1
|
Novel Humanized Biosimulator to Predict Coronary Obstruction in High-Risk Valve-in-Valve Procedures. JACC Case Rep 2022; 7:101711. [PMID: 36776792 PMCID: PMC9911917 DOI: 10.1016/j.jaccas.2022.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022]
Abstract
We developed humanized biosimulator to predict the risk of coronary obstruction among high-risk patients undergoing valve-in-valve (ViV) procedures. In this case, based on unchanged instantaneous wave-free ratio values measured during a ViV simulation session, the procedure was performed safely in the patient the day afterward, without coronary artery issues and with good hemodynamic results. (Level of Difficulty: Advanced.).
Collapse
|
2
|
Coronary Artery Aneurysm Rupture in a Patient With Polyarteritis Nodosa. JACC Case Rep 2022; 4:1522-1528. [PMID: 36444190 PMCID: PMC9700061 DOI: 10.1016/j.jaccas.2022.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 06/12/2023]
Abstract
We present the case of a 42-year-old male patient with ST-segment elevation myocardial infarction and pericardial effusion due to rupture of the left anterior descending artery most likely secondary to polyarteritis nodosa. Successful surgery was performed under cardiopulmonary bypass using antegrade and retrograde cardioplegia combined. (Level of Difficulty: Intermediate.).
Collapse
|
3
|
Coronary Injury Caused by Endocardial Ablation in Midanterior Septum of the Right Ventricle. JACC Case Rep 2022; 4:101628. [PMID: 36684028 PMCID: PMC9847231 DOI: 10.1016/j.jaccas.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Coronary injury or spasm induced by endocardial radiofrequency catheter ablation in the right ventricle (RV) has been rarely reported. We introduce a case of coronary injury from a young patient who underwent catheter ablation for idiopathic ventricular arrhythmia originating from the RV septum. (Level of Difficulty: Advanced.).
Collapse
|
4
|
Spontaneous Coronary Artery Dissection in a Transplanted Heart. JACC Case Rep 2022; 4:1439-1442. [PMID: 36388711 PMCID: PMC9663894 DOI: 10.1016/j.jaccas.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/07/2022] [Accepted: 06/17/2022] [Indexed: 06/16/2023]
Abstract
We report the case of a 37-year-old man who presented with shortness of breath 1 year post heart transplantation. He was receiving tacrolimus, methylprednisolone, and mycophenolate. An angiogram showed spontaneous coronary artery dissection involving the left anterior descending artery. Percutaneous coronary intervention was performed successfully, with stent placement and return of flow. (Level of Difficulty: Advanced.).
Collapse
|
5
|
Bilateral Renal Artery Thromboembolism During Thrombolytic Therapy for Embolism-Induced Acute Limb Ischemia. JACC Case Rep 2022; 4:1256-1262. [PMID: 36406914 PMCID: PMC9666748 DOI: 10.1016/j.jaccas.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
We report a case of bilateral renal infarction following thrombolytic and anticoagulant therapy for left ventricular embolism-induced lower leg artery ischemia. Imaging demonstrated thrombi from the left ventricle leading to bilateral renal arterial occlusion. Catheter embolectomy and long-term oral anticoagulant therapy were initiated, and the patient recovered with no residual complications. (Level of Difficulty: Intermediate.).
Collapse
|
6
|
Coronary Artery Disease, Cardiac Arrest, and Shared Decision Making in a Recreational Athlete. JACC Case Rep 2022; 4:1110-1114. [PMID: 36124148 PMCID: PMC9481915 DOI: 10.1016/j.jaccas.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
A highly active 59-year-old-man with a history of cardiac arrest and myocardial infarction presented for exercise recommendations. Multimodality risk stratification led to ventricular fibrillation cardiac arrest at the completion of a maximal effort cardiopulmonary exercise test. Using shared decision making, the safety and feasibility of returning to exercise were discussed. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- CMR, cardiac magnetic resonance
- CPET, cardiopulmonary exercise test
- CPR, cardiopulmonary resuscitation
- ECG, electrocardiogram
- ICD, implantable cardioverter-defibrillator
- LAD, left anterior descending
- LV, left ventricular
- MI, myocardial infarction
- PVC, premature ventricular complex
- SDM, shared decision making
- VF, ventricular fibrillation
- athlete
- cardiac arrest
- exercise
- return to exercise
- sports cardiology
Collapse
|
7
|
First-in-Human Computational Preprocedural Planning of Left Main Interventions Using a New Everolimus-Eluting Stent. JACC Case Rep 2022; 4:325-335. [PMID: 35495558 PMCID: PMC9040115 DOI: 10.1016/j.jaccas.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
Left main coronary artery stenting requires rigorous planning and optimal execution. This case series presents a new approach to left main stenting guided by preprocedural patient-specific computational simulations. Three patients with significant left main artery disease underwent simulation-guided intervention using a novel stent scaffold purpose-built for large coronary arteries. (Level of Difficulty: Advanced.).
Collapse
|
8
|
Postinfarction Ventricular Septal Rupture: Identification of the Failure Mechanism of a Percutaneous Closure Procedure. JACC Case Rep 2022; 4:255-261. [PMID: 35257098 PMCID: PMC8897053 DOI: 10.1016/j.jaccas.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023]
Abstract
Ventricular septal rupture (VSR) is a rare but highly lethal (∼60%) mechanical complication of myocardial infarction (MI). Although surgical repair has been the gold standard to correct the structural anomaly, percutaneous closure of the defect may represent a valuable therapeutic alternative, with the advantage of immediate shunt reduction to prevent further hemodynamic deterioration in patients with prohibitive surgical risk. Nonetheless, catheter-based VSR closure has faced certain drawbacks that have hampered its application. We describe a clinical case of postinfarction VSR treated with a percutaneous closure device and discuss the procedure's failure mechanism. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- ASD, atrial septal defect
- CMR, cardiac magnetic resonance
- CT, computed tomography
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- STEMI, ST-segment myocardial infarction
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- VSD, ventricular septal defect
- VSR, ventricular septal rupture
- acute myocardial infarction
- mechanical complication
- percutaneous closure device
- percutaneous septal defect closure
- ventricular septal defect
- ventricular septal rupture
Collapse
|
9
|
A Tale of 2 Aneurysms: Cardiogenic Shock Secondary to Vascular Behçet's Syndrome. JACC Case Rep 2021; 3:1858-1862. [PMID: 34917968 PMCID: PMC8642724 DOI: 10.1016/j.jaccas.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022]
Abstract
A patient with vascular Behçet’s syndrome (BS), a subtype of BS with mainly venous/arterial manifestations, presented with a left main aneurysm/thrombus and cardiogenic shock. The clinical diagnosis of BS includes mucocutaneous, vascular, and neurologic criteria. It is important to consider vascular BS as a nonatherosclerotic cause of coronary aneurysms. (Level of Difficulty: Intermediate.)
