardiology, Ankara - Turquia
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Nobre Menezes M, Mamas MA. PCI in Cancer Patients: Adding Another Piece to a Complex and Still Very Incomplete Puzzle. Circ Cardiovasc Interv 2024; 17:e014076. [PMID: 38626081 DOI: 10.1161/circinterventions.124.014076] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Miguel Nobre Menezes
- Structural and Coronary Heart Disease Unit, Cardio-Oncology Unit CHULN Hospital de Santa Maria, Cardiovascular Center of the University of Lisbon (CCUL@RISE), Universidade de Lisboa, Lisbon, Portugal (M.N.M.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom (M.A.M.)
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3
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Tsuda E. Recurrent events of acute coronary syndrome in young adult patients after Kawasaki disease. Cardiol Young 2024; 34:809-814. [PMID: 37850457 DOI: 10.1017/s1047951123003499] [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: 10/19/2023]
Abstract
OBJECTIVE I encountered three adult patients with major coronary artery occlusion after Kawasaki disease in childhood, who had developed again acute coronary syndrome of adults in the peripheral branches, such as the 4th segments, the atrioventricular node artery, and the posterior descending artery, of the right coronary artery. METHODS I reviewed their clinical course and coronary angiograms. RESULTS Their age at onset of acute coronary syndrome ranged from 29 to 33 years. The male patient with a previous anteroseptal myocardial infarction in children had a symptomatic occlusion of the branch of the 4th posterior descending artery at 32 years of age. Acute coronary syndrome occurred in the area of 4th atrioventricular node artery in two female patients. The collateral arteries from the circumflex artery to the 4th atrioventricular node arteries were not clearly injected. It was suspected that they had developed bilateral giant aneurysms after acute Kawasaki disease. Two patients had an acute myocardial infarction due to thrombotic occlusion in a giant aneurysm of the right coronary artery or the left anterior descending artery, and one patient had an asymptomatic coronary occlusion of the right coronary artery and left anterior descending artery in children. CONCLUSION Occlusion of peripheral coronary arteries in adulthood can occur in patients with multi-vessel disease caused by Kawasaki disease. Recurrent events of acute coronary syndrome can occur in adults, although its prevalence may be low. Careful follow-up in adults is also needed in this population.
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Affiliation(s)
- Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Tsugu T, Tanaka K, Nagatomo Y, De Maeseneer M, De Mey J. Discrepancy in Diagnosing Coronary Artery Occluded Lesion: CT-Derived Fractional Flow Reserve (FFRCT) Versus Invasive Coronary Angiography. Turk Kardiyol Dern Ars 2024; 52:208-212. [PMID: 38573090 DOI: 10.5543/tkda.2023.29035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (FFRCT) findings demonstrate high diagnostic accuracy, aligning consistently with invasive coronary angiography (ICA), the gold standard diagnostic technique for coronary artery disease. The differential diagnosis of total versus subtotal coronary occlusion is crucial in determining the appropriate treatment strategy. Subtotal coronary occlusions composed of vulnerable tissue can sometimes present as total coronary occlusions on ICA. This presentation can be inconsistent with findings from CCTA and FFRCT. This case report presents discrepant findings between CCTA, which indicated subtotal coronary occlusion, and ICA, which suggested total coronary occlusion. The stenotic lesion, filled with vulnerable tissue (low-attenuation plaque volume: 20.3 mm3 and intermediate-attenuation plaque volume: 71.6 mm3), could be dilated with a vasodilator during maximal hyperemia. This dilation facilitated the acquisition of CCTA and FFRCT images. We were able to diagnose subtotal coronary occlusion and identify the overall anatomical structure of the vessels prior to percutaneous coronary intervention (PCI). This allowed us to perform a successful and uncomplicated PCI.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | | | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Abramenko EE, Ryabova TR, Ryabov VV, Boshchenko AA, Karpov RS. [Stress-Echocardiography in Low-risk Acute Coronary Syndrome Without Persistent ST-segment Elevation Diagnostic Algorithm]. Kardiologiia 2024; 64:63-71. [PMID: 38597764 DOI: 10.18087/cardio.2024.3.n2430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/05/2023] [Indexed: 04/11/2024]
Abstract
This review addresses the capabilities of stress EchoCG as a simple, non-invasive, non-radiation method for diagnosing occult disorders of coronary blood flow in patients with non-ST-elevation acute coronary syndrome on a low-risk electrocardiogram. The capabilities of the enhanced stress EchoCG protocol are based on supplementing the standard detection of transient disturbances of local contractility, generally associated with coronary artery obstruction, with an assessment of the heart rate reserve, coronary reserve and other parameters. This approach is considered promising for a more complete characterization of heart function during exercise and an accurate prognosis of the clinical case, which allows determining the tactics for patient management not limited to selection for myocardial revascularization.
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Affiliation(s)
- E E Abramenko
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - T R Ryabova
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - V V Ryabov
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - A A Boshchenko
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - R S Karpov
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
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Kim WK, Seiffert M, Rück A, Leistner DM, Dreger H, Wienemann H, Adam M, Möllmann H, Blumenstein J, Eckel C, Buono A, Maffeo D, Messina A, Holzamer A, Sossalla S, Costa G, Barbanti M, Motta S, Tamburino C, von der Heide I, Glasmacher J, Sherif M, Seppelt P, Fichtlscherer S, Walther T, Castriota F, Nerla R, Frerker C, Schmidt T, Wolf A, Adamaszek MM, Giannini F, Vanhaverbeke M, Van de Walle S, Stammen F, Toggweiler S, Brunner S, Mangieri A, Gitto M, Kaleschke G, Ninios V, Ninios I, Hübner J, Xhepa E, Renker M, Charitos EI, Joner M, Rheude T. Comparison of two self-expanding transcatheter heart valves for degenerated surgical bioprostheses: the AVENGER multicentre registry. EUROINTERVENTION 2024; 20:e363-e375. [PMID: 38506737 PMCID: PMC10941672 DOI: 10.4244/eij-d-23-00779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/17/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND There is a lack of comparative data on transcatheter aortic valve implantation (TAVI) in degenerated surgical prostheses (valve-in-valve [ViV]). AIMS We sought to compare outcomes of using two self-expanding transcatheter heart valve (THV) systems for ViV. METHODS In this retrospective multicentre registry, we included consecutive patients undergoing transfemoral ViV using either the ACURATE neo/neo2 (ACURATE group) or the Evolut R/PRO/PRO+ (EVOLUT group). The primary outcome measure was technical success according to Valve Academic Research Consortium (VARC)-3. Secondary outcomes were 30-day all-cause mortality, device success (VARC-3), coronary obstruction (CO) requiring intervention, rates of severe prosthesis-patient mismatch (PPM), and aortic regurgitation (AR) ≥moderate. Comparisons were made after 1:1 propensity score matching. RESULTS The study cohort comprised 835 patients from 20 centres (ACURATE n=251; EVOLUT n=584). In the matched cohort (n=468), technical success (ACURATE 92.7% vs EVOLUT 88.9%; p=0.20) and device success (69.7% vs 73.9%; p=0.36) as well as 30-day mortality (2.8% vs 1.6%; p=0.392) were similar between the two groups. The mean gradients and rates of severe PPM, AR ≥moderate, or CO did not differ between the groups. Technical and device success were higher for the ACURATE platform among patients with a true inner diameter (ID) >19 mm, whereas a true ID ≤19 mm was associated with higher device success - but not technical success - among Evolut recipients. CONCLUSIONS ViV TAVI using either ACURATE or Evolut THVs showed similar procedural outcomes. However, a true ID >19 mm was associated with higher device success among ACURATE recipients, whereas in patients with a true ID ≤19 mm, device success was higher when using Evolut.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Gießen, Gießen, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - David M Leistner
- University Heart & Vascular Center Frankfurt, Frankfurt, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hendrik Wienemann
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matti Adam
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes-Hospital, Dortmund, Germany
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes-Hospital, Dortmund, Germany
- Department of Cardiology, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Clemens Eckel
- Department of Cardiology, St. Johannes-Hospital, Dortmund, Germany
- Department of Cardiology, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Andrea Buono
- Cardiovascular Department, Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Diego Maffeo
- Cardiovascular Department, Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Antonio Messina
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy and Operative Unit of Cardiac Surgery, Poliambulanza Foundation Ospital, Brescia, Italy
| | - Andreas Holzamer
- University Hospital of Regensburg, Medical Center, Regensburg, Germany
| | - Samuel Sossalla
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany
- Department of Cardiology, Justus-Liebig University of Gießen, Gießen, Germany
| | - Giuliano Costa
- Division of Cardiology, AOU Policlinico G. Rodolico-San Marco, Catania, Italy
| | | | - Silvia Motta
- Division of Cardiology, AOU Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, AOU Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Ina von der Heide
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Julius Glasmacher
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mohammad Sherif
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Seppelt
- University Heart & Vascular Center Frankfurt, Frankfurt, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany
| | - Stephan Fichtlscherer
- University Heart & Vascular Center Frankfurt, Frankfurt, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany
| | - Thomas Walther
- University Heart & Vascular Center Frankfurt, Frankfurt, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany
| | | | - Roberto Nerla
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Christian Frerker
- Department of Cardiology, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Tobias Schmidt
- Department of Cardiology, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Alexander Wolf
- Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Martin M Adamaszek
- Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Essen, Germany
| | | | | | | | | | | | | | - Antonio Mangieri
- Cardiocenter, IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mauro Gitto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Gerrit Kaleschke
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Münster, Germany
| | - Vlasis Ninios
- Interbalkan European Medical Center, Thessaloniki, Greece
| | - Ilias Ninios
- Interbalkan European Medical Center, Thessaloniki, Greece
| | - Judith Hübner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | | | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
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Sudhakaran S, Joy P, Sbrocchi A, Hebeler R, Stoler R. Transcatheter Aortic Valve Implantation in a Patient With Anomalous Left Main Coronary Artery from Right Coronary Artery. Am J Cardiol 2024; 215:56-57. [PMID: 37866391 DOI: 10.1016/j.amjcard.2023.09.109] [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] [Received: 06/28/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is now a well-established modality of treating severe symptomatic aortic valve stenosis in patients deemed at great surgical risk. In patients with coexisting anomalous coronary arteries, however, TAVI presents technical challenges, and coronary obstruction is a feared complication. In this study, we present the case of successful TAVI in a 78-year-old patient with anomalous left main coronary artery originating from the right coronary artery.
