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Sample records for invasive coronary vasomotor

  1. Coronary vasomotor function assessed by positron emission tomography.

    PubMed

    Tamaki, Nagara; Yoshinaga, Keiichiro; Naya, Masanao

    2010-06-01

    Cardiac PET has the unique ability to assess coronary flow reserve and coronary endothelial function on the basis of response of blood flow to pharmacological stress and the cold pressor test. Quantitative analysis of coronary vasomotor function is valuable for precise assessment of function and treatment monitoring in the presence of various coronary risk factors. In addition, recent data have shown prognostic value of PET assessment of coronary vasomotor imaging in patients with suspected coronary artery disease. Thus, quantitative analysis of PET has a great potential for wide application in identifying microcirculatory dysfunction and "individualized" monitoring of the effects of primary or preventive medical intervention to optimize cardiovascular outcome. PMID:19937243

  2. Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders.

    PubMed

    Ong, Peter; Athanasiadis, Anastasios; Sechtem, Udo

    2016-01-01

    Intracoronary acetylcholine provocation testing (ACH-test) is an established method for assessment of epicardial coronary artery spasm in the catheterization laboratory which was introduced more than 30 years ago. Due to the short half-life of acetylcholine it can only be applied directly into the coronary arteries. Several studies have demonstrated the safety and clinical usefulness of this test. However, acetylcholine testing is only rarely applied in the U.S. or Europe. Nevertheless, it has been shown that 62% of Caucasian patients with stable angina and unobstructed coronary arteries on coronary angiography suffer from coronary vasomotor disorders that can be diagnosed with acetylcholine testing. In recent years it has been appreciated that the ACH-test not only assesses the presence of epicardial spasm but that it can also be useful for the detection of coronary microvascular spam. In such cases no epicardial spasm is seen after injection of acetylcholine but ischemic ECG shifts are present together with a reproduction of the patient's symptoms during the test. This article describes the experience with the ACH-test and its implementation in daily clinical routine. PMID:27583694

  3. Vasomotor Regulation of Coronary Microcirculation by Oxidative Stress: Role of Arginase

    PubMed Central

    Kuo, Lih; Hein, Travis W.

    2013-01-01

    Overproduction of reactive oxygen species, i.e., oxidative stress, is associated with the activation of redox signaling pathways linking to inflammatory insults and cardiovascular diseases by impairing endothelial function and consequently blood flow dysregulation due to microvascular dysfunction. This review focuses on the regulation of vasomotor function in the coronary microcirculation by endothelial nitric oxide (NO) during oxidative stress and inflammation related to the activation of L-arginine consuming enzyme arginase. Superoxide produced in the vascular wall compromises vasomotor function by not only scavenging endothelium-derived NO but also inhibiting prostacyclin synthesis due to formation of peroxynitrite. The upregulation of arginase contributes to the deficiency of endothelial NO and microvascular dysfunction in various vascular diseases by initiating or following oxidative stress and inflammation. Hydrogen peroxide, a diffusible and stable oxidizing agent, exerts vasodilator function and plays important roles in the physiological regulation of coronary blood flow. In occlusive coronary ischemia, the release of hydrogen peroxide from the microvasculature helps to restore vasomotor function of coronary collateral microvessels with exercise training. However, excessive production and prolonged exposure of microvessels to hydrogen peroxide impairs NO-mediated endothelial function by reducing L-arginine availability through hydroxyl radical-dependent upregulation of arginase. The redox signaling can be a double-edged sword in the microcirculation, which helps tissue survival in one way by improving vasomotor regulation and elicits oxidative stress and tissue injury in the other way by causing vascular dysfunction. The impact of vascular arginase on the development of vasomotor dysfunction associated with angiotensin II receptor activation, hypertension, ischemia-reperfusion, hypercholesterolemia, and inflammatory insults is discussed. PMID:23966996

  4. Diagnostic Value of PET-Measured Heterogeneity in Myocardial Blood Flows during CPT for the Identification of Coronary Vasomotor Dysfunction

    PubMed Central

    Schindler, Thomas H.; Zhang, Xiao-Li; Vincenti, Gabriella; Mhiri, Leila; Nkoulou, Rene; Just, Hanjoerg; Ratib, Osman; Mach, Francois; Dahlbom, Magnus; Schelbert, Heinrich R

    2009-01-01

    Background To evaluate the diagnostic value of a PET-measured heterogeneity in longitudinal myocardial blood flow (MBF) during cold pressor testing (CPT) and global MBF response to CPT from rest (ΔMBF) for identification of coronary vasomotor dysfunction. Methods and Results In 35 patients, CPT-induced alterations in epicardial luminal area were determined with quantitative angiography as reference. MBF was assessed over the whole left ventricle as global MBF, and regionally in the mid and mid-distal myocardium as MBF difference or MBF heterogeneity with 13N-ammonia and PET. The sensitivity and specifity of a longitudinal MBF difference in the identification of epicardial vasomotor dysfunction was significantly higher than the global ΔMBF to CPT, respectively (88% vs. 79% and 82% vs. 64%, p<0.05). Combining both parameters resulted in an optimal sensitivity of 100% at the expense of an intermediate specifity of 73%. The diagnostic accuracy was highest for the combined analysis, than those for the MBF difference or global ΔMBF alone (91 vs. 86% and 74%, respectively, p<0.05). Conclusions The combined evaluation of a CPT-induced heterogeneity in longitudinal MBF and the change in global MBF from rest may emerge as a new promising analytic approach to further optimize the identification and characterization of coronary vasomotor dysfunction. PMID:17826322

  5. Effect of electron radiation on vasomotor function of the left anterior descending coronary artery

    PubMed Central

    Sanzari, Jenine K.; Billings, Paul C.; Wilson, Jolaine M.; Diffenderfer, Eric S.; Arce-Esquivel, Arturo A.; Thorne, Pamela K.; Laughlin, M. H.; Kennedy, Ann R.

    2015-01-01

    The left anterior descending (LAD, interventricular) coronary artery provides the blood supply to the mid-region of the heart and is a major site of vessel stenosis. Changes in LAD function can have major effects on heart function. In this report, we examined the effect of electron simulated solar particle event (eSPE) radiation on LAD function in a porcine animal model. Vasodilatory responses to adenosine diphosphate (ADP; 10−9 – 10−4 M), bradykinin (BK; 10−11 – 10−6 M), and sodium nitroprusside (SNP; 10−10 – 10−4 M) were assessed. The LAD arteries from Control (non-irradiated) and the eSPE (irradiated) animals were isolated and exhibited a similar relaxation response following treatment with either ADP or SNP. In contrast, a significantly reduced relaxation response to BK treatment was observed in the eSPE irradiated group, compared to the control group. These data demonstrate that simulated SPE radiation exposure alters LAD function. PMID:26072960

  6. Non-invasive evaluation of vasomotor and metabolic functions of microvascular endothelium in human skin.

    PubMed

    Fedorovich, Andrey A

    2012-07-01

    Correlation between metabolic and microhemodynamic processes in skin was assessed through acute pharmacological test with metabolically active Actovegin in 28 healthy volunteers. Laser Doppler flowmetry in combination with wavelet analysis of blood flow oscillations was used to identify functional state of arteriolar-venular areas of microvascular bed in the right forearm skin; capillary blood flow parameters were assessed through computer capillaroscopy in the nail bed of the right hand on the 4th finger. The metabolic effect (improved oxygen uptake and glucose disposal by tissues) was accompanied by significant increase in endothelial rhythm amplitude by 98% (p<0.00006), neurogenic rhythm amplitude by 50% (p<0.003) and myogenic rhythm amplitude by 54% (p<0.03), with capillary blood flow rate increasing by 90μm/s (p<0.04), pericapillary zone reducing by 15μm (p<0.0001) and diastolic blood pressure dropping by 4mm Hg (p<0.02). These results show close correlation between metabolic and microhemodynamic processes, which suggests that the amplitude activity within the range of endothelial rhythm (0.0095-0.021Hz) during laser Doppler flowmetry reflects not only solely vasomotor function but also metabolic function of microvascular endothelium. PMID:22497731

  7. [Advanced coronary artery surgery for minimally invasiveness].

    PubMed

    Yamaguchi, Shohjiro; Tomita, Shigeyuki; Watanabe, Go

    2008-07-01

    Since the development of drug-eluting stents, the conditions of coronary artery surgery have changed. The selection criteria for candidates for coronary artery bypass grafting (CABG) have become more stringent. In this era, surgeons should perform less invasive surgery to save such candidates. Off-pump coronary artery bypass (OPCAB) will become the gold standard surgical procedure for the treatment of ischemic heart disease. This paper describes how to perform less invasive OPCAB with some useful devices and points out the pitfalls of the standard procedure. We have also introduced robotic surgery using the DaVinci system. This procedure decreases the length of dermal incisions. Robotic surgery has other advantages compared with the standard endoscopic surgery. The arm of the robot absorbs the vibrations of human hands and the command function can decrease movement significantly. This arm has five joints, allowing the operator to manipulate the equipment easily inside the body. We have also performed awake CABG with high epidural anesthesia for minimally invasive surgery. This procedure is performed especially in patients with severe cerebrovascular disease and lung injury. In our institution, patients can be discharged only 5 days after this surgical procedure. Less invasive surgery will be the standard procedure in future. PMID:18681162

  8. Minimally Invasive Multivessel Coronary Surgery and Hybrid Coronary Revascularization: Can We Routinely Achieve Less Invasive Coronary Surgery?

    PubMed

    Rodriguez, Maria; Ruel, Marc

    2016-01-01

    Coronary artery bypass grafting (CABG) is the gold standard in managing severe coronary artery disease. However, it is associated with prolonged recovery and potential complications, in part due to the invasiveness of the procedure. Less invasive CABG techniques attempt to improve the quality and quantity of life in the same way as surgical revascularization but with fewer complications. Minimally invasive coronary surgery (MICS) through a small thoracotomy allows for complete revascularization with good results in graft patency. Perioperative mortality is low, and there is decreased need for blood transfusion, lower surgical site infection rates, and an earlier return to full physical function. Hybrid coronary revascularization (HCR) attempts to combine the advantages of coronary artery bypass grafting with those of percutaneous coronary intervention. Several studies have shown that HCR provides better short-term outcomes with regard to decreased ventilation and ICU time, reduced need for blood transfusion, and shortened hospital stay. However, the rates for major adverse cardiovascular events and mortality are comparable to conventional CABG, except for patients with a high SYNTAX score who displayed increased mortality rates. There is also strong evidence of a higher need for repeat revascularization with HCR compared to CABG. Overall, MICS and HCR appear to be viable alternatives to conventional CABG, offering a less invasive approach to coronary revascularization, which may be especially beneficial to high-risk patients. This article discusses approaches that deliver the advantages of minimally invasive surgical revascularization that can be adapted by surgeons with minimal investment with regards to training and infrastructure. PMID:27127557

  9. Non‐invasive coronary angiography using multislice computed tomography

    PubMed Central

    Schussler, Jeffrey M; Grayburn, Paul A

    2007-01-01

    Non‐invasive methods for detection of coronary atherosclerosis have been limited to indirect markers, such as myocardial perfusion or wall motion during exercise or pharmacological stress. However, advances in multislice computed tomography (MSCT) not allow sufficient spatial resolution for direct non‐invasive imaging of the coronary arteries. This review focuses on imaging techniques and clinical applications of MSCT in human studies. Published studies of the diagnostic accuracy of MSCT in native coronary arteries and bypass grafts indicate excellent sensitivity and specificity for detection of 50% diameter stenosis. MSCT is particularly good for evaluating the origin and course of anomalous coronary arteries. MSCT offers the ability to visualise both the lumen and wall of artery, as well as to quantify coronary classification. Further technical developments promise to render MSCT the ideal non‐invasive tool for direct visualisation of the coronary arteries. PMID:16387814

  10. Invasive assessment of the coronary microcirculation in the catheter laboratory.

    PubMed

    Layland, Jamie; Nerlekar, Nitesh; Palmer, Sonny; Berry, Colin; Oldroyd, Keith

    2015-11-15

    Historically much of our understanding of the coronary circulation has been centered towards the epicardial vessels. However, recent work has highlighted the importance of the coronary microcirculation across a broad spectrum of clinical conditions in influencing patient outcomes. Therefore an ability to measure microvascular function is most valuable. While evaluation of the epicardial coronary circulation is widely understood, interrogation of the coronary microcirculation is more complex. Many methods are available to assess the integrity of the microcirculation in the catheter laboratory. This review will discuss the physiology of the coronary microcirculation and evaluate the utility of available invasive techniques. PMID:26197399

  11. Stable coronary artery disease: revascularisation and invasive strategies.

    PubMed

    Piccolo, Raffaele; Giustino, Gennaro; Mehran, Roxana; Windecker, Stephan

    2015-08-15

    Stable coronary artery disease is the most common clinical manifestation of ischaemic heart disease and a leading cause of mortality worldwide. Myocardial revascularisation is a mainstay in the treatment of symptomatic patients or those with ischaemia-producing coronary lesions, and reduces ischaemia to a greater extent than medical treatment. Documentation of ischaemia and plaque burden is fundamental in the risk stratification of patients with stable coronary artery disease, and several invasive and non-invasive techniques are available (eg, fractional flow reserve or intravascular ultrasound) or being validated (eg, instantaneous wave-free ratio and optical coherence tomography). The use of new-generation drug-eluting stents and arterial conduits greatly improve clinical outcome in patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). PCI is feasible, safe, and effective in many patients with stable coronary artery disease who remain symptomatic despite medical treatment. In patients with multivessel and left main coronary artery disease, the decision between PCI or CABG is guided by the local Heart Team (team of different cardiovascular specialists, including non-invasive and invasive cardiologists, and cardiac surgeons), who carefully judge the possible benefits and risks inherent to PCI and CABG. In specific subsets, such as patients with diabetes and advanced, multivessel coronary artery disease, CABG remains the standard of care in view of improved protection against recurrent ischaemic adverse events. PMID:26334162

  12. Coronary vasomotor responses to isometric handgrip exercise are primarily mediated by nitric oxide: a noninvasive MRI test of coronary endothelial function.

    PubMed

    Hays, Allison G; Iantorno, Micaela; Soleimanifard, Sahar; Steinberg, Angela; Schär, Michael; Gerstenblith, Gary; Stuber, Matthias; Weiss, Robert G

    2015-06-01

    Endothelial cell release of nitric oxide (NO) is a defining characteristic of nondiseased arteries, and abnormal endothelial NO release is both a marker of early atherosclerosis and a predictor of its progression and future events. Healthy coronaries respond to endothelial-dependent stressors with vasodilatation and increased coronary blood flow (CBF), but those with endothelial dysfunction respond with paradoxical vasoconstriction and reduced CBF. Recently, coronary MRI and isometric handgrip exercise (IHE) were reported to noninvasively quantify coronary endothelial function (CEF). However, it is not known whether the coronary response to IHE is actually mediated by NO and/or whether it is reproducible over weeks. To determine the contribution of NO, we studied the coronary response to IHE before and during infusion of N(G)-monomethyl-l-arginine (l-NMMA, 0.3 mg·kg(-1)·min(-1)), a NO-synthase inhibitor, in healthy volunteers. For reproducibility, we performed two MRI-IHE studies ~8 wk apart in healthy subjects and patients with coronary artery disease (CAD). Changes from rest to IHE in coronary cross-sectional area (%CSA) and diastolic CBF (%CBF) were quantified. l-NMMA completely blocked normal coronary vasodilation during IHE [%CSA, 12.9 ± 2.5 (mean ± SE, placebo) vs. -0.3 ± 1.6% (l-NMMA); P < 0.001] and significantly blunted the increase in flow [%CBF, 47.7 ± 6.4 (placebo) vs. 10.6 ± 4.6% (l-NMMA); P < 0.001]. MRI-IHE measures obtained weeks apart strongly correlated for CSA (P < 0.0001) and CBF (P < 0.01). In conclusion, the normal human coronary vasoactive response to IHE is primarily mediated by NO. This noninvasive, reproducible MRI-IHE exam of NO-mediated CEF promises to be useful for studying CAD pathogenesis in low-risk populations and for evaluating translational strategies designed to alter CAD in patients. PMID:25820391

  13. Invasive coronary imaging: any role in primary and secondary prevention?

    PubMed

    Di Mario, Carlo; Moreno, Pedro R

    2016-06-21

    This review discusses the possibilities offered by new modalities of non-invasive and invasive coronary imaging in an effort to optimize risk stratification for coronary artery disease, and identify subgroups at high risk that may benefit from an aggressive, personalized approach, with access to a growing number of novel drugs and interventions. Special emphasis is placed on the progress of novel invasive imaging techniques such as near infrared spectroscopy and optical coherence tomography that can reliably identify thin-capped fibroatheromas. Multiple trials are exploring the feasibility of these techniques to guide modulation of risk factor control and treatment of non-flow limiting lesions at high risk of destabilization and progression in patients undergoing clinically mandated angioplasty of angiographically critical lesions. Asymptomatic patients at high risk of cardiovascular ischaemic events may also benefit, with the intermediate step of a wider application of calcium score and angiography with multi-slice computed tomography, by a selective use of invasive imaging. PMID:27002121

  14. Minimally invasive coronary artery bypass grafting: initial Connecticut experience.

    PubMed

    Tellides, G; Maragh, M R; Smith, J M; Kopf, G S; Ezekowitz, M; Remetz, M; Elefteriades, J A

    1997-03-01

    We report the initial Connecticut experience with minimally invasive coronary artery bypass grafting. This procedure allows bypass grafting to the left anterior descending coronary artery utilizing the internal mammary artery as the conduit. The procedure is minimally invasive because it is performed through a mini-thoracotomy incision in the fourth anterior intercostal space and it is conducted without the use of cardiopulmonary bypass. The procedure has been applied to 13 patients operated between February and October 1996. All but one patient selected were poor candidates for conventional coronary artery bypass surgery because of advanced age (6), chronic renal failure/dialysis/kidney transplant (4), redo status with vulnerable grafts (1), severe peripheral vascular disease (6), severe chronic obstructive pulmonary disease (4). All patients survived operation and were discharged in good condition. Mean postoperative intubation time was seven hours and mean hospital stay was 4.5 days despite the very high pre-existing comorbidity of these patients. All patients are alive at the current follow-up time. Two patients required a conventional bypass procedure for occlusion of the minimally invasive graft, the first because of diffuse disease in the target artery and the second attributable to the technical limitations of minimally invasive coronary artery bypass grafting; both tolerated the subsequent procedure well. All patients are now angina-free. All four grafts studied by routine postoperative angiography were widely patent. Routine post-operative exercise nuclear imaging was normal in an additional patient. This procedure of minimally invasive coronary artery bypass grafting offers significant advantages compared to the conventional bypass procedure (short hospital stay, quick recovery, and, especially, avoidance of cerebrovascular accidents caused by the heart-lung machine). This minimally invasive procedure is expected to apply to a growing percentage of

  15. Non-invasive and invasive imaging of vulnerable coronary plaque.

    PubMed

    Celeng, Csilla; Takx, Richard A P; Ferencik, Maros; Maurovich-Horvat, Pál

    2016-08-01

    Vulnerable plaque is characterized by a large necrotic core and an overlying thin fibrous cap. Non-invasive imaging modalities such as computed tomography angiography (CTA) and magnetic resonance imaging (MRI) allow for the assessment of morphological plaque characteristics, while positron emission tomography (PET) enables the detection of metabolic activity within the atherosclerotic lesions. Invasive imaging modalities such as intravascular ultrasound (IVUS), optical-coherence tomography (OCT), and intravascular MRI (IV-MRI) display plaques at a high spatial resolution. Near-infrared spectroscopy (NIRS) allows for the detection of chemical components of atherosclerotic plaques. In this review, we describe state-of-the-art non-invasive and invasive imaging modalities and stress the combination of their advantages to identify vulnerable plaque features. PMID:27079893

  16. New Invasive Assessment Measures of Coronary Artery Disease Severity.

    PubMed

    Khanna, Neel; Subramanian, Kathir S; Khera, Sahil; Aronow, Wilbert S; Frishman, William H

    2016-01-01

    Ischemic heart disease is the leading cause of mortality worldwide. The assessment and treatment of patients with ischemic heart disease have advanced greatly over the past decade. Particular attention has been given recently to the recognition of lesions that cause ischemia or that are prone to plaque rupture. New invasive measures of coronary artery disease have been developed, including fractional flow reserve, intravascular ultrasound, optical coherence tomography, and most recently, near-infrared spectroscopy. These technologies have helped to guide the assessment of hemodynamically significant lesions and have shown particular promise in guiding percutaneous coronary interventions. However, mortality and the rate of revascularization have shown mixed results to date. This review seeks to investigate the use and potential benefit of these technologies, with particular attention to clinical end points. PMID:26751263

  17. [Invasive diagnosis, transcatheter and surgical treatment of acute coronary syndromes].

    PubMed

    Fabián, J; Hricák, V; Fridrich, V; Fischer, V

    1998-01-01

    On the basis of long-term personal experiences and critical evaluation of the present literatury sources authors described the role of invasive diagnostic methods and transcathetral and cardiosurgical possibilities in the recognition and therapy of acute coronary syndromes. These techniques are, and in the forthcoming year shall be available only in specialized institutions. The paper describes the indication for these aggressive techniques as well as their limitations and complications. The goal of the presented article is to inform both the cardiological and frequently broad physicians' societies about the possibilities of diaventional cardiology and cardiosurgery which will be gradually more applied in the care of the patients with acute coronary syndromes. (Ref. 39, Tab. 2, Fig. 3.) PMID:9919748

  18. Incidental invasive thymoma during coronary artery bypass surgery.

    PubMed

    Al-Smady, Moaath; Hammdan, Farouq F; Abu-Abeeleh, Mahmood M; Massad, Islam M

    2009-01-01

    We encountered 2 incidental cases of invasive thymomas at Jordan University Hospital, Amman, Jordan; during routine coronary artery bypass graft surgery between 2005 and 2008 with an incidence of 0.6%. Both patients presented with angina pain. None of the 2 patients had pressure symptoms (cough, shortness of breath or superior vena cava syndrome) or Myasthenia Gravis symptoms. Total thymectomy with dissection of perithymic fat was performed on both cases. No radiotherapy was given. No recurrence of the tumor was seen in 2 years follow up. These cases are presented to emphasize the occurrence of this tumor. PMID:19139788

  19. Coronary optical coherence tomography: minimally invasive virtual histology as part of targeted post-mortem computed tomography angiography.

    PubMed

    Adlam, David; Joseph, Shiju; Robinson, Claire; Rousseau, Clement; Barber, Jade; Biggs, Mike; Morgan, Bruno; Rutty, Guy

    2013-09-01

    Social, cultural and practical barriers to conventional invasive autopsy have led to considerable interest in the development of minimally invasive radiological techniques as an alternative to the invasive autopsy for determining the cause of death. Critical to accurate diagnosis in this context is detailed examination of coronary anatomy and pathology. Current computed tomography and magnetic resonance imaging approaches have significantly advanced minimally invasive autopsy practice but have limited spatial resolution. This prohibits assessment at a microscopic level, meaning that histological assessment is still required for detailed analysis of, for example, coronary plaque rupture or dissection. Coronary optical coherence tomography (OCT) is used in the living during percutaneous coronary interventions to provide high-resolution coronary imaging, but this technique for obtaining virtual histology has not, to date, been translated into minimally invasive autopsy practice. We present a first description of minimally invasive post-mortem coronary OCT and discuss the potential for this technique to advance current practice. PMID:23455719

  20. Minimally Invasive Periareolar Approach to Unroofed Coronary Sinus Atrial Septal Defect Repair.

    PubMed

    Bozso, Sabin J; Grant, Aaron; Iglesias, Ivan; Chu, Michael W A

    2016-09-01

    Less invasive techniques are commonly used to treat patients with anatomically suitable secundum atrial septal defects; however, repair of more complex atrial septal defects are still performed through sternotomy. Cosmetically appealing periareolar incisions have been used in breast reconstructive surgery and may provide an esthetically superior alternative to the anterolateral minithoracotomy incision used in minimally invasive cardiac surgery. We describe a patient with an unroofed coronary sinus atrial septal defect who underwent successful minimally invasive, endoscopic repair of this defect with autologous pericardial baffle reconstruction of the coronary sinus roof and closure of the interatrial communication through a periareolar approach. PMID:27549549

  1. Non-invasive assessment of coronary flow and coronary flow reserve by transthoracic Doppler echocardiography: a magic tool for the real world.

    PubMed

    Meimoun, Patrick; Tribouilloy, Christophe

    2008-07-01

    Transthoracic Doppler echocardiography, introduced in the echo-lab in recent last years, to measure coronary flow and coronary flow reserve, is a very attractive tool, totally non-invasive, and easily available at bedside. This review summarizes the actual possibilities of this tool, its multiple potential clinical applications and diagnostic insights, and its arising prognosis value, in coronary artery disease as in various settings affecting the coronary microcirculation. PMID:18296409

  2. Correlation of myocardial perfusion SPECT with invasive and computed tomography coronary angiogram

    PubMed Central

    Shelley, S.; Indirani, M.; Sathyamurthy, I.; Subramanian, K.; Priti, N.; Harshad, K.; Padma, D.

    2012-01-01

    Background The consequences of atherosclerosis can be detected by multislice computed tomography (MSCT), invasive coronary angiogram (CAG) and the resultant myocardial ischaemia by myocardial perfusion single photon emission computed tomography (MPS). In this study an attempt is made to compare MSCT with MPS and also to compare the MSCT findings with that of invasive CAG in patients suspected to have coronary artery disease (CAD). Materials and methods A total of 99 patients suspected to have CAD underwent both MSCT and MPS with 99mTc sestamibi. The MSCT studies were classified as having no CAD, significant CAD (>50% diameter stenosis), and insignificant CAD (<50% diameter stenosis). Myocardial perfusion single photon emission computed tomography was reported as normal and reversible ischaemia. In a subgroup of 33 patient invasive CAG was done. Results In 99 patients, 396 coronaries were evaluated with MSCT and MPS. Coronary artery calcium scoring (CACS) in these patient ranged from 0 to 2200. No CAD was noted in 128 (32%) coronaries but MPS was found abnormal in 9 (7%) coronaries. Insignificant CAD was noted in 169 (43%) coronaries amongst which reversible ischaemia was noted in 23 (14%). Significant CAD was noted in 99 (25%) coronaries of which only 54 (55%) were MPS positive for reversible ischaemia. The MSCT has a negative predictive value (NPV) of 97%. When MSCT was normal, MPS was almost normal, but the reverse was not true. That is when MPS was normal MSCT was not always normal but showed lesion of insignificant obstruction. In the subset of 33 patients, who underwent invasive angiogram, 132 coronaries were evaluated. Coronary angiogram showed 48 coronaries (36%) to have significant CAD (>50% diameter stenosis). Multislice computed tomography correlated well in 46 (84%) with P value of <0.001 (χ2-test) but for 9 (16%) showing overestimation due to increased CACS (>800). Myocardial perfusion single photon emission computed tomography was normal in 15 (27

  3. Comparison of Non-Invasive Methods for the Detection of Coronary Atherosclerosis

    PubMed Central

    Bampi, Angela Bacelar Albuquerque; Rochitte, Carlos Eduardo; Favarato, Desiderio; Lemos, Pedro Alves; da Luz, Protásio Lemos

    2009-01-01

    BACKGROUND: Non-invasive detection of atherosclerosis is critical for its prevention. Objective: To correlate non-invasively detectable indicators of coronary atherosclerosis, or Coronary Artery Disease (i.e., classical risk factors, hs-CRP test results, carotid intima-media thickness, endothelial function, ankle-brachial index and calcium score by computed tomography) with the extent of coronary disease assessed by the Friesinger index from conventional coronary angiography. METHODS: We conducted a prospective study of 100 consecutive patients, mean age 55.1 ± 10.7 years, 55% men and 45% women. Patients with acute coronary syndrome, renal dialytic insufficiency, collagen disease and cancer were not included. All patients were subjected to clinical evaluation and laboratory tests. Endothelial function of the brachial artery and carotid artery were evaluated by high-resolution ultrasound; ankle-brachial index and computed tomography for coronary determination of calcium score were also performed, and non-HDL cholesterol and TG/HDL-c ratio were calculated. All patients were subjected to coronary angiography at the request of the assistant physician. We considered patients without an obstructive lesion (< 29% stenosis) demonstrated by coronary angiography to be normal. RESULTS: Univariate analysis showed that calcium score, HDL-c, TG/HDL ratio and IMT were significantly correlated with the Friesinger index. However, multivariate analysis indicated that only calcium score and low HDL-c levels correlated significantly with the extension of CAD. On the other hand, hs-CRP, LDL-c, flow-mediated dilation, and Framingham score did not correlate with the Friesinger index. ROC analysis showed that calcium score, HDL-c and TG-HDL ratio accurately predicted extensive CAD in a statistically significant manner. CONCLUSION: It is possible to approximately determine the presence and extent of CAD by non-invasive methods, especially by calcium score, HDL-c and TG/HDL-c ratio assays

  4. Lung herniation secondary to minimally invasive direct coronary artery bypass grafting.

    PubMed

    Deeik, R K; Memon, M A; Sugimoto, J T

    1998-06-01

    Lung herniation after thoracotomy is rare. We report a 66-year-old man who presented with this complication after undergoing attempted minimally invasive direct coronary artery bypass grafting. The defect was repaired with a composite of Marlex mesh and methyl methacrylate. PMID:9647101

  5. Should computed tomography angiography supersede invasive coronary angiography for the evaluation of graft patency following coronary artery bypass graft surgery?

    PubMed

    Gabriel, Joseph; Klimach, Stefan; Lang, Peter; Hildick-Smith, David

    2015-08-01

    Invasive coronary angiography (ICA) has long been the established gold standard in assessing graft patency following coronary artery bypass graft (CABG). Over the past decade or so however, improvements in computed tomography angiography (CTA) technology have allowed its emergence as a useful clinical tool in graft assessment. The recent introduction of 64-slice and now 128-slice scanners into widespread distribution, and the development of 320-detector row technology allowing volumetric imaging of the entire heart at single points in time within one cardiac cycle, has increased the potential of CTA to supersede ICA in this capacity. This study sought to examine the evidence surrounding this potential. A best evidence topic was constructed according to a structured protocol. The enquiry: In [patients who have undergone coronary artery bypass graft surgery] is [computed tomography angiography or invasive coronary angiography] superior in terms of [graft patency assessment, stenosis detection, radiation exposure and complication rate]? Four hundred and twenty-four articles were identified from the search strategy. Four additional articles were identified from references of key articles. Seventeen articles selected as best evidence were tabulated. The reliability of CTA as a tool in the detection of graft patency and stenosis has continued to improve with each successive generation of multislice technology. The latest 64- and 128-slice CTA techniques are able to detect graft patency and stenosis with very high sensitivities and specificities comparable with ICA, while remaining non-invasive procedures associated with fewer complications (ICA carries a 0.08% risk of myocardial infarction and 0.7% risk of minor complications in clinically stable patients). Present limitations of the technology include the accurate visualization of distal anastomoses and clip artefacts. In addition, the capacity of diagnostic ICA to be combined simultaneously with percutaneous coronary

  6. Long-term Outcome after Percutaneous Coronary Intervention Compared with Minimally Invasive Coronary Artery Bypass Surgery in the Elderly

    PubMed Central

    Barsoum, Emad A.; Azab, Basem; Patel, Nileshkumar; Spagnola, Jonathan; Shariff, Masood A.; Kaleem, Umar; Morcus, Rewais; Asti, Deepak; McGinn, Joseph T.; Lafferty, James; McCord, Donald A.

    2016-01-01

    Background: Elderly patients with unstable coronary artery disease (CAD) have better outcomes with coronary revascularization than conservative treatment. With the improvement in percutaneous coronary intervention (PCI) techniques using drug eluting-stents, this became an attractive option in elderly. Minimally invasive coronary artery bypass grafting (MICS-CABG) is a safe and effective alternative to conventional CABG. We aimed to explore the long-term outcomes after PCI vs MICS-CABG in ≥75 year-old patients with severe CAD. Methods: A total of 1454 elderly patients (≥75 year-old patients) underwent coronary artery revascularization between January 2005 and December 2009. Patients were selected in the study if they have one of the Class-I indications for CABG. Groups were divided according to the type of procedure, PCI or MICS-CABG, and 5 year follow-up. Results: Among 175 elderly patients, 109 underwent PCI and 66 had MICS-CABG. There was no significant difference observed in both groups with long-term all-cause mortality (31 PCI vs 21% MICS-CABG, p=0.151) and the overall 5 year survival was similar on Kaplan-Meier curve (Log rank p=0.318). The average length of stay in hospital was significantly shorter in the PCI than in the MICS-CABG group (4.3 vs 7.8 days, p<0.001). Only 4.7% of the PCI group were discharged to rehabilitation facility compared with 43.9% of the MICS-CABG group (p<0.001). The rate of repeat revascularization was significantly higher in the PCI group than in the MICS-CABG group (15 vs 3%, p=0.014). Conclusion: Among elderly patients, long-term all-cause mortality is similar after PCI and MICS-CABG. However, there is a significantly higher rate of repeat revascularization after PCI. PMID:27014373

  7. The Prognosis of Patients With Nonobstructive Coronary Artery Disease Versus Normal Arteries Determined by Invasive Coronary Angiography or Computed Tomography Coronary Angiography: A Systematic Review.

    PubMed

    Huang, Fang-Yang; Huang, Bao-Tao; Lv, Wen-Yu; Liu, Wei; Peng, Yong; Xia, Tian-Li; Wang, Peng-Ju; Zuo, Zhi-Liang; Liu, Rui-Shuang; Zhang, Chen; Gui, Yi-Yue; Liao, Yan-Biao; Chen, Mao; Zhu, Ye

    2016-03-01

    Limited data exist regarding the outcomes of patients with nonobstructive coronary artery disease (CAD) detected by computed tomography coronary angiography (CTCA) or invasive coronary angiography (ICA). Our aim was to compare the prognosis of patients with nonobstructive coronary artery plaques with that of patients with entirely normal arteries. The MEDLINE, Cochrane Library, and Embase databases were searched. Studies comparing the prognosis of individuals with nonobstructive CAD versus normal coronary arteries detected by CTCA or ICA were included. The primary outcome was major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization due to unstable angina or revascularization. A fixed effects model was chosen to pool the estimates of odds ratios (ORs). Forty-eight studies with 64,905 individuals met the inclusion criteria. Patients in the nonobstructive CAD arm had a significantly higher risk of MACE compared to their counterparts in the normal artery arm (pooled OR, 3.17, 95% confidence interval, 2.77-3.63). When excluding revascularization as an endpoint, hard cardiac composite outcomes were also more frequent among patients with nonobstructive CAD (pooled OR, 2.10; 95%CI, 1.79-2.45). All subgroups (age, sex, follow-up duration, different outcomes, diagnostic modality, and CAD risk factor) consistently showed a poorer prognosis with nonobstructive CAD than with normal arteries. When dividing the studies into a CTCA and ICA group for further analysis based on the indications for diagnostic tests, we also found nonobstructive CAD to be associated with a higher risk of MACE in both stable and acute chest pain. Patients with nonobstructive CAD had a poorer prognosis compared with their counterparts with normal arteries. PMID:26986161

  8. The Prognosis of Patients With Nonobstructive Coronary Artery Disease Versus Normal Arteries Determined by Invasive Coronary Angiography or Computed Tomography Coronary Angiography

    PubMed Central

    Huang, Fang-Yang; Huang, Bao-Tao; Lv, Wen-Yu; Liu, Wei; Peng, Yong; Xia, Tian-Li; Wang, Peng-Ju; Zuo, Zhi-Liang; Liu, Rui-Shuang; Zhang, Chen; Gui, Yi-Yue; Liao, Yan-Biao; Chen, Mao; Zhu, Ye

    2016-01-01

    Abstract Limited data exist regarding the outcomes of patients with nonobstructive coronary artery disease (CAD) detected by computed tomography coronary angiography (CTCA) or invasive coronary angiography (ICA). Our aim was to compare the prognosis of patients with nonobstructive coronary artery plaques with that of patients with entirely normal arteries. The MEDLINE, Cochrane Library, and Embase databases were searched. Studies comparing the prognosis of individuals with nonobstructive CAD versus normal coronary arteries detected by CTCA or ICA were included. The primary outcome was major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization due to unstable angina or revascularization. A fixed effects model was chosen to pool the estimates of odds ratios (ORs). Forty-eight studies with 64,905 individuals met the inclusion criteria. Patients in the nonobstructive CAD arm had a significantly higher risk of MACE compared to their counterparts in the normal artery arm (pooled OR, 3.17, 95% confidence interval, 2.77–3.63). When excluding revascularization as an endpoint, hard cardiac composite outcomes were also more frequent among patients with nonobstructive CAD (pooled OR, 2.10; 95%CI, 1.79–2.45). All subgroups (age, sex, follow-up duration, different outcomes, diagnostic modality, and CAD risk factor) consistently showed a poorer prognosis with nonobstructive CAD than with normal arteries. When dividing the studies into a CTCA and ICA group for further analysis based on the indications for diagnostic tests, we also found nonobstructive CAD to be associated with a higher risk of MACE in both stable and acute chest pain. Patients with nonobstructive CAD had a poorer prognosis compared with their counterparts with normal arteries. PMID:26986161

  9. Augmented reality image guidance for minimally invasive coronary artery bypass

    NASA Astrophysics Data System (ADS)

    Figl, Michael; Rueckert, Daniel; Hawkes, David; Casula, Roberto; Hu, Mingxing; Pedro, Ose; Zhang, Dong Ping; Penney, Graeme; Bello, Fernando; Edwards, Philip

    2008-03-01

    We propose a novel system for image guidance in totally endoscopic coronary artery bypass (TECAB). A key requirement is the availability of 2D-3D registration techniques that can deal with non-rigid motion and deformation. Image guidance for TECAB is mainly required before the mechanical stabilization of the heart, thus the most dominant source of non-rigid deformation is the motion of the beating heart. To augment the images in the endoscope of the da Vinci robot, we have to find the transformation from the coordinate system of the preoperative imaging modality to the system of the endoscopic cameras. In a first step we build a 4D motion model of the beating heart. Intraoperatively we can use the ECG or video processing to determine the phase of the cardiac cycle. We can then take the heart surface from the motion model and register it to the stereo-endoscopic images of the da Vinci robot using 2D-3D registration methods. We are investigating robust feature tracking and intensity-based methods for this purpose. Images of the vessels available in the preoperative coordinate system can then be transformed to the camera system and projected into the calibrated endoscope view using two video mixers with chroma keying. It is hoped that the augmented view can improve the efficiency of TECAB surgery and reduce the conversion rate to more conventional procedures.