Collapse
Key Words
- HLA, human leukocyte antigen
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- LM, left main
- MAP, mean arterial pressure
- MCS, mechanical circulatory support
- TEE, transesophageal echocardiogram
- TIMI, thrombolysis in myocardial infarction
- VA-ECMO, venoarterial extracorporeal membrane oxygenation
- acute coronary syndrome
- cardiac assist devices
- systolic heart failure
- vascular BS, vascular Behçet’s syndrome
Collapse
|
10
|
Spatio-temporal regulation of calpain activity after experimental myocardial infarction in vivo. Biochem Biophys Rep 2021; 28:101162. [PMID: 34761128 PMCID: PMC8566776 DOI: 10.1016/j.bbrep.2021.101162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/25/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Calpains are calcium activated cysteine proteases that play a pivotal role in the pathophysiology of cardiac remodeling. Methods Here, we performed left anterior descending coronary artery ligation in rats as a model for ischemic systolic heart failure and examined the time- and region-specific regulation of calpain-1 and calpain-2 in the left ventricular myocardium. Results Following anterior wall myocardial infarction, calpain activity was significantly increased restricted to the ischemic anterior area at days 1, 5 and 14. No changes in calpain activity at neither time point were detected in the borderzone and remote posterior area of the left ventricle. Of note, calpain activity in the infarcted anterior myocardium was regulated differentially in the acute vs. subacute and chronic phase. In the acute phase, calpain translocation to the plasma membrane and attenuation of the expression of its endogenous inhibitor, calpastatin, were identified as the driving forces. In the subacute and chronic phase, calpain activity was regulated at the level of protein expression that was shown to be essentially independent of transcriptional activity. Conclusions We conclude that myocardial infarction leads to a distinct calpain regulation pattern in the left ventricular myocardium that is region specific and time dependent. Considering the results from our previous studies, a spatio-temporal interaction between calpains and calcium dependent natriuretic peptide production in the infarcted myocardium is possible. General significance Our results shed more light in the differential regulation of calpain activity in the myocardium and might aid in the development of targeted post-infarct and/or heart failure therapeutics.
Collapse
Key Words
- AGTR1, angiotensin II receptor type 1
- Calcium
- Calpain
- Calpain-1
- Calpain-2
- Calpastatin
- Experimental myocardial infarction
- InsP3, inositol 1,4,5-trisphosphate
- InsP3R, inositol 1,4,5-trisphopshate receptor
- LAD, left anterior descending
- LVEDD, left ventricular enddiastolic diameter
- LVEF, left ventricular ejection fraction
- LVESD, left ventricular endsystolic diameter
- NF-ĸB, nuclear factor kappa B
- NT pro-ANP, N-terminal pro atrial natriuretic peptide
- SBDP, spectrin breakdown products
Collapse
|
11
|
Coronary Artery Perforation, Subepicardial Hematoma, and Cardiac Tamponade After Complex Percutaneous Coronary Intervention. JACC Case Rep 2021; 3:1594-1598. [PMID: 34729508 PMCID: PMC8543142 DOI: 10.1016/j.jaccas.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
This report presents the case of fissured subepicardial hematoma and cardiac tamponade after coronary artery perforation during a complex percutaneous intervention. Surgical therapy was required to achieve hemostasis because a percutaneous sealing result was insufficient. Prompt recognition and cardiac surgery availability are essential for patient survival in such situations. (Level of Difficulty: Beginner.).
Collapse
Key Words
- CTO, chronic total occlusion
- EF, ejection fraction
- LAD, left anterior descending
- LV, left ventricle
- PCI, percutaneous coronary intervention
- RCA, right coronary artery
- SEH, sub epicardial hematoma
- STEMI, ST-segment elevation myocardial infarction
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- cardiac surgery
- cardiac tamponade
- coronary artery perforation
- percutaneous coronary intervention
- pericardiocentesis
- subepicardial hematoma
Collapse
|
12
|
Right Ventricular Free Wall Rupture After Myocardial Infarction. JACC Case Rep 2021; 3:1622-1624. [PMID: 34729515 PMCID: PMC8543129 DOI: 10.1016/j.jaccas.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
This paper describes the case of a 68-year-old man who presented in cardiac tamponade due to a right ventricular free wall rupture after a recent ST-segment elevation myocardial infarction. After a pericardiocentesis, the ventricular defect resolved spontaneously. The patient was managed medically and avoided surgical intervention. (Level of Difficulty: Intermediate.)
Collapse
|
13
|
Giant Coronary Aneurysms in Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection. JACC Case Rep 2021; 3:1499-1508. [PMID: 34642670 PMCID: PMC8494056 DOI: 10.1016/j.jaccas.2021.06.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 12/22/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) can cause a myriad of cardiac manifestations, including coronary dilation and aneurysms; giant aneurysms are infrequent. We describe 3patients with giant coronary aneurysms associated with MIS-C, including the youngest case reported to date, treated with intravenous immunoglobulin, corticosteroids, and biologic agents. (Level of Difficulty: Intermediate.)
Collapse
|
14
|
Transient Asystole From Pacing Inhibition During Percutaneous Coronary Intervention. JACC Case Rep 2021; 3:144-145. [PMID: 34317489 PMCID: PMC8305672 DOI: 10.1016/j.jaccas.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 12/04/2022]
Abstract
A 68-year-old man with a biventricular implantable cardioverter-defibrillator who was pacemaker dependent was admitted for percutaneous coronary intervention. The patient had an asystolic cardiac arrest as a result of electromagnetic interference during an orbital atherectomy. We should keep electromagnetic interference from the machine in mind when performing orbital atherectomy. (Level of Difficulty: Beginner.)