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Affiliation(s)
| | - Parijat Joy
- Baylor University Medical Center, Dallas, Texas.
| | | | | | - Robert Stoler
- Baylor University Medical Center, Dallas, Texas; Baylor Heart and Vascular Institute, Dallas, Texas
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8
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Tarantini G, Fabris T, Banerjee S, Nai Fovino L. The "Fender" Technique for Redo-TAVR in a Degenerated Supra-Annular Valve With High Risk of Coronary Obstruction. Am J Cardiol 2024; 215:8-9. [PMID: 38278433 DOI: 10.1016/j.amjcard.2023.12.063] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/20/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University Hospital of Padova, Italy.
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University Hospital of Padova, Italy
| | - Subhash Banerjee
- Department of Cardiology, Baylor Scott & White Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University Hospital of Padova, Italy
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Jurado-Román A, Wacinski PJ, Egred M. Letter by Jurado-Román et al Regarding Article, "Laser Coronary Atherectomy and Polymeric Coronary Wires in Uncrossable Lesions: A Word of Caution". Circ Cardiovasc Interv 2024; 17:e013954. [PMID: 38502721 DOI: 10.1161/circinterventions.123.013954] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
| | - Piotr J Wacinski
- Cardiology Department, Medical University of Lublin, Poland (P.J.W.)
| | - Mohaned Egred
- Cardiology Department, Freeman Hospital, Newcastle, United Kingdom (M.E.)
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10
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Tarantini G, Cardaioli F. Navigating The Challenges of Redo-Transcatheter Aortic Valve Replacement: Predicting Sinus Sequestration and Coronary Obstruction in The Era Of Expanding Treatment. Am J Cardiol 2024; 214:174-176. [PMID: 37952753 DOI: 10.1016/j.amjcard.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
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11
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Amat-Santos IJ, Marengo G, Cortés C, Sánchez-Luna JP, Gonzalez-Gutiérrez JC, Gómez Herrero J, Sanz-Sanchez J, Gutiérrez H, Serrador A, Campo A, Blasco-Turrión S, Gasparini G, San Román JA. Response by Amat-Santos et al to Letter Regarding Article, "Laser Coronary Atherectomy and Polymeric Coronary Wires in Uncrossable Lesions: a Word of Caution". Circ Cardiovasc Interv 2024; 17:e013996. [PMID: 38502724 DOI: 10.1161/circinterventions.124.013996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 03/21/2024]
Affiliation(s)
- Ignacio J Amat-Santos
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Giorgio Marengo
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Carlos Cortés
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Juan Pablo Sánchez-Luna
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Jose Carlos Gonzalez-Gutiérrez
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Javier Gómez Herrero
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Jorge Sanz-Sanchez
- Cardiology Department, Hospital Universitari i Politécnic La Fe, Valencia, Spain (J.S.-S.)
| | - Hipólito Gutiérrez
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Ana Serrador
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Alberto Campo
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Sara Blasco-Turrión
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
| | - Gabriele Gasparini
- Cardiology Department, Istituto Clinico Humanitas (IRCCS) Humanitas Research Hospital, Milan, Italy (G.G.)
| | - J Alberto San Román
- Cardiology Department, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S., G.M., C.C., J.P.S.-L., J.C.G.-G., J.G.H., H.G., A.S., A.C., S.B.-T., J.A.S.R.)
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12
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Singh K, Niranjan S, Hibbert B, Taramasso M. A stepwise approach to coronary artery stenting in acute type A aortic dissection. Catheter Cardiovasc Interv 2024; 103:560-564. [PMID: 38297982 DOI: 10.1002/ccd.30964] [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] [Received: 12/01/2023] [Revised: 01/14/2024] [Accepted: 01/24/2024] [Indexed: 02/02/2024]
Abstract
We present three cases of acute coronary obstruction postsurgical repair of type A aortic dissection, which were successfully treated with percutaneous coronary intervention. We describe a step-by-step approach to performing percutaneous coronary intervention in selective cases of coronary obstruction related to type A aortic dissection.
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Affiliation(s)
- Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Department of Medicine, Griffith University, Southport, Queensland, Australia
| | - Selva Niranjan
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Department of Medicine, Griffith University, Southport, Queensland, Australia
| | - Benjamin Hibbert
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Maurizio Taramasso
- Department of Cardiac surgery, HerzZentrum Hirslanden Zurich, Zurich, Switzerland
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13
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Rovno HDS. Editorial for "Assessment of Myocardial Viability and Risk Stratification in Coronary Chronic Total Occlusion: A Qualitative and Quantitative Stress Cardiac MRI Study". J Magn Reson Imaging 2024; 59:546-547. [PMID: 37259894 DOI: 10.1002/jmri.28835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
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14
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Ji JY, Seo YH, Jung HS, Chun HR, Park JS, Kim WJ, Ahn JM, Park YJ, Shin YE, Park CH. Coronary Artery Occlusion with Sharp Blood Pressure Drop during General Anesthesia Induction: A Case Report. Medicina (Kaunas) 2024; 60:232. [PMID: 38399520 PMCID: PMC10890261 DOI: 10.3390/medicina60020232] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Most anesthetics reduce cardiac functions and lower blood pressure (BP), potentially causing excessive BP reduction in dehydrated patients or those with heart conditions, such as coronary artery disease (CAD). Considering the increased prevalence of cardiovascular disease with age, anesthesiologists must be cautious about BP reduction during general anesthesia in older adults. In the present case, a 76-year-old male patient with undiagnosed CAD in a hypovolemic state experienced a significant drop in systolic BP to the fifties during propofol and sevoflurane anesthesia. Despite the use of vasopressors, excessive hypotension persisted, leading to anesthesia suspension. Subsequent cardiac examinations, including computed tomography heart angio and calcium score, and coronary angiogram, revealed a near total occlusion of the proximal left anterior descending coronary artery (pLAD) and the formation of collateral circulation. After 5 days of hydration and anticoagulation medications and confirmation of normovolemic state, general anesthesia was attempted again and successfully induced; a normal BP was maintained throughout the surgery. Thus, it is important to conduct a thorough cardiac evaluation and maintain normovolemia for general anesthesia in older adults.
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Affiliation(s)
- Jae Young Ji
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (J.Y.J.); (H.S.J.); (H.R.C.); (J.S.P.); (Y.J.P.); (Y.E.S.)
| | - Yong Han Seo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (J.Y.J.); (H.S.J.); (H.R.C.); (J.S.P.); (Y.J.P.); (Y.E.S.)
| | - Ho Soon Jung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (J.Y.J.); (H.S.J.); (H.R.C.); (J.S.P.); (Y.J.P.); (Y.E.S.)
| | - Hea Rim Chun
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (J.Y.J.); (H.S.J.); (H.R.C.); (J.S.P.); (Y.J.P.); (Y.E.S.)
| | - Jin Soo Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (J.Y.J.); (H.S.J.); (H.R.C.); (J.S.P.); (Y.J.P.); (Y.E.S.)
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea;
| | - Jae Min Ahn
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea;
| | - Yu Jun Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (J.Y.J.); (H.S.J.); (H.R.C.); (J.S.P.); (Y.J.P.); (Y.E.S.)
| | - Ye Eun Shin
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (J.Y.J.); (H.S.J.); (H.R.C.); (J.S.P.); (Y.J.P.); (Y.E.S.)
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Hospital Cheonan, 31, Sooncheonhyang 6-gil, Donam-gu, Cheonan 31151, Republic of Korea;
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15
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Fu M, Chang S, Ma J, Ge J. A case of repeated in-stent restenosis of coronary artery as a primary manifestation of seronegative antiphospholipid antibody syndrome. BMC Cardiovasc Disord 2024; 24:32. [PMID: 38184550 PMCID: PMC10771656 DOI: 10.1186/s12872-023-03568-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/19/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Antiphospholipid antibody syndrome (APS) is a multisystemic autoimmune disorder which affects many organs or systems; however, coronary artery is relatively less frequently involved. CASE PRESENTATION A 65-year-old female with effort chest pain was hospitalized for unstable angina in Janurary, 2015. Coronary angiography revealed sub-total occlusion of proximal left anterior descending (LAD) coronary artery, where a drug-eluting stent was successfully deployed. The patient experienced multiple in-stent stenosis at LAD coronary artery and coronary artery bypass graft (CABG) surgery was advised. Subsequently, severe stenosis of left circumflex (LCX) coronary artery emerged, and the patient suffered persistent in-stent restenosis. Eventually, the patient was diagnosed with seronegative antiphospholipid antibody syndrome and salvaged by immunosuppressants. CONCLUSIONS Repeated in-stent restenosis could be a primary manifestation of seronegative antiphospholipid antibody syndrome, and suppression of autoimmune activity and inflammation other than purely coronary revascularization might be a better option.