  10. Weaknesses in regional primary coronary angioplasty programs: is there still a role for a pharmaco-invasive approach?

    PubMed

    Danchin, Nicolas; Dos Santos Teixeira, Nelson; Puymirat, Etienne

    2014-08-01

    All guidelines recommend primary percutaneous coronary intervention as the default strategy for achieving reperfusion in ST-segment elevation myocardial infarction patients. These recommendations are based upon randomized trials which compared primary percutaneous coronary intervention with stand-alone intravenous fibrinolysis. Since the time these trials were performed, however, it has been shown in further trials that use of rescue percutaneous coronary intervention in patients without signs of reperfusion after lysis, and routine coronary angiography within 24 h of the administration of lysis for all other patients, substantially improved the results of intravenous fibrinolytic treatment. This has led to proposing the pharmaco-invasive strategy as an alternative to primary percutaneous coronary intervention. Actually, it is not uncommon that circumstances prevent performing primary percutaneous coronary intervention within the recommended time limits set by the guidelines. In such cases, using a pharmaco-invasive strategy may constitute a valid alternative. Both the STREAM randomized trial and real-world experience, in particular the long-term results from the FAST-MI registry, suggest that the pharmaco-invasive strategy, when used in an appropriate population, compares favorably with primary percutaneous coronary intervention. Therefore, implementing a pharmaco-invasive strategy protocol may be an important complement to compensate for potential weaknesses in ST-segment elevation myocardial infarction networks. PMID:25037545

  11. Congenital coronary artery anomalies silent until geriatric age: non-invasive assessment, angiography tips, and treatment

    PubMed Central

    Rigatelli, Gianluca; Dell'Avvocata, Fabio; Van Tan, Nguyen; Daggubati, Rames; Nanijundappa, Aravinda

    2015-01-01

    Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities. PMID:25678906

  12. 4D motion modeling of the coronary arteries from CT images for robotic assisted minimally invasive surgery

    NASA Astrophysics Data System (ADS)

    Zhang, Dong Ping; Edwards, Eddie; Mei, Lin; Rueckert, Daniel

    2009-02-01

    In this paper, we present a novel approach for coronary artery motion modeling from cardiac Computed Tomography( CT) images. The aim of this work is to develop a 4D motion model of the coronaries for image guidance in robotic-assisted totally endoscopic coronary artery bypass (TECAB) surgery. To utilize the pre-operative cardiac images to guide the minimally invasive surgery, it is essential to have a 4D cardiac motion model to be registered with the stereo endoscopic images acquired intraoperatively using the da Vinci robotic system. In this paper, we are investigating the extraction of the coronary arteries and the modelling of their motion from a dynamic sequence of cardiac CT. We use a multi-scale vesselness filter to enhance vessels in the cardiac CT images. The centerlines of the arteries are extracted using a ridge traversal algorithm. Using this method the coronaries can be extracted in near real-time as only local information is used in vessel tracking. To compute the deformation of the coronaries due to cardiac motion, the motion is extracted from a dynamic sequence of cardiac CT. Each timeframe in this sequence is registered to the end-diastole timeframe of the sequence using a non-rigid registration algorithm based on free-form deformations. Once the images have been registered a dynamic motion model of the coronaries can be obtained by applying the computed free-form deformations to the extracted coronary arteries. To validate the accuracy of the motion model we compare the actual position of the coronaries in each time frame with the predicted position of the coronaries as estimated from the non-rigid registration. We expect that this motion model of coronaries can facilitate the planning of TECAB surgery, and through the registration with real-time endoscopic video images it can reduce the conversion rate from TECAB to conventional procedures.

  13. Simultaneous “hybrid” percutaneous coronary intervention and minimally invasive surgical bypass grafting: Feasibility, safety, and clinical outcomes

    PubMed Central

    Reicher, Barry; Poston, Robert S.; Mehra, Mandeep R.; Joshi, Ashish; Odonkor, Patrick; Kon, Zachary; Reyes, Peter A.; Zimrin, David A.

    2009-01-01

    Surgical and percutaneous coronary artery intervention revascularization are traditionally considered isolated options. A simultaneous hybrid approach may allow an opportunity to match the best strategy for a particular anatomic lesion. Concerns regarding safety and feasibility of such an approach exist. We examined the safety, feasibility, and early outcomes of a simultaneous hybrid revascularization strategy (minimally invasive direct coronary bypass grafting of the left anterior descending [LAD] artery and drug-eluting stent [DES] to non-LAD lesions) in 13 patients with multivessel coronary artery disease that underwent left internal mammary artery to LAD minimally invasive direct coronary bypass performed through a lateral thoracotomy, followed by stenting of non-LAD lesions, in a fluoroscopy-equipped operating room. Assessment of coagulation parameters was also undertaken. Inhospital and postdischarge outcomes of these patients were compared to a group of 26 propensity score matched parallel controls that underwent standard off-pump coronary artery bypass. Baseline characteristics were similar in both groups. All hybrid patients were successfully treated with DES and no inhospital mortality occurred in either group. Hybrid patients had a shorter length of stay (3.6 ± 1.5 vs 6.3 ± 2.3 days, P < .0001) and intubation times (0.5 ± 1.3 vs 11.7 ± 9.6 hours, P < .02). Despite aggressive anticoagulation and confirmed platelet inhibition, hybrid patients had less blood loss (581 ± 402 vs 1242 ± 941 mL, P < .05) and decreased transfusions (0.33 ± 0.49 vs 1.47 ± 1.53 U, P < .01). Six-month angiographic vessel patency and major adverse cardiac events were similar in the hybrid and off-pump coronary artery bypass groups. A simultaneous hybrid approach consisting of minimally invasive coronary artery bypass grafting with left internal mammary artery to LAD combined with revascularization of the remaining coronary targets using percutaneous coronary artery

  14. [Coronary microvascular dysfunction : Clinical aspects, diagnosis and therapy].

    PubMed

    Ong, P; Sechtem, U

    2016-06-01

    Just as in epicardial coronary stenosis, coronary microvascular dysfunction (CMD) also leads to an imbalance of myocardial oxygen supply and demand. The dysfunction is located at the level of the coronary microcirculation with vessel diameters < 500 µm and structural as well as functional alterations have been described. The underlying mechanisms are diverse, frequently overlap and are still incompletely understood. Among others, conditions such as chronic inflammation, estrogen deficiency and a genetic familial predisposition have been reported. A common and often underdiagnosed clinical manifestation of CMD is found in patients who have symptoms of angina pectoris but no obstructive epicardial coronary artery disease or myocardial disease. The CMD can be diagnosed using non-invasive procedures, such as the combination of coronary computed tomography (CT) angiography and cardiac stress magnetic resonance imaging (MRI) or coronary CT and positron emission tomography (PET). In addition, invasive coronary vasomotor assessment is also suitable. Very little evidence is available regarding the effectiveness of pharmacological treatment of CMD. The current European Society of Cardiology (ESC) guidelines on the management of stable coronary artery disease from 2013 recommend using acetylsalicylic acid (ASS) and a statin as well as beta blockers and/or calcium channel blockers. Patients with CMD have an elevated risk for coronary events and death of approximately 1.7 % per year. Moreover, there is an increased morbidity with frequent presentations in practices and emergency admissions. Clinical research efforts should aim at a better characterization of the underlying mechanisms of CMD in order to develop targeted treatment approaches. PMID:27255117

  15. Off-pump minimally invasive direct coronary artery bypass in patients with cosmetic prosthesis for pectus excavatum.

    PubMed

    Massi, Francesco; Manca, Mario; Muretti, Mirko; Portoghese, Michele

    2016-08-01

    Pectus excavatum can be associated with coronary artery diseases that can become difficult to manage in urgent situations. We describe the use of an off-pump minimally invasive direct coronary artery bypass (MIDCAB) through the fourth intercostal space incision in a patient with pectus excavatum and acute coronary syndrome who previously underwent a cosmetic prosthesis implantation. The patient refused any surgical procedure that could compromise the integrity of his cosmetic prosthesis and a left mini-thoracotomy was a good option to avoid the removal of the prosthesis. The preservation of the integrity of the thoracic cage enhanced chest wall stability and pulmonary function and permitted avoidance of inadvertent cardiac structure iatrogenic injuries. MIDCAB was optimal for the exposure of the left internal thoracic artery and the left anterior descending artery. The deformity of the chest should not be considered as an absolute contraindication to off-pump MIDCAB when other surgical options are not viable, even in emergency situations. PMID:27170745

  16. Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting

    PubMed Central

    Gong, Wenhui; Cai, Junfeng; Wang, Zhe; Chen, Anqing; Ye, Xiaofeng; Li, Haiqing

    2016-01-01

    Background Robot-assisted coronary artery bypass grafts (RACAB) utilizing the da Vinci surgical system are increasingly used and allow the surgeon to conveniently harvest internal mammary arteries (IMAs). The aim of this study was to compare the outcomes of off-pump RACAB and minimally invasive direct coronary artery bypass grafting (MIDCAB) in the short and medium term. Methods We performed a retrospective review of 132 patients with single- or multiple-vessel coronary artery disease who underwent minimally invasive off-pump CABG (OPCAB) between May 2009 and May 2014. The patients were divided into two groups based on the surgical approach, MIDCAB and RACAB group. The anastomosis of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) was performed as regular OPCAB through the incision on the beating heart using regular stabilization devices (Genzyme Corporation). The preoperative, intraoperative, postoperative, and follow-up data, including major adverse cardiac and cerebrovascular events (MACCE), were compared. Results The preoperative data were similar. RACAB significantly shorten the intensive care unit (ICU) stay and postoperative compared with the MIDCAB group (P<0.05). There were 12 (19.7%) patients treated with a two-stage hybrid procedure in the MIDCAB group and 34 (47.9%) patients in the RACAB group (P=0.001). Thirty-day mortality was 1.6% in the MIDCAB group. There were 9 (14.7%) MIDCAB patients and 2 (2.8%) RACAB patients (P=0.013) that developed new arrhythmia. The two groups showed comparable mid-term survival (P=0.246), but the MACCEs were significantly different (P=0.038). Conclusions RACAB may be a valuable alternative for patients requiring single or simple multi-vessel coronary artery bypass grafting (CABG). Although the mid-term mortality outcomes are similar, RACAB improves short-term outcomes and mid-term MACCE-free survival compared with MIDCAB. PMID:27076941

  17. Non-invasive evaluation of coronary artery bypass grafts using multi-slice computed tomography: initial clinical experience.

    PubMed

    Burgstahler, Christof; Kuettner, Axel; Kopp, Andreas F; Herdeg, Christian; Martensen, Jens; Claussen, Claus D; Schroeder, Stephen

    2003-08-01

    Recurrence of angina pectoris in patients with previous coronary artery bypass graft (CABG) surgery due to severe coronary artery disease (CAD) is a common problem. Non-invasive imaging of coronary artery bypass grafts by computed tomography was first described in the early 1980s. Meanwhile, multi-slice computed tomography (MSCT) is now available. This new technique allows detection of coronary lesions with good sensitivity and specificity due to continuous improvement and modification of this method. The aim of this study was to investigate whether stenosis or occlusion of CABG can be detected by MSCT. Ten consecutive male patients (mean age 61+/-9.1 years) with previous CABG surgery and 21 bypass grafts (14 venous grafts, seven arterial grafts) were included in this study. Conventional coronary angiography and MSCT angiography (MSCTA) were performed in all patients. MSCTA results were compared with coronary angiography in regard of visualization and lesion detection in CABG. The analysis of MSCTA was performed blinded to the angiographic results. It was found that 18 of 21 bypass grafts (86%) were analyzable by MSCTA: seven of 21 (33%) grafts showed a significant stenosis (>75%), while six of them were detected by MSCTA (sensitivity: 86%, positive predictive value: 0.75). Dissection of one arterial graft could not be evaluated by MSCTA. Twelve of 13 grafts without severe lesion showed no significant stenosis in MSCTA (negative predictive value: 0.86). All grafts without severe lesions by MSCT showed no significant lesion in X-ray angiography (specificity: 100%). MSCTA is a promising new method for the detection of lesions in coronary artery bypass grafts. However, these data based on a small number has to be reevaluated by larger studies. PMID:12957762

  18. A pilot study of prognostic value of non-invasive cardiac parameters for major adverse cardiac events in patients with acute coronary syndrome treated with percutaneous coronary intervention

    PubMed Central

    Yuan, Min-Jie; Pan, Ye-Sheng; Hu, Wei-Guo; Lu, Zhi-Gang; Zhang, Qing-Yong; Huang, Dong; Huang, Xiao-Li; Wei, Meng; Li, Jing-Bo

    2015-01-01

    The objective of this study was to determine the combination of left ventricular ejection fraction (LVEF) and individual electrocardiographic parameters related to abnormal depolarization/repolarization or baroreceptor sensitivity that had the best predictive value for major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS). Patients with ACS who underwent coronary angiography and percutaneous coronary intervention (PCI) were included in this prospective study. Ventricular late potential (VLP), heart rate turbulence (HRT), heart rate variability (HRV), and T wave alternans (TWA) parameters were measured using 24 h Holter monitoring 2-4 weeks after onset of ACS. Initial and follow-up LVEF was measured by ultrasound. Patients were followed for at least 6 months to record the occurrence of MACE. Models using combinations of the individual independent prognostic factors found by multivariate analysis were then constructed to use for estimation of risk of MACE. In multivariate analysis, VLP measured as QRS duration, HRV measured as standard deviation of normal RR intervals, and followup LVEF, but none of the other parameters studied, were independent risk factors for MACE. Areas under ROC curve (AUCs) for combinations of 2 or all 3 factors ranged from 0.73 to 0.76. Combinations of any of the three independent risk factors for MACE in ACS patients with PCI improved prediction and, because these risk factors were obtained non-invasively, may have future clinical usefulness. PMID:26885226

  19. [Vasomotor Endothelial Function in Healthy Individuals: Contact Types of Character].

    PubMed

    Kirichuk, V F; Olenko, E S; Kodochigova, A I; Barylnik, Y B; Deeva, M A; Bazhenov, V A

    2015-01-01

    We studied the vascular endothelial vasomotor function in healthy young individuals, depending on the type of character accentuation, levels of neuroticism, depression and anxiety. It is shown that the types of character accentuation effect on endothelial vasomotor function in healthy men and women. Personality characteristics of a person can be a significant risk factor for disease, the pathogenesis of which is the starting element of endothelial vasomotor dysfunction. PMID:26237954

  20. Effect of Low-Frame Invasive Coronary Angiography on Radiation and Image Quality.

    PubMed

    Ebrahimi, Ramin; Uberoi, Abhimanyu; Treadwell, Michelle; Sadrzadeh Rafie, Amir H

    2016-07-15

    Invasive coronary angiography (ICA) uses harmful x-ray energy. To date, there are no studies evaluating the effect of performing ICA at lower than the standard 15 frames per second (f/s) on radiation dose and image quality. In this study, we investigated the effect of performing ICAs at 7.5 f/s as opposed to the standard 15 f/s on radiation exposure and image quality. Thirty-nine patients referred for ICA for clinical indications were assigned to have their ICA performed at 7.5 f/s or 15 f/s in a 2:1 ratio, respectively. All studies were performed by one experienced operator in the same laboratory. Magnification, table height, collimation, number of images, and specific angles for image acquisition were kept constant to account for these variables that also effect radiation. Studies performed at 7.5 f/s had significantly less radiation exposure than those performed at 15 f/s (252.2 mGy vs 433.7 mGy, p <0.01). In addition, radiation per unit time was also significantly reduced in the 7.5 f/s versus the 15 f/s group (140.0 mGy/min vs 254.7 mGy/min, p <0.01). Image quality was evaluated by an experienced operator blinded to the goals of the study; allstudies were graded as good to excellent. In conclusion, performing ICA at 7.5 f/s versus 15 f/s significantly reduces x-ray exposure without compromising image quality. The results of this single-center study warrant a larger randomized clinical trial. PMID:27241835

  1. Non-invasive versus invasive management in patients with prior coronary artery bypass surgery with a non-ST segment elevation acute coronary syndrome: study design of the pilot randomised controlled trial and registry (CABG-ACS)

    PubMed Central

    Lee, Matthew M Y; Petrie, Mark C; Rocchiccioli, Paul; Simpson, Joanne; Jackson, Colette; Brown, Ammani; Corcoran, David; Mangion, Kenneth; McEntegart, Margaret; Shaukat, Aadil; Rae, Alan; Hood, Stuart; Peat, Eileen; Findlay, Iain; Murphy, Clare; Cormack, Alistair; Bukov, Nikolay; Balachandran, Kanarath; Papworth, Richard; Ford, Ian; Briggs, Andrew; Berry, Colin

    2016-01-01

    Introduction There is an evidence gap about how to best treat patients with prior coronary artery bypass grafts (CABGs) presenting with non-ST segment elevation acute coronary syndromes (NSTE-ACS) because historically, these patients were excluded from pivotal randomised trials. We aim to undertake a pilot trial of routine non-invasive management versus routine invasive management in patients with NSTE-ACS with prior CABG and optimal medical therapy during routine clinical care. Our trial is a proof-of-concept study for feasibility, safety, potential efficacy and health economic modelling. We hypothesise that a routine invasive approach in patients with NSTE-ACS with prior CABG is not superior to a non-invasive approach with optimal medical therapy. Methods and analysis 60 patients will be enrolled in a randomised clinical trial in 4 hospitals. A screening log will be prospectively completed. Patients not randomised due to lack of eligibility criteria and/or patient or physician preference and who give consent will be included in a registry. We will gather information about screening, enrolment, eligibility, randomisation, patient characteristics and adverse events (including post-discharge). The primary efficacy outcome is the composite of all-cause mortality, rehospitalisation for refractory ischaemia/angina, myocardial infarction and hospitalisation for heart failure. The primary safety outcome is the composite of bleeding, stroke, procedure-related myocardial infarction and worsening renal function. Health status will be assessed using EuroQol 5 Dimensions (EQ-5D) assessed at baseline and 6 monthly intervals, for at least 18 months. Trial registration number NCT01895751 (ClinicalTrials.gov). PMID:27110377

  2. [Thrombocyte function in vasomotor and migraine headaches].

    PubMed

    Grotemeyer, K H; Viand, R; Beykirch, K

    1983-05-20

    The number of circulating platelet aggregates was assessed using a modification of the method of Wu and Hoak. The index for the number of circulating aggregates was 1.04 +/- 0.12 for 35 healthy probands aged 35 +/- 11 years and was different from the index of 25 patients with vasomotor headache aged 37 +/- 14 years of 1.1 +/- 0.14 (P less than 0.1). The number of circulating platelet aggregates with an index of 1.38 +/- 0.24 was significantly higher (P less than 0.001) in 48 migraine patients aged 36 +/- 12 years. PMID:6840009

  3. Percutaneous transluminal coronary angioplasty (PTCA)

    MedlinePlus Videos and Cool Tools

    Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. The procedure ...

  4. Quantitative Upright–Supine High-Speed SPECT Myocardial Perfusion Imaging for Detection of Coronary Artery Disease: Correlation with Invasive Coronary Angiography

    PubMed Central

    Nakazato, Ryo; Tamarappoo, Balaji K.; Kang, Xingping; Wolak, Arik; Kite, Faith; Hayes, Sean W.; Thomson, Louise E.J.; Friedman, John D.; Berman, Daniel S.; Slomka, Piotr J.

    2011-01-01

    A recently developed camera system for high-speed SPECT (HS-SPECT) myocardial perfusion imaging shows excellent correlation with conventional SPECT. Our goal was to test the diagnostic accuracy of an automated quantification of combined upright and supine myocardial SPECT for detection of coronary artery disease (CAD) (≥70% luminal diameter stenosis or, in left main coronary artery, ≥50% luminal diameter stenosis) in comparison to invasive coronary angiography (ICA). Methods We studied 142 patients undergoing upright and supine HS-SPECT, including 56 consecutive patients (63% men; mean age 6 ± SD, 64 ± 13 y; 45% exercise stress) without known CAD who underwent diagnostic ICA within 6 mo of HS-SPECT and 86 consecutive patients with a low likelihood of CAD. Reference limits for upright and supine HS-SPECT were created from studies of patients with a low likelihood of CAD. Automated software adopted from supine–prone analysis was used to quantify the severity and extent of perfusion abnormality and was expressed as total perfusion deficit (TPD). TPD was obtained for upright (U-TPD), supine (S-TPD), and combined upright–supine acquisitions (C-TPD). Stress U-TPD ≥ 5%, S-TPD ≥ 5%, and C-TPD ≥ 3% myocardium were considered abnormal for per-patient analysis, and U-TPD, S-TPD, and C-TPD ≥ 2% in each coronary artery territory were considered abnormal for per-vessel analysis. Results On a per-patient basis, the sensitivity was 91%, 88%, and 94% for U-TPD, S-TPD, and C-TPD, respectively, and specificity was 59%, 73%, and 86% for U-TPD, S-TPD, and C-TPD, respectively. C-TPD had a larger area under the receiver-operating-characteristic curve than U-TPD or S-TPD for identification of stenosis ≥ 70% (0.94 vs. 0.88 and 0.89, P < 0.05 and not significant, respectively). On a per-vessel basis, the sensitivity was 67%, 66%, and 69% for U-TPD, S-TPD, and C-TPD, respectively, and specificity was 91%, 94%, and 97% for U-TPD, S-TPD, and C-TPD, respectively (P = 0

  5. Intracoronary Delivery of Human Mesenchymal/Stromal Stem Cells: Insights from Coronary Microcirculation Invasive Assessment in a Swine Model

    PubMed Central

    Fiarresga, António; Mata, Márcia F.; Cavaco-Gonçalves, Sandra; Selas, Mafalda; Simões, Irina N.; Oliveira, Eunice; Carrapiço, Belmira; Cardim, Nuno; Cabral, Joaquim M. S.; Ferreira, Rui Cruz; da Silva, Cláudia L.

    2015-01-01

    Background Mesenchymal stem/stromal cells have unique properties favorable to their use in clinical practice and have been studied for cardiac repair. However, these cells are larger than coronary microvessels and there is controversy about the risk of embolization and microinfarctions, which could jeopardize the safety and efficacy of intracoronary route for their delivery. The index of microcirculatory resistance (IMR) is an invasive method for quantitatively assessing the coronary microcirculation status. Objectives To examine heart microcirculation after intracoronary injection of mesenchymal stem/stromal cells with the index of microcirculatory resistance. Methods Healthy swine were randomized to receive by intracoronary route either 30x106 MSC or the same solution with no cells (1% human albumin/PBS) (placebo). Blinded operators took coronary pressure and flow measurements, prior to intracoronary infusion and at 5 and 30 minutes post-delivery. Coronary flow reserve (CFR) and the IMR were compared between groups. Results CFR and IMR were done with a variance within the 3 transit time measurements of 6% at rest and 11% at maximal hyperemia. After intracoronary infusion there were no significant differences in CFR. The IMR was significantly higher in MSC-injected animals (at 30 minutes, 14.2U vs. 8.8U, p = 0.02) and intragroup analysis showed a significant increase of 112% from baseline to 30 minutes after cell infusion, although no electrocardiographic changes or clinical deterioration were noted. Conclusion Overall, this study provides definitive evidence of microcirculatory disruption upon intracoronary administration of mesenchymal stem/stromal cells, in a large animal model closely resembling human cardiac physiology, function and anatomy. PMID:26479722

  6. Comparison of Fractional Flow Reserve Based on Computational Fluid Dynamics Modeling Using Coronary Angiographic Vessel Morphology Versus Invasively Measured Fractional Flow Reserve.

    PubMed

    Tröbs, Monique; Achenbach, Stephan; Röther, Jens; Redel, Thomas; Scheuering, Michael; Winneberger, David; Klingenbeck, Klaus; Itu, Lucian; Passerini, Tiziano; Kamen, Ali; Sharma, Puneet; Comaniciu, Dorin; Schlundt, Christian

    2016-01-01

    Invasive fractional flow reserve (FFRinvasive), although gold standard to identify hemodynamically relevant coronary stenoses, is time consuming and potentially associated with complications. We developed and evaluated a new approach to determine lesion-specific FFR on the basis of coronary anatomy as visualized by invasive coronary angiography (FFRangio): 100 coronary lesions (50% to 90% diameter stenosis) in 73 patients (48 men, 25 women; mean age 67 ± 9 years) were studied. On the basis of coronary angiograms acquired at rest from 2 views at angulations at least 30° apart, a PC-based computational fluid dynamics modeling software used personalized boundary conditions determined from 3-dimensional reconstructed angiography, heart rate, and blood pressure to derive FFRangio. The results were compared with FFRinvasive. Interobserver variability was determined in a subset of 25 narrowings. Twenty-nine of 100 coronary lesions were hemodynamically significant (FFRinvasive ≤ 0.80). FFRangio identified these with an accuracy of 90%, sensitivity of 79%, specificity of 94%, positive predictive value of 85%, and negative predictive value of 92%. The area under the receiver operating characteristic curve was 0.93. Correlation between FFRinvasive (mean: 0.84 ± 0.11) and FFRangio (mean: 0.85 ± 0.12) was r = 0.85. Interobserver variability of FFRangio was low, with a correlation of r = 0.88. In conclusion, estimation of coronary FFR with PC-based computational fluid dynamics modeling on the basis of lesion morphology as determined by invasive angiography is possible with high diagnostic accuracy compared to invasive measurements. PMID:26596195

  7. Myeloperoxidase deficiency preserves vasomotor function in humans

    PubMed Central

    Rudolph, Tanja K.; Wipper, Sabine; Reiter, Beate; Rudolph, Volker; Coym, Anja; Detter, Christian; Lau, Denise; Klinke, Anna; Friedrichs, Kai; Rau, Thomas; Pekarova, Michaela; Russ, Detlef; Knöll, Kay; Kolk, Mandy; Schroeder, Bernd; Wegscheider, Karl; Andresen, Hilke; Schwedhelm, Edzard; Boeger, Rainer; Ehmke, Heimo; Baldus, Stephan

    2012-01-01

    Aims Observational studies have suggested a mechanistic link between the leucocyte-derived enzyme myeloperoxidase (MPO) and vasomotor function. Here, we tested whether MPO is systemically affecting vascular tone in humans. Methods and results A total of 12 135 patients were screened for leucocyte peroxidase activity. We identified 15 individuals with low MPO expression and activity (MPOlow), who were matched with 30 participants exhibiting normal MPO protein content and activity (control). Nicotine-dependent activation of leucocytes caused attenuation of endothelial nitric oxide (NO) bioavailability in the control group (P < 0.01), but not in MPOlow individuals (P = 0.12); here the MPO burden of leucocytes correlated with the degree of vasomotor dysfunction (P = 0.008). To directly test the vasoactive properties of free circulating MPO, the enzyme was injected into the left atrium of anaesthetized, open-chest pigs. Myeloperoxidase plasma levels peaked within minutes and rapidly declined thereafter, reflecting vascular binding of MPO. Blood flow in the left anterior descending artery and the internal mammary artery (IMA) as well as myocardial perfusion decreased following MPO injection when compared with albumin-treated animals (P < 0.001). Isolated IMA-rings from animals subjected to MPO revealed markedly diminished relaxation in response to acetylcholine (P < 0.01) and nitroglycerine as opposed to controls (P < 0.001). Conclusion Myeloperoxidase elicits profound effects on vascular tone of conductance and resistance vessels in vivo. These findings not only call for revisiting the biological functions of leucocytes as systemic and mobile effectors of vascular tone, but also identify MPO as a critical systemic regulator of vasomotion in humans and thus a potential therapeutic target. PMID:21724624

  8. Selective lobar blockade in minimally invasive coronary artery bypass grafting: A technical advantage in patients with low respiratory reserve that precludes one-lung ventilation.

    PubMed

    Agrawal, Dharmesh Radheshyam; Nambala, Sathyaki; Fartado, Arul

    2016-01-01

    Minimally invasive cardiac surgery/coronary artery bypass grafting (MICS CABG) is performed through a small 2 inch left thoracotomy incision. Lung isolation is must during MICS CABG. Oxygenation with one-lung ventilation can be difficult, especially during supine position. We report a case of a 53-year-old male patient who underwent MICS CABG with the selective lobar blockade. PMID:27397466

  9. Selective lobar blockade in minimally invasive coronary artery bypass grafting: A technical advantage in patients with low respiratory reserve that precludes one-lung ventilation

    PubMed Central

    Agrawal, Dharmesh Radheshyam; Nambala, Sathyaki; Fartado, Arul

    2016-01-01

    Minimally invasive cardiac surgery/coronary artery bypass grafting (MICS CABG) is performed through a small 2 inch left thoracotomy incision. Lung isolation is must during MICS CABG. Oxygenation with one-lung ventilation can be difficult, especially during supine position. We report a case of a 53-year-old male patient who underwent MICS CABG with the selective lobar blockade. PMID:27397466

  10. Comparison of Economic and Patient Outcomes With Minimally Invasive Versus Traditional Off-Pump Coronary Artery Bypass Grafting Techniques

    PubMed Central

    Poston, Robert S.; Tran, Richard; Collins, Michael; Reynolds, Marty; Connerney, Ingrid; Reicher, Barry; Zimrin, David; Griffith, Bartley P.; Bartlett, Stephen T.

    2009-01-01

    Background Minimally invasive coronary artery bypass grafting (miniCABG) decreases in-hospital morbidity versus traditional sternotomy CABG. We performed a prospective cohort study (NCT00481806) to assess the impact of miniCABG on costs and metrics that influence quality of life after hospital discharge. Methods One hundred consecutive miniCABG cases performed using IMA grafting ± coronary stenting were compared with a matched group of 100 sternotomy CABG patients using IMA and saphenous veins, both treating equivalent number of target coronaries (2.7 vs. 2.9), off-pump. We compared perioperative costs, time to return to work/normal activity, and risk of major adverse cardiac/cerebrovascular events (MACCE) at 1 year: myocardial infarction (elevated troponin or EKG changes), target vessel occlusion (CT angiography at 1 year), stroke, or death. Results For miniCABG, robotic instruments and stents increased intraoperative costs; postoperative costs were decreased from significantly less intubation time (4.80 ± 6.35 vs. 12.24 ± 6.24 hours), hospital stay (3.77 ± 1.51 vs. 6.38 ± 2.23 days), and transfusion (0.16 ± 0.37 vs. 1.37 ± 1.35 U) leading to no significant differences in total costs. Undergoing miniCABG independently predicted earlier return to work after adjusting for confounders (t = − 2.15; P = 0.04), whereas sternotomy CABG increased MACCE (HR, 3.9; 95% CI, 1.4 –7.6), largely from lower target-vessel patency. Conclusions MiniCABG shortens patient recovery time, minimizes MACCE risk at 1 year, and showed superior quality and outcome metrics versus standard-of-care CABG. These findings occurred without increasing costs and with superior target vessel graft patency. PMID:18936577

  11. A Hybrid Data Mining Model to Predict Coronary Artery Disease Cases Using Non-Invasive Clinical Data.

    PubMed

    Verma, Luxmi; Srivastava, Sangeet; Negi, P C

    2016-07-01

    Coronary artery disease (CAD) is caused by atherosclerosis in coronary arteries and results in cardiac arrest and heart attack. For diagnosis of CAD, angiography is used which is a costly time consuming and highly technical invasive method. Researchers are, therefore, prompted for alternative methods such as machine learning algorithms that could use noninvasive clinical data for the disease diagnosis and assessing its severity. In this study, we present a novel hybrid method for CAD diagnosis, including risk factor identification using correlation based feature subset (CFS) selection with particle swam optimization (PSO) search method and K-means clustering algorithms. Supervised learning algorithms such as multi-layer perceptron (MLP), multinomial logistic regression (MLR), fuzzy unordered rule induction algorithm (FURIA) and C4.5 are then used to model CAD cases. We tested this approach on clinical data consisting of 26 features and 335 instances collected at the Department of Cardiology, Indira Gandhi Medical College, Shimla, India. MLR achieves highest prediction accuracy of 88.4 %.We tested this approach on benchmarked Cleaveland heart disease data as well. In this case also, MLR, outperforms other techniques. Proposed hybridized model improves the accuracy of classification algorithms from 8.3 % to 11.4 % for the Cleaveland data. The proposed method is, therefore, a promising tool for identification of CAD patients with improved prediction accuracy. PMID:27286983

  12. Novel Non-invasive Estimation of Coronary Blood Flow using Contrast Advection in Computed Tomography Angiography

    NASA Astrophysics Data System (ADS)

    Eslami, Parastou; Seo, Jung-Hee; Rahsepar, Amirali; George, Richard; Lardo, Albert; Mittal, Rajat

    2014-11-01

    Coronary computed tomography angiography (CTA) is a promising tool for assessment of coronary stenosis and plaque burden. Recent studies have shown the presence of axial contrast concentration gradients in obstructed arteries, but the mechanism responsible for this phenomenon is not well understood. We use computational fluid dynamics to study intracoronary contrast dispersion and the correlation of concentration gradients with intracoronary blood flow and stenotic severity. Data from our CFD patient-specific simulations reveals that contrast dispersions are generated by intracoronary advection effects, and therefore, encode the coronary flow velocity. This novel method- Transluminal Attenuation Flow Encoding (TAFE) - is used to estimate the flowrate in phantom studies as well as preclinical experiments. Our results indicate a strong correlation between the values estimated from TAFE and the values measured in these experiments. The flow physics of contrast dispersion associated with TAFE will be discussed. This work is funded by grants from Coulter Foundation and Maryland Innovation Initiative. The authors have pending patents in this technology and RM and ACL have other financial interests associated with TAFE.

  13. Analysis of the invasive strategy decision in patients with acute coronary syndrome without ST-segment elevation in a real-world setting.