Collapse
|
15
|
Aortic Mural Thrombus and Acute Coronary Syndrome in a Patient With Cannabinoid Hyperemesis Syndrome. JACC Case Rep 2021; 3:694-696. [PMID: 34317606 PMCID: PMC8302793 DOI: 10.1016/j.jaccas.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
A 36-year-old woman with cannabinoid hyperemesis syndrome presented with chest pain and was found to have single-vessel coronary artery disease and an aortic mural thrombus. This case describes unique management with coronary artery bypass and surgical thrombectomy because of the patient’s inability to tolerate uninterrupted antiplatelet therapy given her cannabinoid hyperemesis syndrome. (Level of Difficulty: Intermediate.)
Collapse
|
16
|
Anomalous Left Anterior Descending Coronary Artery With Retroaortic Left Circumflex Artery: A Novel Coronary Pattern. JACC Case Rep 2021; 3:546-549. [PMID: 34317579 PMCID: PMC8302782 DOI: 10.1016/j.jaccas.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 06/13/2023]
Abstract
A novel coronary anatomy in the form of anomalous left anterior descending coronary artery from pulmonary artery with a retroaortic left circumflex arising from the right coronary artery is presented. This unreported anatomy was discovered in a 7-month-old girl with failure to thrive. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- ALADCAPA, anomalous left anterior descending coronary artery from pulmonary artery
- ALCAPA, anomalous left coronary artery arising from pulmonary artery
- CT, computed tomography
- FTT, failure to thrive
- LAD, left anterior descending
- LCA, left coronary artery
- LCx, left circumflex
- MPA, main pulmonary artery
- PA, pulmonary artery
- RCA, right coronary artery
- congenital heart defect
- coronary vessel anomaly
- pediatric surgery
Collapse
|
17
|
Reversible Coronary Artery Aneurysm With Delayed Anti-inflammatory Therapy in Multisystem Inflammatory Syndrome in Children. JACC Case Rep 2021; 3:550-554. [PMID: 33649746 PMCID: PMC7904278 DOI: 10.1016/j.jaccas.2020.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023]
Abstract
A 4-year-old boy with multisystem inflammatory syndrome in children before widespread recognition of this disease developed complications, including coronary artery aneurysm, without anti-inflammatory treatment. With delayed treatment, all sequelae resolved. This case demonstrates a natural history supporting the role of anti-inflammatory treatment even with delayed or equivocal diagnosis. (Level of Difficulty: Intermediate.)
Collapse
|
18
|
Mechanical Prosthetic Aortic Valve Thrombosis Complicated by an Acute Coronary Syndrome During Fibrinolysis. JACC Case Rep 2020; 2:2186-2190. [PMID: 34317135 PMCID: PMC8299831 DOI: 10.1016/j.jaccas.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/02/2020] [Accepted: 08/21/2020] [Indexed: 05/09/2023]
Abstract
A 70-year-old man with mechanical aortic and mitral valves was admitted with progressive shortness of breath. He was found to have thrombosis of the aortic valve prosthesis. Treatment with intravenous thrombolysis was complicated by an acute coronary syndrome related to coronary embolism. The patient was successfully managed conservatively with long-term anticoagulation. An algorithm for the management of coronary embolism is suggested. (Level of Difficulty: Advanced.).
Collapse
Key Words
- ACS, acute coronary syndrome
- AV, aortic valve
- DVI, dimensionless valve index
- INR, international normalized ratio
- LAD, left anterior descending
- NYHA, New York Heart Association
- PVT, prosthetic valve thrombosis
- TEE, transesophageal echocardiogram
- TIMI, Thrombolysis In Myocardial Infarction
- TTE, transthoracic echocardiogram
- acute coronary syndrome
- aortic valve
- coronary embolism
- fibrinolysis
- left-sided prosthetic valve thrombosis
- mitral valve
- t-PA, tissue-type plasminogen activator
- thrombolysis
- thrombus
Collapse
|
19
|
Left Main Coronary Artery Stent Misadventure. JACC Case Rep 2020; 2:1905-1906. [PMID: 34317078 PMCID: PMC8299236 DOI: 10.1016/j.jaccas.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/18/2022]
Abstract
Coronary artery bypass grafting has long been the standard of care for patients with left main coronary artery (LMCA) disease. Lately, percutaneous coronary intervention (PCI) has become a suitable alternative for these patients, but the procedure may be challenging. We describe 2 cases of LMCA PCI failure requiring surgical intervention. (Level of Difficulty: Advanced.).
Collapse
|
20
|
Measurement of coronary artery calcium volume using ultra-high-resolution computed tomography: A preliminary phantom and cadaver study. Eur J Radiol Open 2020; 7:100253. [PMID: 32964073 PMCID: PMC7490539 DOI: 10.1016/j.ejro.2020.100253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Small calcifications were moe accurately detectable on SHR- than NR images. The mean CAC volume was significantly higher on SHR- than NR images of the cadavers. SHR imaging may facilitate the accurate quantification of the CAC.
Objectives In this phantom- and cadaver study we investigated the differences of coronary artery calcium (CAC) volume on ultra-high-resolution computed tomography (U-HRCT) scans and conventional CT. Methods We scanned a coronary calcium phantom and the coronary arteries of five cadavers using U-HRCT in normal- and super-high resolution (NR, SHR) mode. The NR mode was similar to conventional CT; 896 detector channels, a matrix size of 512, and a slice thickness of 0.5 mm were applied. In SHR mode, we used 1792 detector channels, a matrix size of 1024, and a slice thickness of 0.25 mm. The CAC volume on NR- and SHR images were recorded. Differences in the physical- and the calculated CAC volume were defined as the error value and compared between NR- and SHR images of the phantom. Differences between the CAC volume on NR- and SHR scans of the cadavers were also recorded. Results The mean error value was lower on SHR- than NR images of the phantom (14.0 %, SD 11.1 vs 20.1 %, SD 15.2, p = 0.01). The mean CAC volume was significantly higher on SHR- than NR images of the cadavers (153.4 mm3, SD 161.0 vs 144.7 mm3, SD 164.8, p < 0.01). Conclusions As small calcifications were more clearly visualized on U-HRCT images in SHR mode than on conventional (NR) CT scans, SHR imaging may facilitate the accurate quantification of the CAC.