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Affiliation(s)
- Mingqiang Fu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Shufu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China.
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, 200032, China
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16
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Moroni A, El Jattari H, Vermeersch P, Zivelonghi C, Agostoni P. Unintentional Extraction of a 7-Year-Old Stent With the Twisting Wire Technique. JACC Cardiovasc Interv 2023; 16:3045-3046. [PMID: 37902152 DOI: 10.1016/j.jcin.2023.10.034] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Hicham El Jattari
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
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17
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Reid BJ, Lindow T, Warren S, Persson E, Bhindi R, Ringborn M, Ugander M, Allahwala U. Immediate recruitment of dormant coronary collaterals can provide more than half of normal resting perfusion during coronary occlusion in patients with coronary artery disease. J Nucl Cardiol 2023; 30:2338-2345. [PMID: 37280387 PMCID: PMC10682227 DOI: 10.1007/s12350-023-03271-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/24/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Dormant coronary collaterals are highly prevalent and clinically beneficial in cases of coronary occlusion. However, the magnitude of myocardial perfusion provided by immediate coronary collateral recruitment during acute occlusion is unknown. We aimed to quantify collateral myocardial perfusion during balloon occlusion in patients with coronary artery disease (CAD). METHODS Patients without angiographically visible collaterals undergoing elective percutaneous transluminal coronary angioplasty (PTCA) to a single epicardial vessel underwent two scans with 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT). All subjects underwent at least three minutes of angiographically verified complete balloon occlusion, at which time an intravenous injection of the radiotracer was administered, followed by SPECT imaging. A second radiotracer injection followed by SPECT imaging was performed 24 h after PTCA. RESULTS The study included 22 patients (median [interquartile range] age 68 [54-72] years. The perfusion defect extent was 19 [11-38] % of the LV, and the collateral perfusion at rest was 64 [58-67]% of normal. CONCLUSION This is the first study to describe the magnitude of short-term changes in coronary microvascular collateral perfusion in patients with CAD. On average, despite coronary occlusion and an absence of angiographically visible collateral vessels, collaterals provided more than half of the normal perfusion.
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Affiliation(s)
- Brandon J Reid
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Thomas Lindow
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Clinical Sciences, Department of Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
- Clinical Physiology, Department of Research and Development, Växjö Central Hospital, Kronoberg, Sweden
| | - Stafford Warren
- Department of Medicine, Cardiology Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Eva Persson
- Clinical Sciences, Department of Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | | | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia.
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden.
| | - Usaid Allahwala
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
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18
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Agostoni P, Zivelonghi C, Poletti E. Antegrade Dissection Re-Entry and Retrograde Approaches: When the Going Gets Tough, the Tough Get Going. JACC Cardiovasc Interv 2023; 16:2763-2766. [PMID: 37905773 DOI: 10.1016/j.jcin.2023.10.022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Affiliation(s)
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
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19
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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko Y, Alkhoder A, Ejaz K, Alvi Z, Rahbar A, Murtagh G, Jaber WA, Nicholson WJ, Quyyumi AA. High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization. J Am Heart Assoc 2023; 12:e031431. [PMID: 37929763 PMCID: PMC10727412 DOI: 10.1161/jaha.123.031431] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Background The survival benefit of revascularization of chronic total occlusion (CTO) of the coronary arteries remains a subject of controversy. We measured high sensitivity troponin-I (hsTn-I) levels as an estimate of myocardial ischemia in patients with stable coronary artery disease, with the hypothesis that (1) patients with CTO have higher levels of hsTn-I than patients without CTO, (2) hsTn-I levels will predict adverse cardiovascular events in patients with CTO, and (3) patients with elevated hsTn-I levels will have a survival benefit from CTO revascularization. Methods and Results In 428 patients with stable coronary artery disease and CTO undergoing coronary angiography, adverse event rates were investigated. Cox proportional hazards models and Fine and Gray subdistribution hazard models were performed to determine the association between hsTn-I level and incident event rates in patients with CTO. HsTn-I levels were higher in patients with compared with those without CTO (median 6.7 versus 5.6 ng/L, P=0.002). An elevated hsTn-I level was associated with higher adverse event rates (adjusted all-cause mortality hazard ratio, 1.19 [95% CI, 1.08-1.32]; P=0.030) for every doubling of hsTn-I level. CTO revascularization was performed in 28.3% of patients. In patients with a high (>median) hsTn-I level, CTO revascularization was associated with substantially lower all-cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08-0.88]; P=0.030) compared with those who did not undergo revascularization. In patients with a low (
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Affiliation(s)
- Daniel A. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Pratik B. Sandesara
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Vardhmaan Jain
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Matthew E. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Nishant Vatsa
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Shivang R. Desai
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Malika Elhage Hassan
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Yi‐An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Ayman Alkhoder
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Kiran Ejaz
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Zain Alvi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Alireza Rahbar
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | | | - Wissam A. Jaber
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - William J. Nicholson
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
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20
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Mohammed AQ, Abdu FA, Liu L, Yin G, Mareai RM, Mohammed AA, Xu Y, Che W. Coronary microvascular dysfunction and myocardial infarction with non-obstructive coronary arteries: Where do we stand? Eur J Intern Med 2023; 117:8-20. [PMID: 37482469 DOI: 10.1016/j.ejim.2023.07.016] [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] [Received: 04/30/2023] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
In the past decade, scientific and clinical research has provided a translational perspective on myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). MINOCA is characterized by clinical documentation of an acute MI but angiography shows no significant coronary artery obstruction (stenosis <50%). The prevalence of MINOCA is estimated to range from approximately 6 to 10% among MI patients, and those with this condition have a poor prognosis, experiencing high rates of mortality, rehospitalization, and socioeconomic burden. MINOCA represents a major unmet need in cardiovascular medicine, with uncertain clinical management. It is a complex condition that can be caused by various factors, including atherosclerosis, plaque rupture, coronary vasospasm, and microvascular dysfunction. Effective management of MINOCA depends on identifying the underlying mechanism of the infarction, thus a systematic diagnostic approach is recommended. Contemporary data shows that a significant number of patients exhibit structural and functional abnormalities in coronary microcirculation, which is referred to as coronary microvascular dysfunction (CMD). CMD plays a crucial role in patients with signs and symptoms of myocardial ischemia and non-obstructive coronary artery stenosis, including MINOCA. Furthermore, conducting a thorough evaluation of coronary function can have significant prognostic and therapeutic implications, since personalized patient management strategies based on this assessment have been shown to improve symptoms and prognosis. Therefore, an accurate and timely diagnosis of CMD is essential for effective patient management, which can be achieved through various invasive and non-invasive methods. This review will discuss the pathophysiological understanding, current diagnostic techniques, and management strategies of patients with MINOCA and CMD.
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Affiliation(s)
- Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Redhwan M Mareai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ayman A Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, China.
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21
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McLaren JTT, Smith SW. A Bayesian approach to acute coronary occlusion. J Electrocardiol 2023; 81:300-302. [PMID: 37951822 DOI: 10.1016/j.jelectrocard.2023.10.011] [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] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Abstract
In the STEMI paradigm, the disease (acute coronary occlusion) is defined and named after one element (ST elevation, without regard to the remainder of the QRST) of one imperfect test (the ECG). This leads to delayed reperfusion for patients with acute coronary occlusion whose ECGs don't meet STEMI criteria. In this editorial, we elaborate on the article by Jose Nunes de Alencar Neto about applying Bayesian reasoning to ECG interpretation. The Occlusion MI (OMI) paradigm offers evidencebased advances in ECG interpretation, expert-trained artificial intelligence, and a paradigm shift that incorporates a Bayesian approach to acute coronary occlusion.
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Affiliation(s)
- Jesse T T McLaren
- Department of Family and Community Medicine, University Health Network, Toronto, Ontario, Canada.
| | - Stephen W Smith
- Department of Emergency Medicine, Hennepin Country Medical Centre, Minneapolis, MN, USA.
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22
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Watanabe T, Kobara S, Amisaki R, Yamamoto K. Comparison of the crossing methods in case of rota wire introduction failure. Coron Artery Dis 2023; 34:522-524. [PMID: 37799050 DOI: 10.1097/mca.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 10/07/2023]
Affiliation(s)
- Tomomi Watanabe
- Division of Cardiovascular Medicine and Endocrinology and Metabolism. Faculty of Medicine, Tottori University, Tottori, Japan
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23
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Tsuchida K, Nagai H, Oda H, Kashiwa A, Tanaka K, Hosaka Y, Ozaki K, Takahashi K. Acute coronary syndrome with simultaneous two-vessel occlusion De Winter ST-segment depression or reciprocal change? J Electrocardiol 2023; 81:70-74. [PMID: 37597503 DOI: 10.1016/j.jelectrocard.2023.08.008] [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] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
We discuss a case of acute coronary syndrome (ACS) with simultaneous two-vessel occlusions in a man in his 20s. The serial electrocardiograms (ECG) showed very early dynamic changes of ST-T configuration resulting from ischemic zone depth or area between anterior wall versus inferior wall. The upsloping ST depression along with tall tentorial T waves in the precordial leads, as shown in the index ECG, raises the possibilities of a de Winter pattern. The retrospective assessment of the index ECG identified prominent T waves and a mild degree of ST-segment elevations in the inferior leads, given the electrocardiographic findings previously recorded at his workplace medical examination obtained at a later date. If the subtle ST-segment elevations in leads II, III, and aVF and the tall T waves were not overlooked in the index ECG, the probability of reciprocal ST-segment depressions in the precordial leads should also be taken into account. We recognize our ECG findings as intriguing ST-T deviation patterns that can change depending on the time sequence and anatomical dominancy of two infarct-related arteries. We finally suggest physicians should bear in mind the possibility of simultaneous multiple vessel occlusions when they encounter ACS patients with hemodynamic instability as in this present case.