    PubMed

    De Abreu, Maximiliano; Mariani, Javier A; Silberstein, Alejandro; Guridi, Cristian; Hecht, Gabriela; Gagliardi, Juan A; Doval, Hernán C; Tajer, Carlos D

    2014-06-15

    Observational studies have reported a marked discrepancy between the risk estimated by scores and the use of an invasive strategy in patients with acute coronary syndromes. The objective is to describe the criteria used to decide an early invasive strategy and to determine the differences between those criteria and the thrombolysis in myocardial infarction risk score (TRS). Patients entered to the Epi-Cardio registry with a diagnosis of non-ST-elevation acute coronary syndrome were analyzed. A logistic regression model including variables associated with an early invasive strategy was developed and validated in 2 consecutive cohorts. The association between the TRS and the clinical decision model with an early invasive strategy was evaluated by receiver operating characteristic (ROC) curves. We included a total of 3,187 patients. In the derivation cohort, variables associated with an early invasive strategy were previous angioplasty (odds ratio [OR] 1.63), hypercholesterolemia (OR 1.36), ST changes (OR 1.49), elevated biomarkers (OR 1.42), catheterization laboratory availability (OR 1.7), recurrent angina (OR 3.45), age (OR 0.98), previous coronary bypass (OR 0.65), previous heart failure (OR 0.40), and heart rate at admission (OR 0.98). The areas under the ROC curves to predict invasive strategy were 0.55 for the TRS and 0.69 for the clinical decision model, p <0.0001. In the validation cohort, ROC areas were 0.58 and 0.70, respectively, p <0.0001. In conclusion, invasive strategy was guided by variables not completely included in risk scores. The clinical, evolutionary, and structural variables included in the model can explain, partially, the discordance existing between risk stratification and medical strategies. PMID:24793674

  14. Predictive Value of Endothelial Function by Non-invasive Peripheral Arterial Tonometry for Coronary Artery Disease

    PubMed Central

    Matsuzawa, Yasushi; Li, Jing; Aoki, Tatsuo; Guddeti, Raviteja R.; Kwon, Taek-Geun; Cilluffo, Rebecca; Widmer, R. Jay.; Gulati, Rajiv; Lennon, Ryan J.; Lerman, Lilach O.; Lerman, Amir

    2014-01-01

    Background Endothelial dysfunction is a key step in the initiation and progression of atherosclerosis and subsequent cardiovascular complications. We examined whether peripheral endothelial function, as assessed by fingertip reactive hyperemia-peripheral arterial tonometry (RH-PAT) can provide additional clinical value to traditional risk factors for cardiovascular diseases in predicting coronary artery disease (CAD). Methods We included 118 stable patients who were referred for coronary angiography for chest pain evaluation or abnormal stress test. A natural logarithmic value of RH-PAT index (Ln_RHI) was obtained before cardiac catheterization by an independent operator. Significant CAD was defined as luminal stenosis ≥70% (≥50% at left main) and/or fractional flow reserve ≤0.80 in one or more major coronary arteries or their major branches. Results Levels of Ln_RHI were significantly lower in patients with CAD (n=60) compared to patients without CAD (n=58) (0.69±0.29 vs. 0.88±0.27, p<0.001). Ln_RHI was significantly associated with CAD independent from traditional risk factors (odds ratio [OR] for 0.1 decrease in Ln_RHI 1.25, 95% confidence interval [CI] 1.04 to 1.52, p=0.01). The net reclassification index was improved when Ln_RHI was added to traditional risk factors (0.62, 95% CI: 0.27 to 0.97, p=0.001). Conclusions Peripheral endothelial function, as assessed by RH-PAT, improved risk stratification when added to traditional risk factors. RH-PAT is potentially useful for identifying patients at high risk for CAD. PMID:25503420

  15. A novel method for non-invasive plaque morphology analysis by coronary computed tomography angiography.

    PubMed

    Fujimoto, Shinichiro; Kondo, Takeshi; Kodama, Takahide; Fujisawa, Yasuko; Groarke, John; Kumamaru, Kanako K; Takamura, Kazuhisa; Matsunaga, Eriko; Miyauchi, Katsumi; Daida, Hiroyuki; Rybicki, Frank J

    2014-10-01

    Coronary computed tomography angiography (CCTA) plaque morphology based on conventional Hounsfield units relies on absolute CT numbers is influenced by imaging and anatomical variables. The project describes and tests a novel alternative method, termed the "labeling method", which uses relative CT numbers and 3-dimensional plaque structure. Using virtual histology intravascular ultrasound (VH-IVUS) as the reference standard, this study compares the labeling method to a conventional CT-number based method to determine coronary plaque morphology. Thirty-seven high-risk, non-calcified atherosclerotic coronary lesions were prospectively evaluated in 33 consecutive patients who underwent CCTA followed by VH-IVUS (mean interval 8.6 ± 13.3 days). CCTA-derived vessel and minimum lumen areas were compared to VH-IVUS measures. Fibrotic and necrotic core areas were calculated by both the labeling method to the CT-number based method; both were tested for agreement with reference standard VH-IVUS. Inter- and intra-observer correlations were assessed. CCTA significantly underestimated minimum lumen area when compared to VH-IVUS (mean difference -1.4 ± 0.9 mm(2), p < 0.0001). Necrotic core and fibrous areas quantified using the labeling method demonstrated superior correlation with VH-IVUS compared to those quantified using the CT-number based method, Pearson's r = 0.75 versus 0.42 and r = 0.80 and 0.59, respectively. Compared to VH-IVUS, limits of agreement for the labeling method-derived necrotic core (-2.0 to 2.5 mm(2)) and fibrous areas (0.6-8.0 mm(2)) were more narrow than those determined using the CT-number based method (-3.7 to 7.3 and -4.0 to 8.9 mm(2), respectively). Inter- and intraobserver correlations were excellent for all CCTA derived measures (r = 0.85-0.98). A novel CCTA-based labeling method offers an alternative to conventional CT-number based analyses for plaque morphology. The labeling method demonstrates superior correlation to VH-IVUS for measures of

  16. Health economic analysis of ticagrelor in patients with acute coronary syndromes intended for non-invasive therapy

    PubMed Central

    Janzon, M; James, S; Cannon, C P; Storey, R F; Mellström, C; Nicolau, J C; Wallentin, L; Henriksson, M

    2015-01-01

    Objective To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management. Methods A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and health-related quality of life under treatment with either ticagrelor or clopidogrel over 12 months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems. Results Ticagrelor was associated with lifetime quality-adjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of €467, €551, €739 and €574, respectively. The cost per QALY gained with ticagrelor was €2747, €3395, €4419 and €4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability. Conclusions Treatment of patients with ACS scheduled for 12 months’ non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel. Trial registration number NCT000391872. PMID:25227704

  17. Complex stenosis morphology and vasomotor responses to inhibition of nitric oxide synthesis

    PubMed Central

    Tousoulis, D; Tentolouris, C; Crake, T; Goumas, G; Stefanadis, C; Toutouzas, P; Davies, G

    2000-01-01

    OBJECTIVE—To assess the relation between coronary vasomotor effects of NG-monomethyl-L-arginine (LNMMA) administration and coronary stenosis morphology, length, and severity in patients with stable angina.
DESIGN—In 28 patients (24 male, four female) with coronary artery disease and chronic stable angina, intracoronary normal saline and 4 µmol/min LNMMA were infused for four minutes each, followed by an intracoronary bolus of 250 µg glyceryl trinitrate. Coronary stenoses were classified as concentric (smooth), eccentric (smooth), or complicated (irregular). The diameters of these stenoses and their adjacent reference proximal segments were measured by quantitative angiography.
RESULTS—During LNMMA infusion a significantly larger proportion of complicated stenoses than concentric and eccentric stenoses constricted by ⩾ 5% (p < 0.01) and the magnitude of vasoconstriction was greater in complicated than in concentric and eccentric stenoses (p < 0.05). For complicated stenoses the magnitude of constriction (in mm) with reference to normal saline was greater than that of the concentric and eccentric stenoses (p < 0.05), whereas concentric and eccentric stenoses constricted similarly. Irrespective of the type of morphology, there was a correlation (p < 0.05) between both the severity and the length of stenoses and the magnitude of vasoconstriction to LNMMA. A similar proportion of concentric, eccentric, and complicated stenoses showed ⩾ 5% increase in diameter with glyceryl trinitrate, and the magnitude of the response was similar in the three groups.
CONCLUSIONS—In patients with coronary artery disease, the response to LNMMA is greater when stenosis morphology is complex, indicating greater nitric oxide activity. This provides further evidence that plaques with complex morphology are in an active state.


Keywords: endothelium; nitric oxide; coronary artery disease; stenosis morphology PMID:11040015

  18. Central chemoreceptors and sympathetic vasomotor outflow

    PubMed Central

    Moreira, Thiago S; Takakura, Ana C; Colombari, Eduardo; Guyenet, Patrice G

    2006-01-01

    The present study explores how elevations in brain PCO2 increase the sympathetic nerve discharge (SND). SND, phrenic nerve discharge (PND) and putative sympathoexcitatory vasomotor neurons of the rostral ventrolateral medulla (RVLM) were recorded in anaesthetized sino-aortic denervated and vagotomized rats. Hypercapnia (end-expiratory CO2 from 5% to 10%) increased SND (97 ± 6%) and the activity of RVLM neurons (67 ± 4%). Injection of kynurenic acid (Kyn, ionotropic glutamate receptor antagonist) into RVLM or the retrotrapezoid nucleus (RTN) eliminated or reduced PND, respectively, but did not change the effect of CO2 on SND. Bilateral injection of Kyn or muscimol into the rostral ventral respiratory group (rVRG-pre-Bötzinger region, also called CVLM) eliminated PND while increasing the stimulatory effect of CO2 on SND. Muscimol injection into commissural part of the solitary tract nucleus (commNTS) had no effect on PND or SND activation by CO2. As expected, injection of Kyn into RVLM or muscimol into commNTS virtually blocked the effect of carotid body stimulation on SND in rats with intact carotid sinus nerves. In conclusion, CO2 increases SND by activating RVLM sympathoexcitatory neurons. The relevant central chemoreceptors are probably located within or close to RVLM and not in the NTS or in the rVRG-pre-Bötzinger/CVLM region. RVLM sympathoexcitatory neurons may be intrinsically pH-sensitive and/or receive excitatory synaptic inputs from RTN chemoreceptors. Activation of the central respiratory network reduces the overall sympathetic response to CO2, presumably by activating barosensitive CVLM neurons and inhibiting RTN chemoreceptors. PMID:16901945

  19. Trends in P2Y12 Inhibitor Use in Patients Referred for Invasive Evaluation of Coronary Artery Disease in Contemporary US Practice.

    PubMed

    Fan, Weihong; Plent, Stephanie; Prats, Jayne; Deliargyris, Efthymios N

    2016-05-01

    Practice in patients undergoing invasive evaluation for coronary artery disease is variable regarding choice of P2Y12 inhibitor and timing of treatment initiation and is usually dictated by institutional or even individual operator preference. Limited data are available on the actual patterns of P2Y12 inhibitor use in contemporary practice in the United States. We used electronic medical records from the Cerner "Health Facts" database of adults who underwent coronary angiography with or without percutaneous coronary intervention (PCI) from January 2008 to June 2013 and who received a loading dose of clopidogrel, prasugrel, or ticagrelor at any time from 48 hours before the start of procedure up to 6 hours after. Timing of P2Y12 inhibitor administration was categorized as >2 hours before, 0 to 2 hours before (pretreatment groups), or after the start of procedure. Results were also evaluated according to type of P2Y12 inhibitor and patient clinical presentation. A total of 37,964 patients underwent coronary angiography, and 28,306 proceeded to PCI. Pretreatment with a P2Y12 inhibitor was observed in 28% and 23% in the overall and PCI populations, respectively. Moderate variability of pretreatment rates was noted relative to clinical presentation and P2Y12 inhibitor type. Pretreatment rates remained fairly constant over time with the exception of a decreasing trend with prasugrel. In conclusion, among patients referred for invasive evaluation of coronary artery disease, P2Y12 inhibitor pretreatment was low in contemporary US practice, an observation consistent over time and for all available agents and clinical presentations. PMID:27001447

  20. Image quality and diagnostic accuracy of non-invasive coronary imaging with 16 detector slice spiral computed tomography with 188 ms temporal resolution

    PubMed Central

    Kuettner, A; Beck, T; Drosch, T; Kettering, K; Heuschmid, M; Burgstahler, C; Claussen, C D; Kopp, A F; Schroeder, S

    2005-01-01

    Objective: To evaluate image quality and clinical accuracy in detecting coronary artery lesions with a new multidetector spiral computed tomography (MDCT) generation with 16 detector slices and a temporal resolution of 188 ms. Methods: 124 consecutive patients scheduled for invasive coronary angiography (ICA) were additionally studied by MDCT (Sensation 16 Speed 4D). MDCTs were analysed with regard to image quality and presence of coronary artery lesions. The results were compared with ICA. Results: 120 of 124 scans were successful. The image quality of all remaining 120 scans was sufficient (mean (SD) heart rate 64.2 (9.8) beats/min, range 43–95). The mean calcium mass was 167 (223) mg (range 0–1038). Thirteen coronary segments were evaluated for each patient (1560 segments in total). Image quality was graded as follows: excellent, 422 (27.1%) segments; good, 540 (34.6%) segments; moderate, 277 (17.7%) segments; heavily calcified, 215 (13.8%) segments; and blurred, 106 (6.8%) segments. ICA detected 359 lesions with a diameter stenosis > 50% and MDCT detected 304 of 359 (85%). Sensitivity, specificity, and positive and negative predictive values were 85%, 98%, 91%, and 96%, respectively. The correct clinical diagnosis (presence or absence of at least one stenosis > 50%) was obtained for 110 of 120 (92%) patients. Conclusions: MDCT image quality can be further improved with 16 slices and faster gantry rotation time. These results in an unselected population underline the potential of MDCT to become a non-invasive diagnostic alternative, especially for the exclusion of coronary artery disease, in the near future. PMID:15958366

  1. Reduced cerebral vasomotor reactivity as an indicator of postoperative confusion.

    PubMed

    Kessler, C; Junge, H M; Walker, M L; Busack, R; Albrecht, D M; von Ackeren, K

    1997-05-01

    Surgical intervention in elderly patients carries a high risk. A frequent problem with surgery in these patients is the occurrence of a temporary confusional state, which increases both the risk of postoperative complications and the need for intensive care. We hypothesised that, in part, temporary confusional state results from cerebral hypoxia occurring in response to blood pressure fluctuations during surgery. To assess whether disruption of autoregulation of cerebral blood vessels plays a role in temporary confusional state, we studied 31 patients over 55 years of age, using the Doppler-carbon dioxide test. We determined whether vasomotor reactivity could be used diagnostically to identify those patients most likely to experience temporary confusional state. Blood flow velocity in the middle cerebral artery was detected using Doppler ultrasound, and hypercapnia was induced by breathing carbon dioxide until an end-tidal concentration of 8.0% by volume was reached. Vasomotor reactivity was calculated on the basis of the changes in blood flow velocity in response to the increase in carbon dioxide. Temporary confusional state was assessed using the Syndrome Short Test (Syndrom-Kurztest). We found that resting blood flow velocity was inversely related to age (p < 0.05). In addition, there was a significant inverse correlation between vasomotor reactivity and temporary confusional state (p < 0.05). These data indicate that vasomotor reactivity, as measured by the Doppler-carbon dioxide test, is a reliable tool to identify patients at risk for postoperative psychological disturbances. PMID:9165961

  2. The Collagen-Binding Protein Cnm Is Required for Streptococcus mutans Adherence to and Intracellular Invasion of Human Coronary Artery Endothelial Cells ▿

    PubMed Central

    Abranches, Jacqueline; Miller, James H.; Martinez, Alaina R.; Simpson-Haidaris, Patricia J.; Burne, Robert A.; Lemos, José A.

    2011-01-01

    Streptococcus mutans is considered the primary etiologic agent of dental caries, a global health problem that affects 60 to 90% of the population, and a leading causative agent of infective endocarditis. It can be divided into four different serotypes (c, e, f, and k), with serotype c strains being the most common in the oral cavity. In this study, we demonstrate that in addition to OMZ175 and B14, three other strains (NCTC11060, LM7, and OM50E) of the less prevalent serotypes e and f are able to invade primary human coronary artery endothelial cells (HCAEC). Invasive strains were also significantly more virulent than noninvasive strains in the Galleria mellonella (greater wax worm) model of systemic disease. Interestingly, the invasive strains carried an additional gene, cnm, which was previously shown to bind to collagen and laminin in vitro. Inactivation of cnm rendered the organisms unable to invade HCAEC and attenuated their virulence in G. mellonella. Notably, the cnm knockout strains did not adhere to HCAEC as efficiently as the parental strains did, indicating that the loss of the invasion phenotype observed for the mutants was linked to an adhesion defect. Comparisons of the invasive strains and their respective cnm mutants did not support a correlation between biofilm formation and invasion. Thus, Cnm is required for S. mutans invasion of endothelial cells and possibly represents an important virulence factor of S. mutans that may contribute to cardiovascular infections and pathologies. PMID:21422186

  3. Endothelial dysfunction and progressive coronary atherosclerosis: sequential invasive studies in a patient with multiple cardiac risk factors.

    PubMed

    Chander, R; Kuhner, P A; Laws Houghton, J

    2001-08-01

    This manuscript describes sequential angiographic, endothelial and vasoreactivity characteristics of the coronary arterial circulation in a middle-aged patient with multiple cardiac risk factors who developed hemodynamically significant coronary atherosclerosis over a 6-year period. A 56-year-old woman demonstrated marked angiographic progression of coronary atherosclerosis over time beginning with minor luminal irregularities in the setting of severe endothelial dysfunction. The association of endothelial dysfunction, ineffective cardiac risk factor management and progressive atherosclerosis is discussed. PMID:11481511

  4. Beyond frequency: who is most bothered by vasomotor symptoms?

    PubMed Central

    Thurston, Rebecca C.; Bromberger, Joyce T.; Joffe, Hadine; Avis, Nancy E.; Hess, Rachel; Crandall, Carolyn J.; Chang, Yuefang; Green, Robin; Matthews, Karen A.

    2010-01-01

    Objective Most menopausal women report vasomotor symptoms (hot flashes, night sweats). However, not all women with vasomotor symptoms, including frequent symptoms, are bothered by them. The primary aim was to identify correlates of vasomotor symptom bother beyond symptom frequency. Design The Study of Women’s Health Across the Nation participants reporting vasomotor symptoms at annual visit 7 comprised the sample (N = 1,042). Assessments included hot flash and night sweats frequency (number per week) and bother (1, not at all– 4, very much). Negative affect (index of depressive symptoms, anxiety, perceived stress, negative mood), symptom sensitivity, sleep problems, and vasomotor symptom duration (number of years) were examined cross-sectionally in relation to bother in ordinal logistic regression models with symptom frequency and covariates. Hot flashes and night sweats were considered separately. Results In multivariable models controlling for hot flash frequency, negative affect (odds ratio [OR] = 1.27, 95% CI: 1.08–1.51), symptom sensitivity (OR = 1.18, 95% CI: 1.03–1.37), sleep problems (OR = 1.38, 95% CI: 1.04–1.85), poorer health (OR = 1.24, 95% CI: 1.03–1.48), duration of hot flashes (OR = 1.14, 95% CI: 1.06–1.23), younger age (OR = 0.94, 95% CI: 0.89–0.99), and African American race (vs white, OR = 1.59, 95% CI: 1.12–2.26) were associated with hot flash bother. After controlling for night sweats frequency and covariates, sleep problems (OR = 1.84, 95% CI: 1.33–2.55) and night sweats duration (OR = 1.10, 95% CI: 1.02–1.20) were associated with night sweats bother. Conclusions Beyond frequency, factors associated with bothersome hot flashes include mood, symptom sensitivity, symptom duration, sleep problems, age, and race. Correlates of bothersome night sweats include sleep problems and symptom duration. In addition to reducing frequency, interventions for vasomotor symptoms might consider addressing modifiable factors related to

  5. Qigong Effects on Heart Rate Variability and Peripheral Vasomotor Responses.

    PubMed

    Chang, Mei-Ying

    2015-11-01

    Population aging is occurring worldwide, and preventing cardiovascular event in older people is a unique challenge. The aim of this study was to examine the effects of a 12-week qigong (eight-form moving meditation) training program on the heart rate variability and peripheral vasomotor response of middle-aged and elderly people in the community. This was a quasi-experimental study that included the pre-test, post-test, and nonequivalent control group designs. Seventy-seven participants (experimental group = 47; control group = 30) were recruited. The experimental group performed 30 min of eight-form moving meditation 3 times per week for 12 weeks, and the control group continued their normal daily activities. After 12 weeks, the interaction effects indicated that compared with the control group, the experimental group exhibited significantly improved heart rate variability and peripheral vasomotor responses. PMID:24869492

  6. Evaluation of skin vasomotor reflexes by using laser Doppler velocimetry.

    PubMed

    Low, P A; Neumann, C; Dyck, P J; Fealey, R D; Tuck, R R

    1983-09-01

    We used a laser Doppler velocimeter for measurement of skin blood flow in 63 healthy control subjects and in patients with dysautonomias. We measured vasoconstrictor responses to inspiratory gasp, standing, Valsalva maneuver, and cold stimulus. An abnormal profile was defined in terms of the percentage of abnormal test results, the results of individual tests, and the alterations in the shape of the recorded response. These measurements of vasomotor function may permit the diagnosis of focal abnormalities of peripheral nerve sympathetic failure. PMID:6310277

  7. Quantitative parameters to compare image quality of non-invasive coronary angiography with 16-slice, 64-slice and dual-source computed tomography.

    PubMed

    Burgstahler, Christof; Reimann, Anja; Brodoefel, Harald; Daferner, Ulrike; Herberts, Tina; Tsiflikas, Ilias; Thomas, Christoph; Drosch, Tanja; Schroeder, Stephen; Heuschmid, Martin

    2009-03-01

    Multi-slice computed tomography (MSCT) is a non-invasive modality to visualize coronary arteries with an overall good image quality. Improved spatial and temporal resolution of 64-slice and dual-source computed tomography (DSCT) scanners are supposed to have a positive impact on diagnostic accuracy and image quality. However, quantitative parameters to compare image quality of 16-slice, 64-slice MSCT and DSCT are missing. A total of 256 CT examinations were evaluated (Siemens, Sensation 16: n = 90; Siemens Sensation 64: n = 91; Siemens Definition: n = 75). Mean Hounsfield units (HU) were measured in the cavum of the left ventricle (LV), the ascending aorta (Ao), the left ventricular myocardium (My) and the proximal part of the left main (LM), the left anterior descending artery (LAD), the right coronary artery (RCA) and the circumflex artery (CX). Moreover, the ratio of intraluminal attenuation (HU) to myocardial attenuation was assessed for all coronary arteries. Clinical data [body mass index (BMI), gender, heart rate] were accessible for all patients. Mean attenuation (CA) of the coronary arteries was significantly higher for DSCT in comparison to 64- and 16-slice MSCT within the RCA [347 +/- 13 vs. 254 +/- 14 (64-MSCT) vs. 233 +/- 11 (16-MSCT) HU], LM (362 +/- 11/275 +/- 12/262 +/- 9), LAD (332 +/- 17/248 +/- 19/219 +/- 14) and LCX (310 +/- 12/210 +/- 13/221 +/- 10, all p < 0.05), whereas there was no significant difference between DSCT and 64-MSCT for the LV, the Ao and My. Heart rate had a significant impact on CA ratio in 16-slice and 64-slice CT only (p < 0.05). BMI had no impact on the CA ratio in DSCT only (p < 0.001). Improved spatial and temporal resolution of dual-source CT is associated with better opacification of the coronary arteries and a better contrast with the myocardium, which is independent of heart rate. In comparison to MSCT, opacification of the coronary arteries at DSCT is not affected by BMI. The main advantage of DSCT lies with the

  8. Assessment of coronary thrombolysis

    SciTech Connect

    Geltman, E.M.; Abendschein, D.R.; Devries, S.R.

    1987-02-01

    The efficacy of coronary thrombolysis may be assessed by several invasive and noninvasive means, including coronary angiography, contrast and radionuclide angiography, thallium 201 or /sup 99m/Tc-pyrophosphate scintigraphy, positron emission tomography, cardiac ultrasonography, electrocardiography, and analysis of plasma creatine kinase activity. Each technique has its own strengths and limitations, but when used in concert these methods may provide insight into the physiology of coronary reperfusion and the efficacy of reperfusion in individual patients and populations. 104 references.

  9. Temporal trends in the use of invasive cardiac procedures for non-ST segment elevation acute coronary syndromes according to initial risk stratification

    PubMed Central

    Jedrzkiewicz, Sean; Goodman, Shaun G; Yan, Raymond T; Welsh, Robert C; Kornder, Jan; DeYoung, J Paul; Wong, Graham C; Rose, Barry; Grondin, François R; Gallo, Richard; Huang, Wei; Gore, Joel M; Yan, Andrew T

    2009-01-01

    BACKGROUND: Current guidelines support an early invasive strategy in the management of high-risk non-ST elevation acute coronary syndromes (NSTE-ACS). Although studies in the 1990s suggested that high-risk patients received less aggressive treatment, there are limited data on the contemporary management patterns of NSTE-ACS in Canada. OBJECTIVE: To examine the in-hospital use of coronary angiography and revascularization in relation to risk among less selected patients with NSTE-ACS. METHODS: Data from the prospective, multicentre Global Registry of Acute Coronary Events (main GRACE and expanded GRACE2) were used. Between June 1999 and September 2007, 7131 patients from across Canada with a final diagnosis of NSTE-ACS were included the study. The study population was stratified into low-, intermediate- and high-risk groups, based on their calculated GRACE risk score (a validated predictor of in-hospital mortality) and according to time of enrollment. RESULTS: While rates of in-hospital death and reinfarction were significantly (P<0.001) greater in higher-risk patients, the in-hospital use of cardiac catheterization in low- (64.7%), intermediate- (60.3%) and high-risk (42.3%) patients showed an inverse relationship (P<0.001). This trend persisted despite the increase in the overall rates of cardiac catheterization over time (47.9% in 1999 to 2003 versus 51.6% in 2004 to 2005 versus 63.8% in 2006 to 2007; P<0.001). After adjusting for confounders, intermediate-risk (adjusted OR 0.80 [95% CI 0.70 to 0.92], P=0.002) and high-risk (adjusted OR 0.38 [95% CI 0.29 to 0.48], P<0.001) patients remained less likely to undergo in-hospital cardiac catheterization. CONCLUSION: Despite the temporal increase in the use of invasive cardiac procedures, they remain paradoxically targeted toward low-risk patients with NSTE-ACS in contemporary practice. This treatment-risk paradox needs to be further addressed to maximize the benefits of invasive therapies in Canada. PMID:19898699

  10. Critical appraisal of paroxetine for the treatment of vasomotor symptoms

    PubMed Central

    Carroll, Dana G; Lisenby, Katelin M; Carter, Tracy L

    2015-01-01

    Background Vasomotor symptoms (VMS), characterized by hot flashes and night sweats, are the most commonly reported symptoms associated with estrogen deficiency during menopause and occur in up to 70% of women. The goal of treatment is to reduce the frequency and severity of symptoms. Although hormone therapy (HT) is generally recommended as first-line treatment, it is not appropriate for all patients. Antidepressants, specifically selective serotonin reuptake inhibitors, have been evaluated and utilized internationally for alternative treatment for VMS. In 2013, paroxetine mesylate (Brisdelle®) received a US Food and Drug Administration-labeled indication for moderate-to-severe hot flashes, making it the first nonhormonal treatment for VMS associated with menopause. The objective of this review is to critically evaluate available clinical data regarding the efficacy and safety of paroxetine for the treatment of VMS in menopausal women. Methods MEDLINE, PubMed, and Google Scholar were searched using the keywords paroxetine, vasomotor symptoms, hot flashes, and menopause. Searches were limited to humans, English language, and clinical trial design with a primary outcome of hot flash/vasomotor changes. Results Paroxetine (hydrochloride and mesylate) has been associated with a 33%–67% reduction in hot flash frequency with 6–12 weeks of treatment compared to 13.7%–37.8% reductions with placebo in patients both with and without a history of breast cancer. It was also associated with significant reductions in hot flash severity. Benefits of treatment persisted through 24 weeks in the study of the longest duration. Most adverse effects reported were of mild-to-moderate severity, with improved tolerability associated with lower doses (7.5–12.5 mg/day). Conclusion Paroxetine is a safe and effective therapy for the treatment of VMS during menopause. Paroxetine (7.5–12.5 mg/day) should be considered a first-line therapy option for VMS in patients when HT is either

  11. Giant coronary aneurysm caused by Kawasaki disease: consistency between catheter angiography and electrocardiogram gated dual-source computed tomography angiography.

    PubMed

    Hwang, Eun-Ha; Ju, Jung-Ki; Cho, Min-Jung; Lee, Ji-Won; Lee, Hyoung-Doo

    2015-12-01

    We present the case of a 5-year-old child with coronary complications due to Kawasaki disease; this patient unintentionally underwent both dual-source computed tomography (DSCT) coronary angiography and invasive coronary angiographic examination in 2 months. This case highlights the strong consistency of the results between DSCT coronary angiography and invasive coronary angiography. Compared to conventional invasive coronary angiography, DSCT coronary angiography offered additional advantages such as minimal invasiveness and less radiation exposure. PMID:26770226

  12. Usefulness of MRI to Differentiate Between Temporary and Long-Term Coronary Artery Occlusion in a Minimally Invasive Model of Experimental Myocardial Infarction

    SciTech Connect

    Abegunewardene, Nico Vosseler, Markus; Gori, Tommaso; Hoffmann, Nico; Schmidt, Kai-Helge; Becker, Dietmar; Kreitner, Karl-Friedrich; Petersen, Steffen E.; Schreiber, Laura M.; Horstick, Georg; Muenzel, Thomas

    2009-09-15

    The surgical technique employed to determine an experimental ischemic damage is a major factor in the subsequent process of myocardial scar development. We set out to establish a minimally invasive porcine model of myocardial infarction using cardiac contrast-enhanced magnetic resonance imaging (ce-MRI) as the basic diagnostic tool. Twenty-seven domestic pigs were randomized to either temporary or permanent occlusion of the left anterior descending artery (LAD). Temporary occlusion was achieved by inflation of a percutaneous balloon in the left anterior descending artery directly beyond the second diagonal branch. Occlusion was maintained for 30 or 45 min, followed by reperfusion. Permanent occlusion was achieved via thrombin injection. Thirteen animals died peri- or postinterventionally due to arrhythmias. Fourteen animals survived the 30-min ischemia (four animals; group 1), the 45-min ischemia (six animals; group 2), or the permanent occlusion (4 animals; group 3). Coronary angiography and ce-MRI were performed 8 weeks after coronary occlusion to document the coronary flow grade and the size of myocardial scar tissue. The LAD was patent in all animals in groups 1 and 2, with normal TIMI flow; in group 3 animals, the LAD was totally occluded. Fibrosis of the left ventricle in group 1 (4.9 {+-} 4.4%; p = 0.008) and group 2 (9.4 {+-} 2.9%; p = 0.05) was significantly lower than in group 3 (14.5 {+-} 3.9%). Wall thickness of the ischemic area was significantly lower in group 3 versus group 1 and group 2 (2.9 {+-} 0.3, 5.9 {+-} 0.7, and 6.1 {+-} 0.7 mm; p = 0.005). The extent of late enhancement of the left ventricle was also significantly higher in group 3 (16.9 {+-} 2.1%) compared to group 1 (5.3 {+-} 5.4%; p = 0.003) and group 2 (9.7 {+-} 3.4%, p = 0.013). In conclusion, the present model of minimally invasive infarction coupled with ce-MRI may represent a useful alternative to the open chest model for studies of myocardial infarction and scar development.

  13. Heart bypass surgery - minimally invasive

    MedlinePlus

    ... in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass ... Thiele H, Neumann-Schniedewind P, Jacobs S, et al. Randomized comparison of minimally invasive direct coronary artery bypass ...

  14. Transauricular embolization of the rabbit coronary artery for experimental myocardial infarction: comparison of a minimally invasive closed-chest model with open-chest surgery

    PubMed Central

    2012-01-01

    Introduction To date, most animal studies of myocardial ischemia have used open-chest models with direct surgical coronary artery ligation. We aimed to develop a novel, percutaneous, minimally-invasive, closed-chest model of experimental myocardial infarction (EMI) in the New Zealand White rabbit and compare it with the standard open-chest surgical model in order to minimize local and systemic side-effects of major surgery. Methods New Zealand White rabbits were handled in conformity with the "Guide for the Care and Use of Laboratory Animals" and underwent EMI under intravenous anesthesia. Group A underwent EMI with an open-chest method involving surgical tracheostomy, a mini median sternotomy incision and left anterior descending (LAD) coronary artery ligation with a plain suture, whereas Group B underwent EMI with a closed-chest method involving fluoroscopy-guided percutaneous transauricular intra-arterial access, superselective LAD catheterization and distal coronary embolization with a micro-coil. Electrocardiography (ECG), cardiac enzymes and transcatheter left ventricular end-diastolic pressure (LVEDP) measurements were recorded. Surviving animals were euthanized after 4 weeks and the hearts were harvested for Hematoxylin-eosin and Masson-trichrome staining. Results In total, 38 subjects underwent EMI with a surgical (n = 17) or endovascular (n = 21) approach. ST-segment elevation (1.90 ± 0.71 mm) occurred sharply after surgical LAD ligation compared to progressive ST elevation (2.01 ± 0.84 mm;p = 0.68) within 15-20 min after LAD micro-coil embolization. Increase of troponin and other cardiac enzymes, abnormal ischemic Q waves and LVEDP changes were recorded in both groups without any significant differences (p > 0.05). Infarct area was similar in both models (0.86 ± 0.35 cm in the surgical group vs. 0.92 ± 0.54 cm in the percutaneous group;p = 0.68). Conclusion The proposed model of transauricular coronary coil embolization avoids thoracotomy and major

  15. Coronary angiography in rats using synchrotron radiation

    NASA Astrophysics Data System (ADS)

    Matsushita, S.; Hyodo, K.; Akishima, S.; Sato, F.; Imazuru, T.; Noma, M.; Hiramatsu, Y.; Shigeta, O.; Sakakibara, Y.

    2005-08-01

    Monochromatic X-rays obtained from synchrotron radiation (SR), provide a high-quality tool for medical imaging including, coronary angiography. To pursue higher resolution in experimental coronary angiography, a smaller visual field had seemed to be inevitable. However, there are cases in which whole coronary angiography is preferable in order to investigate such vasomotor activities as coronary vasospasm. To meet these requirements, we are trying to develop a new type of SR coronary angiography using Langendorff excised rat hearts. Experiments were performed at Photon Factory Accelerator Ring (PF-AR), High Energy Accelerator Research Organization (KEK), Japan. SR was obtained from a 6.5 GeV electron beam. The energy of the monochromatic X-rays was 33.3 keV, which is just above the K-edge energy of iodine. Iodine (35%) was infused as a contrast material to the aorta at the rate of 1 ml/min for 1 s. In the image obtained from coronary angiography, the resolution was 13 μm and the width of the visual field 26 mm×26 mm. Whole heart coronary vasculature identifying small arteries down to those 100 μm in diameter was obtained in beating hearts. Arteries as small as 50 μm were identified in arrested hearts. This method of SR coronary angiography is useful for the investigation of whole coronary configurations simultaneously in one visual field to the level of microvasculature.