Collapse
Key Words
- AEC, automatic exposure control
- CAC, coronary artery calcium
- CTDI, CT dose index
- Cadaver
- Coronary artery calcium scores
- DLP, dose-length product
- ERD, edge rise distance
- ERS, edge rise slope
- FOV, field of view
- FWHM, full-width at half maximum
- HA, hydroxyapatite
- HU, hounsfield units
- LAD, left anterior descending
- LCX, left circumflex
- NR, normal resolution
- RCA, right coronary artery
- ROI, region of interest
- SD, standard deviation
- SHR, super-high resolution
- U-HRCT, ultra-high-resolution CT
- Ultra-high-resolution CT
Collapse
|
21
|
A Novel Hybrid Approach to the Treatment of a Left Main Coronary Artery Aneurysm. JACC Case Rep 2020; 2:1675-1678. [PMID: 34317032 PMCID: PMC8312127 DOI: 10.1016/j.jaccas.2020.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022]
Abstract
A 66-year-old man with a ramus chronic total occlusion had escalating angina and a high-risk stress test. Coronary angiography the day of his planned ramus chronic total occlusion percutaneous coronary intervention demonstrated a large left main aneurysm. He underwent bypass with left internal mammary artery left anterior descending and failed saphenous vein graft ramus, followed by successful covered stent placement from left main into left circumflex and ramus chronic total occlusion percutaneous coronary intervention. (Level of Difficulty: Advanced.)
Collapse
|
22
|
Large Animal Models of Heart Failure: A Translational Bridge to Clinical Success. JACC Basic Transl Sci 2020; 5:840-856. [PMID: 32875172 PMCID: PMC7452204 DOI: 10.1016/j.jacbts.2020.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Abstract
Preclinical large animal models play a critical and expanding role in translating basic science findings to the development and clinical approval of novel cardiovascular therapeutics. This state-of-the-art review outlines existing methodologies and physiological phenotypes of several HF models developed in large animals. A comprehensive list of porcine, ovine, and canine models of disease are presented, and the translational importance of these studies to clinical success is highlighted through a brief overview of recent devices approved by the FDA alongside associated clinical trials and preclinical animal reports. Increasing the use of large animal models of HF holds significant potential for identifying new mechanisms underlying this disease and providing valuable information regarding the safety and efficacy of new therapies, thus, improving physiological and economical translation of animal research to the successful treatment of human HF.
Preclinical large animal models of heart failure (HF) play a critical and expanding role in translating basic science findings to the development and clinical approval of novel therapeutics and devices. The complex combination of cardiovascular events and risk factors leading to HF has proved challenging for the development of new treatments for these patients. This state-of-the-art review presents historical and recent studies in porcine, ovine, and canine models of HF and outlines existing methodologies and physiological phenotypes. The translational importance of large animal studies to clinical success is also highlighted with an overview of recent devices approved by the Food and Drug Administration, together with preclinical HF animal studies used to aid both development and safety and/or efficacy testing. Increasing the use of large animal models of HF holds significant potential for identifying the novel mechanisms underlying the clinical condition and to improving physiological and economical translation of animal research to successfully treat human HF.
Collapse
Key Words
- AF, atrial fibrillation
- ECM, extracellular matrix
- EDP, end-diastolic pressure
- EF, ejection fraction
- FDA, Food and Drug Administration
- HF, heart failure
- HFpEF
- HFpEF, heart failure with preserved ejection fraction
- HFrEF
- HFrEF, heart failure with reduced ejection fraction
- I/R, ischemia/reperfusion
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- LCx, left circumflex
- LV, left ventricular
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- RV, right ventricular
- heart failure
- large animal model
- preclinical
Collapse
|
23
|
Coronary Artery Aneurysm After Drug-Eluting Stent Implantation Causing Coronary-Bronchial Fistula. JACC Case Rep 2020; 2:1692-1697. [PMID: 34317036 PMCID: PMC8312138 DOI: 10.1016/j.jaccas.2020.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022]
Abstract
Coronary artery aneurysm (CAA) after drug-eluting stent implantation is rare, with a reported incidence of 0.3% to 6.0%. Most of these aneurysms are asymptomatic. Hemoptysis as a presentation of CAA is very rare. The patient in our case had CAA after zotarolimus-eluting stent implantation and presented with hemoptysis resulting from a leaking coronary-bronchial fistula. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- BMS, bare metal stent(s)
- CAA, coronary artery aneurysm
- CT, computed tomography
- DES, drug-eluting stent(s)
- ECG, electrocardiogram
- LA, left atrial
- LAD, left anterior descending
- LCX, left circumflex
- LM, left main (coronary artery)
- LV, left ventricular
- NC, noncompliant
- PCI, percutaneous coronary intervention
- complication
- coronary angiography
- percutaneous coronary intervention
Collapse
|
24
|
Relapsing Polychondritis Requiring Orthotopic Heart Transplant Despite Coronary Artery Bypass and Surgical Aortic Valve Replacement. JACC Case Rep 2020; 2:1527-1531. [PMID: 34317010 PMCID: PMC8302168 DOI: 10.1016/j.jaccas.2020.05.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/29/2020] [Indexed: 11/06/2022]
Abstract
A 32-year-old man with a history of relapsing polychondritis presented with acute coronary syndrome due to aortitis with ostial coronary artery involvement from his underlying autoimmune condition. Concomitant aortic insufficiency with ostial coronary lesions is a rare complication of relapsing polychondritis, requiring a multidisciplinary team approach for management. (Level of Difficulty: Advanced.)
Collapse
|
25
|
A Challenging and Unexpected Case of MINOCA Using Multimodality Imaging. JACC Case Rep 2020; 2:1564-1569. [PMID: 34317018 PMCID: PMC8302167 DOI: 10.1016/j.jaccas.2020.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 11/01/2022]
Abstract
We describe a challenging case of a patient with MINOCA due to isolated right ventricular myocardial infarction with microvascular obstruction identified on cardiac magnetic resonance imaging. This case highlights that even a comprehensive, guideline-based assessment of these patients can initially fail to detect the underlying pathology. (Level of Difficulty: Beginner.).