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Affiliation(s)
- Keiichi Tsuchida
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan.
| | - Hideya Nagai
- Emergency Medical Center, Fukui Prefectural Hospital, Fukui, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
| | - Asami Kashiwa
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
| | - Komei Tanaka
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
| | - Yukio Hosaka
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
| | - Kazuyuki Ozaki
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
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24
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Leibundgut G, Brilakis ES, Garbo R. A novel device for additional guide wire support to cross tortuous anatomy and tight lesions - the Micro Rx rapid exchange microcatheter. J Invasive Cardiol 2023; 35. [PMID: 37984326 DOI: 10.25270/jic/23.00217] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Successful crossing of the target coronary lesion with a guidewire is an essential step in percutaneous coronary intervention. Guidewire advancement can be challenging, especially in tortuous, severely stenosed, and heavily calcified lesions. The use of a microcatheter significantly improves the guidewire steerability and penetration force, but it requires specific training and is associated with increased procedural costs. We present the first in vivo experience with a new type of rapid exchange microcatheter (Micro Rx, Interventional Medical Device Solutions), describe bench testing of combinations of guidewires and microcatheters, and suggest potential applications.
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Affiliation(s)
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Roberto Garbo
- Maria Pia Hospital, GVM Care and Research, Turin, Italy
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Kajiya T, Takei T, Atsuchi N, Ohishi M. Right atrial appendage detected by intravascular ultrasound. J Invasive Cardiol 2023; 35. [PMID: 37984327 DOI: 10.25270/jic/23.00180] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
A 70-year-old woman with a history of type 2 diabetes mellitus was transferred to our hospital due to inferior ST-segment elevation myocardial infarction. An emergent coronary angiogram revealed occlusion of the distal right coronary artery. Primary percutaneous coronary intervention was performed, preceded by lesion assessment using intravascular ultrasound (IVUS).
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Affiliation(s)
- Takashi Kajiya
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan.
| | - Tatsuro Takei
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Nobuhiko Atsuchi
- Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University, Kagoshima, Japan
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Hirai T. "Crossing the invisible". Catheter Cardiovasc Interv 2023; 102:774-775. [PMID: 37471717 DOI: 10.1002/ccd.30780] [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] [Received: 06/28/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
Key Points
Using the septal collaterals without angiographic connection during retrograde CTO PCI was associated with high collateral channel crossing rate (>80%).
Two predicators for channel crossing failure were shorter posterior descending artery (less than 2/3 of the distance to cardiac apex) and well developed non‐septal collateral.
Further studies focusing on retrograde channel selection could improve the success rate and safety of retrograde CTO PCI.
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Affiliation(s)
- Taishi Hirai
- Divison of Cardiology, University of Missouri, Columbia, Missouri, USA
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Kovačić M. Stiff wire scratching to fenestration, de-escalation, and re-entry technique (SSDR): A novel wire-based antegrade dissection/re-entry technique for coronary chronic total occlusion recanalization. Cardiol J 2023; 30:843-845. [PMID: 37772354 PMCID: PMC10635719 DOI: 10.5603/cj.92864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/26/2023] [Accepted: 08/26/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Mihajlo Kovačić
- Department of Interventional Cardiology, County Hospital Čakovec, Croatia.
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28
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Uehara H, Okuyama M, Oe Y, Yoshimura T, Gunji T. Tertiary Cardiovascular Syphilis Presenting as Aortic Regurgitation, Aortitis, Thrombus, and Coronary Artery Occlusion, Requiring Percutaneous Coronary Intervention. Am J Case Rep 2023; 24:e941070. [PMID: 37735866 PMCID: PMC10519639 DOI: 10.12659/ajcr.941070] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/07/2023] [Accepted: 08/02/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Heart failure is caused by coronary artery disease, valvular disease, and arrhythmias and is highly treatable with recent technology. However, the incidence of syphilis is increasing worldwide. This case report describes tertiary cardiovascular syphilis, accompanied by aortic regurgitation, syphilitic aortitis complicated by thrombus of the ascending aorta, and coronary artery occlusion, requiring percutaneous coronary artery intervention. CASE REPORT A 51-year-old Japanese man with no significant medical history was admitted to the hospital for worsening shortness of breath on exertion. On physical examination, there was no edema in either lower leg. Chest X-rays showed an enlarged heart and pulmonary congestion, and echocardiography showed a left ventricular ejection fraction of 18%, with full circumferential wall motion impairment. Heart failure was diagnosed, and the patient was found to have severe coronary artery disease and aortic regurgitation. He underwent percutaneous coronary intervention (PCI) for his coronary artery occlusion and was treated with medications for heart failure. Two months later, his condition improved, and PCI was performed for the revascularization of the remaining coronary artery. After PCI was completed, the patient was evaluated for vasculitis. The aortic wall lesion was likely a result of non-active syphilitic aortitis, and the results of serological tests of syphilis were positive. Therefore, we concluded that the diagnosis was cardiovascular syphilis. CONCLUSIONS This case report has highlighted the need for clinicians to be aware of the cardiovascular findings in syphilis, including syphilitic aortitis, particularly at this time, when the global incidence of syphilis is increasing.
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Mushtaq S, Gigante C, Conte E, Capovilla TM, Sonck J, Tanzilli A, Barbato E, Monizzi G, Belmonte M, De Bruyne B, Bartorelli AL, Schillaci M, Marchetti D, Carerj ML, Pontone G, Collet C, Andreini D. Preoperative angiography-derived fractional flow reserve may predict coronary artery bypass grafting occlusion and disease progression. J Cardiovasc Med (Hagerstown) 2023; 24:651-658. [PMID: 37605957 DOI: 10.2459/jcm.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Graft occlusion after coronary artery bypass grafting (CABG) has been associated with competitive flow of native coronary arteries. OBJECTIVES To assess with coronary computed tomography angiography (CCTA) graft occlusion and coronary artery disease (CAD) progression of native vessels after CABG and their relationship with angiography-derived vessel fractional flow reserve (vFFR) performed before surgery. METHODS Between 2006 and 2018, serial vFFR analyses were obtained before CABG in each major native coronary vessel from two institutions. All patients underwent follow-up CCTA. RESULTS In 171 consecutive patients, serial preoperative angiograms were suitable for vFFR analysis of 298 grafted and 59 nongrafted vessels. Median time between CABG and CCTA was 2.1 years. Preoperative vFFR was assessed in 131 left anterior descending artery (LAD), 132 left circumflex artery (LCX) and 94 right coronary aretry (RCA) and was less than 0.80 in 255 of 298 bypassed vessels. Graft occlusion was observed at CCTA in 28 of 298 grafts. The median preoperative vFFR value of native coronaries was higher in occluded compared with patent grafts (0.75 vs. 0.60, P < 0.001) and was associated with graft. The best vFFR cut-off to predict graft occlusion was 0.67. Progression of CAD was higher in grafted than in nongrafted vessels (89.6 vs. 47.5%, P < 0.001). Pre-CABG vFFR predicted disease progression of grafted native vessels (AUC = 0.83). CONCLUSION Preoperative vFFR derived from invasive coronary angiography was able to predict graft occlusion and CAD progression of grafted coronary arteries.
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Affiliation(s)
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
| | - Matteo Schillaci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Davide Marchetti
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Maria Ludovica Carerj
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, 'G. Martino' University Hospital Messina, Messina
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
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Alkhalil M, Ghazal Asswad A, Farag M, Zaman A. A case series of novel technique of coronary protection for patients with low coronary height undergoing transcatheter aortic valve implantation. J Invasive Cardiol 2023; 35. [PMID: 37983106 DOI: 10.25270/jic/23.00146] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Coronary artery occlusion (CAO) in patients undergoing transcatheter aortic valve implantation (TAVI) is rare but is associated with up to 50% mortality risk. We report a case series of a novel technique of coronary protection for patients undergoing TAVI at high risk of CAO. METHODS Patients with symptomatic severe aortic stenosis scheduled for TAVI and at high risk of CAO were included. A noncompliant coronary angioplasty balloon was placed between the left coronary artery and the transcatheter heart valve. The distal "nose" of the balloon was positioned at the ostium of the left main and its main body "hanging" in the aorta. The coronary balloon was sized 1:1 to the left main, and simultaneous kissing balloon inflation was performed during valve deployment. RESULTS Eight patients were included in this series. Five patients had previous isolated surgical bioprosthetic valves. The median left coronary height was 7.1 (6.0-8.4) mm with a median valve-to-coronary (VTC) distance of 3.3 (2.9-3.6) mm. There were no procedural complications, but one patient had a stroke during their in-hospital stay. After a median follow up of 12 (5.8-16.8) months, there were no mortality or rehospitalization events. CONCLUSION Simultaneous kissing balloon is a novel technique of coronary protection in patients undergoing TAVI at high risk of CAO. Further studies are required to establish the safety of this novel technique.