  16. Association of Vasomotor and Other Menopausal Symptoms with Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis

    PubMed Central

    Colpani, Veronica; Kunutsor, Setor; Chowdhury, Susmita; Chowdhury, Rajiv

    2016-01-01

    Importance Vasomotor symptoms (hot flushes and night sweats) and other symptoms, including depression, anxiety and panic attacks, are commonly experienced by menopausal women and have been associated with an unfavourable cardiovascular risk profile. Objective To investigate whether presence of menopausal symptoms is associated with the development of cardiovascular disease (CVD). Methods Five electronic databases (Medline, EMBASE and Web of Science) were search until February 17th, 2015 to identify relevant studies. Observational cohort studies or randomised intervention studies were eligible for inclusion if they followed participants prospectively (at least 1 year of follow-up), and reported relevant estimates on the association of any vasomotor symptoms, or other menopausal symptoms, with risk of CVD, coronary heart disease (CHD), or stroke in perimenopausal, menopausal, or postmenopausal women. Data were extracted by two independent reviewers using a pre-designed data collection form. Separate pooled relative risks (RRs) for age and non-established cardiovascular risk factors (e.g., education, ethnicity) adjusted data and for established cardiovascular risk factors and potential mediators-adjusted data (e.g., smoking, body mass index, and hypertension) were calculated. Results Out of 9,987 initially identified references, ten studies were selected, including 213,976 women with a total of 10,037 cardiovascular disease outcomes. The age and non-established cardiovascular risk factors adjusted RRs) [95% confidence intervals] for development of CHD, Stroke and CVD comparing women with and without any menopausal symptoms were 1.34 [1.13–1.58], 1.30 [0.99–1.70], 1.48 [1.21–1.80] respectively, and the corresponding RRs adjusted for cardiovascular risk factors and potential mediators were 1.18 [1.03–1.35], 1.08 [0.89–1.32], 1.29 [0.98–1.71]. However, these analyses were limited by potential unmeasured confounding and the small number of studies on this

  17. Myeloperoxidase evokes substantial vasomotor responses in isolated skeletal muscle arterioles of the rat

    PubMed Central

    Csató, V; Pető, A; Fülöp, G Á; Rutkai, I; Pásztor, E T; Fagyas, M; Kalász, J; Édes, I; Tóth, A; Papp, Z

    2015-01-01

    Aims Myeloperoxidase (MPO) catalyses the formation of a wide variety of oxidants, including hypochlorous acid (HOCl), and contributes to cardiovascular disease progression. We hypothesized that during its action MPO evokes substantial vasomotor responses. Methods Following exposure to MPO (1.92 mU mL−1) in the presence of increasing concentrations of hydrogen peroxide (H2O2), changes in arteriolar diameter of isolated gracilis skeletal muscle arterioles (SMAs) and coronary arterioles (CAs) and in the isometric force in basilar arteries (BAs) of the rat were monitored. Results Myeloperoxidase increased vascular tone to different degrees in CAs, SMAs and BAs. The mechanism of increased vasoconstriction was studied in detail in SMAs. MPO-evoked vasoconstrictions were prevented by the MPO inhibitor 4-aminobenzhydrazide (50 μm), by endothelium removal in the SMAs. Surprisingly, the HOCl scavenger L-methionine (100 μm), the thromboxane A2 (TXA2) antagonist SQ-29548 (1 μm) or the non-specific cyclooxygenase (COX) antagonist indomethacin (1 μm) converted the MPO-evoked vasoconstrictions to pronounced vasodilations in SMAs, not seen in the presence of H2O2. In contrast to noradrenaline-induced vasoconstrictions, the MPO-evoked vasoconstrictions were not accompanied by significant increases in arteriolar [Ca2+] levels in SMAs. Conclusion These data showed that H2O2-derived HOCl to be a potent vasoconstrictor upon MPO application. HOCl activated the COX pathway, causing the synthesis and release of a TXA2-like substance to increase the Ca2+ sensitivity of the contractile apparatus in vascular smooth muscle cells and thereby to augment H2O2-evoked vasoconstrictions. Nevertheless, inhibition of the HOCl–COX–TXA2 pathway unmasked the effects of additional MPO-derived radicals with a marked vasodilatory potential in SMAs. PMID:25760778

  18. FMLP provokes coronary vasoconstriction and myocardial ischemia in rabbits

    SciTech Connect

    Gillespie, M.N.; Booth, D.C.; Friedman, B.J.; Cunningham, M.R.; Jay, M.; De Maria, A.N. )

    1988-03-01

    Recent pathological studies of coronary arteries from humans with suspected coronary spasm have revealed an augmented intramural burden of inflammatory cells. To test the hypothesis than inappropriate activation of inflammatory cells participates in the evolution of coronary vasospasm, the present experiment employed a newly developed coronary arteriographic technique for use in pentobarbital-anesthetized rabbits to evaluate the coronary vasomotor actions of the nonselective inflammatory cell stimulant, N-formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP). In 10 of 10 animals, selective left intracoronary injection of 200 ng fMLP evoked profound left coronary narrowing accompanied in all cases by ST segment deviation and dysrhythmias. Thallium-201 scintigraphy demonstrated hypoperfusion of the left ventricular free wall and septum supplied by the spastic coronary artery. The fMLP-induced epicardial vasoconstriction, ischemic electrocardiogram (ECG) changes, and thallium perfusion defects were reversed by intravenous nitroglycerin. Neither the right coronary artery nor its distribution were influenced by left coronary injection of fMLP. Additional experiments in isolated, salt solution-perfused rabbit hearts demonstrated that fMLP failed to exert direct coronary vasoconstrictor effects. These observations indicate that the nonselective inflammatory cell stimulant, fMLP, provokes arteriographically demonstrable coronary spasm with attendant myocardial hypoperfusion and ischemic ECG changes in anesthetized rabbits. Such a model may be useful in exploring the dynamic role of inflammatory cells in development of coronary spasm.

  19. Gains in Body Fat and Vasomotor Symptom Reporting Over the Menopausal Transition

    PubMed Central

    Sowers, MaryFran R.; Sternfeld, Barbara; Gold, Ellen B.; Bromberger, Joyce; Chang, Yuefang; Joffe, Hadine; Crandall, Carolyn J.; Waetjen, L. Elaine; Matthews, Karen A.

    2009-01-01

    Although most women report vasomotor symptoms (hot flashes, night sweats) during midlife, their etiology and risk factors are incompletely understood. Body fat is positively associated with vasomotor symptoms cross-sectionally, but the longitudinal relation between changes in body fat and vasomotor symptoms is uncharacterized. The study aim was to examine whether gains in body fat were related to vasomotor symptom reporting over time. Measures of bioelectrical impedance for body fat, reproductive hormones, and reported vasomotor symptoms were assessed annually over 4 years from 2002 to 2006 among 1,659 women aged 47–59 years participating in the Study of Women's Health Across the Nation. Body fat change was examined in relation to vasomotor symptoms by using generalized estimating equations. Body fat gains were associated with greater odds of reporting hot flashes in models adjusted for age, site, race/ethnicity, education, smoking, parity, anxiety, and menopausal status (relative to stable body fat, gain: odds ratio = 1.23, 95% confidence interval: 1.02, 1.48; P = 0.03; loss: odds ratio = 1.07, 95% confidence interval: 0.89, 1.29; P = 0.45). Findings persisted controlling for estradiol, the free estradiol index, or follicle-stimulating hormone concentrations. The relations between body fat changes and night sweats were not statistically significant. Body fat gains are associated with greater hot flash reporting during the menopausal transition. PMID:19675142

  20. Treatment options for vasomotor symptoms in menopause: focus on desvenlafaxine

    PubMed Central

    Umland, Elena M; Falconieri, Laura

    2012-01-01

    Vasomotor symptoms (VMS), including hot flashes and night sweats, occur in as many as 68.5% of women as a result of menopause. While the median duration of these symptoms is 4 years, approximately 10% of women continue to experience VMS as many as 12 years after their final menstrual period. As such, VMS have a significant impact on the quality of life and overall physical health of women experiencing VMS, leading to their pursuance of treatment to alleviate these symptoms. Management of VMS includes lifestyle modifications, some herbal and vitamin supplements, hormonal therapies including estrogen and tibolone, and nonhormonal therapies including clonidine, gabapentin, and some of the serotonin and serotonin–norepinephrine reuptake inhibitors. The latter agents, including desvenlafaxine, have been the focus of increased research as more is discovered about the roles of serotonin and norepinephrine in the thermoregulatory control system. This review will include an overview of VMS as they relate to menopause. It will discuss the risk factors for VMS as well as the proposed pathophysiology behind their occurrence. The variety of treatment options for VMS will be discussed. Focus will be given to the role of desvenlafaxine as a treatment option for VMS management. PMID:22870045

  1. DC photoplethysmography in the evaluation of sympathetic vasomotor responses.

    PubMed

    Barron, S A; Rogowski, Z; Kanter, Y; Hemli, J

    1993-11-01

    The d.c. component of the photoplethsmographic signal was used to determine the response of the finger vasculature to three standard tests of vasomotor function: (1) an inspiratory gasp (IG), (2) immersion of the contralateral hand in ice water (IW), and (3) the Valsalva manoeuvre. The vasoconstrictor response to the first two of these stimuli could be measured in all of 25 normal subjects. The response to the Valsalva manoeuvre could not be detected consistently. Seven patients with known sympathetic autonomic dysfunction showed no response to either IG or IW. In 30 patients with diabetes mellitus of over 10 years duration, 46.7% had no response to IG, and 20% had no response to IW. Absent responses correlated with abnormal autonomic cardiovascular reflexes, with absent sympathetic skin responses and with the severity of peripheral somatic neuropathy. The d.c. photoplethysmographic determination of the vasoconstrictor response in the finger after a deep inspiratory gasp and after ice water immersion offers an additional measure of the function of small (2 mu-6 mu) peripheral nerve fibres. Because of variability in the amplitude of the responses in normals, only an absent response should be accepted as abnormal. PMID:8119051

  2. Hops for Menopausal Vasomotor Symptoms: Mechanisms of Action.

    PubMed

    Abdi, Fatemeh; Mobedi, Hamid; Roozbeh, Nasibeh

    2016-08-01

    Menopause is a critical stage of women's life associated with various complaints and distresses. Vasomotor symptoms (VMS), such as hot flushes, night sweats, sleep disturbances, and fatigue, are the most common menopause symptoms affecting about 50% to 80% of middle-aged women. Obviously, these symptoms, resulting from estrogen deficiency during menopause, can exert negative effects on women's health and quality of life and thus require to be managed through approaches such as hormone replacement therapy (HRT). Many herbal treatments for menopause symptoms contain and its components such as 8-prenylnaringenin, 6-PN, isoxanthohumol and xanthohumol. Recent in-vivo studies have highlighted the ability of 8-prenylnaringenin to reduce serum-luteinizing hormone (LH) and follicle-stimulating hormone (FSH), to increase serum prolactin levels and uterine weight, and to induce vaginal hyperplastic epithelium. Previous research has shown that hops extract can strongly bind to both estrogen receptors, stimulate alkaline phosphatase activity in Ishikawa cells, and upregulate presenelin-2 and progesterone receptor mRNA in Ishikawa cells. Numerous clinical trials have documented significant reductions in the frequency of hot flushes following the administration of hop-containing preparations. Nevertheless, further clinical trials with larger sample size and longer follow-up are warranted to confirm such benefits. PMID:27617238

  3. Hops for Menopausal Vasomotor Symptoms: Mechanisms of Action

    PubMed Central

    Abdi, Fatemeh; Mobedi, Hamid

    2016-01-01

    Menopause is a critical stage of women's life associated with various complaints and distresses. Vasomotor symptoms (VMS), such as hot flushes, night sweats, sleep disturbances, and fatigue, are the most common menopause symptoms affecting about 50% to 80% of middle-aged women. Obviously, these symptoms, resulting from estrogen deficiency during menopause, can exert negative effects on women's health and quality of life and thus require to be managed through approaches such as hormone replacement therapy (HRT). Many herbal treatments for menopause symptoms contain and its components such as 8-prenylnaringenin, 6-PN, isoxanthohumol and xanthohumol. Recent in-vivo studies have highlighted the ability of 8-prenylnaringenin to reduce serum-luteinizing hormone (LH) and follicle-stimulating hormone (FSH), to increase serum prolactin levels and uterine weight, and to induce vaginal hyperplastic epithelium. Previous research has shown that hops extract can strongly bind to both estrogen receptors, stimulate alkaline phosphatase activity in Ishikawa cells, and upregulate presenelin-2 and progesterone receptor mRNA in Ishikawa cells. Numerous clinical trials have documented significant reductions in the frequency of hot flushes following the administration of hop-containing preparations. Nevertheless, further clinical trials with larger sample size and longer follow-up are warranted to confirm such benefits. PMID:27617238

  4. Percutaneous transluminal coronary angioplasty (PTCA)

    MedlinePlus Videos and Cool Tools

    ... minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart ... area and putting a needle into the femoral artery, the blood vessel that runs down the leg. ...

  5. Olfactory Receptor Gene Polymorphisms and Nonallergic Vasomotor Rhinitis

    PubMed Central

    Bernstein, Jonathan A.; Zhang, Ge; Jin, Li; Abbott, Carol; Nebert, Daniel W.

    2009-01-01

    We sought a genotype-phenotype association: between single-nucleotide polymorphisms (SNPs) in olfactory receptor (OR) genes from the two largest OR gene clusters and odor-triggered nonallergic vasomotor rhinitis (nVMR). In the initial pedigree screen, using transmission disequilibrium test (TDT) analysis, six SNPs showed “significant” p-values between 0.0449 and 0.0043. In a second case-control population, the previously identified six SNPs did not re-emerge, whereas four new SNPs showed p-values between 0.0490 and 0.0001. Combining both studies, none of the SNPs in the TDT analysis survived the Bonferroni correction. In the population study, one SNP showed an empirical p-value of 0.0066 by shuffling cases and controls with 105 replicates; however, the p-value for this SNP was 0.83 in the pedigree study. This study emphasizes that underpowered studies having p-values between <0.05 and 0.0001 should be regarded as inconclusive and require further replication before concluding the study is “informative.” However, we believe that our hypothesis that an association between OR genotypes and the nVMR phenotype remains feasible. Future studies using either a genomewide association study of all OR gene-pseudogene regions throughout the genome—at the current recommended density of 2.5 to 5 kb per tag SNP—or studies incorporating microarray analyses of the entire “OR genome” in well-characterized nVMR patients are required. PMID:18446592

  6. Methods for the Design of Vasomotor Symptom Trials: The MsFLASH Network

    PubMed Central

    Newton, Katherine M.; Carpenter, Janet S.; Guthrie, Katherine A.; Anderson, Garnet L.; Caan, Bette; Cohen, Lee S.; Ensrud, Kristine E.; Freeman, Ellen W.; Joffe, Hadine; Sternfeld, Barbara; Reed, Susan D.; Sherman, Sheryl; Sammel, Mary D.; Kroenke, Kurt; Larson, Joseph C.; LaCroix, Andrea Z.

    2013-01-01

    Objective This report describes the "Menopausal Strategies: Finding Lasting Answers to Symptoms and Health” (MsFLASH) network and methodological issues addressed in designing and implementing vasomotor symptom trials. Methods Established in response to a National Institute of Health request for applications, the network was charged with conducting rapid throughput randomized trials of novel and understudied available interventions postulated to alleviate vasomotor and other menopausal symptoms. Included are descriptions of and rationale for criteria used for interventions and study selection, common eligibility and exclusion criteria, common primary and secondary outcome measures, consideration of placebo response, establishment of a biorepository, trial duration, screening and recruitment, statistical methods, and quality control. All trial designs are presented including: 1) a randomized, double-blind, placebo-controlled clinical trial designed to evaluate effectiveness of the selective serotonin reuptake inhibitor escitalopram in reducing vasomotor symptom frequency and severity; 2) a 2×3 factorial design trial to test three different interventions (yoga, exercise, and omega-3 supplementation) for improvement of vasomotor symptom frequency and bother; and 3) a three-arm comparative efficacy trial of the serotonin-norepinephrine reuptake inhibitor venlafaxine and low-dose oral estradiol versus placebo for reducing vasomotor symptom frequency compared to placebo. The network’s structure and governance are also discussed. Conclusions The methods used and lessons learned in the MsFLASH trials are shared to encourage and support the conduct of similar trials and encourage collaborations with other researchers. PMID:23760428

  7. Effect of Black Cohosh (Cimicifuga Racemosa) on Vasomotor Symptoms in Postmenopausal Women: A Randomized Clinical Trial

    PubMed Central

    Shahnazi, Mahnaz; Nahaee, Jila; Mohammad-Alizadeh-Charandabi, Sakineh; Bayatipayan, Somaye

    2013-01-01

    Introduction:Hot flash is considered to be an early and common symptom of menopause. The present study aimed to determine the impact of black cohosh (Cimicifuga racemosa) on vasomotor symptoms in postmenopausal women. Methods:This was a randomized, double-blind, placebo-controlled clinical trial. This study was performed on 84 postmenopausal women. The participants were randomly divided into control and intervention groups. The participants of the intervention group received one black cohosh tablet per day and the control group received one placebo tablet per day for eight weeks. The severity of vasomotor symptoms and number of hot flashes were recorded during the pre-intervention phase, and 4 and 8 weeks after the intervention. The data were analyzed using repeated measures ANOVA and ANCOVA tests. The level of significance was considered lower than 0.05. Results:There was a significant difference between the two groups in terms of severity and number of hot flashes in weeks 4 and 8 by controlling the intensity of vasomotor symptoms and number of hot flashes before the intervention. Moreover, using repeated measures ANOVA, the intergroup comparison indicated a significant difference in bothgroups (the test and control groups) in terms of severity of vasomotor symptoms and number of hot flashes. Conclusion:According to the findings of the study, it seems that black cohosh can be used as an effective alternative medicine in relieving menopausal vasomotor symptoms. PMID:25276716

  8. Non-invasive Detection of Aortic and Coronary Atherosclerosis in Homozygous Familial Hypercholesterolemia by 64 Slice Multi-detector Row Computed Tomography Angiography

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis, often at the ostia of coronary arteries. In this study we document for the first time that aortic and coronary atherosclerosis can be detected using 64 slice multiple detector-row ...

  9. Non-invasive detection of aortic and coronary atherosclerosis in homozygous familial hypercholesterolemia by 64 slice multi-detector row computed tomography angiography

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis, often at the ostia of coronary arteries. In this study we document for the first time that aortic and coronary atherosclerosis can be detected using 64 slice multiple detector row ...

  10. Coronary physiology assessment in the catheterization laboratory

    PubMed Central

    Díez-delhoyo, Felipe; Gutiérrez-Ibañes, Enrique; Loughlin, Gerard; Sanz-Ruiz, Ricardo; Vázquez-Álvarez, María Eugenia; Sarnago-Cebada, Fernando; Angulo-Llanos, Rocío; Casado-Plasencia, Ana; Elízaga, Jaime; Fernández Avilés Diáz, Francisco

    2015-01-01

    Physicians cannot rely solely on the angiographic appearance of epicardial coronary artery stenosis when evaluating patients with myocardial ischemia. Instead, sound knowledge of coronary vascular physiology and of the methods currently available for its characterization can improve the diagnostic and prognostic accuracy of invasive assessment of the coronary circulation, and help improve clinical decision-making. In this article we summarize the current methods available for a thorough assessment of coronary physiology. PMID:26413229

  11. The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry

    PubMed Central

    Prakash, Roshan; Chew, Derek P

    2012-01-01

    Objective To evaluate the impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes (ACS). Design Retrospective analysis of a national Acute Coronary Syndrome registry (ACACIA). Setting Multiple Australian (n=39) centres; 25% rural, 52% with onsite cardiac surgery. Patients Unselected consecutive patients admitted with confirmed ACS, total n=2559, median 99 per centre. Interventions Management was at the discretion of the treating physician. Analysis of outcome based on age >75 years was compared using Cox proportional hazard with a propensity model to adjust for baseline covariates. Main outcome measures Primary outcome was all-cause mortality. Secondary outcomes were bleeding and a composite of any vascular event or unplanned readmission. Results Elderly patients were more likely to present with high-risk features yet were less likely to receive evidence-based medical therapies or receive diagnostic coronary angiography (75% vs 49%, p<0.0001) and early revascularisation (50% vs 30%, p<0.0001). Multivariate analysis found early revascularisation in the elderly cohort to be associated with lower 12-month mortality hazard (0.4 (0.2–0.7)) and composite outcome (0.6 (0.5–0.8)). Propensity model suggested a greater absolute benefit in elderly patients compared to others. Conclusions Following presentation with ACS, elderly patients are less likely to receive evidence-based medical therapies, to be considered for an early invasive strategy and be revascularised. Increasing age is a significant barrier to physicians when considering early revascularisation. An early invasive strategy with revascularisation when performed was associated with substantial benefit and the absolute accrued benefit appears to be higher in elderly patients. PMID:22344538

  12. Coronary Angioplasty

    MedlinePlus

    ... page from the NHLBI on Twitter. What Is Percutaneous Coronary Intervention? Español Percutaneous (per-ku-TA-ne-us) coronary intervention (PCI), commonly known as coronary angioplasty (AN-jee- ...

  13. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition

    PubMed Central

    Avis, Nancy E.; Crawford, Sybil L.; Greendale, Gail; Bromberger, Joyce T.; Everson-Rose, Susan A.; Gold, Ellen B.; Hess, Rachel; Joffe, Hadine; Kravitz, Howard M.; Tepper, Ping G.; Thurston, Rebecca C.

    2015-01-01

    IMPORTANCE The expected duration of menopausal vasomotor symptoms (VMS) is important to women making decisions about possible treatments. OBJECTIVES To determine total duration of frequent VMS (≥6 days in the previous 2 weeks) (hereafter total VMS duration) during the menopausal transition, to quantify how long frequent VMS persist after the final menstrual period (FMP) (hereafter post-FMP persistence), and to identify risk factors for longer total VMS duration and longer post-FMP persistence. DESIGN, SETTING, AND PARTICIPANTS The Study of Women’s Health Across the Nation (SWAN) is a multiracial/multiethnic observational study of the menopausal transition among 3302 women enrolled at 7 US sites. From February 1996 through April 2013, women completed a median of 13 visits. Analyses included 1449 women with frequent VMS. MAIN OUTCOMES AND MEASURES Total VMS duration (in years) (hot flashes or night sweats) and post-FMP persistence (in years) into postmenopause. RESULTS The median total VMS duration was 7.4 years. Among 881 women who experienced an observable FMP, the median post-FMP persistence was 4.5 years. Women who were premenopausal or early perimenopausal when they first reported frequent VMS had the longest total VMS duration (median, >11.8 years) and post-FMP persistence (median, 9.4 years). Women who were postmenopausal at the onset of VMS had the shortest total VMS duration (median, 3.4 years). Compared with women of other racial/ethnic groups, African American women reported the longest total VMS duration (median, 10.1 years). Additional factors related to longer duration of VMS (total VMS duration or post-FMP persistence) were younger age, lower educational level, greater perceived stress and symptom sensitivity, and higher depressive symptoms and anxiety at first report of VMS. CONCLUSIONS AND RELEVANCE Frequent VMS lasted more than 7 years during the menopausal transition for more than half of the women and persisted for 4.5 years after the FMP

  14. Childhood abuse or neglect is associated with increased vasomotor symptom reporting among midlife women

    PubMed Central

    Thurston, Rebecca C.; Bromberger, Joyce; Chang, Yuefang; Goldbacher, Edie; Brown, Charlotte; Cyranowski, Jill M.; Matthews, Karen A.

    2010-01-01

    Objectives This study tested the hypothesis that women exposed to childhood abuse or neglect would have an increased likelihood of reporting hot flashes and night sweats during the menopausal transition. Design This hypothesis was evaluated in 332 white and African American women participating in the Study of Women’s Health Across the Nation Mental Health Study, a prospective investigation of women transitioning through menopause. Childhood abuse and neglect were measured once with the Child Trauma Questionnaire. Vasomotor symptoms (any/none hot flashes, night sweats) were reported annually over 8 years. Associations between maltreatment and vasomotor symptoms were estimated with generalized estimating equations. Results Childhood abuse or neglect was associated with increased reporting of hot flashes (odds ratio = 1.73, 95% CI: 1.23–2.43) and night sweats (odds ratio = 1.75, 95% CI: 1.26–2.43) in age-adjusted models. Results persisted in multivariable models and across several types of abuse and neglect. Conclusions The experience of childhood abuse and neglect is associated with increased vasomotor symptom reporting in adulthood. The sequelae of childhood abuse and neglect may persist well into adulthood to influence the occurrence of vasomotor symptoms at midlife. PMID:18257140

  15. [Complex assessment of vasomotor function of vascular endothelium in patients with hypertension].

    PubMed

    Gel'tser, B I; Savchenko, S V; Kotel'nikov, V N; Plotnikova, I V

    2004-01-01

    Vasomotor function of vascular endothelium was studied in 62 patients with grade 1-2 hypertension with moderate and high added risk. Methods included study of brachial and middle cerebral artery endothelium dependent and independent vasodilation/vasoconstriction, measurement of plasma levels of nitric oxide metabolites (NO(n)-), endothelin-1, and antithrombin, as well as registration of their changes during vasomotor tests with calculation of integral indexes. Most patients with hypertension differed from controls by preponderance of vasoconstrictor over vasodilator reactions both in peripheral and cerebral vascular bed. At the same time patients with hypertension had pronounced dissociation between vasomotor responses of cerebral and peripheral vessels compared with subjects with normal blood pressure (p<0.05). Besides lowered basal level of NO(n)- and high concentration of endothelin-1 patients with hypertension were characterized by hyperreactivity of nitricoxidergic system, augmented lability of endothelin producing system, and impaired athrombogenecity of vascular endothelium. Complex assessment of vasomotor function of vascular endothelium by sequential vasoactive tests characterizes functional and metabolic activity of cerebral and peripheral vessels and can be used for improvement of risk stratification and monitoring of efficacy of treatment of patients with hypertension. PMID:15111971

  16. Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms

    PubMed Central

    Guthrie, Katherine A.; LaCroix, Andrea Z.; Ensrud, Kristine E.; Joffe, Hadine; Newton, Katherine M.; Reed, Susan D.; Caan, Bette; Carpenter, Janet S.; Cohen, Lee S.; Freeman, Ellen W.; Larson, Joseph C.; Manson, JoAnn E.; Rexrode, Kathy; Skaar, Todd C.; Sternfeld, Barbara; Anderson, Garnet L.

    2015-01-01

    Objective To describe the effects of six interventions for menopausal vasomotor symptoms relative to control in a pooled analysis, facilitating translation of the results for clinicians and symptomatic women. The MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) network tested these interventions in three randomized clinical trials (RCTs). Methods An analysis of pooled individual-level data from three RCTs is presented. Participants were 899 peri- and postmenopausal women with at least 14 bothersome vasomotor symptoms/week. Interventions included escitalopram 10–20 mg/day, non-aerobic yoga, aerobic exercise, 1.8 g/day omega-3 fatty acid supplementation, low-dose oral 17-beta-estradiol 0.5-mg/day, and low-dose venlafaxine XR 75-mg/day. The main outcome measures were changes from baseline in mean daily vasomotor symptoms frequency and bother during 8–12 weeks of treatment. Linear regression models estimated differences in outcomes between each intervention and corresponding control group, adjusted for baseline characteristics. Models included trial-specific intercepts, effects of the baseline outcome measure, and time. Results The 8-week reduction in vasomotor symptoms frequency from baseline relative to placebo was similar for escitalopram at −1.4/day (95% CI: −2.7 to −0.2), low-dose estradiol at −2.4 (95% CI: −3.4 to −1.3), and venlafaxine at −1.8 (95% CI: −2.8 to −0.8); vasomotor symptoms bother reduction was minimal and did not vary across these three pharmacologic interventions (means −0.2 to −0.3 relative to placebo). No effects on vasomotor symptoms frequency or bother were seen with aerobic exercise, yoga or omega-3 supplements. Conclusions These analyses suggest that escitalopram, low-dose estradiol, and venlafaxine provide comparable, modest reductions in vasomotor symptoms frequency and bother among women with moderate hot flushes. Clinical Trial Registration ClinicalTrials.gov, www

  17. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: A comprehensive review

    PubMed Central

    Utian, Wulf H

    2005-01-01

    Many women experience vasomotor symptoms at or around the time of menopause. Hot flushes and night sweats are considered primary menopausal symptoms that may also be associated with sleep and mood disturbances, as well as decreased cognitive function. All of these symptoms may lead to social impairment and work-related difficulties that significantly decrease overall quality of life. Hot flushes have shown a great deal of variability in their frequency and severity in women. In some women, hot flushes persist for several months; in others, they may last for more than 10 years. Traditionally vasomotor symptoms were reported to begin 5 to 10 years prior to the cessation of the final menstrual cycle, corresponding with the initial decline in circulating gonadal hormones; however, night sweats in particular most often begin in perimenopause. The pathogenesis of hot flushes has not yet been fully elucidated, but the circuitry involving estrogen and neurotransmitters, norepinephrine and serotonin specifically, are hypothesized to play a major role in the altered homeostatic thermoregulatory mechanisms underlying these events. Menopause-associated vasomotor symptoms are associated with significant direct and indirect costs. Overall costs of traditional pharmacotherapy or complementary and alternative medicine modalities, including over-the-counter treatments and dietary supplements, for managing menopause-related vasomotor symptoms are substantial and include initial and follow-up physician visits and telephone calls. Additional costs include laboratory testing, management of adverse events, loss of productivity at work, and personal and miscellaneous costs. Pharmacoeconomic analyses, including those that consider risks identified by the Women's Health Initiative, generally support the cost-effectiveness of hormonal therapy for menopause-associated vasomotor symptoms, which have been the mainstay for the management of these symptoms for more than 50 years. However

  18. The role of intranasal estradiol spray in the management of moderate to severe vasomotor symptoms in menopausal women.

    PubMed

    Castelo-Branco, Camil; Coloma, Josep Lluis

    2010-01-01

    Hormone therapy (HT) is the most effective treatment at present available for climacteric symptoms. As harmful effects were highlighted in recent randomized clinical trials, the risk-benefit ratio does not favor the use of HT for prevention of cardiovascular diseases and bone fractures in postmenopausal women. Nevertheless, experimental and clinical trials suggest that adverse effects of HT basically depend on the estrogen and progestin formulation, dosage, route of administration, patient's age, associated diseases, and duration of treatment. All estrogen formulations and routes of administration have comparable beneficial effects on vasomotor and urogenital symptoms and on bone structure. But adverse effects may differ. Thus, cardiovascular and invasive breast cancer risks are higher with oral estrogen than with transdermal estradiol. However, transdermal estradiol is not free of inconveniences such as differences among individuals in absorption rates, loss of patches due to poor adhesion, and skin irritation. HT requires careful adjustment to each individual patient and continuous monitoring of clinical evolution. In the future, this adjustment and maybe the use of alternative routes such as intranasal could benefit from genetic screening to maximize in each individual the ratio between positive and adverse effects of HT. PMID:19639494

  19. [Position paper of the Italian Society of Invasive Cardiology (SICI-GISE) on indications for coronary angiography in patients with stable angina].

    PubMed

    Marchese, Alfredo; Rossini, Roberta; Basile, Marco; Bedogni, Francesco; Danzi, Gian Battista; Musumeci, Giuseppe; Paradies, Valeria; Piccaluga, Emanuela; Sardella, Gennaro; Varbella, Ferdinando; Giordano, Arturo; Berti, Sergio

    2015-10-01

    Available data suggest a steep increase in stable coronary artery disease with age. Its prevalence reaches a peak of almost 12-14% in men aged 65-84 years with an annual mortality ranging from 1.2% to 2.4%. The diagnosis of stable angina is primarily based on history and therefore relies on clinical judgment. In addition, its diagnosis can be extremely challenging because of the frequent transition from unstable to stable angina. Current European guidelines on the management of stable coronary artery disease give increased importance to the pre-test probability, which strongly affects the diagnostic algorithms. Imaging techniques play a greater role in the diagnosis of stable angina than in the past. Conversely, despite recent advances in technology and in the physiological assessment of coronary stenosis, an ever decreasing relevance is conferred to coronary angiography. Another difficult and controversial issue relates to the prognostic benefit of myocardial revascularization. The aim of this position paper is to review the most relevant clinical aspects of the European guidelines on the management of stable coronary artery disease. PMID:26444218

  20. Skin vasomotor hemiparesis followed by overactivity: characteristic thermography findings in a patient with Horner syndrome due to spinal cord infarction.

    PubMed

    Kobayashi, Makoto

    2016-04-01

    We present a 21-year-old female with Horner syndrome due to spinal cord infarction. In this patient, infrared thermography revealed a hemibody skin temperature increase followed by excessive focal decreases, indicating skin vasomotor hemiparesis and overactivity. PMID:26811085

  1. [Coronary endarterectomy].

    PubMed

    Murtra, M; González, I; Igual, A

    1998-01-01

    The technique of coronary endarterectomy, in coronary artery surgery, has been controversial and alternatively indicated or contraindicated by different authors. In this paper coronary endarterectomy is reviewed, including its definition, history and development of different techniques. Early and late results of the main papers in the literature are commented on as well as our results. The surgical technique of endarterectomy in the different coronary artery territories is described with the primary indications and contraindications. Coronary endarterectomy is a valid and well established technique that can provide possibilities of revascularization in patients with extended and diffused coronary artery obstructions, which are unable to be treated with conventional coronary artery bypass grafts. Operative mortality and morbidity are slightly higher, but long-term results, as far as survival and functional class are concerned, are similar to standard coronary artery surgical procedures. PMID:9717404

  2. Gains in body fat and vasomotor symptom reporting over the menopausal transition: the study of women's health across the nation.

    PubMed

    Thurston, Rebecca C; Sowers, MaryFran R; Sternfeld, Barbara; Gold, Ellen B; Bromberger, Joyce; Chang, Yuefang; Joffe, Hadine; Crandall, Carolyn J; Waetjen, L Elaine; Matthews, Karen A

    2009-09-15

    Although most women report vasomotor symptoms (hot flashes, night sweats) during midlife, their etiology and risk factors are incompletely understood. Body fat is positively associated with vasomotor symptoms cross-sectionally, but the longitudinal relation between changes in body fat and vasomotor symptoms is uncharacterized. The study aim was to examine whether gains in body fat were related to vasomotor symptom reporting over time. Measures of bioelectrical impedance for body fat, reproductive hormones, and reported vasomotor symptoms were assessed annually over 4 years from 2002 to 2006 among 1,659 women aged 47-59 years participating in the Study of Women's Health Across the Nation. Body fat change was examined in relation to vasomotor symptoms by using generalized estimating equations. Body fat gains were associated with greater odds of reporting hot flashes in models adjusted for age, site, race/ethnicity, education, smoking, parity, anxiety, and menopausal status (relative to stable body fat, gain: odds ratio = 1.23, 95% confidence interval: 1.02, 1.48; P = 0.03; loss: odds ratio = 1.07, 95% confidence interval: 0.89, 1.29; P = 0.45). Findings persisted controlling for estradiol, the free estradiol index, or follicle-stimulating hormone concentrations. The relations between body fat changes and night sweats were not statistically significant. Body fat gains are associated with greater hot flash reporting during the menopausal transition. PMID:19675142

  3. Platelet-activating factor modulates pulmonary vasomotor tone in the perinatal lamb.

    PubMed

    Ibe, B O; Hibler, S; Raj, J U

    1998-09-01

    Eight near-term fetal lambs were studied acutely in utero to determine role of platelet-activating factor (PAF) in the regulation of vasomotor tone in systemic and pulmonary circulations in the immediate perinatal period. Four fetal lambs were studied predelivery and 2 h postdelivery to determine circulating PAF levels. Aortic and pulmonary arterial pressures and cardiac output were measured continuously, and systemic and pulmonary vascular resistances were calculated. Left pulmonary arterial blood flow was also measured in four fetal lambs. After delivery and oxygenation, circulating PAF levels fell significantly. When WEB-2170, a specific PAF-receptor antagonist, was infused to block effect of endogenous PAF in the eight near-term fetal lambs, systemic vascular resistance fell 30% but pulmonary vascular resistance fell dramatically by 68%. Specificity of WEB-2170 was tested in juvenile lambs and was found to be very specific in lowering vasomotor tone only when tone was elevated by action of PAF. Our data show that endogenous PAF levels in the fetus contribute to maintain a high basal systemic and pulmonary vasomotor tone and that a normal fall in circulating PAF levels after birth and oxygenation may facilitate fall in pulmonary vascular resistance at birth. PMID:9729586

  4. Acupuncture for menopausal vasomotor symptoms: study protocol for a randomised controlled trial

    PubMed Central

    2014-01-01

    Background Hot flushes and night sweats (vasomotor symptoms) are common menopausal symptoms, often causing distress, sleep deprivation and reduced quality of life. Although hormone replacement therapy is an effective treatment, there are concerns about serious adverse events. Non-hormonal pharmacological therapies are less effective and can also cause adverse effects. Complementary therapies, including acupuncture, are commonly used for menopausal vasomotor symptoms. While the evidence for the effectiveness of acupuncture in treating vasomotor symptoms is inconclusive, acupuncture has a low risk of adverse effects, and two small studies suggest it may be more effective than non-insertive sham acupuncture. Our objective is to assess the efficacy of needle acupuncture in improving hot flush severity and frequency in menopausal women. Our current study design is informed by methods tested in a pilot study. Methods/design This is a stratified, parallel, randomised sham-controlled trial with equal allocation of participants to two trial groups. We are recruiting 360 menopausal women experiencing a minimum average of seven moderate hot flushes a day over a seven-day period and who meet diagnostic criteria for the Traditional Chinese Medicine diagnosis of Kidney Yin deficiency. Exclusion criteria include breast cancer, surgical menopause, and current hormone replacement therapy use. Eligible women are randomised to receive either true needle acupuncture or sham acupuncture with non-insertive (blunt) needles for ten treatments over eight weeks. Participants are blinded to treatment allocation. Interventions are provided by Chinese medicine acupuncturists who have received specific training on trial procedures. The primary outcome measure is hot flush score, assessed using the validated Hot Flush Diary. Secondary outcome measures include health-related quality of life, anxiety and depression symptoms, credibility of the sham treatment, expectancy and beliefs about

  5. Randomized Controlled Trial of Low-Dose Estradiol and the SNRI Venlafaxine for Vasomotor Symptoms

    PubMed Central

    Joffe, Hadine; Guthrie, Katherine A.; LaCroix, Andrea Z.; Reed, Susan D.; Ensrud, Kristine E.; Manson, JoAnn E.; Newton, Katherine M.; Freeman, Ellen W.; Anderson, Garnet L.; Larson, Joseph C.; Hunt, Julie; Shifren, Jan; Rexrode, Kathryn M.; Caan, Bette; Sternfeld, Barbara; Carpenter, Janet S.; Cohen, Lee

    2014-01-01

    Importance Estrogen therapy is the gold standard treatment for hot flashes and night sweats, but some women are unable or unwilling to use it because of associated risks. The serotonin-norepinephrine reuptake inhibitor venlafaxine is used widely as a non-hormonal treatment. While clinical impression is that serotonin-norepinephrine reuptake inhibitors are less effective than estrogen, these medications have not been simultaneously evaluated in one clinical trial. Objective To determine the efficacy and tolerability of low-dose oral 17-beta-estradiol and low-dose venlafaxine XR in alleviating vasomotor symptoms. Design and Participants 339 peri- and postmenopausal women with ≥2 bothersome vasomotor symptoms per day (mean 8.1, SD 5.3/day) were recruited from the community to MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) clinical network sites November 2011—October 2012. Interventions Participants were randomized to double-blinded treatment with low-dose oral 17-beta-estradiol 0.5-mg/day (n=97), low-dose venlafaxine XR 75-mg/day (n=96), or placebo (n=146) for 8 weeks. Main Outcomes Primary outcome was the mean daily frequency of vasomotor symptoms after 8 weeks of treatment. Secondary outcomes were vasomotor symptom severity, bother and interference. Intent-to-treat analyses compared change in vasomotor symptom frequency between each active intervention and placebo and between the two active treatments. Results Compared to baseline, mean vasomotor symptom frequency at week 8 decreased by 53% with estradiol, 48% with venlafaxine, and 29% with placebo. Estradiol reduced the frequency of symptoms by 2.3 (95% CI 1.3–3.4) more per day than placebo (p<0.001), and venlafaxine by 1.8 (95% CI 0.8–2.7) more per day than placebo (p=0.005). Results were consistent for VMS severity, bother and interference. Low-dose estradiol reduced symptom frequency by 0.6 more per day than venlafaxine (95% CI, 1.8 more per day to 0.6 fewer per day than

  6. Bioresorbable scaffolds for percutaneous coronary interventions

    PubMed Central

    Gogas, Bill D.