Collapse
Key Words
- CMR, cardiac magnetic resonance
- CRP, C-reactive protein
- CTPA, computed tomography pulmonary angiogram
- ECG, electrocardiogram
- LAD, left anterior descending
- LGE, late gadolinium enhancement
- MINOCA, myocardial infarction with nonobstructive coronary arteries
- MVO, microvascular obstruction
- OCT, optical coherence tomography
- RV, right ventricle
- cardiac magnetic resonance
- coronary angiography
- myocardial infarction
- right ventricle
Collapse
|
26
|
de Winter Electrocardiographic Pattern Caused by Diagonal Branch Lesion. JACC Case Rep 2020; 2:1451-1453. [PMID: 34316994 PMCID: PMC8302171 DOI: 10.1016/j.jaccas.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022]
Abstract
A woman in her 50s developed acute coronary syndrome with de Winter pattern electrocardiogram (ECG). A coronary angiography revealed diagonal branch lesion caused by spontaneous coronary artery dissection, whereas the left-anterior descending artery was intact. The ECG change was transient and returned to normal without treatment 2 h later. (Level of Difficulty: Beginner.)
Collapse
Key Words
- AV, atrioventricular
- CAG, coronary angiography
- ECG, electrocardiogram
- LAD, left anterior descending
- LAO, left anterior oblique
- MI, myocardial infarction
- RAO, right anterior oblique
- RCA, right coronary artery
- SCAD, spontaneous coronary artery dissection
- TIMI, Thrombolysis In Myocardial Infarction
- acute myocardial infarction
- de Winter pattern
- spontaneous coronary artery dissection
Collapse
|
27
|
Misdiagnosis in the COVID-19 Era: When Zebras Are Everywhere, Don't Forget the Horses. JACC Case Rep 2020; 2:1614-1619. [PMID: 32342051 PMCID: PMC7184023 DOI: 10.1016/j.jaccas.2020.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022]
Abstract
We describe a patient who presented with respiratory failure, chest pain, and fever. In the COVID-19 pandemic era, the focus was diverted to the coronavirus infection, and ST-segment elevation myocardial infarction was missed. Although we need to be vigilant in the diagnosis of COVID-19, we should not forget about the common disorders. (Level of Difficulty: Beginner.).
Collapse
|
28
|
Abstract
Coronavirus disease-2019 (COVID-19) triggers a hypercoagulable state with a high incidence of thrombotic complications. We have noted a higher than expected incidence of stent thrombosis in these patients. (Level of Difficulty: Intermediate.).
Collapse
|
29
|
Subacute Left Ventricular Free Wall Rupture after Delayed STEMI Presentation During the COVID-19 Pandemic. JACC Case Rep 2020; 2:1603-1609. [PMID: 32835259 PMCID: PMC7342086 DOI: 10.1016/j.jaccas.2020.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 12/04/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic is causing delayed ST-segment elevation myocardial infarction (STEMI) presentations associated with now unusual postinfarction complications. We describe a delayed (5-day) STEMI presentation because the patient feared contracting COVID-19 in the hospital. The patient experienced an extensive anterolateral STEMI complicated by subacute left ventricular free wall rupture that required a rapid surgical repair. (Level of Difficulty: Intermediate.)
Collapse
Key Words
- COVID-19, coronavirus disease-2019
- CT, computed tomography
- ECG, electrocardiogram
- LAD, left anterior descending
- LV, left ventricular
- LVFWR
- LVFWR, left ventricular free wall rupture
- PCI, percutaneous coronary intervention
- RV, right ventricular
- STEMI, ST-segment elevation myocardial infarction
- TTE, transthoracic echocardiogram
- coronary angiography
- coronavirus disease-2019
- left ventricular aneurysm
- myocardial infarction
- percutaneous coronary intervention
- pericardial effusion
Collapse
|
30
|
Post-MI Ventricular Septal Defect During the COVID-19 Pandemic. JACC Case Rep 2020; 2:1628-1632. [PMID: 32835262 PMCID: PMC7311914 DOI: 10.1016/j.jaccas.2020.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/08/2023]
Abstract
With the COVID-19 pandemic, the fear among patients of contracting it has made them reluctant to seek medical attention on a timely basis even for emergent conditions. We present a case of post infarction ventricular septal rupture due to delayed presentation as a consequence of the fear of COVID-19. (Level of Difficulty: Intermediate.)
Collapse
|
31
|
Coronary Artery Perforation After Shockwave Intravascular Lithotripsy. JACC Case Rep 2020; 2:247-249. [PMID: 34317214 PMCID: PMC8298537 DOI: 10.1016/j.jaccas.2019.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/22/2022]
Abstract
Severely calcified coronary lesions remain a challenge in current percutaneous coronary interventions. Shockwave intravascular lithotripsy (Shockwave Medical, Inc., Santa Clara, California) is an alternative for rotational atherectomy in such lesions that supports stent deliverability and achieves optimal results. We describe a case of coronary artery perforation after use of this lithotripsy device. (Level of Difficulty: Advanced.)
Collapse
|
32
|
Zero-Contrast Multivessel Revascularization for Acute Coronary Syndrome in a Patient With Chronic Kidney Disease. JACC Case Rep 2019; 1:774-780. [PMID: 34316930 PMCID: PMC8288793 DOI: 10.1016/j.jaccas.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 11/22/2022]
Abstract
Patients with chronic kidney disease are at elevated risk for adverse events after traditional coronary angiography and percutaneous intervention with contrast media. The case presented in this report highlights the potential benefits of zero-contrast multivessel percutaneous coronary intervention in a patient presenting with a non–ST-segment elevation acute coronary syndrome. (Level of Difficulty: Beginner.)