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Affiliation(s)
- Mohammad Alkhalil
- Cardiothroacic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK. ,
| | | | - Mohamed Farag
- Cardiothroacic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Azfar Zaman
- Cardiothroacic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
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Fujimoto Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP. J Atheroscler Thromb 2023; 30:1229-1241. [PMID: 36529503 PMCID: PMC10499455 DOI: 10.5551/jat.63956] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/31/2022] [Indexed: 09/05/2023] Open
Abstract
AIMS Complex and high-risk intervention in indicated patients (CHIP) is an emerging concept in the contemporary percutaneous coronary intervention (PCI). CHIP is known to consist three factors, namely, (1) patient factors, (2) complicated heart disease, and (3) complex PCI. However, it remains unclear whether additional CHIP factors further increase the incidence of complications in complex PCI. Thus, in this study, we aim to compare the incidence of complications among definite CHIP, possible CHIP, and non-CHIP in terms of complex PCI and to further investigate the association between CHIP and complications. METHODS The primary aim of this study was to determine the major complications in PCI. We included 989 PCI lesions and divided those into definite CHIP (n=140), possible CHIP (n=397), and the non-CHIP groups (n=452). RESULTS The incidence of major complications was noted to be the highest in the definite CHIP, followed by the possible CHIP, and lowest in the non-CHIP (p=0.001). The multivariate logistic regression analysis using a generalized estimating equation revealed definite CHIP (versus non-CHIP: odds ratio (OR) 2.099, 95% confidence interval (CI) 1.062-4.150, p=0.033) was significantly associated with major complications after controlling for confounding factors. Another multivariate logistic regression analysis revealed immunosuppressive drugs (OR 3.040, 95% CI 1.251-7.386, p=0.014), unstable hemodynamics (OR 5.753, 95% CI 1.217-27.201, p=0.027), and frailty (OR 2.039, 95% CI 1.108-3.751, p=0.022) were significantly associated with major complications among CHIP factors. CONCLUSIONS The incidence of major complications in complex PCI was determined to be the highest in the definite CHIP, followed by the possible CHIP and lowest in the non-CHIP. Thus, more attention should be given to the three components of CHIP to prevent major complications in complex PCI.
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Affiliation(s)
- Yudai Fujimoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Farhad A, Reza R, Azamossadat H, Ali G, Arash R, Mehrad A, Zahra K. Artificial intelligence in estimating fractional flow reserve: a systematic literature review of techniques. BMC Cardiovasc Disord 2023; 23:407. [PMID: 37596521 PMCID: PMC10439535 DOI: 10.1186/s12872-023-03447-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/12/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Fractional Flow Reserve (FFR) is the gold standard for the functional evaluation of coronary arteries, which is effective in selecting patients for revascularization, avoiding unnecessary procedures, and reducing treatment costs. However, its use is limited due to invasiveness, high cost, and complexity. Therefore, the non-invasive estimation of FFR using artificial intelligence (AI) methods is crucial. OBJECTIVE This study aimed to identify the AI techniques used for FFR estimation and to explore the features of the studies that applied AI techniques in FFR estimation. METHODS The present systematic review was conducted by searching five databases, PubMed, Scopus, Web of Science, IEEE, and Science Direct, based on the search strategy of each database. RESULTS Five hundred seventy-three articles were extracted, and by applying the inclusion and exclusion criteria, twenty-five were finally selected for review. The findings revealed that AI methods, including Machine Learning (ML) and Deep Learning (DL), have been used to estimate the FFR. CONCLUSION This study shows that AI methods can be used non-invasively to estimate FFR, which can help physicians diagnose and treat coronary artery occlusion and provide significant clinical performance for patients.
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Affiliation(s)
- Arefinia Farhad
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rabiei Reza
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hosseini Azamossadat
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ghaemian Ali
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roshanpoor Arash
- Department of Computer Science, Sama Technical and Vocational Training College, Tehran Branch (Tehran), Islamic Azad University (IAU), Tehran, Iran
| | - Aria Mehrad
- Department of Information Technology and Computer Engineering and Ophthalmic Epidemiology Research Center, Azarbaijan Shahid Madani University, Tabriz, Iran
| | - Khorrami Zahra
- Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tabriz, Iran
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Jaworek M, Gelpi G, Perico F, Romagnoni C, Tasca G, Salurso E, Contino M, Redaelli A, Fiore GB, Vismara R. Coronary Perfusion After Valve-in-Valve Transcatheter Aortic Valve Implantation in Small Aortic Root: In Vitro Experimental Assessment. J Cardiovasc Transl Res 2023; 16:956-967. [PMID: 37097591 PMCID: PMC10480284 DOI: 10.1007/s12265-023-10364-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/13/2023] [Indexed: 04/26/2023]
Abstract
Coronary flow obstruction following transcatheter aortic valve-in-valve implantation (VIV-TAVI) is associated with a high mortality risk. The aim of this work was to quantify the coronary perfusion after VIV-TAVI in a high-risk aortic root anatomy. 3D printed models of small aortic root were used to simulate the implantation of a TAVI prosthesis (Portico 23) into surgical prostheses (Trifecta 19 and 21). The aortic root models were tested in a pulsatile in vitro bench setup with a coronary perfusion simulator. The tests were performed at baseline and post-VIV-TAVI procedure in aligned and misaligned commissural configurations under simulated hemodynamic rest and exercise conditions. The experimental design provided highly controllable and repeatable flow and pressure conditions. The left and right coronary mean flow did not differ significantly at pre- and post-VIV-TAVI procedure in any tested configurations. The commissural misalignment did not induce any significant alterations to the coronary flow. High-risk aortic root anatomy did not trigger coronary ostia obstruction or coronary flow alteration after transcatheter aortic valve implantation in a surgical bioprosthesis as shown from in-vitro flow loop tests.
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Affiliation(s)
- Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Guido Gelpi
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Perico
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Claudia Romagnoni
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Giordano Tasca
- Cardiac Surgery Department, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Eleonora Salurso
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Monica Contino
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Gianfranco Beniamino Fiore
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
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Bermudez-Gonzalez JL, Gonzalez-Hernandez MA, Proaño-Bernal L, Gilabert-García A, Villarreal-Guerrero C, Luna-Alvarez-Amezquita JA, Espinola-Zavaleta N, Alexanderson-Rosas E. Impact of collateral circulation in a patient with chronic coronary occlusion. J Nucl Cardiol 2023; 30:844-847. [PMID: 34893963 DOI: 10.1007/s12350-021-02870-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jorge Luis Bermudez-Gonzalez
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Miguel Angel Gonzalez-Hernandez
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Leonardo Proaño-Bernal
- Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico City, Mexico
| | - Ana Gilabert-García
- Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico City, Mexico
| | | | - Jose Antonio Luna-Alvarez-Amezquita
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Erick Alexanderson-Rosas
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
- Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico City, Mexico.
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Nakashima M, Enta Y, Ishii K, Miyasaka M, Hata M, Tada N. Bioprosthetic or native aortic scallop intentional laceration to prevent coronary artery obstruction using available devices in Japan. Cardiovasc Interv Ther 2023; 38:251-255. [PMID: 36422830 PMCID: PMC10020244 DOI: 10.1007/s12928-022-00899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Masaki Nakashima
- Department of Cardiology, Sendai Kosei Hospital, 4-15 Hirose-Machi, Aoba Ward, Sendai, Miyagi, 980-0873, Japan.
| | - Yusuke Enta
- Department of Cardiology, Sendai Kosei Hospital, 4-15 Hirose-Machi, Aoba Ward, Sendai, Miyagi, 980-0873, Japan
| | - Kazunori Ishii
- Department of Cardiology, Sendai Kosei Hospital, 4-15 Hirose-Machi, Aoba Ward, Sendai, Miyagi, 980-0873, Japan
| | - Masaki Miyasaka
- Department of Cardiology, Sendai Kosei Hospital, 4-15 Hirose-Machi, Aoba Ward, Sendai, Miyagi, 980-0873, Japan
- Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaki Hata
- Department of Cardiovascular Surgery, Sendai Kousei Hospital, Sendai, 4-15 Hirose-Machi, Aoba Ward, Miyagi, 980-0873, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, 4-15 Hirose-Machi, Aoba Ward, Sendai, Miyagi, 980-0873, Japan
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Paez Perez Y, Rimm S, Bove J, Hochman S, Liu T, Catapano A, Shroff N, Lim J, Rimm B. Does the Electrocardiogram Machine Interpretation Affect the Ability to Accurately Diagnose ST-Elevation Myocardial Infarction by Emergency Physicians? Crit Pathw Cardiol 2023; 22:8-12. [PMID: 36812338 DOI: 10.1097/hpc.0000000000000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
INTRODUCTION An ST-elevation myocardial infarction (STEMI) can portend significant morbidity and mortality to the patient and therefore must be rapidly diagnosed by an emergency medicine (EM) physician. The primary aim of this study is to determine whether EM physicians are more or less likely to accurately diagnose STEMI on an electrocardiogram (ECG) if they are blinded to the ECG machine interpretation as opposed to if they are provided the ECG machine interpretation. METHODS We performed a retrospective chart review of adult patients over 18 years of age admitted to our large, urban tertiary care center with a diagnosis of STEMI from January 1, 2016, to December 31, 2017. From these patients' charts, we selected 31 ECGs to create a quiz that was presented twice to a group of emergency physicians. The first quiz contained the 31 ECGs without the computer interpretations revealed. The second quiz, presented to the same physicians 2 weeks later, contained the same set of ECGs with the computer interpretations revealed. Physicians were asked "Based on the ECG above, is there a blocked coronary artery present causing a STEMI?" RESULTS Twenty-five EM physicians completed two 31-question ECG quizzes for a total of 1550 ECG interpretations. On the first quiz with computer interpretations blinded, the overall sensitivity in identifying a "true STEMI" was 67.2% with an overall accuracy of 65.6%. On the second quiz in which the ECG machine interpretation was revealed, the overall sensitivity was 66.4% with an accuracy of 65.8 % in correctly identifying a STEMI. The differences in sensitivity and accuracy were not statistically significant. CONCLUSION This study demonstrated no significant difference in physicians blinded versus those unblinded to computer interpretations of possible STEMI.