    2014-01-01

    Innovations in drug-eluting stents (DES) have substantially reduced rates of in-segment restenosis and early stent thrombosis, improving clinical outcomes following percutaneous coronary interventions (PCI). However a fixed metallic implant in a vessel wall with restored patency and residual disease remains a precipitating factor for sustained local inflammation, in-stent neo-atherosclerosis and impaired vasomotor function increasing the risk for late complications attributed to late or very late stent thrombosis and late target lesion revascularization (TLR) (late catch-up). The quest for optimal coronary stenting continues by further innovations in stent design and by using biocompatible materials other than cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding, local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics have been recently developed. These devices have been utilized in selected clinical applications so far providing preliminary evidence of safety showing comparable performance with current generation drug-eluting stents (DES). Herein we provide a comprehensive overview of the current status of these technologies, we elaborate on the potential benefits of transient coronary scaffolds over permanent stents in the context of vascular reparation therapy, and we further focus on the evolving challenges these devices have to overcome to compete with current generation DES. Condensed Abstract:: The quest for optimizing percutaneous coronary interventions continues by iterative innovations in device materials beyond cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding; local drug-elution and future

  7. Reviewing hybrid coronary revascularization: challenges, controversies and opportunities.

    PubMed

    Kayatta, Michael O; Halkos, Michael E

    2016-07-01

    Two main approaches to myocardial revascularization currently exist, coronary artery bypass and percutaneous coronary intervention. In patients with advanced coronary artery disease, coronary artery bypass surgery is associated with improved long term outcomes while percutaneous coronary intervention is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach. This new approach, hybrid coronary revascularization, has shown encouraging early results. Minimally invasive techniques for bypass surgery have played a large part of bringing this approach into contemporary practice. PMID:27042753

  8. Comparison of Noninvasively and Invasively Managed Patients, With or Without Revascularization in Non-ST Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey).

    PubMed

    Blatt, Alex; Kalmanovich, Eran; Karny-Rahkovich, Orit; Brener, Svetlana; Shlezinger, Meital; Shlomo, Nir; Vered, Zvi; Hod, Hanoch; Goldenberg, Ilan; Elbaz-Greener, Gabby

    2016-07-01

    Patients with non-ST elevation myocardial infarction who are managed noninvasively at presentation or are catheterized but without revascularization represent a heterogeneous and understudied population. We evaluated the clinical characteristics, management strategies, and outcomes of patients with non-ST elevation myocardial infarction (NSTEMI) who were enrolled in the prospective biannual Acute Coronary Syndrome Israeli Surveys from 2004 to 2013. Patients were divided into 3 groups: no catheterization (no angio), catheterization with revascularization (angio-revascularized), and catheterization without revascularization (angio-nonrevascularized) groups. The study included 3,198 patients with NSTEMI. Coronary angiography was performed in 2,525 (79%) during the index hospitalization, of whom 1899 (59%) underwent revascularization. Evidence-based therapies were administered during the index hospitalization at a significantly higher rate to those in the angio-revascularized group compared with the other 2 groups. Multivariate analysis showed that compared with those in the angio-revascularized and angio-nonrevascularized groups, patients in the no angio group experienced a significantly higher risk for 1-year mortality (hazard ratio 2.04 [p ≤0.0001] and 1.21 [p = 0.01], respectively). The risk associated with no revascularized was consistent in each risk subset analyzed, including an older age, and increased creatinine levels. In conclusion, our data, from a large real-world contemporary experience, suggest that patients with NSTEMI who do not undergo coronary revascularization during the index hospitalization represent a greater risk and undertreated group with increased risk for long-term mortality. PMID:27217207

  9. Influence of radiographic contrast agents on quantitative coronary angiography

    SciTech Connect

    Jost, Stefan; Hausmann, Dirk; Lippolt, Peter; Gerhardt, Uwe; Lichtlen, Paul R.

    1997-01-15

    Purpose. Quantitative angiographic studies on the vasomotility of epicardial coronary arteries are gaining increasing relevance. We investigated whether radiographic contrast agents might influence coronary vasomotor tone and thereby the results of such studies. Methods. Coronary angiograms were taken in 12 patients with coronary artery disease at intervals of 5, 3, 2, and 1 min with the low-osmolar, nonionic contrast agent iopamidol 300, and were repeated at identical intervals with the high-osmolar, ionic agent diatrizoate 76%. Results. Quantitative cine film analysis demonstrated no significant diameter changes in angiographically normal and stenotic coronary arteries with iopamidol. With diatrizoate, however, normal segments were dilated 2%{+-}2% (p<0.01) after 2 min and 10%{+-}3% after the 1 min interval (p<0.001). Stenoses showed no uniform responses to diatrizoate. Conclusion. Low-osmolar, nonionic contrast agents should be preferred for quantitative angiographic studies on epicardial coronary vasomotility. When using ionic contrast agents, injection intervals of at least 3 min are required.

  10. The effect of topical capsaicin-induced sensitization on heat-evoked cutaneous vasomotor responses

    PubMed Central

    Nielsen, Thomas A; da Silva, Larissa Bittencourt; Arendt-Nielsen, Lars; Gazerani, Parisa

    2013-01-01

    Brief, localized, cutaneous, non-painful thermal stimuli can evoke a transient vasomotor response, causing increased cutaneous blood flow and elevated skin temperature. The aims of this study were to investigate 1) if cutaneous sensitization by topical application of capsaicin (TRPV1 receptor agonist) can facilitate the size, duration and spatial extent of this vasomotor response and 2) if males and females respond differently. Thermal pulses (43°C for 60 seconds) were applied on left/right volar forearms of 15 age-matched males and females. Skin temperature and cutaneous blood flow were measured 1, 5, 10, 15, and 30 minutes after heat application before and after topical capsaicin (1%, 30 min application) with contralateral arm serving as the control. Recordings were made from the region of interest at distances of 2, 4, 6, 8, and 10 cm from the capsaicin application site. Sensitization significantly enhanced skin temperature for up to 30 min and compared with non-sensitized skin at 10 min. Females showed the strongest response after sensitization, but the response lasted longer and spread more widely in males. The blood flow responses were significantly longer after capsaicin (from 5 to 30 minutes after thermal application). This increased blood flow extended outside the treated area up to 10 min after stimulation. After sensitization, the area under the blood flow response curves showed significantly stronger responses in females, spreading 4 cm outside the stimulation site. Cutaneous sensitizing caused prolonged and spatially expanded vasomotor responses to standardized thermal stimulation with sex specific differences. PMID:24044034

  11. Effect of engineered nanoparticles on vasomotor responses in rat intrapulmonary artery

    SciTech Connect

    Courtois, Arnaud; Andujar, Pascal; Ladeiro, Yannick; Ducret, Thomas; Rogerieux, Francoise; Lacroix, Ghislaine; Baudrimont, Isabelle; Guibert, Christelle; Roux, Etienne; Canal-Raffin, Mireille; Brochard, Patrick; Marano, Francelyne; Marthan, Roger; Muller, Bernard

    2010-06-01

    Pulmonary circulation could be one of the primary vascular targets of finest particles that can deeply penetrate into the lungs after inhalation. We investigated the effects of engineered nanoparticles on vasomotor responses of small intrapulmonary arteries using isometric tension measurements. Acute in vitro exposure to carbon nanoparticles (CNP) decreased, and in some case abolished, the vasomotor responses induced by several vasoactive agents, whereas acute exposure to titanium dioxide nanoparticles (TiO{sub 2}NP) did not. This could be attributed to a decrease in the activity of those vasoactive agents (including PGF{sub 2{alpha}}, serotonin, endothelin-1 and acetylcholine), as suggested when they were exposed to CNP before being applied to arteries. Also, CNP decreased the contraction induced by 30 mM KCl, without decreasing its activity. After endoplasmic reticulum calcium stores depletion (by caffeine and thapsigargin), CaCl{sub 2} addition induced a contraction, dependent on Store-Operated Calcium Channels that was not modified by acute CNP exposure. Further addition of 30 mM KCl elicited a contraction, originating from activation of Voltage-Operated Calcium Channels that was diminished by CNP. Contractile responses to PGF{sub 2{alpha}} or KCl, and relaxation to acetylcholine were modified neither in pulmonary arteries exposed in vitro for prolonged time to CNP or TiO{sub 2}NP, nor in those removed from rats intratracheally instilled with CNP or TiO{sub 2}NP. In conclusion, prolonged in vitro or in vivo exposure to CNP or TiO{sub 2}NP does not affect vasomotor responses of pulmonary arteries. However, acute exposure to CNP decreases contraction mediated by activation of Voltage-Operated, but not Store-Operated, Calcium Channels. Moreover, interaction of some vasoactive agents with CNP decreases their biological activity that might lead to misinterpretation of experimental data.

  12. Metabolic and vasomotor responses of rhesus monkeys exposed to 225-MHz radiofrequency energy

    SciTech Connect

    Lotz, W.G.; Saxton, J.L.

    1987-01-01

    A previous study showed a substantial increase in the colonic temperature of rhesus monkeys (Macaca mulatta) exposed to radio-frequency (RF) fields at a frequency near whole-body resonance and specific absorption rates (SAR) of 2 to 3 W/kg. The present experiments were conducted to determine the metabolic and vasomotor responses during exposures to similar RF fields. Five adult male rhesus monkeys were exposed to 225-MHz radiation (E orientation) in an anechoic chamber. The monkeys were irradiated at two carefully-controlled ambient temperatures, either cool (20 C) or thermoneutral (26 C). Power densities ranged from 0 (sham) to 10.0 mW/sq cm with an average whole-body SAR of 0.285 (W/kg)/(mW/sq cm). Two experimental protocols were used, each of which began with a 120-min preexposure equilibration period. Then, one protocol involved repetitive 10-min RF exposures at successively higher power densities with a recovery period between exposures. In the second protocol, a 120-min RF exposure permitted the measurement of steady-state thermoregulatory responses. Metabolic and vasomotor adjustments in the rhesus monkey exposed to 225 MHz occurred during brief or sustained exposures at SARs at or above 1.4 W/kg. Metabolic and vasomotor responses were coordinated effectively to produce a stable deep-body temperature. The results show that the thermoregulatory response of the rhesus monkey to an RF exposure at a resonant frequency limits storage of heat in the body. However, substantial increases in colonic temperature were not prevented by such responses, even in a cool environment.

  13. Metabolic and vasomotor responses of rhesus monkeys exposed to 225-MHz radiofrequency energy. [Macaca mulatta

    SciTech Connect

    Lotz, W.G.; Saxton, J.L.

    1987-01-01

    A previous study showed a substantial increase in the colonic temperature of rhesus monkeys (Macaca mulatta) exposed to radiofrequency (RF) fields at a frequency near whole-body resonance and specific absorption rates (SAR) of 2-3 W/kg. The present experiments were conducted to determine the metabolic and vasomotor responses during exposures to similar RF fields. We exposed five adult male rhesus monkeys to 225 MHz radiation (E orientation) in an anechoic chamber. Oxygen consumption and carbon dioxide production were measured before, during, and after RF exposure. Colonic, tail and leg skin temperatures were continuously monitored with RF-nonperturbing probes. The monkeys were irradiated at two carefully-controlled ambient temperatures, either cool (20 degrees C) or thermoneutral (26 degrees C). Power densities ranged from 0 (sham) to 10.0 mW/cm2 with an average whole-body SAR of 0.285 (W/kg)/(mW/cm2). We used two experimental protocols, each of which began with a 120-min pre-exposure equilibration period. One protocol involved repetitive 10-min RF exposures at successively higher power densities with a recovery period between exposures. In the second protocol, a 120-min RF exposure permitted the measurement of steady-state thermoregulatory responses. Metabolic and vasomotor adjustments in the rhesus monkey exposed to 225 MHz occurred during brief or sustained exposures at SARs at or above 1.4 W/kg. The SAR required to produce a given response varied with ambient temperature. Metabolic and vasomotor responses were coordinated effectively to produce a stable deep body temperature. The results show that the thermoregulatory response of the rhesus monkey to an RF exposure at a resonant frequency limits storage of heat in the body. However, substantial increases in colonic temperature were not prevented by such responses, even in a cool environment.

  14. Patient-specific coronary territory maps

    NASA Astrophysics Data System (ADS)

    Beliveau, Pascale; Setser, Randolph; Cheriet, Farida; O'Donnell, Thomas

    2007-03-01

    It is standard practice for physicians to rely on empirical, population based models to define the relationship between regions of left ventricular (LV) myocardium and the coronary arteries which supply them with blood. Physicians use these models to infer the presence and location of disease within the coronary arteries based on the condition of the myocardium within their distribution (which can be established non-invasively using imaging techniques such as ultrasound or magnetic resonance imaging). However, coronary artery anatomy often varies from the assumed model distribution in the individual patient; thus, a non-invasive method to determine the correspondence between coronary artery anatomy and LV myocardium would have immediate clinical impact. This paper introduces an image-based rendering technique for visualizing maps of coronary distribution in a patient-specific approach. From an image volume derived from computed tomography (CT) images, a segmentation of the LV epicardial surface, as well as the paths of the coronary arteries, is obtained. These paths form seed points for a competitive region growing algorithm applied to the surface of the LV. A ray casting procedure in spherical coordinates from the center of the LV is then performed. The cast rays are mapped to a two-dimensional circular based surface forming our coronary distribution map. We applied our technique to a patient with known coronary artery disease and a qualitative evaluation by an expert in coronary cardiac anatomy showed promising results.

  15. Prediction of cardiovascular outcomes by imaging coronary atherosclerosis

    PubMed Central

    Pathan, Faraz

    2016-01-01

    Over the last two decades, several invasive and non-invasive coronary atherosclerosis imaging modalities have emerged as predictors of cardiovascular outcomes in at-risk population. These modalities have demonstrated independent or incremental prognostic information over existing/standard risk stratification schemes, such as the Framingham risk score (FRS), by identifying characteristics of coronary artery diseases (CADs). In this review, we begin with discussing the importance of pre-test probability and quality of outcome measure, followed by specific findings of each modality in relation to prognosis. We focused on both short and long term prognostic aspects of coronary computed tomography (CT) (including coronary calcium score and coronary angiography) and magnetic resonance imaging as non-invasive tools, as well as invasive modalities including intravascular ultrasound (IVUS), optical coherence tomography (OCT), near infrared spectroscopy and Angioscopy. PMID:27500091

  16. Contribution of flow-dependent vasomotor mechanisms to the autoregulation of cerebral blood flow.

    PubMed

    Koller, Akos; Toth, Peter

    2012-01-01

    Regulation of cerebral blood flow (CBF) is the result of multilevel mechanisms to maintain the appropriate blood supply to the brain while having to comply with the limited space available in the cranium. The latter requirement is ensured by the autoregulation of CBF, in which the pressure-sensitive myogenic response is known to play a pivotal role. However, in vivo increases in pressure are accompanied by increases in flow; yet the effects of flow on the vasomotor tone of cerebral vessels are less known. Earlier studies showed flow-sensitive dilation and/or constriction or both, but no clear picture emerged. Recently, the important role of flow-sensitive mechanism(s) eliciting the constriction of cerebral vessels has been demonstrated. This review focuses on the effect of hemodynamic forces (especially intraluminal flow) on the vasomotor tone of cerebral vessels and the underlying cellular and molecular mechanisms. A novel concept of autoregulation of CBF is proposed, suggesting that (in certain areas of the cerebrovascular tree) pressure- and flow-induced constrictions together maintain an effective autoregulation, and that alterations in these mechanisms may contribute to the development of cerebrovascular disorders. Future studies are warranted to explore the signals, the details of signaling processes and the in vivo importance of these mechanisms. PMID:22739136

  17. Electrically induced vasomotor responses and their propagation in rat renal vessels in vivo.

    PubMed Central

    Steinhausen, M; Endlich, K; Nobiling, R; Parekh, N; Schütt, F

    1997-01-01

    1. Vasomotor responses (VMR) induced by local electrical stimulation were studied in the vasculature of the split hydronephrotic rat kidney by in vivo microscopy. 2. Unipolar pulses, which were applied by a micropipette positioned close to the vessel wall, elicited local and propagated VMR. Depolarizing and hyperpolarizing currents caused vasoconstriction and vasodilatation, respectively. 3. The magnitude of VMR could be controlled within seconds by variation of pulse frequency, pulse width and voltage. VMR were abolished by slight retraction of the stimulating micropipette. Repetitive electrical stimulation resulted in reproducibly uniform VMR. 4. Propagated VMR decayed with increasing distance from the stimulation site. They decayed more rapidly in the upstream than in the downstream flow direction in interlobular arteries. The longitudinal decay was well approximated by an exponential function with significantly different length constants of 150 +/- 40 microns (upstream, n = 5) and 420 +/- 90 microns (downstream, n = 8). 5. Our results show that vasomotor responses, which are initiated by changes in membrane potential, are propagated over distances of potential physiological importance in interlobular arteries. Images Figure 1 PMID:9423188

  18. The location of descending fibres to sympathetic preganglionic vasomotor and sudomotor neurons in man.

    PubMed Central

    Nathan, P W; Smith, M C

    1987-01-01

    Evidence is given of the location in the spinal cord of man of the central sympathetic fibres supplying vasomotor and sudomotor neurons of the body caudal to the head and neck. The evidence is based on anterolateral cordotomies. The fibres lie within the medial part of the equatorial plane, extending from the base of the posterior horn and the lateral horn across the medial half of the white matter. The evidence from a previous paper together with that of the present paper is that the pathway maintains this position throughout the spinal cord as far as the L2 segment. The sympathomotor fibres caudal to the head and neck are supplied from both sides of the cord: sympathetic activity is not removed, although it may be slightly diminished, by a hemisection of the cord. The evidence suggests that sympathetic fibres for vasomotor control leave the cord cranial to the Th 7 segment. The knowledge of the location of the pathways is of value to neurosurgeons so that they may be avoided in the operation of anterolateral cordotomy. Images PMID:3681303

  19. Vasomotor symptoms in menopause: where we've been and where we're going.

    PubMed

    Pinkerton, JoAnn V; Zion, Adrienne S

    2006-03-01

    The decline in gonadal hormones during menopause gives rise to a wide range of physiological and psychological changes with the potential to significantly impact a woman's health and quality of life. Most notable among these are menopausal vasomotor symptoms, hot flushes and night sweats, along with mood and sleep disturbances. Given the biological and social significance of menopause, it is remarkable that the language used to describe this event and its associated symptoms is inconsistent. This review traces the history of Western medical writing about menopause-associated vasomotor symptoms and considers how terminology has contributed to the current confusion regarding symptoms and symptom reporting. Although hormone therapy is the only treatment for menopausal symptoms currently approved by the U.S. Food and Drug Administration, other forms of therapy are under evaluation. Agreement about the definition of menopause and its associated symptoms is critically important for the design and evaluation of new therapies and for the optimal treatment of women during this important phase of their lives. PMID:16536677

  20. Obesity Related Coronary Microvascular Dysfunction: From Basic to Clinical Practice

    PubMed Central

    Selthofer-Relatić, K.; Bošnjak, I.; Kibel, A.

    2016-01-01

    Obesity related coronary microvascular disease is a medical entity which is not yet fully elucidated. The pathophysiological basis of coronary microcirculatory dysfunction consists of a heterogeneous group of disorders with individual morphologic/functional/clinical presentation and prognosis. Coronary microcirculatory changes include mechanisms connected with vascular dysfunction, as well as extravascular and vasostructural changes in responses to neural, mechanical, and metabolic factors. Cardiometabolic changes that include obesity, dyslipidemia, diabetes mellitus type II, and hypertension are associated with atherosclerosis of epicardial coronary arteries and/or microvascular coronary dysfunction, with incompletely understood underlying mechanisms. In obesity, microvascular disease is mediated via adipokines/cytokines causing chronic, subclinical inflammation with (a) reduced NO-mediated dilatation, (b) changed endothelial- and smooth muscle-dependent vasoregulating mechanisms, (c) altered vasomotor control with increased sympathetic activity, and (d) obesity related hypertension with cardiomyocytes hypertrophy and impaired cardiac vascular adaptation to metabolic needs. From a clinical point of view it can present itself in acute or chronic form with different prognosis, as a practice problem for real-life diagnosis and treatment. PMID:27092288

  1. Coronary angiography

    MedlinePlus

    Coronary angiography is often done along with cardiac catheterization . This is a procedure which measures pressures in ... Cardiac catheterization carries a slightly increased risk when compared with other heart tests. However, the test is very safe ...

  2. Coronary Arteries

    MedlinePlus

    ... side of the heart is smaller because it pumps blood only to the lungs. The left coronary artery, ... heart is larger and more muscular because it pumps blood to the rest of the body. Updated August ...

  3. Coronary heart disease

    MedlinePlus

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... Coronary heart disease is the leading cause of death in the United States for men and women. Coronary heart ...

  4. Coronary Calcium Scan

    MedlinePlus

    ... the NHLBI on Twitter. What Is a Coronary Calcium Scan? A coronary calcium scan is a test ... you have calcifications in your coronary arteries. Coronary Calcium Scan Figure A shows the position of the ...

  5. Coronary Artery Bypass Grafting

    MedlinePlus

    ... Rehabilitation Coronary Heart Disease Heart Attack Heart Surgery Percutaneous Coronary Intervention Send a link to NHLBI to someone by ... include lifestyle changes, medicines, and a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty. PCI is ...

  6. Diagnosis of coronary microvascular dysfunction - Present status.

    PubMed

    Mittal, S R

    2015-01-01

    Definite clinical diagnosis of microvascular angina is not possible with the existing knowledge. Resting electrocardiogram may be normal, and exercise electrocardiogram may be unremarkable. Echocardiography usually does not show regional wall motion abnormalities. Transthoracic Doppler echocardiography can satisfactorily evaluate only left anterior descending coronary artery and that too in some patients. Radio-isotope imaging can detect only severe localized disease. Noninvasive diagnosis needs high index of suspicion. At present, definite diagnosis is based on documentation of normal epicardial coronaries, coronary flow reserve less than 2.5 on adenosine induced hyperemia, and absence of spasm of epicardial coronaries on acetylcholine provocation. Invasive evaluation is costly, needs sophisticated equipments and expertise. Therapeutic and prognostic implications of various parameters remains to be evaluated. At present invasive evaluation is recommended only for patients with intractable symptoms with unconfirmed diagnosis, requiring repeated hospitalization and evaluation with failure of empirical therapy. PMID:26702685

  7. Coronary Computed Tomography Angiography of Spontaneous Coronary Artery Dissection: A Case Report and Review of the Literature

    PubMed Central

    Torres-Ayala, Stephanie C.; Maldonado, Jose; Scott Bolton, J.; Bhalla, Sanjeev

    2015-01-01

    Patient: Male, 23 Final Diagnosis: Spontaneous coronary artery dissection Symptoms: Chest discomfort • chest pain Medication: — Clinical Procedure: Coronary computed tomography angiography Specialty: Radiology Objective: Rare disease Background: Multidetector computed tomography (MDCT) has gained wide acceptance in the evaluation of the cardiovascular system. Of particular clinical interest is its ability to non-invasively evaluate coronary arteries in patients presenting to the emergency room. In acute coronary syndromes, myocardial ischemia is most often caused by atherosclerosis. We present a case of a rare cause of acute coronary syndrome, spontaneous coronary artery dissection (SCAD), which was initially evaluated with MDCT and followed by intravascular ultrasound (IVUS) and invasive coronary angiography (ICA). We discuss the findings and role of each modality with particular attention to coronary computed tomographic angiography (CCTA) in the diagnosis and management of SCAD. As the use of CCTA in the emergency department continues to rise, radiologists must become familiar with CT appearance of SCAD. Case Report: We report the multidetector computed tomography (MDCT), intravascular ultrasound (IVUS), and invasive coronary angiography (ICA) findings in a case of spontaneous coronary artery dissection of the left anterior descending artery in a previously healthy 23-year-old man. The role of coronary computed tomographic angiography (CCTA) in diagnosis and management of this potentially life-threatening condition is discussed. Conclusions: In the clinical setting of acute coronary syndrome, SCAD must be a consideration, particularly in young patients without clear risk factors for coronary artery disease and in women in the peripartum period. CCTA is a very helpful diagnostic tool to diagnose the condition in a non-invasive manner and to follow up after treatment. PMID:25738889

  8. Nonallergic Rhinitis, With a Focus on Vasomotor Rhinitis Clinical Importance, Differential Diagnosis, and Effective Treatment Recommendations

    PubMed Central

    2009-01-01

    The term "rhinitis" denotes nasal inflammation causing a combination of rhinorrhea, sneezing, congestion, nasal itch, and/or postnasal drainage. Allergic rhinitis is the most prevalent and most frequently recognized form of rhinitis. However, nonallergic rhinitis (NAR) is also very common, affecting millions of people. By contrast, NAR is less well understood and less often diagnosed. Nonallergic rhinitis includes a heterogeneous group of conditions, involving various triggers and distinct pathophysiologies. Nonallergic vasomo-tor rhinitis is the most common form of NAR and will be the primary focus of this review. Understanding and recognizing the presence of NAR in a patient is essential for the correct selection of medications and for successful treatment outcomes. PMID:23282951

  9. Vasomotor symptoms and the homeostatic model assessment of insulin-resistance in Korean postmenopausal women

    PubMed Central

    Kwon, Dae Hui; Lee, Ju Hak; Ryu, Ki-Jin; Park, Hyun-Tae

    2016-01-01

    The aim of this cross-sectional study was to evaluate the association between vasomotor symptoms (VMS) and insulin resistance, which can be postulated by the homeostatic model assessment (HOMA) index. This study involved 1,547 Korean postmenopausal women (age, 45 to 65 years) attending a routine health check-up at a single institution in Korea from January 2010 to December 2012. A menopause rating scale questionnaire was used to assess the severity of VMS. The mean age of participants was 55.22±4.8 years and 885 (57.2%) reported VMS in some degree. The mean HOMA index was 1.79±0.96, and the HOMA index increased with an increase in severity of VMS (none, mild, moderate and severe) in logistic regression analysis (β=0.068, t=2.665, P =0.008). Insulin resistance needs to be considered to understand the linkage between VMS and cardiometabolic disorders. PMID:26866035

  10. Investigation of the relationship between personality characteristics and vasomotor symptoms in menopausal women

    PubMed Central

    Ghorbani, Mahboubeh; Azhari, Sedigheh; Esmaily, Habib Allah; GhanbariHashemabadi, Bahram Ali

    2016-01-01

    Background: Research demonstrates that most of the menopausal symptoms and problems are the reflection of individual and social circumstances rather than the endocrine events of the menopause. As majority of women live 30 years or more through postmenopausal period, treatment and following up their problems during this period is among the main duties of a midwife. The aim of this study is to determine the relationship between personality traits and vasomotor symptoms in postmenopausal women. Materials and Methods: This correlation study was conducted on 400 postmenopausal women referring to the training maternity centers of Mashhad, Iran. Subjects were selected through simple sampling method and filled NEO Five-Factor Inventory (NEO-FFI (questionnaire. Their daily records of hot flashes and night sweats were also collected. NEO-FFI questionnaire assesses the five personality aspects of neuroticism, extraversion, openness to experience, conscientiousness, and agreeableness. After the data were collected, they were analyzed by Pearson and Spearman correlation coefficients, Mann-Whitney, Kruskal-Wallis, and linear regression statistical tests. P < 0.05 was considered as a statistically significant value. Results: Most of the women were in average level of personality traits. Among the aspects of personality traits, there was a significant correlation between intensity of hot flashes (P = 0.041) and night sweats (P = 0.028), and conscientiousness. Conclusions: According to the results of the study, during treatment of the vasomotor symptoms, a midwife should pay close attention to the personality of postmenopausal women to achieve an effective treatment. These women should also be referred to a psychologist, if needed. PMID:27563331

  11. Discharge of RVLM vasomotor neurons is not increased in anesthetized angiotensin II-salt hypertensive rats.

    PubMed

    Pedrino, Gustavo R; Calderon, Alfredo S; Andrade, Mary Ann; Cravo, Sergio L; Toney, Glenn M

    2013-12-01

    Neurons of the rostral ventrolateral medulla (RVLM) are critical for generating and regulating sympathetic nerve activity (SNA). Systemic administration of ANG II combined with a high-salt diet induces hypertension that is postulated to involve elevated SNA. However, a functional role for RVLM vasomotor neurons in ANG II-salt hypertension has not been established. Here we tested the hypothesis that RVLM vasomotor neurons have exaggerated resting discharge in rats with ANG II-salt hypertension. Rats in the hypertensive (HT) group consumed a high-salt (2% NaCl) diet and received an infusion of ANG II (150 ng·kg(-1)·min(-1) sc) for 14 days. Rats in the normotensive (NT) group consumed a normal salt (0.4% NaCl) diet and were infused with normal saline. Telemetric recordings in conscious rats revealed that mean arterial pressure (MAP) was significantly increased in HT compared with NT rats (P < 0.001). Under anesthesia (urethane/chloralose), MAP remained elevated in HT compared with NT rats (P < 0.01). Extracellular single unit recordings in HT (n = 28) and NT (n = 22) rats revealed that barosensitive RVLM neurons in both groups (HT, 23 cells; NT, 34 cells) had similar cardiac rhythmicity and resting discharge. However, a greater (P < 0.01) increase of MAP was needed to silence discharge of neurons in HT (17 cells, 44 ± 5 mmHg) than in NT (28 cells, 29 ± 3 mmHg) rats. Maximum firing rates during arterial baroreceptor unloading were similar across groups. We conclude that heightened resting discharge of sympathoexcitatory RVLM neurons is not required for maintenance of neurogenic ANG II-salt hypertension. PMID:24124187

  12. Sympathetic vasomotor outflow and blood pressure increase during exercise with expiratory resistance.

    PubMed

    Katayama, Keisho; Itoh, Yuka; Saito, Mitsuru; Koike, Teruhiko; Ishida, Koji

    2015-05-01

    The purpose of the present study was to elucidate the effect of increasing expiratory muscle work on sympathetic vasoconstrictor outflow and arterial blood pressure (BP) during dynamic exercise. We hypothesized that expiratory muscle fatigue would elicit increases in sympathetic vasomotor outflow and BP during submaximal exercise. The subjects performed four submaximal exercise tests; two were maximal expiratory pressure (PE max) tests and two were muscle sympathetic nerve activity (MSNA) tests. In each test, the subjects performed two 10-min exercises at 40% peak oxygen uptake using a cycle ergometer in a semirecumbent position [spontaneous breathing for 5 min and voluntary hyperpnoea with and without expiratory resistive breathing for 5 min (breathing frequency: 60 breaths/min, inspiratory and expiratory times were set at 0.5 sec)]. PE max was estimated before and immediately after exercises. MSNA was recorded via microneurography of the right median nerve at the elbow. PE max decreased following exercise with expiratory resistive breathing, while no change was found without resistance. A progressive increase in MSNA burst frequency (BF) appeared during exercise with expiratory resistance (MSNA BF, without resistance: +22 ± 5%, with resistance: +44 ± 8%, P < 0.05), accompanied by an augmentation of BP (mean BP, without resistance: +5 ± 2%, with resistance: +29 ± 5%, P < 0.05). These results suggest that an enhancement of expiratory muscle activity leads to increases in sympathetic vasomotor outflow and BP during dynamic leg exercise. PMID:26019293

  13. Sympathetic vasomotor outflow and blood pressure increase during exercise with expiratory resistance

    PubMed Central

    Katayama, Keisho; Itoh, Yuka; Saito, Mitsuru; Koike, Teruhiko; Ishida, Koji

    2015-01-01

    The purpose of the present study was to elucidate the effect of increasing expiratory muscle work on sympathetic vasoconstrictor outflow and arterial blood pressure (BP) during dynamic exercise. We hypothesized that expiratory muscle fatigue would elicit increases in sympathetic vasomotor outflow and BP during submaximal exercise. The subjects performed four submaximal exercise tests; two were maximal expiratory pressure (PEmax) tests and two were muscle sympathetic nerve activity (MSNA) tests. In each test, the subjects performed two 10-min exercises at 40% peak oxygen uptake using a cycle ergometer in a semirecumbent position [spontaneous breathing for 5 min and voluntary hyperpnoea with and without expiratory resistive breathing for 5 min (breathing frequency: 60 breaths/min, inspiratory and expiratory times were set at 0.5 sec)]. PEmax was estimated before and immediately after exercises. MSNA was recorded via microneurography of the right median nerve at the elbow. PEmax decreased following exercise with expiratory resistive breathing, while no change was found without resistance. A progressive increase in MSNA burst frequency (BF) appeared during exercise with expiratory resistance (MSNA BF, without resistance: +22 ± 5%, with resistance: +44 ± 8%, P < 0.05), accompanied by an augmentation of BP (mean BP, without resistance: +5 ± 2%, with resistance: +29 ± 5%, P < 0.05). These results suggest that an enhancement of expiratory muscle activity leads to increases in sympathetic vasomotor outflow and BP during dynamic leg exercise. PMID:26019293

  14. Autonomic correlations with MRI are abnormal in the brainstem vasomotor centre in Chronic Fatigue Syndrome.

    PubMed

    Barnden, Leighton R; Kwiatek, Richard; Crouch, Benjamin; Burnet, Richard; Del Fante, Peter

    2016-01-01

    Autonomic changes are often associated with the chronic fatigue syndrome (CFS), but their pathogenetic role is unclear and brain imaging investigations are lacking. The vasomotor centre and, through it, nuclei in the midbrain and hypothalamus play a key role in autonomic nervous system regulation of steady state blood pressure (BP) and heart rate (HR). In this exploratory cross-sectional study, BP and HR, as indicators of autonomic function, were correlated with volumetric and T1- and T2-weighted spin-echo (T1w and T2w) brain MRI in 25 CFS subjects and 25 normal controls (NC). Steady state BP (systolic, diastolic and pulse pressure) and HR in two postures were extracted from 24 h blood pressure monitoring. We performed (1) MRI versus autonomic score interaction-with-group regressions to detect locations where regression slopes differed in the CFS and NC groups (collectively indicating abnormality in CFS), and (2) MRI regressions in the CFS and NC groups alone to detect additional locations with abnormal correlations in CFS. Significant CFS regressions were repeated controlling for anxiety and depression (A&D). Abnormal regressions were detected in nuclei of the brainstem vasomotor centre, midbrain reticular formation and hypothalamus, but also in limbic nuclei involved in stress responses and in prefrontal white matter. Group comparisons of CFS and NC did not find MRI differences in these locations. We propose therefore that these regulatory nuclei are functioning correctly, but that two-way communication between them is impaired in CFS and this affects signalling to/from peripheral effectors/sensors, culminating in inverted or magnified correlations. This single explanation for the diverse abnormal correlations detected here consolidates the conclusion for a brainstem/midbrain nerve conduction deficit inferred earlier (Barnden et al., 2015). Strong correlations were also detected in isolated NC regressions. PMID:27114901

  15. Autonomic correlations with MRI are abnormal in the brainstem vasomotor centre in Chronic Fatigue Syndrome

    PubMed Central

    Barnden, Leighton R.; Kwiatek, Richard; Crouch, Benjamin; Burnet, Richard; Del Fante, Peter

    2016-01-01

    Autonomic changes are often associated with the chronic fatigue syndrome (CFS), but their pathogenetic role is unclear and brain imaging investigations are lacking. The vasomotor centre and, through it, nuclei in the midbrain and hypothalamus play a key role in autonomic nervous system regulation of steady state blood pressure (BP) and heart rate (HR). In this exploratory cross-sectional study, BP and HR, as indicators of autonomic function, were correlated with volumetric and T1- and T2-weighted spin-echo (T1w and T2w) brain MRI in 25 CFS subjects and 25 normal controls (NC). Steady state BP (systolic, diastolic and pulse pressure) and HR in two postures were extracted from 24 h blood pressure monitoring. We performed (1) MRI versus autonomic score interaction-with-group regressions to detect locations where regression slopes differed in the CFS and NC groups (collectively indicating abnormality in CFS), and (2) MRI regressions in the CFS and NC groups alone to detect additional locations with abnormal correlations in CFS. Significant CFS regressions were repeated controlling for anxiety and depression (A&D). Abnormal regressions were detected in nuclei of the brainstem vasomotor centre, midbrain reticular formation and hypothalamus, but also in limbic nuclei involved in stress responses and in prefrontal white matter. Group comparisons of CFS and NC did not find MRI differences in these locations. We propose therefore that these regulatory nuclei are functioning correctly, but that two-way communication between them is impaired in CFS and this affects signalling to/from peripheral effectors/sensors, culminating in inverted or magnified correlations. This single explanation for the diverse abnormal correlations detected here consolidates the conclusion for a brainstem/midbrain nerve conduction deficit inferred earlier (Barnden et al., 2015). Strong correlations were also detected in isolated NC regressions. PMID:27114901

  16. Robotically assisted totally endoscopic coronary artery bypass surgery

    PubMed Central

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the “best of both worlds” from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations. PMID:24251021

  17. Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis.