Collapse
Key Words
- CAD, coronary artery disease
- CKD, chronic kidney disease
- CSA, cross-sectional area
- ISR, in-stent restenosis
- IVUS, intravascular ultrasound
- LAD, left anterior descending
- LCX, left circumflex
- MLD, minimal lumen diameter
- NSTEACS, non–ST-segment elevation acute coronary syndrome
- OM, obtuse marginal
- PCI, percutaneous coronary intervention
- RCA, right coronary artery
- coronary angiography
- iFR, instantaneous wave-free ratio
- intravascular ultrasound
- percutaneous coronary intervention
Collapse
|
33
|
Case-Based Review of the Current Global Evidence Supporting Impella-Facilitated Complex and Complete Revascularization. JACC Case Rep 2019; 1:869-872. [PMID: 34316948 PMCID: PMC8289125 DOI: 10.1016/j.jaccas.2019.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022]
Abstract
A 74-year-old male patient who was admitted with non–ST-segment elevation myocardial infarction, severe left ventricular impairment, severe mitral regurgitation, and full viability who was turned down for surgery underwent high-risk and indicated multivessel stenting with Impella (Abiomed) support. At 6-month follow-up he was angina free, with complete resolution of the mitral regurgitation. (Level of Difficulty: Intermediate.)
Collapse
Key Words
- AMICS, acute myocardial infarction with cardiogenic shock
- CTO, chronic total occlusion
- HR-PCI, high-risk percutaneous coronary intervention
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- LMS, left main stem
- LV, left ventricular
- MCS, mechanical circulatory support
- MR, mitral regurgitation
- OM, obtuse marginal
- PCI, percutaneous coronary intervention
- RCA, right coronary artery
- RCT, randomized controlled trial
- myocardial ischemia
- myocardial revascularization
- percutaneous coronary intervention
Collapse
|
34
|
Dual Chamber Pacemaker Implantation Complicated by Left Anterior Descending Coronary Artery Injury. JACC Case Rep 2019; 1:633-637. [PMID: 34316895 PMCID: PMC8288713 DOI: 10.1016/j.jaccas.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/22/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022]
Abstract
A 53-year-old female underwent dual-chamber pacemaker implantation for tachy-brady syndrome, which was complicated by anterior ST-segment elevation myocardial infarction and ventricular fibrillation due to right ventricular lead impingement on the left anterior descending coronary artery. Coronary artery injury is a rare complication of cardiac device implantation which requires a multidisciplinary team for management. (Level of Difficulty: Beginner.)
Collapse
|
35
|
Preservation of Post-Infarction Cardiac Structure and Function via Long-Term Oral Formyl Peptide Receptor Agonist Treatment. JACC Basic Transl Sci 2019; 4:905-920. [PMID: 31909300 PMCID: PMC6939031 DOI: 10.1016/j.jacbts.2019.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022]
Abstract
Myocardial infarction leads to recruitment of monocyte/macrophages to the injured myocardium to drive infarct healing. Activation of formyl peptide receptors (FPR1 and FPR2) present on macrophages contributes to key cellular activities that can potentiate wound healing. Myocardial infarction was induced in rodents to study the effects of long-term treatment with Compound 43, a small molecule agonist of FPR1 and FPR2. Main findings: Compound 43 stimulated proresolution macrophage activities, improved left ventricle and infarct structure, and preserved cardiac function post-myocardial infarction. The results suggest that stimulation of proresolution activities of FPRs can favorably alter post-myocardial infarction pathophysiology that leads to heart failure.
Dysregulated inflammation following myocardial infarction (MI) promotes left ventricular (LV) remodeling and loss of function. Targeting inflammation resolution by activating formyl peptide receptors (FPRs) may limit adverse remodeling and progression towards heart failure. This study characterized the cellular and signaling properties of Compound 43 (Cmpd43), a dual FPR1/FPR2 agonist, and examined whether Cmpd43 treatment improves LV and infarct remodeling in rodent MI models. Cmpd43 stimulated FPR1/2-mediated signaling, enhanced proresolution cellular function, and modulated cytokines. Cmpd43 increased LV function and reduced chamber remodeling while increasing proresolution macrophage markers. The findings demonstrate that FPR agonism improves cardiac structure and function post-MI.
Collapse
Key Words
- Cmpd43, Compound 43
- Compound 43
- FPR, formyl peptide receptor
- HF, heart failure
- IL, interleukin
- IR, ischemia–reperfusion
- KO, knockout
- LAD, left anterior descending
- LV, left ventricular
- MI, myocardial infarction
- PV, pressure–volume
- SAA, serum amyloid A
- WT, wild-type
- agonist
- formyl peptide receptor
- heart failure
- myocardial infarction
Collapse
|
36
|
Massive Accumulation of Myofibroblasts in the Critical Isthmus Is Associated With Ventricular Tachycardia Inducibility in Post-Infarct Swine Heart. JACC Clin Electrophysiol 2019; 3:703-714. [PMID: 28770255 PMCID: PMC5527067 DOI: 10.1016/j.jacep.2016.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objectives In this study the authors determined the extent of cellular infiltration and dispersion, and regional vascularization in electrophysiologically (EP) defined zones in post–myocardial infarction (MI) swine ventricle. Background The critical isthmus (CI) in post-MI re-entrant ventricular tachycardia (VT) is a target for catheter ablation. In vitro evidence suggests that myofibroblasts (MFB) within the scar border zone (BZ) may increase the susceptibility to slow conduction and VT, but whether this occurs in vivo remains unproven. Methods Six weeks after mid–left anterior descending coronary artery occlusion, EP catheter-based mapping was used to assess susceptibility to VT induction. EP data were correlated with detailed cellular profiling of ventricular zones using immunohistochemistry and spatial distribution analysis of cardiomyocytes, fibroblasts, MFB, and vascularization. Results In pigs with induced sustained monomorphic VT (mean cycle length: 353 ± 89 ms; n = 6) the area of scar that consisted of the BZ (i.e., between the normal and the low-voltage area identified by substrate mapping) was greater in VT-inducible hearts (iVT) than in noninducible hearts (non-VT) (p < 0.05). Scar in iVT hearts was characterized by MFB accumulation in the CI (>100 times that in normal myocardium and >5 times higher than that in the BZ in non-VT hearts) and by a 1.7-fold increase in blood vessel density within the dense scar region extending towards the CI. Sites of local abnormal ventricular activity potentials exhibited cellularity and vascularization that were intermediate to the CI in iVT and BZ in non-VT hearts. Conclusions The authors reported the first cellular analysis of the VT CI following an EP-based zonal analysis of iVT and non-VT hearts in pigs post-MI. The data suggested that VT susceptibility was defined by a remarkable number of MFB in the VT CI, which appeared to bridge the few remaining dispersed clusters of cardiomyocytes. These findings define the cellular substrate for the proarrhythmic slow conduction pathway.