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Affiliation(s)
| | - Sarah Rimm
- Emergency Department, MedStar Franklin Square Medical Center, Baltimore, MD
| | - Joseph Bove
- Emergency Department, St. Joseph's University Medical Center, Paterson, NJ
| | - Steven Hochman
- Emergency Department, St. Joseph's University Medical Center, Paterson, NJ
| | - Tianci Liu
- Emergency Department, Harbor-UCLA Medical Center, Torrance, CA
| | - Anthony Catapano
- Emergency Department, St. Joseph's University Medical Center, Paterson, NJ
| | - Ninad Shroff
- Emergency Department, St. Joseph's University Medical Center, Paterson, NJ
| | - Jessica Lim
- Emergency Department, AdventHealth Apopka, Apopka, FL
| | - Brian Rimm
- Organizational Assessment, Uniformed Services University of the Health Sciences, Bethesda, MD
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Khan JM, Kamioka N, Lisko JC, Perdoncin E, Zhang C, Maini A, Chen M, Li Y, Ludwig S, Westermann D, Amat Santos IJ, Kalińczuk Ł, Sinning JM, Kawaguchi T, Fuku Y, Cheema AN, Félix-Oliveira A, Yamamoto M, Kagase A, Codner P, Valle RD, Iyer VS, Kim HS, Lin MS, Maini B, Rodriguez R, Montorfano M, Ancona MB, Tada N, Miyasaka M, Ahmad H, Ruggiero NJ, Torguson R, Ben-Dor I, Shults CC, Weissman G, Lederman RJ, Greenbaum AB, Babaliaros VC, Waksman R, Rogers T. Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model. JACC Cardiovasc Interv 2023; 16:415-425. [PMID: 36858660 PMCID: PMC9991077 DOI: 10.1016/j.jcin.2022.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR)-related coronary artery obstruction prediction remains unsatisfactory despite high mortality and novel preventive therapies. OBJECTIVES This study sought to develop a predictive model for TAVR-related coronary obstruction in native aortic stenosis. METHODS Preprocedure computed tomography and fluoroscopy images of patients in whom TAVR caused coronary artery obstruction were collected. Central laboratories made measurements, which were compared with unobstructed patients from a single-center database. A multivariate model was developed and validated against a 1:1 propensity-matched subselection of the unobstructed cohort. RESULTS Sixty patients with angiographically confirmed coronary obstruction and 1,381 without obstruction were included. In-hospital death was higher in the obstruction cohort (26.7% vs 0.7%; P < 0.001). Annular area and perimeter, coronary height, sinus width, and sinotubular junction height and width were all significantly smaller in the obstructed cohort. Obstruction was most common on the left side (78.3%) and at the level of the coronary artery ostium (92.1%). Coronary artery height and sinus width, but not annulus area, were significant risk factors for obstruction by logistic regression but performed poorly in predicting obstruction. The new multivariate model (coronary obstruction IF cusp height > coronary height, AND virtual valve-to-coronary distance ≤4 mm OR culprit leaflet calcium volume >600 mm3) performed well, with an area under the curve of 0.93 (sensitivity = 0.93, specificity = 0.84) for the left coronary artery and 0.94 (sensitivity = 0.92, specificity = 0.96) for the right. CONCLUSIONS A novel computed tomography-based multivariate prediction model that can be implemented routinely in real-world practice predicted coronary artery obstruction from TAVR in native aortic stenosis.
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Affiliation(s)
- Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Norihiko Kamioka
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA; Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Emily Perdoncin
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Aneel Maini
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mao Chen
- Department of Cardiology, West China School of Medicine, West China Hospital, Sichuan University, China
| | - Yijian Li
- Department of Cardiology, West China School of Medicine, West China Hospital, Sichuan University, China
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Cardiovascular Research Foundation, New York, New York, USA
| | - Dirk Westermann
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Ignacio J Amat Santos
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Asim N Cheema
- Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Afonso Félix-Oliveira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Institute of Pharmacology and Neurosciences, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center/Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Toyohashi Heart Center/Nagoya Heart Center, Nagoya, Japan
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Raquel Del Valle
- Interventional Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Vijay S Iyer
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Brijeshwar Maini
- Department of Cardiology, Florida Atlantic University, Boca Raton, Florida, USA
| | - Roberto Rodriguez
- Structural Heart Program, Main Line Health, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masaki Miyasaka
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Nicholas J Ruggiero
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Cho SG, Lee JE, Kim HY, Song HC, Kim YH. Association between myocardial ischemia and plaque characteristics in chronic total occlusion. J Nucl Cardiol 2023; 30:388-398. [PMID: 35836093 DOI: 10.1007/s12350-022-03020-6] [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] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Myocardial ischemia varies in chronic total occlusion (CTO) despite the occluded artery. We analyzed whether it is associated with the plaque characteristics of the occluded segment. METHODS We retrospectively enrolled 100 patients with CTO who underwent myocardial perfusion single-photon emission computed tomography (SPECT) and coronary computed tomography angiography (CCTA) within 2 months. CTO-related ischemia was classified as moderate to severe (summed difference score [SDS] of the CTO territory ≥ 5) or mild or none (SDS < 5) on SPECT. Using CCTA, the atherosclerotic plaques of the occluded segment were subdivided into low-density (- 100-30 HU), intermediate-density (31-350 HU), and high-density (351-1000 HU) plaques. The plaque composition was compared according to the severity of CTO-related ischemia. RESULTS Moderate-to-severe CTO-related ischemia (n = 23) showed significantly higher proportion of intermediate-density plaques (72.4% vs. 64.0%), intermediate/low-density (7.10 vs. 3.65) and intermediate-to-high/low-density (7.78 vs. 3.80) plaque ratios, frequent shorter occlusion (30% vs. 6%), and lower volume (26.5 mm3 vs. 58.8 mm3) and proportion (11.4% vs. 20.8%) of low-density plaques. Multivariable analysis revealed significant associations between higher proportion of intermediate-density plaques and moderate-to-severe CTO-related ischemia, independent of occlusion length. CONCLUSION Higher proportion of intermediate-density plaques in the occluded segment was associated with the moderate-to-severe CTO-related ischemia.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Radiology, Chonnam National University Medical School, Gwangju, Republic of Korea
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Alahdab F, Ahmed AI, Al-Mallah M. Coronary computed tomography angiography and single-photon emission computerized tomography in chronic total occlusions: the Rosetta Stone for PCI planning? J Nucl Cardiol 2023; 30:399-402. [PMID: 36682017 DOI: 10.1007/s12350-022-03157-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 01/23/2023]
Affiliation(s)
- Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Mouaz Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower-Suite 1801, Houston, TX, 77030, USA.
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Reddy S. Stumpless ostial right coronary artery chronic total occlusion: Retrograde approach. Turk Kardiyol Dern Ars 2023; 51:63-68. [PMID: 36689281 DOI: 10.5543/tkda.2022.05808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Percutaneous coronary interventions of the coronary total occlusions, especially of the aorto-ostial lesions, portray challenges. As the antegrade wiring is not feasible in aorto-ostial chronic total occlusions, the retrograde wiring remains the lone strategy. We present a successful case of stumpless ostial right coronary artery chronic total occlusion, which was successfully opened by retrograde wiring and externalization by snaring. Intravascular ultrasound was performed to comprehend the diffusely narrowed distal right coronary artery and posterior left ventricular branch (PLVB) to guide stenting strategy in percutaneous coronary intervention.
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Affiliation(s)
- Sharath Reddy
- Department of Cardiology, Medicover Hospitals, Madhapur, Telangana, India
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Lu Z, Liu T, Wang C, Xuan H, Yan Y, Chen J, Lu Y, Li D, Xu T. The evaluation of coronary microvascular obstruction in patients with STEMI by cardiac magnetic resonance T2-STIR image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography. Heart Vessels 2023; 38:40-48. [PMID: 35915265 DOI: 10.1007/s00380-022-02131-x] [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] [Received: 12/11/2021] [Accepted: 06/29/2022] [Indexed: 01/06/2023]
Abstract
This study was designed to assess coronary microvascular obstruction (MVO) in patients with acute ST-segment elevation myocardial infarction (STEMI) by cardiac magnetic resonance T2-weighted short tau inversion recovery (T2-STIR) image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography (LDDSE-LS2D-STE). 32 patients were enrolled to perform cardiac magnetic resonance and echocardiography 5-7 days after primary percutaneous coronary intervention. Infarcted myocardium was categorized into MVO+ group and MVO- group by late gadolinium enhancement as gold standard. At T2-weighted image, the area of hyper-intense region and hypo-intense core inside were marked as A1, A2 and A2/A1 > 0 represented MVO. Strain parameters were composed of longitudinal strain (LS), circumferential strain and radial strain at rest and dobutamine stress. There were 94 MVO+ segments, 136 MVO- segments according to gold standard. 96 segments had hypo-intense core at T2-STIR image. The sensitivity and specificity of T2-STIR in detecting MVO were 91.49 and 92.65%. Endocardial LS was superior to other parameters, and stress endocardial LS was higher than that of resting endocardial LS (sensitivity: 77.11% vs 72.29%, specificity: 93.28% vs 83.19%, AUC: 0.87 vs 0.82, P < 0.05). The combination of T2-STIR and stress endocardial LS in parallel test could improve sensitivity significantly (98.05% vs 91.49%). T2-STIR has higher diagnostic value in detecting MVO with some limitations. However, LDDSE-LS2D-STE with cost-effective and handling may be a good alternative to T2-STIR. It provides additional and reliable diagnostic tools to identify MVO in STEMI patients after reperfusion.