    PubMed

    Choi, Jin-Ho; Min, James K; Labounty, Troy M; Lin, Fay Y; Mendoza, Dorinna D; Shin, Dae Hee; Ariaratnam, Nikki S; Koduru, Sunaina; Granada, Juan F; Gerber, Thomas C; Oh, Jae K; Gwon, Hyeon-Cheol; Choe, Yeon Hyeon

    2011-11-01

    Coronary computed tomography angiography (CTA) assessment of calcified or complex coronary lesions is frequently challenging. Transluminal attenuation gradient (TAG), defined as the linear regression coefficient between luminal attenuation and axial distance, has a potential to evaluate the degree of coronary stenosis. We examined the value of TAG in determining the stenosis severity on 64-slice coronary CTA. The value of TAG of 370 major coronary arteries was measured from 7,263 intervals of 5-mm length. Compared with coronary CTA and invasive coronary angiography, TAG decreased consistently and significantly with maximum stenosis severity on a per-vessel basis, from -1.91 ± 4.25 Hounsfield units/10 mm for diameter stenosis of 0% to 49% to -13.37 ± 9.81 Hounsfield units/10 mm for diameter stenosis of 100% (p < 0.0001). Adding TAG to the interpretation of coronary CTA improved diagnostic accuracy (p = 0.001), especially in vessels with calcified lesions (N = 127; net reclassification improvement 0.095; p = 0.046). TAG appears to be able to contribute to improved classification of coronary artery stenosis severity in coronary CTA, especially in severely calcified lesions. PMID:22093264

  18. Localised pericardial effusion mimicking anterior myocardial infarction following coronary angiography.

    PubMed

    Acibuca, Aynur; Gerede, Demet M; Baris, Veysel O; Kilickap, Mustafa

    2016-01-01

    The diagnosis of pericarditis is important, especially in patients assumed to have acute coronary syndrome. Distinguishing these two conditions is vital but not always easy. Accurate diagnosis is essential to provide appropriate treatment as soon as possible and to avoid inappropriate invasive procedures. By highlighting this distinction, we report a case of pericarditis that occurred after percutaneous coronary intervention and mimicked acute coronary syndrome. PMID:26956614

  19. Beyond Coronary Stenosis: Coronary Computed Tomographic Angiography for the Assessment of Atherosclerotic Plaque Burden

    PubMed Central

    Kwan, Alan C; Cater, George; Vargas, Jose

    2013-01-01

    Coronary computed tomographic angiography (CCTA) is emerging as a key non-invasive method for assessing cardiovascular risk by measurement of coronary stenosis and coronary artery calcium (CAC). New advancements in CCTA technology have led to the ability to directly identify and quantify the so-called “vulnerable” plaques that have features of positive remodeling and low density components. In addition, CCTA presents a new opportunity for noninvasive measurement of total coronary plaque burden that has not previously been available. The use of CCTA needs also to be balanced by its risks and, in particular, the associated radiation exposure. We review current uses of CCTA, CCTA’s ability to measure plaque quantity and characteristics, and new developments in risk stratification and CCTA technology. CCTA represents a quickly developing field that will play a growing role in the non-invasive management of cardiovascular disease. PMID:23524381

  20. Coronary artery computed tomography as the first-choice imaging diagnostics in patients with high pre-test probability of coronary artery disease (CAT-CAD)

    PubMed Central

    Rudziński, Piotr N.; Demkow, Marcin; Dzielińska, Zofia; Pręgowski, Jerzy; Witkowski, Adam; Rużyłło, Witold; Kępka, Cezary

    2015-01-01

    Introduction The primary diagnostic examination performed in patients with a high pre-test probability of coronary artery disease (CAD) is invasive coronary angiography. Currently, approximately 50% of all invasive coronary angiographies do not end with percutaneous coronary intervention (PCI) because of the absence of significant coronary artery lesions. It is desirable to eliminate such situations. There is an alternative, non-invasive method useful for exclusion of significant CAD, which is coronary computed tomography angiography (CCTA). Aim We hypothesize that use of CCTA as the first choice method in the diagnosis of patients with high pre-test probability of CAD may reduce the number of invasive coronary angiographies not followed by interventional treatment. Coronary computed tomography angiography also seems not to be connected with additional risks and costs of the diagnosis. Confirmation of these assumptions may impact cardiology guidelines. Material and methods One hundred and twenty patients with indications for invasive coronary angiography determined by current ESC guidelines regarding stable CAD are randomized 1 : 1 to classic invasive coronary angiography group and the CCTA group. Results All patients included in the study are monitored for the occurrence of possible end points during the diagnostic and therapeutic cycle (from the first imaging examination to either complete revascularization or disqualification from the invasive treatment), or during the follow-up period. Conclusions Based on the literature, it appears that the use of modern CT systems in patients with high pre-test probability of CAD, as well as appropriate clinical interpretation of the imaging study by invasive cardiologists, enables precise planning of invasive therapeutic procedures. Our randomized study will provide data to verify these assumptions. PMID:26677376

  1. Cerebral vasomotor reactivity: steady-state versus transient changes in carbon dioxide tension.

    PubMed

    Brothers, R Matthew; Lucas, Rebekah A I; Zhu, Yong-Sheng; Crandall, Craig G; Zhang, Rong

    2014-11-01

    Cerebral vasomotor reactivity (CVMR) to changes in arterial carbon dioxide tension (P aCO 2) is assessed during steady-state or transient changes in P aCO 2. This study tested the following two hypotheses: (i) that CVMR during steady-state changes differs from that during transient changes in P aCO 2; and (ii) that CVMR during rebreathing-induced hypercapnia would be blunted when preceded by a period of hyperventilation. For each hypothesis, end-tidal carbon dioxide tension (P ET , CO 2) middle cerebral artery blood velocity (CBFV), cerebrovascular conductance index (CVCI; CBFV/mean arterial pressure) and CVMR (slope of the linear regression between changes in CBFV and CVCI versus P ET , CO 2) were assessed in eight individuals. To address the first hypothesis, measurements were made during the following two conditions (randomized): (i) steady-state increases in P ET , CO 2 of 5 and 10 Torr above baseline; and (ii) rebreathing-induced transient breath-by-breath increases in P ET , CO 2. The linear regression for CBFV versus P ET , CO 2 (P = 0.65) and CVCI versus P ET , CO 2 (P = 0.44) was similar between methods; however, individual variability in CBFV or CVCI responses existed among subjects. To address the second hypothesis, the same measurements were made during the following two conditions (randomized): (i) immediately following a brief period of hypocapnia induced by hyperventilation for 1 min followed by rebreathing; and (ii) during rebreathing only. The slope of the linear regression for CBFV versus P ET , CO 2 (P < 0.01) and CVCI versus P ET , CO 2 (P < 0.01) was reduced during hyperventilation plus rebreathing relative to rebreathing only. These results indicate that cerebral vasomotor reactivity to changes in P aCO 2 is similar regardless of the employed methodology to induce changes in P aCO 2 and that hyperventilation-induced hypocapnia attenuates the cerebral vasodilatory responses during a subsequent period of rebreathing

  2. Protocol for systematic review and meta-analysis: hop (Humulus lupulus L.) for menopausal vasomotor symptoms

    PubMed Central

    Abdi, Fatemeh; Kazemi, Farideh; Ramezani Tehrani, Fahimeh; Roozbeh, Nasibeh

    2016-01-01

    Introduction Menopause is a critical stage in every woman's life. It can cause a distressing time for women by creating various vasomotor symptoms (VMS). Phytoestrogens can potentially exert various favourable effects and alleviate VMS in postmenopausal women. The hop (Humulus lupulus L.) contains 8-prenylnaringenin (8-PN), the most potent phytoestrogen known to date. The hop is eight times stronger than any other herbal oestrogens. This study aims to conduct a comprehensive systematic review and a meta-analysis survey of the effects of hop in the management of VMS in postmenopausal women. Methods Only randomised controlled clinical trials, with cluster randomisation and crossover, blinded and non-blinded designs, conducted between 2000 and 2015, will be included in this review. Quasi-experimental and observational studies as well as case reports will be excluded. The studies will be selected if their participants were aged 40–60 years, had elevated follicle-stimulating hormone (FSH) levels and/or menstrual irregularities, and experienced discomforting VMS (at least hot flashes or night sweats). The primary outcome will be the rate of response to treatment, such as changes in frequency and intensity of symptoms in the intervention and placebo groups. ‘Hop’, ‘Humulus’, ‘menopause’, ‘vasomotor’, ‘hot flashes’, ‘phytoestrogen’ and ‘night sweats’ will be used as search key words. Prior to their inclusion in the review, the selected papers will be assessed by two independent reviewers for methodological validity. Any disagreements will be resolved through a third reviewer. The risk of bias will be independently determined using the Cochrane Risk of Bias Tool. The quality of the papers will be assessed based on the CONSORT checklist. Ethics and dissemination Results will be disseminated through traditional academic literature. Dissemination of results will occur by peer-reviewed publications. The results of our project can help

  3. Atherosclerosis and vasomotor dysfunction in arteries of animals after exposure to combustion-derived particulate matter or nanomaterials.

    PubMed

    Møller, Peter; Christophersen, Daniel Vest; Jacobsen, Nicklas Raun; Skovmand, Astrid; Gouveia, Ana Cecília Damião; Andersen, Maria Helena Guerra; Kermanizadeh, Ali; Jensen, Ditte Marie; Danielsen, Pernille Høgh; Roursgaard, Martin; Jantzen, Kim; Loft, Steffen

    2016-05-01

    Exposure to particulate matter (PM) from traffic vehicles is hazardous to the vascular system, leading to clinical manifestations and mortality due to ischemic heart disease. By analogy, nanomaterials may also be associated with the same outcomes. Here, the effects of exposure to PM from ambient air, diesel exhaust and certain nanomaterials on atherosclerosis and vasomotor function in animals have been assessed. The majority of studies have used pulmonary exposure by inhalation or instillation, although there are some studies on non-pulmonary routes such as the gastrointestinal tract. Airway exposure to air pollution particles and nanomaterials is associated with similar effects on atherosclerosis progression, augmented vasoconstriction and blunted vasorelaxation responses in arteries, whereas exposure to diesel exhaust is associated with lower responses. At present, there is no convincing evidence of dose-dependent effects across studies. Oxidative stress and inflammation have been observed in the arterial wall of PM-exposed animals with vasomotor dysfunction or plaque progression. From the data, it is evident that pulmonary and systemic inflammation does not seem to be necessary for these vascular effects to occur. Furthermore, there is inconsistent evidence with regard to altered plasma lipid profile and systemic inflammation as a key step in vasomotor dysfunction and progression of atherosclerosis in PM-exposed animals. In summary, the results show that certain nanomaterials, including TiO2, carbon black and carbon nanotubes, have similar hazards to the vascular system as combustion-derived PM. PMID:27028752

  4. Coronary artery disease

    MedlinePlus Videos and Cool Tools

    The coronary arteries supply blood to the heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, a ...

  5. [Regulation of vasomotor tone of small skeletal muscle veins by intrinsic mechanisms].

    PubMed

    Szénási, Annamária; Dörnyei, Gabriella; Rácz, Anita; Debreczeni, Béla; Koller, Ákos

    2016-05-22

    In many developed countries the prevalence of venous disorders and its consequences are higher than that of arterial diseases. Thus it is very important to understand the exact physiological and pathophysiological function of small veins and their control mechanisms. Small veins and venules have an important role in the regulation of capillary fluid exchange, as well as return of the venous blood into the heart. However, there is only limited knowledge available regarding the role of local mechanisms controlling the vasomotor tone and diameter of small veins. In the last decade the authors focused on the elucidation of these mechanisms in isolated skeletal muscle venules of rats. Their results suggest that the tone of small veins is controlled by the integration of several mechanisms, activated by the intraluminal pressure and flow/wall shear stress, in addition to numerous local mediators synthesized and released from the smooth muscle and endothelium. These mechanisms are involved - in a complex manner - in the control of postcapillary resistance, thus regulation of tissue blood supply, venous return and consequently in the modulation of the cardiac output, as well. PMID:27177786

  6. Assessment of vasomotor oscillations with Fourier analysis of biological tissue impedance

    NASA Astrophysics Data System (ADS)

    Nesterov, A.; Gavrilov, I.; Selector, L.; Mudraya, I.; Revenko, S.

    2010-04-01

    Fourier analysis revealed a number of periodicities in small variations of bioimpedance of human finger including the major spectrum peaks at the frequencies of heart beats, respiration, and Mayer wave (0.1 Hz). These periodic variations of bioimpedance were detected under the normal conditions and during blood flow arrest in the hand by a pneumatic cuff placed on the arm. They are explained by periodic variations in systemic blood pressure and by oscillations of regional vascular tone resulted from neural vasomotor control. During normal blood flow, the greatest variations in bioimpedance were observed at the heart rate, and their amplitude surpassed by an order of magnitude the amplitudes of respiratory oscillations and Mayer wave. In contrast, during blood arrest, the largest amplitude of rhythmical changes of the impedance characterized the oscillations at respiration rate, while the amplitude of oscillations at the heart rate was the smallest. During normal respiration and circulation, two side cardiac peaks were revealed in bioimpedance amplitude spectrum which disappeared during respiration arrest and thought to reflect the amplitude respiratory modulation of the cardiac output via sympathetic influences. During normal breathing, the second and the third harmonics of the cardiac spectrum peak were split reflecting frequency respiratory modulation of the heart rate by parasympathetic influences. The results favour applicability of Fourier analysis of bioimpedance variations in assessment of regional neural influences and neurogenic modulation of cardiac activity.

  7. Vasomotor tone does not affect perfusion heterogeneity and gas exchange in normal primate lungs during normoxia

    NASA Technical Reports Server (NTRS)

    Glenny, R. W.; Robertson, H. T.; Hlastala, M. P.

    2000-01-01

    To determine whether vasoregulation is an important cause of pulmonary perfusion heterogeneity, we measured regional blood flow and gas exchange before and after giving prostacyclin (PGI(2)) to baboons. Four animals were anesthetized with ketamine and mechanically ventilated. Fluorescent microspheres were used to mark regional perfusion before and after PGI(2) infusion. The lungs were subsequently excised, dried inflated, and diced into approximately 2-cm(3) pieces (n = 1,208-1,629 per animal) with the spatial coordinates recorded for each piece. Blood flow to each piece was determined for each condition from the fluorescent signals. Blood flow heterogeneity did not change with PGI(2) infusion. Two other measures of spatial blood flow distribution, the fractal dimension and the spatial correlation, did not change with PGI(2) infusion. Alveolar-arterial O(2) differences did not change with PGI(2) infusion. We conclude that, in normal primate lungs during normoxia, vasomotor tone is not a significant cause of perfusion heterogeneity. Despite the heterogeneous distribution of blood flow, active regulation of regional perfusion is not required for efficient gas exchange.

  8. Nitric oxide control of lower vertebrate blood vessels by vasomotor nerves.

    PubMed

    Donald, John A; Broughton, Brad R S

    2005-10-01

    In mammals, much is understood about the endothelial and neural NO control mechanisms in the vasculature. In contrast, NO control of blood vessels in lower vertebrates is poorly understood, with the majority of research focusing on the presence of an endothelial NO system; however, its presence remains controversial. This study examined the mechanisms by which NO regulates the large blood vessels of non-mammalian vertebrates. In all species examined, the arteries and veins contained a plexus of NOS-positive perivascular nerves that included nerve bundles and fine, varicose nerve terminals. However, in the large arteries and veins of various species of fishes and amphibians, no anatomical evidence was found for endothelial NOS using both NADPH-diaphorase and eNOS immunohistochemistry. In contrast, perinuclear NOS staining was readily apparent in blue-tongue lizard, pigeon and rat, which suggested that eNOS first appeared in reptiles. Physiological analysis of NO signalling in the vascular smooth muscle of short-finned eel and cane toad could not find any evidence for endothelial NO signalling. In contrast, it appears that activation of the nitrergic vasomotor nerves is responsible for NO control of the blood vessels. PMID:16139537

  9. Role of the caudal pressor area in the regulation of sympathetic vasomotor tone.

    PubMed

    Campos, R R; Carillo, B A; Oliveira-Sales, E B; Silva, A M; Silva, N F; Futuro Neto, H A; Bergamaschi, C T

    2008-07-01

    It is well known that the ventrolateral medulla contains neurons involved in the tonic and reflex control of the cardiovascular system. Two regions within the ventrolateral medulla were initially identified: the rostral ventrolateral medulla (RVLM) and the caudal ventrolateral medulla (CVLM). Activation of the RVLM raises arterial blood pressure and sympathetic nerve activity, and activation of the CVLM causes opposite effects. The RVLM premotor neurons project directly to sympathetic preganglionic neurons and are involved in the maintenance of resting sympathetic vasomotor tone. A significant proportion of tonic activity in the RVLM sympathetic premotor neurons is driven by neurons located in a third region of the ventrolateral medulla denominated caudal pressor area (CPA). The CPA is a pressor region located at the extreme caudal part of the ventrolateral medulla that appears to have an important role controlling the activity of RVLM neurons. In this brief review, we will address the importance of the ventrolateral medulla neurons for the generation of resting sympathetic tone related to arterial blood pressure control focusing on two regions, the RVLM and the CPA. PMID:18719736

  10. Perivascular innervation: A multiplicity of roles in vasomotor control and myoendothelial signaling

    PubMed Central

    Westcott, Erika B.; Segal, Steven S.

    2013-01-01

    The control of vascular resistance and tissue perfusion reflect coordinated changes in the diameter of feed arteries and the arteriolar networks they supply. Against a background of myogenic tone and metabolic demand, vasoactive signals originating from perivascular sympathetic and sensory nerves are integrated with endothelium-derived signals to produce vasodilation or vasoconstriction. PVNs release adrenergic, cholinergic, peptidergic, purinergic, and nitrergic neurotransmitters that lead to SMC contraction or relaxation via their actions on SMCs, ECs, or other PVNs. ECs release autacoids that can have opposing actions on SMCs. Respective cell layers are connected directly to each other through GJs at discrete sites via MEJs projecting through holes in the IEL. Whereas studies of intercellular communication in the vascular wall have centered on endothelium-derived signals that govern SMC relaxation, attention has increasingly focused on signaling from SMCs to ECs. Thus, via MEJs, neurotransmission from PVNs can evoke distinct responses from ECs subsequent to acting on SMCs. To integrate this emerging area of investigation in light of vasomotor control, the present review synthesizes current understanding of signaling events that originate within SMCs in response to perivascular neurotransmission in light of EC feedback. Though often ignored in studies of the resistance vasculature, PVNs are integral to blood flow control and can provide a physiological stimulus for myoendothelial communication. Greater understanding of these underlying signaling events and how they may be affected by aging and disease will provide new approaches for selective therapeutic interventions. PMID:23289720

  11. Contemporary management of acute coronary syndrome

    PubMed Central

    Large, G

    2005-01-01

    This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the predicted level of risk. Patients at high risk should also receive a glycoprotein IIb/IIIa receptor inhibitor and should undergo early coronary arteriography with a view to percutaneous or surgical revascularisation. Lower risk patients should undergo non-invasive testing. When inducible myocardial ischaemia is exhibited coronary arteriography should follow. When non-invasive testing is negative, a conservative management strategy is safe. PMID:15811883

  12. Coronary venous oximetry using MRI.

    PubMed

    Foltz, W D; Merchant, N; Downar, E; Stainsby, J A; Wright, G A

    1999-11-01

    Based on the Fick law, coronary venous blood oxygen measurements have value for assessing functional parameters such as the coronary flow reserve. At present, the application of this measure is restricted by its invasive nature. This report describes the design and testing of a noninvasive coronary venous blood oxygen measurement using MRI, with a preliminary focus on the coronary sinus. After design optimization including a four-coil phased array and an optimal set of data acquisition parameters, quality tests indicate measurement precision on the order of the gold standard optical measurement (3%O(2)). Comparative studies using catheter sampling suggest reasonable accuracy (3 subjects), with variability dominated by sampling location uncertainty ( approximately 7%O(2)). Intravenous dipyridamole (5 subjects) induces significant changes in sinus blood oxygenation (22 +/- 9% O(2)), corresponding to flow reserves of 1.8 +/- 0.4, suggesting the potential for clinical utility. Underestimation of flow reserve is dominated by right atrial mixing and the systemic effects of dipyridamole. Magn Reson Med 42:837-848, 1999. PMID:10542342

  13. Cerebral vasomotor reactivity during hypo- and hypercapnia in sedentary elderly and Masters athletes.

    PubMed

    Zhu, Yong-Sheng; Tarumi, Takashi; Tseng, Benjamin Y; Palmer, Dean M; Levine, Benjamin D; Zhang, Rong

    2013-08-01

    Physical activity may influence cerebrovascular function. The objective of this study was to determine the impact of life-long aerobic exercise training on cerebral vasomotor reactivity (CVMR) to changes in end-tidal CO2 (EtCO2) in older adults. Eleven sedentary young (SY, 27±5 years), 10 sedentary elderly (SE, 72±4 years), and 11 Masters athletes (MA, 72±6 years) underwent the measurements of cerebral blood flow velocity (CBFV), arterial blood pressure, and EtCO2 during hypocapnic hyperventilation and hypercapnic rebreathing. Baseline CBFV was lower in SE and MA than in SY while no difference was observed between SE and MA. During hypocapnia, CVMR was lower in SE and MA compared with SY (1.87±0.42 and 1.47±0.21 vs. 2.18±0.28 CBFV%/mm Hg, P<0.05) while being lowest in MA among all groups (P<0.05). In response to hypercapnia, SE and MA exhibited greater CVMR than SY (6.00±0.94 and 6.67±1.09 vs. 3.70±1.08 CBFV1%/mm Hg, P<0.05) while no difference was observed between SE and MA. A negative linear correlation between hypo- and hypercapnic CVMR (R(2)=0.37, P<0.001) was observed across all groups. Advanced age was associated with lower resting CBFV and lower hypocapnic but greater hypercapnic CVMR. However, life-long aerobic exercise training appears to have minimal effects on these age-related differences in cerebral hemodynamics. PMID:23591649

  14. Effects of skeletal unloading on the vasomotor properties of the rat femur principal nutrient artery

    PubMed Central

    Prisby, Rhonda D.; Behnke, Bradley J.; Allen, Matthew R.

    2015-01-01

    Spaceflight and prolonged bed rest induce deconditioning of the cardiovascular system and bone loss. Previous research has shown declines in femoral bone and marrow perfusion during unloading and with subsequent reloading in hindlimb-unloaded (HU) rats, an animal model of chronic disuse. We hypothesized that the attenuated bone and marrow perfusion may result from altered vasomotor properties of the bone resistance vasculature. Therefore, the purpose of this study was to determine the effects of unloading on the vasoconstrictor and vasodilator properties of the femoral principal nutrient artery (PNA), the main conduit for blood flow to the femur, in 2 wk HU and control (CON) rats. Vasoconstriction of the femoral PNA was assessed in vitro using norepinephrine, phenylephrine, clonidine, KCl, endothelin-1, arginine vasopressin, and myogenic responsiveness. Vasodilation through endothelium-dependent [acetylcholine, bradykinin, and flow-mediated dilation (FMD)] and endothelium-independent mechanisms [sodium nitroprusside (SNP) and adenosine] were also determined. Vasoconstrictor responsiveness of the PNA from HU rats was not enhanced through any of the mechanisms tested. Endothelium-dependent vasodilation to acetylcholine (CON, 86 ± 3%; HU, 48 ± 7% vasodilation) and FMD (CON, 61 ± 9%; HU, 11 ± 11% vasodilation) were attenuated in PNAs from HU rats, while responses to bradykinin were not different between groups. Endothelium-independent vasodilation to SNP and adenosine were not different between groups. These data indicate that unloading-induced decrements in bone and marrow perfusion and increases in vascular resistance are not the result of enhanced vasoconstrictor responsiveness of the bone resistance arteries but are associated with reductions in endothelium-dependent vasodilation. PMID:25635000

  15. A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients.

    PubMed

    Drewe, Juergen; Bucher, Kathleen A; Zahner, Catherine

    2015-01-01

    The cardinal climacteric symptoms of hot flushes and night sweats affect 24-93% of all women during the physiological transition from reproductive to post-reproductive life. Though efficacious, hormonal therapy and partial oestrogenic compounds are linked to a significant increase in breast cancer. Non-hormonal treatments are thus greatly appreciated. This systematic review of published hormonal and non-hormonal treatments for climacteric, and breast and prostate cancer-associated hot flushes, examines clinical efficacy and therapy-related cancer risk modulation. A PubMed search included literature up to June 19, 2014 without limits for initial dates or language, with the search terms, (hot flush* OR hot flash*) AND (clinical trial* OR clinical stud*) AND (randomi* OR observational) NOT review). Retrieved references identified further papers. The focus was on hot flushes; other symptoms (night sweats, irritability, etc.) were not specifically screened. Included were some 610 clinical studies where a measured effect of the intervention, intensity and severity were documented, and where patients received treatment of pharmaceutical quality. Only 147 of these references described studies with alternative non-hormonal treatments in post-menopausal women and in breast and prostate cancer survivors; these results are presented in Additional file 1. The most effective hot flush treatment is oestrogenic hormones, or a combination of oestrogen and progestins, though benefits are partially outweighed by a significantly increased risk for breast cancer development. This review illustrates that certain non-hormonal treatments, including selective serotonin reuptake inhibitors, gabapentin/pregabalin, and Cimicifuga racemosa extracts, show a positive risk-benefit ratio. Key pointsSeveral non-hormonal alternatives to hormonal therapy have been established and registered for the treatment of vasomotor climacteric symptoms in peri- and post-menopausal women.There are indications

  16. Coronary CT angiography: current status and continuing challenges

    PubMed Central

    Sun, Z; Choo, G H; Ng, K H

    2012-01-01

    Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease owing to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with multislice CT scanners (64 slice and higher), and in selected patients coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. With high-quality coronary CT imaging increasingly being performed, patients can benefit from an imaging modality that provides a rapid and accurate diagnosis while avoiding an invasive procedure. Despite the tremendous contributions of coronary CT angiography to cardiac imaging, study results reported in the literature should be interpreted with caution as there are some limitations existing within the study design or related to patient risk factors. In addition, some attention must be given to the potential health risks associated with the ionising radiation received during cardiac CT examinations. Radiation dose associated with coronary CT angiography has raised serious concerns in the literature, as the risk of developing malignancy is not negligible. Various dose-saving strategies have been implemented, with some of the strategies resulting in significant dose reduction. The aim of this review is to present an overview of the role of coronary CT angiography on cardiac imaging, with focus on coronary artery disease in terms of the diagnostic and prognostic value of coronary CT angiography. Various approaches for dose reduction commonly recommended in the literature are discussed. Limitations of coronary CT angiography are identified. Finally, future directions and challenges with the use of coronary CT angiography are highlighted. PMID:22253353

  17. Coronary CT angiography: current status and continuing challenges.

    PubMed

    Sun, Z; Choo, G H; Ng, K H

    2012-05-01

    Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease owing to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with multislice CT scanners (64 slice and higher), and in selected patients coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. With high-quality coronary CT imaging increasingly being performed, patients can benefit from an imaging modality that provides a rapid and accurate diagnosis while avoiding an invasive procedure. Despite the tremendous contributions of coronary CT angiography to cardiac imaging, study results reported in the literature should be interpreted with caution as there are some limitations existing within the study design or related to patient risk factors. In addition, some attention must be given to the potential health risks associated with the ionising radiation received during cardiac CT examinations. Radiation dose associated with coronary CT angiography has raised serious concerns in the literature, as the risk of developing malignancy is not negligible. Various dose-saving strategies have been implemented, with some of the strategies resulting in significant dose reduction. The aim of this review is to present an overview of the role of coronary CT angiography on cardiac imaging, with focus on coronary artery disease in terms of the diagnostic and prognostic value of coronary CT angiography. Various approaches for dose reduction commonly recommended in the literature are discussed. Limitations of coronary CT angiography are identified. Finally, future directions and challenges with the use of coronary CT angiography are highlighted. PMID:22253353

  18. The increase of vasomotor tone avoids the ability of the dynamic preload indicators to estimate fluid responsiveness

    PubMed Central

    2013-01-01

    Background The use of vasoconstrictor can affect the dynamic indices to predict fluid responsiveness. We investigate the effects of an increase of vascular tone on dynamic variables of fluid responsiveness in a rabbit model of hemorrhage, and to examine the ability of the arterial pressure surrogates dynamic indices to track systolic volume variation (SVV) during hypovolemia under increased vasomotor tone. Methods Eighteen anesthetized and mechanically ventilated rabbits were studied during normovolemia (BL) and after blood progressive removal (15 mL/kg, BW). Other two sets of data were obtained during PHE infusion with normovolemia (BL + PHE) and during hypovolemia (BW + PHE). We measured central venous and left ventricular (LV) pressures and infra diaphragmatic aortic blood flow (AoF) and pressure. Pulse pressure variation (PPV), systolic pressure variation (SPV) and SVV were estimated manually by the variation of beat-to-beat PP, SP and SV, respectively. We also calculated PPVapnea as 100 × (PPmax-PPmin)/PP during apnea. The vasomotor tone was estimated by total peripheral resistance (TPR = mean aortic pressure/mean AoF), dynamic arterial elastance (Eadyn = PPV/SVV) and arterial compliance (C = SV/PP). We assessed LV preload by LV end-diastolic pressure (LVEDP). We compared the trending abilities between SVV and pressure surrogate indices using four-quadrant plots and polar plots. Results Baseline PPV, SPV, PPVapnea, and SVV increased significantly during hemorrhage, with a decrease of AoF (P < 0.05). PHE induced significant TPR and Eadyn increase and C decrease in bled animals, and a further decrease in AoF with a significant decrease of all dynamic indices. There was a significant correlation between SVV and PPV, PPVapnea and SPV in normal vasomotor tone (r2 ≥ 0.5). The concordance rate was 91%, 95% and 76% between SVV and PPV, PPVapnea and SPV, respectively, in accordance with the polar plot analysis. During PHE infusion

  19. Is there a gender difference in noninvasive coronary imaging? Multislice computed tomography for noninvasive detection of coronary stenoses

    PubMed Central

    Dewey, Marc; Rutsch, Wolfgang; Hamm, Bernd

    2008-01-01

    Background Multislice computed tomography (MSCT) coronary angiography is the foremost alternative to invasive coronary angiography. Methods We sought to compare the diagnostic accuracy of MSCT in female and male patients with suspected coronary disease. Altogether 50 women and 95 men underwent MSCT with 0.5 mm detector collimation. Coronary artery stenoses of at least 50% on conventional coronary angiography were considered significant. Results The coronary vessel diameters of all four main coronary artery branches were significantly larger in men than in women. The diagnostic accuracy of MSCT in identifying patients with coronary artery disease was significantly lower for women (72%) compared with men (89%, p < 0.05). Also sensitivity (70% vs. 95%), positive predictive value (64% vs. 93%), and the rate of nondiagnostic examinations (14% vs. 4%, all: p < 0.05) were significantly worse for women. The effective radiation dose of MSCT coronary angiography was significantly higher in the examination of women (13.7 ± 1.2 mSv) than of men (11.7 ± 0.9 mSv, p < 0.001), mainly as a result of the fact that the radiosensitive female breast (contributing 24.5% of the dose in women) is in the x-ray path. Conclusion Noninvasive coronary angiography with MSCT might be less accurate and sensitive for women than men. Also, women are exposed to a significantly higher effective radiation dose than men. PMID:18230167

  20. Adjunctive intra-coronary imaging for the assessment of coronary artery disease

    PubMed Central

    Shah, Nikunj; Ussen, Bassey

    2016-01-01

    Atherosclerotic coronary artery disease remains a leading cause of worldwide morbidity and mortality. Invasive angiography currently remains the gold standard method of diagnosing and treating coronary disease; however, more sophisticated adjunctive interventional technologies have been developed to combat the inter and intra-observer variability frequently encountered in the assessment of lesion severity. Intravascular imaging now plays a key role in optimising percutaneous coronary interventions and provides invaluable information as part of the interventional cardiologist’s diagnostic arsenal. The principles, technical aspects and uses of two modalities of intracoronary imaging, intravascular ultrasound and optical coherence tomography, are discussed. We additionally provide examples of cases where the adjunctive intracoronary imaging was superior to angiography alone in successfully identifying and treating acute coronary syndromes. PMID:27540480

  1. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

    PubMed Central

    Williams, Michelle C.; Hunter, Amanda; Shah, Anoop S.V.; Assi, Valentina; Lewis, Stephanie; Smith, Joel; Berry, Colin; Boon, Nicholas A.; Clark, Elizabeth; Flather, Marcus; Forbes, John; McLean, Scott; Roditi, Giles; van Beek, Edwin J.R.; Timmis, Adam D.; Newby, David E.