Collapse
Key Words
- BZ, border zone
- CI, critical isthmus
- CM, cardiomyocytes
- ECM, extracellular matrix
- EP, electrophysiology
- FB, fibroblasts
- IHC, immunohistochemistry
- LAD, left anterior descending
- LAVA, local abnormal ventricular activity
- MFB, myofibroblasts
- MI, myocardial infarction
- MRI, magnetic resonance imaging
- VT
- VT, ventricular tachycardia
- Vim, vimentin
- border zone
- cTnT, cardiac troponin T
- critical isthmus
- iVT, inducible ventricular tachycardia
- myocardial infarction
- myofibroblasts
- pig
- vWF, von Willebrand factor
- α-SMA, α-smooth muscle actin
Collapse
|
37
|
Plasma Ceramides as Prognostic Biomarkers and Their Arterial and Myocardial Tissue Correlates in Acute Myocardial Infarction. JACC Basic Transl Sci 2018; 3:163-175. [PMID: 30062203 PMCID: PMC6060200 DOI: 10.1016/j.jacbts.2017.12.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/29/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
Abstract
Targeted profiling of ceramides identified a 12-ceramide plasma signature that predicted 12-month cardiovascular death, MI, and stroke in 2 prospective cohorts of AMI patients. Among coronary artery bypass grafting patients, plasma ceramides were higher in those with recent AMI compared with those without recent acute MI. Analysis of rat ischemic myocardium revealed a consistent increase in ceramide levels and overexpression of 3 enzymes in ceramide biosynthesis.
We identified a plasma signature of 11 C14 to C26 ceramides and 1 C16 dihydroceramide predictive of major adverse cardiovascular events in patients with acute myocardial infarction (AMI). Among patients undergoing coronary artery bypass surgery, those with recent AMI, compared with those without recent AMI, showed a significant increase in 5 of the signature’s 12 ceramides in plasma but not simultaneously-biopsied aortic tissue. In contrast, a rat AMI model, compared with sham control, showed a significant increase in myocardial concentrations of all 12 ceramides and up-regulation of 3 ceramide-producing enzymes, suggesting ischemic myocardium as a possible source of this ceramide signature.
Collapse
Key Words
- AMI, acute myocardial infarction
- CABG, coronary artery bypass graft
- CAD, coronary artery disease
- CerS6, ceramide synthase 6
- DDg, data-driven grouping
- HILIC, hydrophilic interaction LC
- LAD, left anterior descending
- MACCE, major adverse cardiac and cerebrovascular events
- MI, myocardial infarction
- SPT, serine palmitoyl transferase
- SPTLC2, serine palmitoyl transferase-2
- SWVg, statistically-weighted voting grouping
- acute coronary syndrome
- ceramides
- dihydroceramides
- major adverse cardiovascular and cerebrovascular events
- nSMase, neutral sphingomelinase
- prognosis
- risk prediction
Collapse
|
38
|
Effect of chronic pretreatment with beta-blockers on no-reflow phenomenon in diabetic patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Egypt Heart J 2018; 69:171-175. [PMID: 29622973 PMCID: PMC5883489 DOI: 10.1016/j.ehj.2017.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/23/2017] [Indexed: 01/01/2023] Open
Abstract
Background No-reflow is an important factor as it predicts a poor outcome in patients undergoing primary angioplasty. In comparison with patients attaining TIMI 3 flow, patients with no-reflow have an increased incidence of ventricular arrhythmias, early congestive cardiac failure, cardiac rupture and cardiac death. As such, it is of paramount importance to consider strategies to prevent the occurrence of no-reflow phenomenon. Previous evidence suggests that Beta (β) blockers have multiple favorable effects on the vascular system not directly related to their effect on blood pressure. However, there are insufficient data regarding the effects of prior Beta blocker use on coronary blood flow after primary PCI in patients with AMI. Aim The aim of this study was to test the hypothesis that Beta blocker treatment before admission would have beneficial effects on the development of the no-reflow phenomenon after acute myocardial infarction. Methods and results The study included 107 diabetic patients who had presented with acute STEMI within 12 h from the onset of chest pain. All of them have undergone primary angioplasty at Ain Shams University hospitals or National Heart institute. The incidence of no-reflow phenomenon was 21%. No-reflow phenomenon was significantly lower in patients on chronic B-blocker therapy (12% vs. 28%; P = 0.04). The heart rate was significantly lower in the normal reflow group than in the no-reflow group (P = 0.03). The study also showed that B-blocker pretreatment is an independent protective predictor for the no-reflow phenomenon (P = 0.045). Conclusion Chronic pre-treatment with B-blocker in diabetic patients presenting with STEMI, is associated with lower rate of occurrence of no-reflow phenomenon after primary PCI.
Collapse
Key Words
- AMI, acute myocardial infarction
- B-Blocker, beta-blocker
- Beta blockers
- CABG, coronary artery bypass grat
- ECG, electrocardiogram
- IRA, infarct related artery
- LAD, left anterior descending
- LCx, left circumflex
- LVEF, left ventricular ejection fraction
- No reflow
- PCI, percutaneous coronary intervention
- PTCA, percutaneous transluminal coronary angioplasty
- Primary angioplasty
- RCA, right coronary artery
- SD, standard deviation
- STEMI, ST segment elevation myocardial infarction
- TIMI, thrombolysis in myocardial infarction
Collapse
|
39
|
Value of global longitudinal strain by two dimensional speckle tracking echocardiography in predicting coronary artery disease severity. Egypt Heart J 2016; 69:95-101. [PMID: 29622962 PMCID: PMC5839366 DOI: 10.1016/j.ehj.2016.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/16/2016] [Accepted: 08/06/2016] [Indexed: 11/30/2022] Open
Abstract
Background Significant coronary artery stenosis might cause persistently impaired longitudinal left ventricle (LV) function at rest. LV global longitudinal strain (LVGLS) can be accurately assessed by 2D speckle-tracking strain echocardiography(2D-STE). Objective We aimed to evaluate the diagnostic accuracy of LV global longitudinal strain obtained by 2D-STE in prediction of severity of CAD. Methods Eighty patients with suspected stable angina pectoris were included. They underwent transthoracic echocardiography (TTE) to measure LV ejection fraction, 2-D-STE to measure GLS and coronary angiography (CA). The patients were divided into two groups: group 1 (58 patients) with significant (>70%) CAD, and group 2 (22 patients) with non-significant (<70%) CAD. Images were obtained in the apical long-axis, four-chamber, and two chamber views. Regional longitudinal systolic strain was measured in 17 myocardial segments and averaged to provide global longitudinal strain (LVGLS). Results There was significant decrease in GLS in group 1 compared to group 2 (−11.86 ± 2.89% versus −18.65 ± 0.79%, P < 0.000). The optimal cutoff value of GLS for prediction of significant CAD was −15.6% [AUC 0.88, 95% CI 0.78–0.96 p < 0.000]. The sensitivity, specificity and accuracy of GLS for detecting significant CAD were 93.1%, 81.8%,and 90% respectively.There was a significant positive correlation between GLS and EF (r = 0.33; p = 0.036).There was incremental significant decrease in GLS with increasing number of coronary vessels involved. Conclusion Measurement of global longitudinal strain using 2D speckle tracking echocardiography is sensitive and accurate tool in the prediction of severe CAD.