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Affiliation(s)
- Zhihao Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Tao Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Yan Yan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Yuan Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China.
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai west road, Xuzhou, Jiangsu, China.
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Nummi A, Pätilä T, Mulari S, Lampinen M, Nieminen T, Mäyränpää MI, Vento A, Harjula A, Kankuri E. Epicardial transplantation of autologous atrial appendage micrografts: evaluation of safety and feasibility in pigs after coronary artery occlusion. SCAND CARDIOVASC J 2022; 56:352-360. [PMID: 36002941 DOI: 10.1080/14017431.2022.2111462] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
Objectives. Several approaches devised for clinical utilization of cell-based therapies for heart failure often suffer from complex and lengthy preparation stages. Epicardial delivery of autologous atrial appendage micrografts (AAMs) with a clinically used extracellular matrix (ECM) patch provides a straightforward therapy alternative. We evaluated the operative feasibility and the effect of micrografts on the patch-induced epicardial foreign body inflammatory response in a porcine model of myocardial infarction. Design. Right atrial appendages were harvested and mechanically processed into AAMs. The left anterior descending coronary artery was ligated to generate acute infarction. Patches of ECM matrix with or without AAMs were transplanted epicardially onto the infarcted area. Four pigs received the ECM and four received the AAMs patch. Cardiac function was studied by echocardiography both preoperatively and at 3-week follow-up. The primary outcome measures were safety and feasibility of the therapy administration, and the secondary outcome was the inflammatory response to ECM. Results. Neither AAMs nor ECM patch-related complications were detected during the follow-up time. AAMs patch preparation was feasible according to time and safety. Inflammation was greatly reduced in AAMs when compared with ECM patches as measured by the amount of infiltrated inflammatory cells and area of inflammation. Immunohistochemistry demonstrated an increased CD3+ cell density in the AAMs patch infiltrate. Conclusions. Epicardial AAMs transplantation demonstrated safety and clinical feasibility. The use of micrografts significantly inhibited ECM-induced foreign body inflammatory reactivity. Transplantation of AAMs shows good clinical applicability as adjuvant therapy to cardiac surgery and can suppress acute inflammatory reactivity.
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Affiliation(s)
- Annu Nummi
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommi Pätilä
- Pediatric Cardiac Surgery, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Severi Mulari
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Milla Lampinen
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuomo Nieminen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Mikko I Mäyränpää
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Vento
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ari Harjula
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Esko Kankuri
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Lieder HR, Skyschally A, Sturek M, Heusch G, Kleinbongard P. Remote ischemic conditioning in Ossabaw minipigs induces the release of humoral cardioprotective triggers, but the myocardium does not respond with reduced infarct size. Am J Physiol Heart Circ Physiol 2022; 323:H1365-H1375. [PMID: 36367697 PMCID: PMC9744643 DOI: 10.1152/ajpheart.00580.2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Ischemic preconditioning (IPC; brief cycles of coronary occlusion/reperfusion) is operative in all species tested so far and reduces infarct size through the release of trigger molecules and activation of signal transducer and activator of transcription (STAT)3 in pigs. We have recently demonstrated that IPC failed to protect Ossabaw minipigs, which had a genetic predisposition to, but not yet established a metabolic syndrome, from infarction and did not activate STAT3. We now subjected Ossabaw minipigs to remote ischemic conditioning (RIC; 4 × 5 min/5 min bilateral hindlimb ischemia-reperfusion) and analyzed the release of cardioprotective triggers into the circulation with the aim to distinguish whether IPC failed to stimulate trigger release or to activate intracellular signaling cascades upstream of STAT3. RIC or a placebo protocol, respectively, was induced in anesthetized pigs before 60 min/180 min coronary occlusion/reperfusion. Plasma, prepared from Ossabaw minipigs after RIC or placebo, was infused into isolated rat hearts subjected to 30 min/120 min global ischemia-reperfusion. In the Ossabaw minipigs, RIC did not reduce infarct size (49.5 ± 12.1 vs. 56.0 ± 11.8% of area at risk with placebo), and STAT3 was not activated. In isolated rat hearts, infusion of RIC plasma reduced infarct size (19.7 ± 6.7 vs. 33.2 ± 5.5% of ventricular mass with placebo) and activated STAT3. Pretreatment of rat hearts with the STAT3 inhibitor stattic abrogated such infarct size reduction and STAT3 activation. In conclusion, Ossabaw minipigs release cardioprotective triggers in response to RIC into the circulation, and lack of cardioprotection is attributed to myocardial nonresponsiveness.NEW & NOTEWORTHY Ischemic conditioning reduces myocardial infarct size in all species tested so far. In the present study, we used Ossabaw minipigs that had a genetic predisposition to, but not yet established a metabolic syndrome. In these pigs, remote ischemic conditioning (RIC) induced the release of cardioprotective triggers but did not reduce infarct size. Transfer of their plasma, however, reduced infarct size in isolated recipient rat hearts, along with signal transducer and activator of transcription (STAT)3 activation.
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Affiliation(s)
- Helmut Raphael Lieder
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Essen, Germany
| | - Andreas Skyschally
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Essen, Germany
| | - Michael Sturek
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Essen, Germany
| | - Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Essen, Germany
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Li YH, Wu MH, Lee WJ, Lee IT. A Synergistic Effect between Plasma Dickkopf-1 and Obstructive Coronary Artery Disease on the Prediction of Major Adverse Cardiac Events in Patients with Angina: An Observational Study. Biomolecules 2022; 12:biom12101408. [PMID: 36291617 PMCID: PMC9599804 DOI: 10.3390/biom12101408] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
The canonical β-catenin-dependent wingless (Wnt) pathway is associated with endothelial function. We examined the effect of plasma dickkopf-1 (DKK-1), an inhibitor of the Wnt pathway, on the prediction of major adverse cardiac events (MACEs). We enrolled patients who had undergone selective coronary angiography for angina. DKK-1 levels were determined using plasma collected at the outpatient visit after fasting. MACEs served as the primary endpoint. All 470 enrolled patients were divided into four groups according to their median plasma DKK-1 levels and the presence of obstructive coronary artery disease (CAD). Forty-eight patients reached the primary endpoint during a median follow-up time of 4.8 years. Kaplan–Meier survival analysis indicated that the group with high DKK-1 and obstructive CAD had a significantly higher mortality rate than the other three groups (log-rank test p = 0.001). Compared with the low plasma DKK-1 without significant coronary obstruction group, the high DKK-1 with obstructive CAD group had a hazard ratio of 10.640 (95% confidence interval: 1.350–83.874) for MACEs, as determined by multivariable Cox proportional hazard regression analysis. In conclusion, we observed a synergistic effect between high plasma DKK-1 and obstructive CAD on the prediction of MACEs in patients with angina.
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Affiliation(s)
- Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei 106216, Taiwan
| | - Min-Huan Wu
- Bachelor of Science in Senior Wellness and Sport Science, Tunghai University, Taichung 407224, Taiwan
- Senior Life and Innovation Technology Center, Tunghai University, Taichung 407224, Taiwan
- Life Science Research Center, Tunghai University, Taichung 407224, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
- Correspondence:
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Inci S, Gul M, Elcik D, Aktas H, Yildirim O, Kelesoglu S, Kalay N. Identification of subclinical myocardial dysfunction by Speckle Tracking Imaging in patients with myocardial infarction with non-occlusive coronary arteries (MINOCA). Int J Cardiovasc Imaging 2022; 38:2099-2106. [PMID: 37726472 DOI: 10.1007/s10554-022-02602-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this study was to investigate subclinical left ventricular dysfunction in patients diagnosed with myocardial infarction with non-occlusive coronary arteries (MINOCA). METHODS Thirty-five patients with MINOCA (average age 54.26 ± 12.24 years) and thirty-five patients with ischemia with non-obstructed coronary artery disease (INOCA) (average age 55.20 ± 8.36 years) were enrolled in the study. All clinical conditions that could affect left ventricular functions were considered exclusion criteria. Echocardiographic studies were conducted in the patient and control groups in the left lateral decubitus position using a medical ultrasound device (EPIQ 7, Philips Medical System, USA). The left ventricle was examined longitudinally with apical images of chamber 4-3-2 using the available software (QLAB 6.0). RESULTS There were no differences in age, blood pressure level, baseline echocardiogram measurements, and tissue Doppler parameters between the two groups. In two-dimensional speckle tracking echocardiography (2D-STE) measurements, left ventricular longitudinal strain and strain rate in systole, early and late diastole from apical 4-3-2 chamber and global measurements of each parameter were significantly decreased in the MINOCA group compared to the INOCA group (p < 0.05). A significant negative correlation was observed between the global longitudinal strain rate and the troponin I in the MINOCA patients group (r=-0.43 p = 0.009). CONCLUSIONS Our study showed that while standard echocardiographic parameters for patients diagnosed with MINOCA were normal, their left ventricular systolic and diastolic functions were reduced by the 2D-STE method.
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Affiliation(s)
- Sinan Inci
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Murat Gul
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey.