    2016-01-01

    Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621). Conclusions In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) PMID:27081014

  2. Usefulness of multidetector CT angiography for anomalous origin of coronary artery

    PubMed Central

    Ishisone, Takenori; Satoh, Mamoru; Okabayashi, Hitoshi; Nakamura, Motoyuki

    2014-01-01

    A 17-year-old man underwent clinical evaluation of exercise-induced syncope. Routine exercise stress test did not show any myocardial ischaemic changes or arrhythmias on the ECG recording. However, multidetector CT (MDCT) angiography of the coronary arteries revealed an abnormal origin of the left coronary artery from the right coronary sinus. The participants’ symptoms were diagnosed as cardiogenic syncope possibly due to transient stenosis of the left main coronary artery caught between the functionally distended aortic root and the pulmonary trunk during exercise. After successful patch coronary angioplasty, his symptoms disappeared completely even during a similar degree of strenuous exercise. It is important for clinicians not to overlook possible coronary artery anomalies during management of patients with exercise-induced syncope. MDCT coronary angiography may be a useful and non-invasive tool to establish diagnosis and a surgical approach to rectify congenital coronary artery anomalies. PMID:25150237

  3. Feline cerebral veins and arteries: comparison of autonomic innervation and vasomotor responses

    PubMed Central

    Edvinsson, Lars; McCulloch, James; Uddman, Rolf

    1982-01-01

    1. The innervation of feline cerebral (pial) vessels by nerve fibres containing noradrenaline, substance P or vasoactive intestinal polypeptide (VIP) has been examined using the Falck—Hillarp histo-fluorescence method and immunohistochemical techniques. Cerebral veins were shown to be innervated by nerve fibres containing noradrenaline, substance P or VIP. Nerve fibres containing noradrenaline were the most numerous, while fibres containing substance P were observed least frequently in both types of vessel. For each putative neurotransmitter, the density of the innervation of the cerebral veins was less than that of cerebral arteries. 2. The vasomotor responses of individual pial arteries and veins on the convexity of the cerebral cortex to perivascular micro-injection of noradrenaline, substance P and VIP were examined in twenty-five cats anaesthetized with α-chloralose. 3. The perivascular micro-application of noradrenaline resulted in pronounced dose-dependent reductions in the diameter of pial veins (maximum calibre reduction: 32±3% noradrenaline 10-5 M) and arteries (22±3% noradrenaline 10-5 M). Pial veins were more sensitive to noradrenaline than were pial arteries tested under similar conditions. The reductions in the diameter of cerebral veins and arteries resulting from the administration of noradrenaline could be attenuated by the concomitant micro-application of phentolamine (10-6 M). 4. The perivascular micro-application of substance P effected significant dose-dependent increases in the calibre of pial veins (maximum calibre increase: 16±4% substance P 10-7 M) which were of a similar magnitude to those observed in pial arteries in response to this peptide (21±4% substance P 10-6 M). 5. The perivascular micro-application of VIP resulted in small increases in the calibre of pial veins (maximum calibre increase: 9±2% VIP 10-8 M) which were proportionately smaller than those observed in pial arteries in response to this peptide (23±5% VIP 10-7 M

  4. Vasomotor symptoms in infertile premenopausal women: a hitherto unappreciated risk for low bone mineral density

    PubMed Central

    Pal, Lubna; Norian, John; Zeitlian, Gohar; Bevilacqua, Kris; Freeman, Ruth; Santoro, Nanette

    2008-01-01

    Objective To identify the prevalence of vasomotor symptoms (VMS) in a population of premenopausal infertile women and to determine if VMS associate with enhanced bone turnover and low bone mineral density (BMD). Design Cross-sectional study. Setting Academic infertility practice. Patients 82 premenopausal infertile but otherwise healthy women attending for routine infertility care. Intervention BMD testing, general health and profile of mood state (POMS) questionnaires, serum samples (cycle days 1–3). Main Outcome Measures VMS, specifically hot flashes-HF and night sweats-NS; BMD-Z score, BMD categorized as “Low” (Z ≤ −1.0 ) or “Normal” (Z > −1.0); ovarian reserve assessment (biochemical and ovarian dimensions on transvaginal ultrasound); serum markers of bone turnover (NTX, TRAP, BSAP) and ovarian reserve (FSH, Estradiol and Inhibin B). Multivariable regression analyses determined the associations between VMS, BMD and bone turnover (individual markers and composite turnover score). Results The prevalence of VMS was 12% in this relatively young population (mean age 34.53 ± SD 4.32). Symptomatic women were significantly more likely to report sleep disturbances (p<0.01), exhibit evidence of low BMD (p<0.01), enhanced bone turnover and poorer ovarian reserve parameters. Multivariable logistic regression analyses confirmed HF (p<0.01) and NS (p<0.01) as independent correlates to low BMD after adjusting for age, BMI, smoking status, menstrual regularity and ovarian reserve status. Multivariable linear regression analyses demonstrated that NS, but not HF, predicted higher bone turnover (p= 0.02) after adjusting for age, smoking, menstrual regularity and ovarian reserve. Conclusions We demonstrate, in a premenopausal population of infertile women, evidence of morbid accompaniments to VMS, including sleep disturbances and evidence of low BMD. Our data further suggest a state of enhanced bone turnover in association with VMS, specifically in those

  5. Coronary vasomotion one year after drug-eluting stent implantation: comparison of everolimus-eluting and paclitaxel-eluting coronary stents.

    PubMed

    Hamilos, Michalis; Ribichini, Flavio; Ostojic, Miodrag C; Ferrero, Valeria; Orlic, Dejan; Vassanelli, Corrado; Karanovic, Nevena; Sarno, Giovanna; Cuisset, Thomas; Vardas, Panos E; Wijns, William

    2014-06-01

    First-generation drug-eluting stents (DES) have been associated with impaired localized coronary vasomotion and delayed endothelialization. We aimed to compare coronary vasomotion after implantation of a newer-generation everolimus-eluting stent (EES), with a first-generation paclitaxel-eluting stent (PES). Coronary vasomotion was studied in 19 patients with EES and 13 with PES. Vasomotor response was measured proximally and distally to the stent and in a remote vessel (reference segment). Quantitative coronary angiography was performed offline. Endothelium independent vasomotion did not differ significantly between the two groups. EES showed significant vasodilatation while PES showed vasoconstriction at both proximal (+4.5 ± 3.6 vs -4.2 ± 6.9, p < 0.001) and distal (+4.6 ± 7.9 vs -4.8 ± 9.3, p = 0.003) segments. The reference segment did not show any significant difference in vasodilatation between the two groups (+9.8 ± 6.4 vs +7.2 ± 5.2, p = 0.17). Endothelium-dependent vasomotion at adjacent stent segments is relatively preserved after EES implantation while vasoconstriction was observed after PES implantation. PMID:24794876

  6. Investigating Invasives

    ERIC Educational Resources Information Center

    Lightbody, Mary

    2008-01-01

    Invasive species, commonly known as "invasives," are nonnative plants, animals, and microbes that completely take over and change an established ecosystem. The consequences of invasives' spread are significant. In fact, many of the species that appear on the Endangered Species list are threatened by invasives. Therefore, the topic of invasive…

  7. Risks and Complications of Coronary Angiography: A Comprehensive Review

    PubMed Central

    Tavakol, Morteza; Ashraf, Salman; Brener, Sorin J.

    2012-01-01

    Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient’s concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading. PMID:22980117

  8. Risks and complications of coronary angiography: a comprehensive review.

    PubMed

    Tavakol, Morteza; Ashraf, Salman; Brener, Sorin J

    2012-01-01

    Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient's concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading. PMID:22980117

  9. Spontaneous Coronary Dissection: "Live Flash" Optical Coherence Tomography Guided Angioplasty.

    PubMed

    Bento, Angela Pimenta; Fernandes, Renato Gil Dos Santos Pinto; Neves, David Cintra Henriques Silva; Patrício, Lino Manuel Ribeiro; de Aguiar, José Eduardo Chambel

    2016-01-01

    Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast. PMID:26989520

  10. Counseling the Coronary Patient

    ERIC Educational Resources Information Center

    Semmler, Caryl; Semmler, Maynard

    1974-01-01

    The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)

  11. Coronary artery fistula

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/007315.htm Coronary artery fistula To use the sharing features on this page, please enable JavaScript. Coronary artery fistula is an abnormal connection between one of ...

  12. Coronary artery disease

    MedlinePlus Videos and Cool Tools

    ... heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, a process called atherosclerosis ...

  13. Coronary artery stents.

    PubMed Central

    Stewart, A. J.; Coltart, D. J.

    1996-01-01

    The use of coronary stents to treat the acute complications of percutaneous transluminal coronary angioplasty and to reduce the restenosis rate following this procedure is reviewed. Images Figure 1 Figure 2 Figure 3 PMID:8761499

  14. What Is Coronary Angiography?

    MedlinePlus

    ... OG-rah-fee) is a test that uses dye and special x rays to show the insides ... the coronary arteries. Overview During coronary angiography, special dye is released into the bloodstream. The dye makes ...

  15. Peripheral artery disease in patients with coronary artery disease.

    PubMed

    Atmer, B; Jogestrand, T; Laska, J; Lund, F

    1995-03-01

    The prevalence of peripheral vascular disease in patients with coronary artery disease has been investigated in many different ways and depends on the diagnostic methods and the definition of the atherosclerotic manifestations in the different vascular beds. In this study we used the non-invasive methods digital volume pulse plethysmography and ankle and toe blood pressure measurements to identify arterial abnormalities in the lower limbs in 58 patients (49 males and 9 females; age 37-72 years) examined with coronary angiography. The prevalence of peripheral artery disease was 22%, in agreement with the results of most previous investigations. There was a tendency towards increasing prevalence of peripheral artery disease with more advanced coronary artery disease: 14% of the patients with no or minimal coronary atheromotous lesions, 18% of the patients with moderate coronary atheromotous lesions and 32% of the patients with marked coronary atheromotous disease. For this reason a non-invasive investigation of the peripheral arterial circulation should be included early in the clinical consideration of patients with chest pain or similar symptoms suggesting coronary heart disease. Toe pressure measurement appears to be the most appropriate technique being rather simple in management and also in evaluation of results. PMID:7658111

  16. Racial Disparities in Outcomes Following Coronary Artery Bypass Grafting

    PubMed Central

    Hravnak, Marilyn; Ibrahim, Said; Kaufer, Abigail; Sonel, Ali; Conigliaro, Joseph

    2013-01-01

    More than 12 million people in the United States have coronary heart disease, the second leading cause of hospitalization in the United States. It is known that persons within racial minorities, specifically African Americans, have a higher prevalence of coronary heart disease, yet are much less likely to undergo invasive cardiac treatment interventions. An invasive intervention commonly used to treat coronary heart disease is coronary artery bypass grafting, with over 140,000 operations performed annually in the United States. However, blacks are known to experience higher post–coronary artery bypass graft morbidity and mortality. The causes for racial disparities in post–coronary artery bypass graft outcomes are not well known but may include factors related to the individual, provider, system, and society/environment, either alone or in combination. The purpose of this article is to provide an overview of the literature regarding disparities in the health and healthcare of black patients with coronary heart disease with respect to CABG, and examine potential hypotheses for variant outcomes after surgery. PMID:16966914

  17. Variation of pain and vasomotor responses evoked by intramuscular infusion of hypertonic saline in human subjects: influence of gender and its potential neural mechanisms.

    PubMed

    Lei, Jing; You, Hao-Jun

    2012-04-10

    The aim of current study was to explore role of gender in pain and cutaneous vasomotor responses during the condition of intramuscular (i.m.) hypertonic (HT, 5.8%) saline induced muscle pain. In 20 healthy human subjects (10 females), 2-4.8ml of either HT or isotonic (IT, 0.9%) saline was infused into the left tibialis anterior muscle to elicit muscle pain, during which the intensity and distribution of pain together with skin vasomotor responses were investigated. Cutaneous blood flow was assessed using laser-Doppler flowmetry in 4 different skin areas: ipsilateral infusion area (5cm×5cm), ipsilateral referred pain area (5cm×10cm), contralateral area to the infusion site (5cm×5cm), and contralateral area to the referred pain site (5cm×10cm). Among the different i.m. infusions, 4.8ml HT saline evoked the highest pain intensity, the longest pain duration, and the largest pain distribution area in different subjects (P<0.001). Gender-related differences in pain and skin vasomotor responses were observed following the i.m. HT, but not IT, saline infusion while women exhibited stronger pain intensity and duration (P<0.001), and more expressed vasomotor responses (P<0.05) at the infusion area and contralateral mirror site. Intramuscularly pre-treating the infusion area with 1ml of 2% lidocaine markedly reduced the muscle pain and blocked the increased skin blood flow in both men and women (P<0.05). However, post-treatment with lidocaine significantly reduced the pain intensity and the increased skin blood flow only in men, but not women. The data demonstrate that gender-associated difference exists in HT saline intramuscularly induced local muscle pain and vasomotor responses. Neural mechanisms underlying gender-related differences in vasomotor responses is significantly different, suggesting that local pre-treatment, but not post-treatment, with anesthetic may provide superior analgesia to block sex-associated difference in pain and vasomotor responses. PMID

  18. [Robot-assisted Coronary Artery Bypass Grafting].

    PubMed

    Ishikawa, Norihiko; Watanabe, Go

    2016-07-01

    The application for robot-assisted coronary surgery ranges from internal thoracic artery (ITA) harvesting with hand-sewn anastomoses to totally endoscopic coronary artery bypass grafting (TECAB), either on- or off-pump. The bilateral IMA can be harvested with the aid of a surgical robot and then multivessel bypass grafting can follow. Such robot-assisted minimally invasive direct coronary artery bypass grafting is called "ThoraCAB". Surgical robots cannot only endoscopically harvest the ITA but they can also anastomose the coronary artery in TECAB. But TECAB still has the difficulties, such as narrow surgical field in Japanese patients. Both procedures have the significant advantages of minimizing surgical trauma, such as reduced comlications, faster return back to normal activities and being improved cosmesis, and which have resulted in the development of minimally invasive surgery. Robot-assisted cardiac surgery for structural heart disease has been approved by the Ministry of Health, Labour and Welfare (MHLW) since December 2015, however, robot-assisted cardiac surgery for TECAB has not been approved yet in Japan. PMID:27440015

  19. [Value and limitations of coronary artery imaging with the MRI navigator technique. Comparison with coronary angiography results in 37 patients].

    PubMed

    Haffner, C; Germain, Ph; Roul, G; Jahn, Ch; Beaujeux, R; Bareiss, P

    2002-10-01

    The introduction of a non-invasive method of imaging the coronary arteries would be a great advance in daily cardiological practice. The authors report their experience of imaging the coronary arteries with 1 Tesla MRI using the "navigator technique". Twenty-five sections 1.2 mm thick, focused on the proximal left coronary artery, were acquired with a 512 matrix, without injecting contrast during normal respiration with a tolerance on the portion of the right diaphragmatic cupola of 5 mm. Analysis of the coronary segments included in the field of view was performed on native sections after curve reconstruction and on targetedMIP series. A comparison of the results with respect to conventional coronary angiography showed a relatively limited visualisation of the proximal coronary segments because, in addition to the impossibility of carrying out the investigation in 24% of cases (faulty cardiac or respiratory synchronisation, poor signal/noise ratio), only 93% of the left main coronary and 75% of the proximal left anterior descending arteries could be visualised. In the analyzable segments, the diagnostic performances were modest with a global sensitivity of 60.8% and specificity of 91%. With the exception of the left main coronary artery, the sensitivities observed did not make MRI of the coronary arteries a rival to conventional coronary angiography. These limited performances may be explained by the lack of rapidity of the sequences of acquisition compared to the rapid motion of the structures under investigation whose dimensions are 5 to 10 times smaller than their amplitude of excursion. Technical developments are regularly accomplished in this domain, especially 3rd generation sequences in apnoea with injection of contrast media. At present, despite some results reported in the literature, angio-MRI of the coronary arteries cannot be used reliably to guide clinical decisions in coronary artery disease with the exception of some situations like congenital

  20. Diagnostic Value of Transthoracic Echocardiography in Patients With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

    PubMed Central

    Li, Rong-Juan; Sun, Zhonghua; Yang, Jiao; Yang, Ya; Li, Yi-Jia; Leng, Zhao-Ting; Liu, Guo-Wen; Pu, Li-Hong

    2016-01-01

    Abstract Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality associated with early infant mortality and sudden death in adults. Transthoracic echocardiography (TTE) plays an important role in early detection and diagnosis of ALCAPA as a noninvasive modality. However, its diagnostic value is not well studied. The purpose of this study is to determine the performance of TTE in the diagnostic assessment of ALCAPA as compared with coronary CT and invasive coronary angiography. A total of 22 patients (13 women and 9 men, mean age, 12.9 ± 19.5 years) with ALCAPA who underwent echocardiographic examination for clinical diagnosis were retrospectively reviewed and analyzed. Transthoracic echocardiographic features of ALCAPA were analyzed and its diagnostic value was compared with invasive coronary angiography and coronary CT angiography (CTA) with surgical findings serving as the gold standard. Surgery was performed in all of the patients to establish the dual coronary artery system. Five underwent the Takeuchi procedure and 17 had re-implantation of the anomalous left coronary artery. Of 20 patients, echocardiographic diagnoses were in good agreement with findings at surgery, resulting in the diagnostic accuracy of 90.9%. Two cases were misdiagnosed—one as the right coronary artery to pulmonary artery fistula and the other as rheumatic heart disease. The echocardiographic features of these patients with ALCAPA included: abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow in 20 patients; enlargement of the right coronary artery in 17 patients; abundant intercoronary septal collaterals in 17 patients; and moderate and significant mitral regurgitation in 14 patients. The diagnostic accuracy of invasive coronary angiography (in 17 patients) and coronary CTA (in 9 patients) was 100%. This study shows that TTE is an accurate, noninvasive imaging modality

  1. Diagnostic Value of Transthoracic Echocardiography in Patients With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery.

    PubMed

    Li, Rong-Juan; Sun, Zhonghua; Yang, Jiao; Yang, Ya; Li, Yi-Jia; Leng, Zhao-Ting; Liu, Guo-Wen; Pu, Li-Hong

    2016-04-01

    Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality associated with early infant mortality and sudden death in adults. Transthoracic echocardiography (TTE) plays an important role in early detection and diagnosis of ALCAPA as a noninvasive modality. However, its diagnostic value is not well studied. The purpose of this study is to determine the performance of TTE in the diagnostic assessment of ALCAPA as compared with coronary CT and invasive coronary angiography.A total of 22 patients (13 women and 9 men, mean age, 12.9 ± 19.5 years) with ALCAPA who underwent echocardiographic examination for clinical diagnosis were retrospectively reviewed and analyzed. Transthoracic echocardiographic features of ALCAPA were analyzed and its diagnostic value was compared with invasive coronary angiography and coronary CT angiography (CTA) with surgical findings serving as the gold standard. Surgery was performed in all of the patients to establish the dual coronary artery system. Five underwent the Takeuchi procedure and 17 had re-implantation of the anomalous left coronary artery. Of 20 patients, echocardiographic diagnoses were in good agreement with findings at surgery, resulting in the diagnostic accuracy of 90.9%. Two cases were misdiagnosed-one as the right coronary artery to pulmonary artery fistula and the other as rheumatic heart disease. The echocardiographic features of these patients with ALCAPA included: abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow in 20 patients; enlargement of the right coronary artery in 17 patients; abundant intercoronary septal collaterals in 17 patients; and moderate and significant mitral regurgitation in 14 patients. The diagnostic accuracy of invasive coronary angiography (in 17 patients) and coronary CTA (in 9 patients) was 100%.This study shows that TTE is an accurate, noninvasive imaging modality for displaying

  2. Longitudinal Analysis of the Association Between Vasomotor Symptoms and Race/Ethnicity Across the Menopausal Transition: Study of Women’s Health Across the Nation

    PubMed Central

    Gold, Ellen B.; Colvin, Alicia; Avis, Nancy; Bromberger, Joyce; Greendale, Gail A.; Powell, Lynda; Sternfeld, Barbara; Matthews, Karen

    2006-01-01

    Objectives. We investigated whether vasomotor symptom reporting or patterns of change in symptom reporting over the perimenopausal transition among women enrolled in a national study differed according to race/ethnicity. We also sought to determine whether racial/ethnic differences were explained by sociodemographic, health, or lifestyle factors. Methods. We followed 3198 women enrolled in the Study of Women’s Health Across the Nation during 1996 through 2002. We analyzed frequency of vasomotor symptom reporting using longitudinal multiple logistic regressions. Results. Rates of vasomotor symptom reporting were highest among African Americans (adjusted odds ratio [OR]=1.63; 95% confidence interval [CI]=1.21, 2.20). The transition to late perimenopause exhibited the strongest association with vasomotor symptoms (adjusted OR = 6.64; 95% CI = 4.80, 9.20). Other risk factors were age (adjusted OR=1.17; 95% CI=1.13, 1.21), having less than a college education (adjusted OR = 1.91; 95% CI = 1.40, 2.61), increasing body mass index (adjusted OR=1.03 per unit of increase; 95% CI=1.01, 1.04), smoking (adjusted OR=1.63; 95% CI=1.25, 2.12), and anxiety symptoms at baseline (adjusted OR=3.10; 95% CI=2.33, 4.12). Conclusions. Among the risk factors assessed, vasomotor symptoms were most strongly associated with menopausal status. After adjustment for covariates, symptoms were reported most often in all racial/ethnic groups in late perimenopause and nearly as often in postmenopause. PMID:16735636

  3. Invasive Candidiasis

    MedlinePlus

    ... Invasive candidiasis is an infection caused by a yeast (a type of fungus) called Candida . Unlike Candida ... mouth and throat (also called “thrush”) or vaginal “yeast infections,” invasive candidiasis is a serious infection that ...

  4. Assessment of coronary artery disease using coronary computed tomography angiography and biochemical markers

    PubMed Central

    Gitsioudis, Gitsios; Katus, Hugo A; Korosoglou, Grigorios

    2014-01-01

    Chronic inflammatory mechanisms in the arterial wall lead to atherosclerosis, and include endothelial cell damage, inflammation, apoptosis, lipoprotein deposition, calcification and fibrosis. Cardiac computed tomography angiography (CCTA) has been shown to be a promising tool for non-invasive assessment of theses specific compositional and structural changes in coronary arteries. This review focuses on the technical background of CCTA-based quantitative plaque characterization. Furthermore, we discuss the available evidence for CCTA-based plaque characterization and the potential role of CCTA for risk stratification of patients with coronary artery disease. PMID:25068026

  5. Classification of Nonallergic Rhinitis Syndromes With a Focus on Vasomotor Rhinitis, Proposed to be Known henceforth as Nonallergic Rhinopathy

    PubMed Central

    2009-01-01

    Many patients have nasal syndromes that are nonallergic and noninfectious and not caused by mechanical or anatomic abnormalities. There are at least 8 recognized nonallergic rhinitis syndromes: drug-induced rhinitis including rhinitis medicamentosa, gustatory rhinitis, hormonally induced rhinitis including the rhinitis of pregnancy, nonallergic rhinitis with eosinophilia syndrome, senile rhinitis, atrophic rhinitis, cerebral spinal fluid leak, and vasomotor rhinitis. Few studies have explored etiologic causes. These syndromes are distinguished by clinical characteristics, recognized triggering conditions, and concomitant observations such as nasal eosinophilia or cerebral spinal fluid leak. Until more specific subjective clinical characteristics and/or objective measures can better define and differentiate underlying causes for these disparate diseases, they will remain a murky group of overlapping syndromes. PMID:24229372

  6. Impact of an Early Invasive Strategy versus Conservative Strategy for Unstable Angina and Non-ST Elevation Acute Coronary Syndrome in Patients with Chronic Kidney Disease: A Systematic Review

    PubMed Central

    Shaw, Catriona; Nitsch, Dorothea; Lee, Jasmine; Fogarty, Damian; Sharpe, Claire C.

    2016-01-01

    Background Clinical practice guidelines support an early invasive approach after NSTE-ACS in patients with chronic kidney disease (CKD). There is no direct randomised controlled trial evidence in the CKD population, and whether the benefit of an early invasive approach is maintained across the spectrum of severity of CKD remains controversial. Methods We conducted a systematic review to evaluate the association between an early invasive approach and all-cause mortality in patients with CKD. We searched MEDLINE and EMBASE (1990-May 2015) and article reference lists. Data describing study design, participants, invasive management strategies, renal function, all-cause mortality and risk of bias were extracted. Results 3,861 potentially relevant studies were identified. Ten studies, representing data on 147,908 individuals with NSTE-ACS met the inclusion criteria. Qualitative heterogeneity in the definitions of early invasive approach, comparison groups and renal dysfunction existed. Meta-analysis of the RCT derived and observational data were generally supportive of an early invasive approach in CKD (RR0.76 (95% CI 0.49–1.17) and RR0.50 (95%CI 0.42–0.59) respectively). Meta-analysis of the observational studies demonstrated a large degree of heterogeneity (I2 79%) driven in part by study size and heterogeneity across various kidney function levels. Conclusions The observational data support that an early invasive approach after NSTE-ACS confers a survival benefit in those with early-moderate CKD. Local opportunities for quality improvement should be sought. Those with severe CKD and the dialysis population are high risk and under-studied. Novel and inclusive approaches for CKD and dialysis patients in cardiovascular clinical trials are needed. PMID:27195786

  7. Antithrombotic strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome

    PubMed Central

    Pham, Son V; Pham, Phuong-Chi T; Pham, Phuong-Mai T; Miller, Jeffrey M; Pham, Phuong-Thu T; Pham, Phuong-Anh T

    2010-01-01

    In patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings. While clopidogrel may be of little beneficial effect if administered immediately prior to PCI and may even increase major bleeding risk if coronary artery bypass grafting is anticipated, early discontinuation of the drug may result in insufficient antiplatelet coverage with thrombotic complications. Optimal and rapid inhibition of platelet activity to suppress ischemic and thrombotic events while minimizing bleeding complications is an important therapeutic goal in the management of patients undergoing percutaneous coronary intervention. In this article we present an overview of the literature on clinical trials evaluating the different aspects of antithrombotic therapy in patients undergoing PCI and discuss the emerging role of these agents in the contemporary era of early invasive coronary intervention. Clinical trial acronyms and their full names are provided in Table 1. PMID:20856846

  8. The iatrogenic pathology of percutaneous interventions in coronary arteries.

    PubMed

    Li, X; De Winter, R J; Van Der Wal, A C

    2012-12-01

    Acute coronary syndromes (ACS) represent the clinical manifestations of sudden flow limiting coronary artery disease leading to acute myocardial ischemia or necrosis. Treatment of progressive coronary stenosis or acute thrombotic occlusion by means of percutaneous coronary intervention (PCI) with balloon dilatation and stent placement aims to reduce the risk of myocardial ischemia or necrosis by restoring coronary flow. But, being an invasive technique, it is associated with a periprocedural and also eventually long-term risk of complications. Pathological examination of atherosclerotic coronary arteries after PCI treatment has been shown to be very helpful in providing insights in this iatrogenic pathology. Importantly, the pathological substrate of the treated coronary artery segment in patients with ACS differs significantly from coronary artery segments in patients with stable coronary artery disease. Such studies have shown that besides the physical trauma induced by a balloon or a stent also the specific histomorphological and biological properties of the treated coronary plaques play an important role in the risk of PCI related vascular complications. Major complications, which are thrombosis and restenosis, have reduced significantly over the past years. Still, late stent thrombosis remains a small but clinically important problem after placement of drug eluting stents DES, mainly related to delayed in stent wound healing and early withdrawal of antiplatelet therapy. Moreover, restenosis remains a problem in the still large group of patients treated with bare metal stents (BMS) worldwide. Both in case of BMS and DES emerging evidence from recent histopathological studies on coronary resected stents shows that the outcome of PCI can be influenced by the occurrence of in stent neo- atherosclerosis, in DES more frequent than in BMS, which in turn may stimulate both thrombosis and restenosis on the very long term. PMID:23229368

  9. Automatic centerline extraction of coronary arteries in coronary computed tomographic angiography.

    PubMed

    Yang, Guanyu; Kitslaar, Pieter; Frenay, Michel; Broersen, Alexander; Boogers, Mark J; Bax, Jeroen J; Reiber, Johan H C; Dijkstra, Jouke

    2012-04-01

    Coronary computed tomographic angiography (CCTA) is a non-invasive imaging modality for the visualization of the heart and coronary arteries. To fully exploit the potential of the CCTA datasets and apply it in clinical practice, an automated coronary artery extraction approach is needed. The purpose of this paper is to present and validate a fully automatic centerline extraction algorithm for coronary arteries in CCTA images. The algorithm is based on an improved version of Frangi's vesselness filter which removes unwanted step-edge responses at the boundaries of the cardiac chambers. Building upon this new vesselness filter, the coronary artery extraction pipeline extracts the centerlines of main branches as well as side-branches automatically. This algorithm was first evaluated with a standardized evaluation framework named Rotterdam Coronary Artery Algorithm Evaluation Framework used in the MICCAI Coronary Artery Tracking challenge 2008 (CAT08). It includes 128 reference centerlines which were manually delineated. The average overlap and accuracy measures of our method were 93.7% and 0.30 mm, respectively, which ranked at the 1st and 3rd place compared to five other automatic methods presented in the CAT08. Secondly, in 50 clinical datasets, a total of 100 reference centerlines were generated from lumen contours in the transversal planes which were manually corrected by an expert from the cardiology department. In this evaluation, the average overlap and accuracy were 96.1% and 0.33 mm, respectively. The entire processing time for one dataset is less than 2 min on a standard desktop computer. In conclusion, our newly developed automatic approach can extract coronary arteries in CCTA images with excellent performances in extraction ability and accuracy. PMID:21637981

  10. Clinical value of multidetector CT coronary angiography as a preoperative screening test before non‐coronary cardiac surgery

    PubMed Central

    Russo, Vincenzo; Gostoli, Valentina; Lovato, Luigi; Montalti, Maurizio; Marzocchi, Antonio; Gavelli, Giampaolo; Branzi, Angelo; Bartolomeo, Roberto Di; Fattori, Rossella

    2007-01-01

    Objective Myocardial scintigraphy and/or conventional angiography (CA) are often performed before cardiac surgery in an attempt to identify unsuspected coronary artery disease which might result in significant cardiac morbidity and mortality. Multidetector CT coronary angiography (MDCTCA) has a recognised high negative predictive value and may provide a non‐invasive alternative in this subset of patients. The aim of this study was to evaluate the clinical value of MDCTCA as a preoperative screening test in candidates for non‐coronary cardiac surgery. Methods 132 patients underwent MDCTCA (Somatom Sensation 16 Cardiac, Siemens) in the assessment of the cardiac risk profile before surgery. Coronary arteries were screened for ⩾50% stenosis. Patients without significant stenosis (Group 1) underwent surgery without any adjunctive screening tests while all patients with coronary lesions ⩾50% at MDCTCA (Group 2) underwent CA. Results 16 patients (12.1%) were excluded due to poor image quality. 72 patients without significant coronary stenosis at MDCTCA were submitted to surgery. 30 out of 36 patients with significant (⩾50%) coronary stenosis at MDCTCA and CA underwent adjunctive bypass surgery or coronary angioplasty. In 8 patients, MDCTCA overestimated the severity of the coronary lesions (>50% MDCTCA, <50% CA). No severe cardiovascular perioperative events such as myocardial ischaemia, myocardial infarction or cardiac failure occurred in any patient in Group 1. Conclusions MDCTCA seems to be effective as a preoperative screening test prior to non‐coronary cardiac surgery. In this era of cost containment and optimal care of patients, MDCTCA is able to provide coronary vessel and ventricular function evaluation and may become the method of choice for the assessment of a cardiovascular risk profile prior to major surgery. PMID:17164488

  11. What Causes Coronary Microvascular Disease?

    MedlinePlus

    ... Living With Clinical Trials Links Related Topics Angina Atherosclerosis Coronary Heart Disease Coronary Heart Disease Risk Factors ... Microvascular Disease? The same risk factors that cause atherosclerosis may cause coronary microvascular disease. Atherosclerosis is a ...

  12. How Is Coronary Angioplasty Done?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Percutaneous Coronary Intervention Done? Before you have percutaneous coronary intervention (PCI), ... wall, relieving the blockage and improving blood flow. Percutaneous Coronary Intervention Figure A shows the location of the heart ...

  13. Who Needs Coronary Artery Bypass Grafting?

    MedlinePlus

    ... Rehabilitation Coronary Heart Disease Heart Attack Heart Surgery Percutaneous Coronary Intervention Send a link to NHLBI to someone by ... coronary arteries that can't be treated with percutaneous coronary intervention (PCI), also known as coronary angioplasty. Your doctor ...

  14. Adenosine-induced coronary vasospasm following drug-eluting stent implantation

    PubMed Central

    Matsumoto, Naoya; Nagao, Ken; Hirayama, Atsushi; Kasama, Shu

    2014-01-01

    We present the case of coronary vasospasm during adenosine stress in a patient with a prior drug-eluting stent implantation. The patient had a stent implantation in the left anterior descending coronary artery 3 years ago. Recently, he developed a chest pain and underwent adenosine stress myocardial perfusion single photon emission CT (SPECT). During the adenosine stress, he felt severe chest pain and ST elevation on electrocardiogram. An invasive coronary angiography showed no in-stent restenosis. This phenomenon deemed to be adenosine-induced coronary vasospasm after stent implantation. PMID:24518394

  15. Thrombotic thrombocytopenic purpura presenting as acute coronary syndrome.

    PubMed

    Mouabbi, Jason Aboudi; Zein, Rami; Kafri, Zyad; Al-Katib, Ayad; Hadid, Tarik

    2016-08-01

    In patients presenting with thrombotic thrombocytopenia purpura and non-ST elevation myocardial infarction, prompt initiation of plasma exchange takes precedence over other invasive diagnostic procedures for coronary artery disease. Such procedures should be delayed until clinical condition and laboratory parameters have been stabilized. PMID:27525072

  16. Use of CT Angiogram in Interventions Involving Coronary Artery Anomalies: A Case Series

    PubMed Central

    Ramesh, Dwarakanath; Setty Natraj Setty, Huliyurdurga S.; Patil, Veeresh; Swamy, Kumar; Kumar, Sunil; Guruprasad, Guruprasad; Manjunath, Cholenahalli Nanjappa

    2015-01-01

    Case series Patient: — Final Diagnosis: Coronary anamolies Symptoms: Chest pain Medication: None Clinical Procedure: PTCA with stent/CABG Specialty: Cardiology Objective: Challenging differential diagnosis Background: Coronary artery anomalies are rare, accounting for about 0.3–1.3% of patients undergoing diagnostic coronary angiography. Interventions in these cases are still rare, and therefore pose technical challenges during intervention. CT Angiography provides a non-invasive means of assessment of coronary artery disease and also shows the anatomy of the coronary tree. This helps in knowing the origin of the coronaries and also to plan selection of hardware. There are no specific guidelines for use of guiding catheters and guide wires in anomalous coronary artery intervention. Case Report: We report a series of 5 patients presenting with effort angina who had anomalous coronary arteries with coronary stenosis diagnosed by CT angiography. Three patients received percutaneous intervention, 1 patient underwent CABG, and 1 patient received medical management. Conclusions: CT Angiography provides a useful tool for showing the coronary anatomy and for selecting the guiding catheter and the guide wire that remain the mainstay of interventions in coronary artery anomalies. PMID:26637639

  17. Assessment of coronary artery stenosis pressure gradient by quantitative coronary arteriography in patients with coronary artery disease.

    PubMed

    Atar, D; Ramanujam, P S; Saunamäki, K; Haunsø, S

    1994-01-01

    The aim of the study described here was to correlate coronary artery (CA) stenosis pressure gradients calculated by quantitative coronary arteriography (QCA) to invasively measured transstenotic pressure drops in patients with anginal symptoms and with known or suspected coronary artery disease. Furthermore, the known mathematical models are improved by introducing (1) pressure catheter-corrected minimal stenosis area, (2) modification of flow assumptions, and (3) stenosis exit angle. Included in the study were 45 patients with 61 stenoses. The visually estimated CA lesion severity in these non-complex stenoses was in the equivocal range of 40-70%. All measurements were performed after intracoronary administration of nifedipine and nitroglycerin. Stenosis dimensions were assessed from magnified cinefilms, using hand-held calipers. Highly significant overall correlation was found between measured and calculated pressure gradients with correction for the impact of the intracoronary catheter (P < 0.00001, r = 0.84). In particular, a substantial number of stenoses with haemodynamically-insignificant pressure gradients were identified by hydrodynamic calculations. In conclusion, the great majority of the coronary artery stenoses could be classified reliably by QCA as being haemodynamically insignificant or significant, respectively. PMID:8149707

  18. Anomalous origin of the right coronary artery from the left anterior descending artery: review of the literature.

    PubMed

    Yurtdaş, Mustafa; Gülen, Oktay

    2012-01-01

    Coronary artery anomalies that take place during fetal development are determined in approximately 1.3% of coronary angiograms. The right coronary artery originating from the left coronary system is an extremely rare variation of the single coronary artery anomaly in which the prognosis is usually benign provided that the anomalous vessel dose not pass between the aorta and the pulmonary artery. Anomalous right coronary artery anomaly has been rarely associated with other congenital cardiovascular anomalies such as transposition of the great vessels and tetralogy of Fallot. To date, a few attempts at classification have been made for coronary artery anomalies, but none of them seems comprehensive or practical for clinicians. The clinical significance of coronary anomalies is usually determined by underlying anatomic features of the wrong coronary origin and/or coronary atherosclerosis. Although coronary angiography is an important diagnostic method, new non-invasive methods such as coronary computed tomography angiography and cardiac magnetic resonance imaging have important roles to play in characterizing this coronary anomaly. It should be noted that the management strategy of these patients may vary based on clinical presentation, anatomical details and additional findings. PMID:22461044

  19. Computed tomographic coronary angiography: experience at Baylor University Medical Center/Baylor Jack and Jane Hamilton Heart and Vascular Hospital

    PubMed Central

    2005-01-01

    Noninvasive cardiac computed tomographic imaging using multislice or electron beam technology has been shown to be highly specific and sensitive in diagnosing coronary heart disease. It is about a fifth of the cost of coronary angiography and is particularly well suited for evaluating patients with a low or low to moderate probability of having obstructive coronary atherosclerosis. In addition, it offers more information than calcium scoring: because of the intravenous contrast used, it temporarily increases the density of the lumen and allows differentiation of soft plaque from calcified plaque. The Baylor Hamilton Heart and Vascular Hospital now uses this modality to define coronary atherosclerosis in patients who would otherwise have needed invasive coronary angiography; several research protocols with the technique are also under way. Baylor has recently upgraded to the 64-slice scanner. It is expected that computed tomographic coronary angiography will replace a significant percentage of invasive cardiac catheterizations. PMID:16200178

  20. 64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: A meta-analysis.