Collapse
Key Words
- 2-D speckle tracking echocardiography
- 2-DSTE, speckle-tracking strain echocardiography
- AVC, aortic valve closure
- BMI, body mass index
- BSA, body surface area
- CA, coronary angiography
- CAD
- CAD, coronary artery disease
- Coronary angiography
- DM, diabetes mellitus
- DVD, double vessel disease
- EDV, end diastolic volume
- EF, ejection fraction
- ESV, end systolic volume
- Global strain
- HTN, hypertension
- LAD, left anterior descending
- LCX, left circumflex
- LV, left ventricle
- RCA, right coronary artery
- SVD, single vessel disease
- TTE, transthoracic echocardiography, TVD, triple vessel disease
Collapse
|
40
|
Antagomir-92a impregnated gelatin hydrogel microsphere sheet enhances cardiac regeneration after myocardial infarction in rats. Regen Ther 2016; 5:9-16. [PMID: 31245495 PMCID: PMC6581790 DOI: 10.1016/j.reth.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/04/2016] [Accepted: 04/23/2016] [Indexed: 01/07/2023] Open
Abstract
Introduction We investigated whether attachment of gelatin hydrogel microsphere (GHM) sheet impregnated with antagomir-92a on the infarcted heart promotes angiogenesis and cardiomyogenesis, and improves cardiac function after myocardial infarction (MI) in rats. Methods GHM sheet impregnated with antagomir-92a, its scramble sequence antagomir-control sheet or the sheet alone was attached on the area at risk of MI after the left anterior descending coronary artery ligation. Bromodeoxyuridine (BrdU) was included in the sheet to trace proliferating cells. Results The antagomir-92a sheet significantly increased capillary density in the infarct border zone 14 days after MI compared to the antagomir-control sheet or the sheet alone, associated with an increase in endothelial cells incorporated with BrdU. The antagomir-92a sheet significantly increased cardiac stem cells incorporated with BrdU 3 days after MI in the infarct border zone. This was associated with an increase in cardiomyocytes incorporated with BrdU 14 days after MI. Scar area was significantly reduced by the antagomir-92a sheet compared to the antagomir-control sheet or the sheet alone (12.8 ± 1.3 vs 25.2 ± 2.2, 24.0 ± 1.7% LV area, respectively) 14 days after MI. LV dilatation was inhibited, and LV wall motion was improved 14 days after MI in rats with the antagomir-92a sheet compared to the antagomir-control sheet or the sheet alone. Conclusions These results suggest that attachment of the GHM sheet impregnated with antagomir-92a on the area at risk of MI enhances angiogenesis, promotes cardiomyogenesis, and ameliorates LV function.
Collapse
Key Words
- Angiogenesis
- BrdU, bromodeoxyuridine
- DAPI, 4′,6-diamidino-2-phenylindole
- DDA, double-distilled water
- FGF, fibroblast growth factor
- FS, fractional shortening
- GA, glutaraldehyde
- GHM, gelatin hydrogel microsphere
- Gelatin hydrogel microsphere
- Heart regeneration
- LAD, left anterior descending
- LV, left ventricular
- LVDd, left ventricular end-diastolic diameter
- LVDs, left ventricular end-systolic diameter
- MI, myocardial infarction
- MSCs, mesenchymal stem cells
- MicroRNA-92a
- VEGF, vascular endothelial growth factor
- miRs, microRNAs
Collapse
|
41
|
Inactivation of the cardiomyocyte glucagon-like peptide-1 receptor (GLP-1R) unmasks cardiomyocyte-independent GLP-1R-mediated cardioprotection. Mol Metab 2014; 3:507-17. [PMID: 25061556 PMCID: PMC4099509 DOI: 10.1016/j.molmet.2014.04.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 04/27/2014] [Accepted: 04/28/2014] [Indexed: 01/07/2023] Open
Abstract
GLP-1R agonists improve outcomes in ischemic heart disease. Here we studied GLP-1R-dependent adaptive and cardioprotective responses to ventricular injury. Glp1r−/− hearts exhibited chamber-specific differences in gene expression, but normal mortality and left ventricular (LV) remodeling after myocardial infarction (MI) or experimental doxorubicin-induced cardiomyopathy. Selective disruption of the cardiomyocyte GLP-1R in Glp1rCM−/− mice produced no differences in survival or LV remodeling following LAD coronary artery occlusion. Unexpectedly, the GLP-1R agonist liraglutide still produced robust cardioprotection and increased survival in Glp1rCM−/− mice following LAD coronary artery occlusion. Although liraglutide increased heart rate (HR) in Glp1rCM−/− mice, basal HR was significantly lower in Glp1rCM−/− mice. Hence, endogenous cardiomyocyte GLP-1R activity is not required for adaptive responses to ischemic or cardiomyopathic injury, and is dispensable for GLP-1R agonist-induced cardioprotection or enhanced chronotropic activity. However the cardiomyocyte GLP-1R is essential for the control of HR in mice.
Collapse
|