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Deniz Elcik
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Aktas
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Oguz Yildirim
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Saban Kelesoglu
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Nihat Kalay
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Liu L, Ding F, Shen Y, Tu S, Yang J, Zhao Q, Chu M, Shen W, Zhang R, Zimarino M, Werner GS, Gutiérrez-Chico JL. Automatic assessment of collaterals physiology in chronic total occlusions by means of artificial intelligence. Cardiol J 2022; 30:685-695. [PMID: 36117292 PMCID: PMC10635726 DOI: 10.5603/cj.a2022.0089] [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] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/28/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Assessment of collaterals physiology in chronic total occlusions (CTO) currently requires dedicated devices, adds complexity, and increases the cost of the intervention. This study sought to derive collaterals physiology from flow velocity changes (ΔV) in donor arteries, calculated with artificial intelligence- aided angiography. METHODS Angiographies with successful percutaneous coronary intervention (PCI) in 2 centers were retro- spectively analyzed. CTO collaterals were angiographically evaluated according to Rentrop and collateral connections (CC) classifications. Flow velocities in the primary and secondary collateral donor arteries (PCDA, SCDA) were automatically computed pre and post PCI, based on a novel deep-learning model to extract the length/time curve of the coronary filling in angiography. Parameters of collaterals physiology, Δcollateral-flow (Δfcoll) and Δcollateral-flow-index (ΔCFI), were derived from the ΔV pre-post. RESULTS The analysis was feasible in 105 out of 130 patients. Flow velocity in the PCDA significantly decreased after CTO-PCI, proportionally to the angiographic collateral grading (Rentrop 1: 0.02 ± 0.01 m/s; Rentrop 2: 0.04 ± 0.01 m/s; Rentrop 3: 0.07 ± 0.02 m/s; p < 0.001; CC0: 0.01 ± 0.01 m/s; CC1: 0.04 ± ± 0.02 m/s; CC2: 0.06 ± 0.02 m/s; p < 0.001). Δfcoll and ΔCFI paralleled ΔV. SCDA also showed a greater reduction in flow velocity if its collateral channels were CC1 vs. CC0 (0.03 ± 0.01 vs. 0.01 ± 0.01 m/s; p < 0.001). For each individual patient, ΔV was more pronounced in the PCDA than in the SCDA. CONCLUSIONS Automatic assessment of collaterals physiology in CTO is feasible, based on a deeplearning model analyzing the filling of the donor vessels in angiography. The changes in collateral flow with this novel method are quantitatively proportional to the angiographic grading of the collaterals.
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Affiliation(s)
- Lili Liu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Ding
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Shen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junqing Yang
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong, China
| | - Qiuyang Zhao
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Weifeng Shen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Marco Zimarino
- Institute of Cardiology, G. D’Annunzio University, Chieti-Pescara, Italy
| | - Gerald S. Werner
- Klinikum Darmstadt GmbH, Medizinische Klinik I, Darmstadt, Germany
| | - Juan Luis Gutiérrez-Chico
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Bundeswehrzentralkrankenhaus, Koblenz, Germany
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Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington USA.
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Salihu A, Roux O, Tzimas G, Antiochos P, Le Bloa M, Fournier S, Carron PN, Muller O, Lu H. [An update on some atypical electrocardiographic forms of acute coronary syndrome The "STEMI equivalents"]. Rev Med Suisse 2022; 18:1030-1037. [PMID: 35612475 DOI: 10.53738/revmed.2022.18.783.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The diagnosis of acute coronary syndrome with ST segment elevation (STEMI) is based on clinical symptoms suggestive of acute myocardial ischemia and precise ECG criteria. STEMI is due to an acute occlusion or subocclusion of a coronary artery, generating a transmural ischaemia, requiring coronary angiography with urgent coronary revascularization. However, some authors consider the current STEMI ECG criteria to be too restrictive: up to 30 % of patients who do not meet these criteria present with critical coronary artery stenosis or acute coronary occlusion. Atypical electrocardiographic patterns, known as "STEMI equivalents", can be found in some cases and justify a rapid cardiological evaluation. We present a pragmatic review of five STEMI equivalents.
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Affiliation(s)
- Adil Salihu
- Service de médecine interne, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Olivier Roux
- Service de cardiologie, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Georgios Tzimas
- Service de cardiologie, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Panagiotis Antiochos
- Service de cardiologie, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Mathieu Le Bloa
- Service de cardiologie, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Stephane Fournier
- Service de cardiologie, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Pierre-Nicolas Carron
- Service des urgences, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Olivier Muller
- Service de cardiologie, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Henri Lu
- Service de cardiologie, Faculté de biologie et de médecine, Université de Lausanne et Centre hospitalier universitaire vaudois, 1011 Lausanne
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Akçay M, Çoksevim M, Yıldırım U, Gedikli Ö, Gülel O, Yüksel S, Meriç M, Soylu K, Yılmaz Ö, Şahin M. Low-Dose Slow Infusion Tissue Plasminogen Activator (tPA) in Treatment of Thrombotic Coronary Artery Occlusions: Case Series and Literature Review. Anatol J Cardiol 2022; 26:249-257. [PMID: 35435835 PMCID: PMC9366437 DOI: 10.5152/anatoljcardiol.2022.1083] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thrombotic coronary artery occlusions usually manifest as acute coronary syndrome with cardiogenic shock, acute pulmonary edema, cardiac arrest, fatal arrhythmias, or sudden cardiac death. Although it usually occurs based on atherosclerosis, it can also occur without atherosclerosis. There is no predictor of coronary artery thrombosis clinically and no consensus regarding the optimal treatment. In the current literature, treatment options include emergency coronary artery bypass grafting, entrapment of thrombus in vessel wall with stent implantation, intracoronary thrombolysis, glycoprotein IIb/IIIa inhibitors, anticoagulation with heparin, and thrombus aspiration as reperfusion strategies. Here, we reviewed a new treatment strategy based on the literature, and a case series with successful results in hemodynamically stable patients with low-dose slow infusion tissue plasminogen activator (tPA) for thrombotic coronary artery occlusions that allow coronary flow was reported. Prospective randomized studies and common consensus are needed on low-dose, slow-infusion tissue plasminogen activator treatment regimen and optimal treatment management for thrombotic coronary artery occlusions.
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Dai W, Amoedo ND, Perry J, Le Grand B, Boucard A, Carreno J, Zhao L, Brown DA, Rossignol R, Kloner RA. Effects of OP2113 on Myocardial Infarct Size and No Reflow in a Rat Myocardial Ischemia/Reperfusion Model. Cardiovasc Drugs Ther 2022; 36:217-227. [PMID: 33555510 DOI: 10.1007/s10557-020-07113-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The present study was to determine whether OP2113 could limit myocardial infarction size and the no-reflow phenomenon in a rat myocardial ischemia/reperfusion model. METHODS Rat heart-isolated mitochondria (RHM) were used to investigate mitochondrial respiration and mitochondrial reactive oxygen species (mtROS) generation both in normal conditions and in ischemia/reperfusion-mimicking conditions (using high concentrations of succinate). Human skeletal muscle myoblasts (HSMM) in culture were used to investigate the cellular intermittent deprivation in energy substrates and oxygen as reported in ischemia/reperfusion conditions. In vivo, rats were anesthetized and subjected to 30 min of left coronary artery occlusion followed by 3 h of reperfusion. Rats were randomized to receive OP2113 as an intravenous infusion starting either 5 min prior to coronary artery occlusion (preventive), or 5 min prior to reperfusion (curative), or to receive vehicle starting 5 min prior to coronary artery occlusion. Infusions continued until the end of the study (3 h of reperfusion). RESULTS RHM treated with OP2113 showed a concentration-dependent reduction of succinate-induced mtROS generation. In HSMM cells, OP2113 treatment (5-10 μM) during 48H prevented the reduction in the steady-state level of ATP measured just after reperfusion injuries and decreased the mitochondrial affinity to oxygen. In vivo, myocardial infarct size, expressed as the percentage of the ischemic risk zone, was significantly lower in the OP2113-treated preventive group (44.5 ± 2.9%) versus that in the vehicle group (57.0 ± 3.6%; p < 0.05), with a non-significant trend toward a smaller infarct size in the curative group (50.8 ± 3.9%). The area of no reflow as a percentage of the risk zone was significantly smaller in both the OP2113-treated preventive (28.8 ± 2.4%; p = 0.026 vs vehicle) and curative groups (30.1 ± 2.3%; p = 0.04 vs vehicle) compared with the vehicle group (38.9 ± 3.1%). OP2113 was not associated with any hemodynamic changes. CONCLUSIONS These results suggest that OP2113 is a promising mitochondrial ROS-modulating agent to reduce no-reflow as well as to reduce myocardial infarct size, especially if it is on board early in the course of the infarction. It appears to have benefit on no-reflow even when administered relatively late in the course of ischemia.
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Affiliation(s)
- Wangde Dai
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S. Fair Oaks Avenue, Pasadena, CA, 91105, USA.
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | | | - Justin Perry
- Virginia Polytechnic Institute and State University, 1035 ILSB, 1981 Kraft Drive, Virginia Tech Corporate Research Center, Blacksburg, VA, 24060, USA
| | | | | | - Juan Carreno
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S. Fair Oaks Avenue, Pasadena, CA, 91105, USA
| | - Lifu Zhao
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S. Fair Oaks Avenue, Pasadena, CA, 91105, USA
| | - David A Brown
- Virginia Polytechnic Institute and State University, 1035 ILSB, 1981 Kraft Drive, Virginia Tech Corporate Research Center, Blacksburg, VA, 24060, USA
| | | | - Robert A Kloner
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S. Fair Oaks Avenue, Pasadena, CA, 91105, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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