    PubMed

    Barbero, Umberto; Iannaccone, Mario; d'Ascenzo, Fabrizio; Barbero, Cristina; Mohamed, Abdirashid; Annone, Umberto; Benedetto, Sara; Celentani, Dario; Gagliardi, Marco; Moretti, Claudio; Gaita, Fiorenzo

    2016-08-01

    A non-invasive approach to define grafts patency and stenosis in the follow-up of coronary artery bypass graft (CABG) patients may be an interesting alternative to coronary angiography. 64-slice-coronary computed tomography is nowadays a diffused non-invasive method that permits an accurate evaluation of coronary stenosis, due to a high temporal and spatial resolution. However, its sensitivity and specificity in CABG evaluation has to be clearly defined, since published studies used different protocols and scanners. We collected all studies investigating patients with stable symptoms and previous CABG and reporting the comparison between diagnostic performances of invasive coronary angiography and 64-slice-coronary computed tomography. As a result, sensitivity and specificity of 64-slice-coronary computed tomography for CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00) with an area under the curve (AUC) of 0.99. 64-slice-coronary computed tomography sensitivity and specificity for the presence of any CABG stenosis >50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98), while AUC was 0.99. At meta-regression, neither the age nor the time from graft implantation had effect on sensitivity and specificity of 64-slice-coronary computed tomography detection of significant CABG stenosis or occlusion. In conclusion 64-slice-coronary computed tomography confirmed its high sensitivity and specificity in CABG stenosis or occlusion evaluation. PMID:27140337

  1. Short-Term Isoflavone Intervention in the Treatment of Severe Vasomotor Symptoms after Surgical Menopause: A Case Report and Literature Review

    PubMed Central

    Teekachunhatean, Supanimit; Mattawanon, Natnita; Khunamornpong, Surapan

    2015-01-01

    Isoflavones are soy phytoestrogens that potentially exert various favorable effects in postmenopausal women, for example, alleviating vasomotor episodes, attenuating bone loss, and stimulating vaginal epithelial maturation. There has, however, been lack of consensus regarding those therapeutic effects. Most clinical studies of isoflavones have been conducted with women who had undergone natural menopause, but not those who had undergone surgical menopause. This study reports on a 51-year-old woman who presented with severe vasomotor episodes after undergoing a hysterectomy and a bilateral oophorectomy due to hypermenorrhea secondary to myoma uteri. She refused hormone therapy due to fear of adverse drug reactions so was treated with oral soy isoflavones (two capsules twice daily, equivalent to at least 100 mg daily dose) for 8 weeks. The number and severity of hot flushes and her menopause-specific quality of life dramatically improved from baseline values. The serum bone resorption marker (beta C-telopeptide) decreased markedly, while vaginal epithelial maturation improved slightly, suggesting the potential of isoflavones in attenuating bone loss and stimulating vaginal maturation. The intervention did not adversely affect the hormonal profile (FSH, LH, and estradiol) and liver or renal functions. Thus, isoflavones could be an option for women experiencing severe vasomotor episodes after surgical menopause. PMID:26605099

  2. Short-Term Isoflavone Intervention in the Treatment of Severe Vasomotor Symptoms after Surgical Menopause: A Case Report and Literature Review.

    PubMed

    Teekachunhatean, Supanimit; Mattawanon, Natnita; Khunamornpong, Surapan

    2015-01-01

    Isoflavones are soy phytoestrogens that potentially exert various favorable effects in postmenopausal women, for example, alleviating vasomotor episodes, attenuating bone loss, and stimulating vaginal epithelial maturation. There has, however, been lack of consensus regarding those therapeutic effects. Most clinical studies of isoflavones have been conducted with women who had undergone natural menopause, but not those who had undergone surgical menopause. This study reports on a 51-year-old woman who presented with severe vasomotor episodes after undergoing a hysterectomy and a bilateral oophorectomy due to hypermenorrhea secondary to myoma uteri. She refused hormone therapy due to fear of adverse drug reactions so was treated with oral soy isoflavones (two capsules twice daily, equivalent to at least 100 mg daily dose) for 8 weeks. The number and severity of hot flushes and her menopause-specific quality of life dramatically improved from baseline values. The serum bone resorption marker (beta C-telopeptide) decreased markedly, while vaginal epithelial maturation improved slightly, suggesting the potential of isoflavones in attenuating bone loss and stimulating vaginal maturation. The intervention did not adversely affect the hormonal profile (FSH, LH, and estradiol) and liver or renal functions. Thus, isoflavones could be an option for women experiencing severe vasomotor episodes after surgical menopause. PMID:26605099

  3. Coronary Microvascular Disease (MVD)

    MedlinePlus

    ... narrows the heart's large arteries and reduces the flow of oxygen-rich blood to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can mostly or completely block blood flow through a coronary artery. In coronary MVD, however, ...

  4. Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial

    PubMed Central

    Thom, Howard; West, Nicholas E J; Hughes, Vikki; Dyer, Matthew; Buxton, Martin; Sharples, Linda D; Jackson, Christopher H; Crean, Andrew M

    2014-01-01

    Objectives To compare outcomes and cost-effectiveness of various initial imaging strategies in the management of stable chest pain in a long-term prospective randomised trial. Setting Regional cardiothoracic referral centre in the east of England. Participants 898 patients (69% man) entered the study with 869 alive at 2 years of follow-up. Patients were included if they presented for assessment of stable chest pain with a positive exercise test and no prior history of ischaemic heart disease. Exclusion criteria were recent infarction, unstable symptoms or any contraindication to stress MRI. Primary outcome measures The primary outcomes of this follow-up study were survival up to a minimum of 2 years post-treatment, quality-adjusted survival and cost-utility of each strategy. Results 898 patients were randomised. Compared with angiography, mortality was marginally higher in the groups randomised to cardiac MR (HR 2.6, 95% CI 1.1 to 6.2), but similar in the single photon emission CT-methoxyisobutylisonitrile (SPECT-MIBI; HR 1.0, 95% CI 0.4 to 2.9) and ECHO groups (HR 1.6, 95% CI 0.6 to 4.0). Although SPECT-MIBI was marginally superior to other non-invasive tests there were no other significant differences between the groups in mortality, quality-adjusted survival or costs. Conclusions Non-invasive cardiac imaging can be used safely as the initial diagnostic test to diagnose coronary artery disease without adverse effects on patient outcomes or increased costs, relative to angiography. These results should be interpreted in the context of recent advances in imaging technology. Trial registration ISRCTN 47108462, UKCRN 3696. PMID:24508847

  5. Invasive FFR and Noninvasive CFR in the Evaluation of Ischemia: What Is the Future?

    PubMed

    Johnson, Nils P; Gould, K Lance; Di Carli, Marcelo F; Taqueti, Viviany R

    2016-06-14

    This review provides an integrative and forward-looking perspective on the gamut of coronary physiology for the diagnosis and management of atherosclerosis. Because clinical events serve as the ultimate gold standard, the future of all diagnostic tests, including invasive fractional flow reserve and noninvasive coronary flow reserve, depends on their ability to improve patient outcomes. Given the prominent role of acute coronary syndromes and invasive procedures in cardiology, we practically consider 2 broad categories of patients with coronary disease: acute and stable. For patients with acute coronary disease, coronary physiology may potentially refine treatment of the culprit lesion. For both patients with stable and acute nonculprit disease, reducing hard endpoints with revascularization potentially occurs at the severe end of the focal physiological spectrum, an area under-represented in existing trials. Nonepicardial disease and diffuse atherosclerosis remain underexplored aspects of coronary physiology for testing of novel treatments. PMID:27282899

  6. Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

    PubMed Central

    Rahsepar, Amir Ali; Arbab-Zadeh, Armin

    2015-01-01

    Diagnosis and management of coronary artery disease represent a major challenge to our health care systems affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease could be conclusively determined only by invasive coronary angiography. To avoid risks from cardiac catheterization, many healthcare systems relied on stress testing as gatekeeper for coronary angiography. Advancements in cardiac computed tomography angiography technology now allows to noninvasively visualize coronary artery disease, challenging the role of stress testing as the default noninvasive imaging tool for evaluating patients with chest pain. In this review, we summarize current data on the clinical utility of cardiac computed tomography and stress testing in stable patients with suspected coronary artery disease. PMID:26500716

  7. Robotic total endoscopic coronary artery bypass hybrid revascularization procedure in a patient with a preoperative tracheostoma.

    PubMed

    Lehr, Eric J; van Wagenberg, Frans S; Haque, Reyaz; Bonatti, Johannes

    2011-05-01

    Preoperative tracheostoma presents a significant risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injury in patients requiring cardiac surgery. Several approaches have been described to limit these risks. Robotic totally endoscopic coronary artery bypass grafting in patients with a tracheostoma has not been reported. We describe a case of completely endoscopic coronary surgery using the daVinci(®) Si™ system in a patient with a tracheostoma. Single left internal mammary artery grafting to the left coronary artery system was carried out successfully as the first stage of a hybrid revascularization and followed by percutaneous coronary intervention to the circumflex coronary artery. We regard this technique as the most minimally-invasive method of surgical coronary revascularization with a significant potential to reduce the risk of mediastinitis in patients with a tracheostoma. PMID:21297145

  8. Pathophysiology of Coronary Collaterals#

    PubMed Central

    Stoller, Michael; Seiler, Christian

    2014-01-01

    While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand. However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion. This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation. PMID:23701025

  9. A comparative tolerance study of terfenadine-pseudoephedrine combination tablets and pseudoephedrine tablets in patients with allergic or vasomotor rhinitis.

    PubMed

    Stroh, J E; Ayars, G H; Bernstein, I L; Kemp, J P; Podleski, W K; Prenner, B M; Schoenwetter, W F; Salzmann, J K

    1988-01-01

    In this multicentre, double-blind, randomized, parallel group study, 315 patients with allergic or vasomotor rhinitis were treated on a twice daily dosing schedule with either a 60 mg terfenadine-120 mg pseudoephedrine hydrochloride combination or 120 mg pseudoephedrine hydrochloride (extended release) for 2 weeks. No clinically significant differences between the two groups were noted in body weight, temperature, respiration rate or blood pressure following the treatment period. An increase in mean heart rate of approximately 5 beats/min from entry to the final clinic visit was noted in both treatment groups. No clinically significant changes were noted in either treatment group when pre- and post-treatment electrocardiograms were compared. There were also no clinically significant alterations in laboratory values, which included serum chemistry, haematology and urinalysis, within or between either group. The adverse events profiles for both groups were similar. The most frequent adverse event was insomnia, in 40 (25.3%) patients given the terfenadine-pseudoephedrine combination and in 42 (26.8%) of those given pseudoephedrine. No unusual or unexpected adverse events were reported. PMID:2906887

  10. Are vasomotor symptoms associated with sleep characteristics among symptomatic midlife women? Comparisons of self-report and objective measures

    PubMed Central

    Thurston, Rebecca C.; Santoro, Nanette; Matthews, Karen A.

    2013-01-01

    Objective Many women report vasomotor symptoms (VMS) and sleep problems during the menopausal transition. Although reported VMS are consistently related to reported sleep disturbance, findings using physiologic measures of VMS or sleep have been more mixed. Our objective was to examine whether more VMS during sleep are associated with poorer sleep among midlife women with VMS using physiologic measures of both VMS and sleep. Methods A subcohort of participants (N = 52) with VMS, a uterus and both ovaries, and free of medications affecting VMS from the Pittsburgh site of the Study of Women’s Health Across the Nation underwent four 24-hour periods of in-home ambulatory VMS and sleep measurement. Measures included sternal skin conductance for the measurement of VMS, actigraphy for assessing sleep, a VMS diary, and a sleep diary completed before bed and upon waking. Associations between VMS and sleep were evaluated using generalized estimating equations with covariates age, body mass index, medications affecting sleep, race, financial strain, and depressive symptoms. Results More VMS recalled upon waking were associated with significantly lower actigraphy-assessed sleep efficiency, significantly higher wakefulness after sleep onset, and somewhat longer sleep latency. Conversely, physiologically measured VMS and VMS reported during the night were largely unrelated to sleep characteristics. Conclusions Associations between VMS and sleep may depend more on the awareness of and recall of VMS rather than solely on their physiologic occurrence. PMID:22415568

  11. Contribution of reactive oxygen species to cerebral amyloid angiopathy, vasomotor dysfunction, and microhemorrhage in aged Tg2576 mice.

    PubMed

    Han, Byung Hee; Zhou, Meng-Liang; Johnson, Andrew W; Singh, Itender; Liao, Fan; Vellimana, Ananth K; Nelson, James W; Milner, Eric; Cirrito, John R; Basak, Jacob; Yoo, Min; Dietrich, Hans H; Holtzman, David M; Zipfel, Gregory Joseph

    2015-02-24

    Cerebral amyloid angiopathy (CAA) is characterized by deposition of amyloid β peptide (Aβ) within walls of cerebral arteries and is an important cause of intracerebral hemorrhage, ischemic stroke, and cognitive dysfunction in elderly patients with and without Alzheimer's Disease (AD). NADPH oxidase-derived oxidative stress plays a key role in soluble Aβ-induced vessel dysfunction, but the mechanisms by which insoluble Aβ in the form of CAA causes cerebrovascular (CV) dysfunction are not clear. Here, we demonstrate evidence that reactive oxygen species (ROS) and, in particular, NADPH oxidase-derived ROS are a key mediator of CAA-induced CV deficits. First, the NADPH oxidase inhibitor, apocynin, and the nonspecific ROS scavenger, tempol, are shown to reduce oxidative stress and improve CV reactivity in aged Tg2576 mice. Second, the observed improvement in CV function is attributed both to a reduction in CAA formation and a decrease in CAA-induced vasomotor impairment. Third, anti-ROS therapy attenuates CAA-related microhemorrhage. A potential mechanism by which ROS contribute to CAA pathogenesis is also identified because apocynin substantially reduces expression levels of ApoE-a factor known to promote CAA formation. In total, these data indicate that ROS are a key contributor to CAA formation, CAA-induced vessel dysfunction, and CAA-related microhemorrhage. Thus, ROS and, in particular, NADPH oxidase-derived ROS are a promising therapeutic target for patients with CAA and AD. PMID:25675483

  12. 2014 Williams Harvey Lecture: importance of coronary vasomotion abnormalities-from bench to bedside.

    PubMed

    Shimokawa, Hiroaki

    2014-12-01

    Coronary vasomotion abnormalities play important roles in the pathogenesis of ischaemic heart disease, in which endothelial dysfunction and coronary artery spasm are substantially involved. Endothelial vasodilator functions are heterogeneous depending on the vessel size, with relatively greater role of nitric oxide (NO) in conduit arteries and predominant role of endothelium-derived hyperpolarizing factor (EDHF) in resistance arteries, where endothelium-derived hydrogen peroxide serves as an important EDHF. The functions of NO synthases in the endothelium are also heterogeneous with multiple mechanisms involved, accounting for the diverse functions of the endothelium in vasomotor as well as metabolic modulations. Cardiovascular abnormalities and metabolic phenotypes become evident when all three NO synthases are deleted, suggesting the importance of both NO and EDHF. Coronary artery spasm plays important roles in the pathogenesis of a wide range of ischaemic heart disease. The central mechanism of the spasm is hypercontraction of vascular smooth muscle cells (VSMCs), but not endothelial dysfunction, where activation of Rho-kinase, a molecular switch of VSMC contraction, plays a major role through inhibition of myosin light-chain phosphatase. The Rho-kinase pathway is also involved in the pathogenesis of a wide range of cardiovascular diseases and new Rho-kinase inhibitors are under development for various indications. The registry study by the Japanese Coronary Spasm Association has demonstrated many important aspects of vasospastic angina. The ongoing international registry study of vasospastic angina in six nations should elucidate the unknown aspects of the disorder. Coronary vasomotion abnormalities appear to be an important therapeutic target in cardiovascular medicine. PMID:25354517

  13. Comprehensive assessment of coronary fractional flow reserve

    PubMed Central

    Qi, Xiaolong; Fan, Guoxin; Zhu, Deqiu; Ma, Wanrong

    2015-01-01

    Fractional flow reserve (FFR) is considered nowadays as the gold standard for invasive assessment of physiologic stenosis significance and an indispensable tool for decision-making in coronary revascularization. Robust studies have shown that FFR is more effective in accurately identifying which lesions should be stented, and revascularization guided by FFR improves the outcome of coronary artery disease in patients. Therefore, FFR has been upgraded to a class A recommendation in current guidelines when the ischemic potential for specific target lesions is controversial. This article reviews the laboratory practice, functional evaluation of FFR as a gold standard and its emerging clinical application. In addition, novel noninvasive technologies of FFR measurement are discussed in depth. PMID:26170840

  14. [Pregnancy and coronary artery dissection].

    PubMed

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. PMID:25795261

  15. Ectopic Origin of Coronary Arteries Diagnozed by Coronary Angiography

    PubMed Central

    Krasniqi, Xhevdet; Gorani, Daut; Sejdiu, Basri; Citaku, Hajdin

    2016-01-01

    Introduction: Anomalous origin of coronary arteries from opposite sinus of Valsalva is rare finding. The incidence of anomalous origination of the left coronary artery from right sinus is 0.15% and the right coronary artery from the left sinus is 0.92%. The ectopic origin of left coronary artery or right coronary artery from opposite sinus depending on pathways and considering atherosclerotic changes are manifested with different clinical significance. Case report: We report two cases, the first case the coronary angiography showed the left coronary artery arising from the right coronary sinus, presenting with proximally and distally stenosed left anterior descending artery (LAD), associated with medial and distal stenosed right coronary artery (RCA). The second case the coronary angiography revealed the right coronary artery arising from the left coronary sinus, associated with tortuous medial and distal segments of left anterior descending artery (LAD), without atherosclerotic changes. The first case successfully underwent treatment procedures based on guidelines for revascularization. Conclusion: The coronary angiography of patients with coronary ischemia determines atherosclerotic disease with possibility of the presence of coronary artery anomalies that in cases with ectopic origin from opposite sinus continues to exist as a challenge during treatment in interventional cardiology. PMID:27482140

  16. Predominant endothelial vasomotor activity during human sleep: a near-infrared spectroscopy study.

    PubMed

    Zhang, Zhongxing; Khatami, Ramin

    2014-11-01

    Vasomotion is important in the study of vascular disorders, including stroke. Spontaneous low and very low hemodynamic oscillations (3-150 mHz) measured with near-infrared spectroscopy (NIRS) reflect the endothelial (3-20 mHz), neurogenic (20-40 mHz) and myogenic (40-150 mHz) components of vasomotion. We investigated sleep-specific patterns of vasomotion by characterizing hemodynamic oscillations with NIRS in healthy subjects, and tested the feasibility of NIRS as a bedside tool for monitoring vasomotion during whole-night sleep. To characterize local cerebral vasomotion, we compared cerebral NIRS measurements with muscular NIRS measurements and peripheral arterial oxygen saturation (SpO2 ) during different sleep stages in 14 healthy volunteers. Spectral powers of hemodynamic oscillations in the frequency range of endothelial vasomotion were systemically predominant in every sleep stage, and the powers of endothelial and neurogenic vasomotion decreased in deep sleep as compared with light sleep and rapid eye movement (REM) sleep in brain, muscle, and SpO2 . The decrease in the powers of myogenic vasomotion in deep sleep only occurred in brain, and not in muscle. These results point to a predominant role of endothelial function in regulating vasomotion during sleep. The decline in cerebral endothelial and neurogenic vasomotion during progression to deeper non-REM sleep suggests that deep sleep may play a protective role for vascular function. NIRS can be used to monitor endothelial control of vasomotion during nocturnal sleep, thus providing a promising non-invasive bedside tool with which to study the sleep-relevant pathological mechanisms in vascular diseases and stroke. PMID:25156240

  17. [Coronary angioplasty in elderly patients].

    PubMed

    Liistro, Francesco; Colombo, Antonio

    2002-01-01

    Developed nations are experiencing an unprecedented growth in the number of elderly citizens. Thanks to the modernization of both society and medical care, over the past century, life expectancy in most countries has nearly doubled. The elderly (80 years or over) represent the fastest-growing segment of our population. Owing to their age, the elderly are more afflicted with chronic diseases, including coronary artery disease. Recently, clinicians became more aggressive in the use of invasive cardiovascular diagnostic tests in these patients. With regard to younger patients, we have a wealth of data from large, randomized trials that defined which subsets of patients benefit from revascularization therapies. However, because the very elderly were severely underrepresented in these randomized studies, we have almost no information concerning the choice of treatment in these patients. Initial results of percutaneous revascularization procedures in elderly patients come from retrospective analysis performed during the pre-stent era. In these studies a procedural mortality risk 5-fold higher in patients > 80 years compared with those < 60 is reported. With the advent of coronary stenting, a significant increase in the rate of procedural success and a reduction in the incidence of procedural mortality, acute myocardial infarction and emergency coronary artery bypass grafting were observed also in the elderly. These initial positive results prompted physicians to treat patients with impaired clinical conditions and with unfavorable angiographic characteristics, resulting in a long-term freedom from major adverse cardiac events comparable to those observed in younger patients (78% in patients < 70 years vs 75% in patients > 80 years). The comparison between the percutaneous approach and the surgical approach to coronary artery disease in the elderly has its major limitation in the lack of data from randomized trials. The available information suggests similar results with

  18. [Coronary artery disease in women: True specificities to know in order to improve management and outcome].

    PubMed

    Madika, Anne-Laure; Mounier-Vehier, Claire

    2016-06-01

    Coronary artery disease is the leading death for women in Europe and developed countries. It kills seven times more than breast cancer. The number of deaths from coronary artery disease increase and affects also younger women (< 55 years old). Coronary artery disease in women is a major public health problem, often underestimated. Women should become a priority target of prevention. Traditional vision of coronary artery disease as myocardial ischemia due to obstruction of major coronary arteries do not represent all the aspects of ischemic disease in women. Myocardial ischemia without obstruction of major coronary arteries, described as microvascular dysfunction is often unknown and ignored. It is yet a situation at high cardiovascular risk. Presentation and symptoms of coronary artery disease are misleading in women. Coronary artery disease in women remains under-diagnosed and under-treated. It is necessary to improve management of women at cardiovascular risk, whose inequalities contribute to the excess of female mortality from coronary artery disease. Coronary artery disease in women needs new diagnostic and therapeutic approaches. It must take into account specific risk stratification, evaluation of particular chest pain and reduced performance of non-invasive testing. PMID:27199207

  19. Microvascular Coronary Dysfunction in Women- Pathophysiology, Diagnosis, and Management

    PubMed Central

    Kothawade, Kamlesh; Merz, C. Noel Bairey

    2011-01-01

    Women exhibit a greater symptom burden, more functional disability, and a higher prevalence of no obstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. Microvascular Coronary Dysfunction (MCD) defined as limited coronary flow reserve (CFR) and/or coronary endothelial dysfunction is the predominant etiological mechanism of ischemia in women with the triad of persistent chest pain, no obstructive CAD, and ischemia evidenced by stress testing. Evidence shows that approximately 50% of these patients have physiologic evidence of MCD. MCD is associated with a 2.5% annual major adverse event rate that includes death, nonfatal MI, nonfatal stroke and congestive heart failure. Although tests such as adenosine stress cardiac magnetic resonance imaging (CMRI) may be a useful non-invasive method to predict subendocardial ischemia, the gold standard test to diagnose MCD is an invasive Coronary Reactivity Testing (CRT). Early identification of MCD by CRT may be beneficial in prognostication and stratifying these patients for optimal medical therapy. Currently, understanding of MCD pathophysiology can be used to guide diagnosis and therapy. Continued research in MCD is needed to further advance our understanding. PMID:21723447

  20. Imaging of coronary atherosclerosis in various susceptible groups.

    PubMed

    Munnur, Ravi Kiran; Nerlekar, Nitesh; Wong, Dennis T L

    2016-08-01

    Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Atherosclerosis, which is the primary pathophysiologic mechanism for the development of plaque leading to CAD, is a multifactorial process resulting from a complex interplay between genetic susceptibility and various risk factors such as hypertension (HT), dyslipidaemia, diabetes mellitus (DM) and smoking. In addition, influences from other disease states such as chronic kidney disease (CKD), obesity and the metabolic syndrome as well as gender and ethnic diversity also contribute to the disease process. Insights from pathological observations and advances in cellular and molecular biology have helped us understand the process of plaque formation, progression and rupture leading to events. Several intravascular imaging techniques such as intravascular ultrasound (IVUS), Virtual histology IVUS (VH-IVUS) and optical coherence tomography (OCT) allow in vivo assessment of plaque burden, plaque morphology and response to therapy. In addition, non invasive assessment using coronary artery calcium (CAC) score allows risk stratification and plaque burden assessment whilst computed tomography coronary angiography (CTCA) allows evaluation of luminal stenosis, plaque characterisation and quantification. This review aims to summarise the results of invasive and non-invasive imaging studies of coronary atherosclerosis seen in various high-risk populations including DM, metabolic syndrome, obesity, CKD and, gender differences and ethnicity. Understanding the phenotype of plaques in various susceptible groups may allow potential development of personalised therapies. PMID:27500095

  1. Imaging of coronary atherosclerosis in various susceptible groups

    PubMed Central

    Nerlekar, Nitesh; Wong, Dennis T. L.

    2016-01-01

    Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Atherosclerosis, which is the primary pathophysiologic mechanism for the development of plaque leading to CAD, is a multifactorial process resulting from a complex interplay between genetic susceptibility and various risk factors such as hypertension (HT), dyslipidaemia, diabetes mellitus (DM) and smoking. In addition, influences from other disease states such as chronic kidney disease (CKD), obesity and the metabolic syndrome as well as gender and ethnic diversity also contribute to the disease process. Insights from pathological observations and advances in cellular and molecular biology have helped us understand the process of plaque formation, progression and rupture leading to events. Several intravascular imaging techniques such as intravascular ultrasound (IVUS), Virtual histology IVUS (VH-IVUS) and optical coherence tomography (OCT) allow in vivo assessment of plaque burden, plaque morphology and response to therapy. In addition, non invasive assessment using coronary artery calcium (CAC) score allows risk stratification and plaque burden assessment whilst computed tomography coronary angiography (CTCA) allows evaluation of luminal stenosis, plaque characterisation and quantification. This review aims to summarise the results of invasive and non-invasive imaging studies of coronary atherosclerosis seen in various high-risk populations including DM, metabolic syndrome, obesity, CKD and, gender differences and ethnicity. Understanding the phenotype of plaques in various susceptible groups may allow potential development of personalised therapies. PMID:27500095

  2. The clinical significance and management of patients with incomplete coronary angiography and the value of additional computed tomography coronary angiography.

    PubMed

    Pregowski, Jerzy; Kepka, Cezary; Kruk, Mariusz; Mintz, Gary S; Kalinczuk, Lukasz; Ciszewski, Michal; Kochanowski, Lukasz; Wolny, Rafal; Chmielak, Zbigniew; Jastrzębski, Jan; Klopotowski, Mariusz; Zalewska, Joanna; Demkow, Marcin; Karcz, Maciej; Witkowski, Adam

    2014-04-01

    To assess the anatomical background and significance of incomplete invasive coronary angiography (ICA) and to evaluate the value of coronary computed tomography angiography (CTA) in this scenario. The current study is an analysis of high volume center experience with prospective registry of coronary CTA and ICA. The target population was identified through a review of the electronic database. We included consecutive patients referred for coronary CTA after ICA, which did not visualize at least one native coronary artery or by-pass graft. Between January 2009 and April 2013, 13,603 diagnostic ICA were performed. There were 45 (0.3 %) patients referred for coronary CTA after incomplete ICA. Patients were divided into 3 groups: angina symptoms without previous coronary artery by-pass grafting (CABG) (n = 11,212), angina symptoms with previous CABG (n = 986), and patients prior to valvular surgery (n = 925). ICA did not identify by-pass grafts in 21 (2.2 %) patients and in 24 (0.2 %) cases of native arteries. The explanations for an incomplete ICA included: 11 ostium anomalies, 2 left main spasms, 5 access site problems, 5 ascending aorta aneurysms, and 2 tortuous take-off of a subclavian artery. However, in 20 (44 %) patients no specific reason for the incomplete ICA was identified. After coronary CTA revascularization was performed in 11 (24 %) patients: 6 successful repeat ICA and percutaneous intervention and 5 CABG. Incomplete ICA constitutes rare, but a significant clinical problem. Coronary CTA provides adequate clinical information in these patients. PMID:24623270

  3. [The single coronary artery].

    PubMed

    Godart, F; Berzin, B; Rihani, R; Pecheux, M; Dutoit, A

    1992-04-01

    Single coronary artery is a fairly rare entity which may nevertheless be found in 0.4 per cent of coronary arteriograms. The authors report 3 cases seen in 2 departments of cardiology. In each patient, despite the existence of definite cardiovascular risk factors, this distribution was a factor worsening coronary ischemia, leading to complete thrombosis in one case. Although most often a chance discovery, a review of the literature justifies the attribution to this anomaly of the onset of angina, infarction or even sudden death. PMID:1642437

  4. Detection, visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT.

    PubMed

    van Ooijen, Peter M A; Dorgelo, Joost; Zijlstra, Felix; Oudkerk, Matthijs

    2004-12-01

    Early identification and evaluation of relatively frequent anomalous coronary anatomy is quite relevant because of the occurrence of sudden cardiac death or related symptoms of myocardial ischemia. Selective coronary angiography (CAG) is invasive, expensive and cannot always provide the required information adequately. Recently, non-invasive imaging techniques such as magnetic resonance imaging and multidetector-row computed tomography (MDCT) have been shown to provide a good anatomical view of the coronary artery tree. This study aims to demonstrate the value of 16-MDCT for evaluation of anomalous coronary anatomy. In 13 patients scanned using 16-MDCT, six different coronary anomalies were diagnosed [two absent left main, one single vessel left coronary artery (LCA), three LCA originating from the right (two with interarterial course), six right coronary artery originating from the left, one double left anterior descending (LAD)]. Mean diagnostic quality, recorded by two observers using a 5-point scale (1= non-diagnostic to 5= excellent diagnostic quality), resulted in a mean score of 3.73 (SD 1.19) without any non-diagnostic result. MDCT offers an accurate diagnostic modality to visualize the origin and course of anomalous coronary arteries by a three-dimensional display of anatomy. Shortcomings in CAG can be overcome by the use of contrast-enhanced MDCT. PMID:15452665

  5. Coronary computed tomographic angiography: current role in the diagnosis and management of coronary artery disease

    PubMed Central

    Bowman, Andrew W.; Kantor, Birgit; Gerber, Thomas C.

    2009-01-01

    Advances in computed tomography (CT) technology allow images to be obtained with high spatial and temporal resolution. These features now permit noninvasive coronary CT angiography (CCTA). Many studies addressing proof of concept, feasibility, and clinical robustness have been published since CCTA was first described. More recently, the scientific evaluation of CCTA has rightly focused less on technical aspects and more on multicenter trials of the diagnostic value of CCTA and on head-to-head comparisons with other noninvasive modalities for the detection of coronary artery disease (CAD), such as stress myocardial perfusion imaging (MPI) with radionuclides. Recent peer-reviewed publications that compare CCTA to invasive, selective coronary angiography (SCA) or MPI, or that address radiation protection issues related to CCTA, were reviewed and summarized. Overall, there is high agreement between CCTA and both SCA and MPI for the presence of CAD. However, CCTA can over- or underestimate the severity of CAD compared to SCA as a reference standard. Initial studies that compared CCTA to MPI found their accuracies for determining the presence of high-grade luminal obstructions comparable. Limitations of CCTA include inability to reliably assess the coronary artery lumen dimensions in patients with large amounts of coronary artery calcium, artifacts caused by coronary and respiratory motion, and the need for ionizing radiation and intravenous administration of iodinated contrast material. Various dose reduction methods for CCTA now exist that may substantially lower patient dose to levels less than those of SCA or MPI. Although current expert consensus does not call for CCTA to be a first-line test for CAD, particularly for screening in asymptomatic individuals, current data suggest a promising role in the evaluation of symptomatic patients for possible CAD. PMID:19694220

  6. [Hybrid revascularization: a combined approach to multivessel coronary artery lesions].

    PubMed

    Repossini, A; Roĭtberg, G E; Kotelnikov, I; Sokolov, D V

    2013-01-01

    Analysis of effectiveness and feasibility of hybrid approach to multivessel coronary artery disease and problems of interaction between cardiac surgeons and interventional cardiologists in deciding on the choice of revascularization method is performed in the article. Hybrid approach to multivessel disease defined as sternal sparing, off-pump, minimally invasive, hand sewn left internal mammary - left anterior descending (LAD) arteries by-pass graft with percutaneous coronary revascularization of non-LAD lesions to achieve functionally complete revascularization is described in detail. Data of multicenter studies and clinical recommendations for myocardial revascularization is discussed. PMID:24090389

  7. Coronary artery spasm

    MedlinePlus

    ... blocker or a long-acting nitrate long-term. Beta-blockers are another type of medicine that is used with other coronary artery problems. However, beta-blockers may make this problem worse. They should be ...

  8. Coronary Artery Disease

    MedlinePlus

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women. CAD happens when the arteries that supply blood to ...

  9. Coronary Artery Bypass Surgery

    MedlinePlus

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  10. Coronary Artery Disease

    MedlinePlus

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened ...

  11. Directional coronary atherectomy (DCA)

    MedlinePlus Videos and Cool Tools

    ... caused by blockages. The procedure begins with the doctor injecting some local anesthesia into the groin area ... ostium of one of the coronary arteries, the doctor injects dye and takes an x-ray. If ...

  12. Coronary Artery Disease

    MedlinePlus

    ... ve started to help the medicine work. Other Organizations American Heart Association Questions to Ask Your Doctor Am I at risk for coronary artery disease (CAD)? What lifestyle changes should I make to decrease my risk of ...

  13. Coronary artery fistulas

    PubMed Central

    Said, S.A.M.; Thiadens, A.A.H.J.; Fieren, M.J.C.H.; Meijboom, E.J.; van der Werf, T.; Bennink, G.B.W.E.

    2002-01-01

    The aetiology of congenital coronary artery fistulas remains a challenging issue. Coronary arteries with an anatomically normal origin may, for obscure reasons, terminate abnormally and communicate with different single or multiple cardiac chambers or great vessels. When this occurs, the angiographic morphological appearance may vary greatly from discrete channels to plexiform network of vessels. Coronary arteriovenous fistulas (CAVFs) have neither specific signs nor pathognomonic symptoms; the spectrum of clinical features varies considerably. The clinical presentation of symptomatic cases can include angina pectoris, myocardial infarction, fatigue, dyspnoea, CHF, SBE, ventricular and supraventricular tachyarrhythmias or even sudden cardiac death. CAVFs may, however, be a coincidental finding during diagnostic coronary angiography (CAG). CAG is considered the gold standard for diagnosing and delineating the morphological anatomy and pathway of CAVFs. There are various tailored therapeutic modalities for the wide spectrum of clinical manifestations of CAVFs, including conservative pharmacological strategy, percutaneous transluminal embolisation and surgical ligation. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696067

  14. Negative Affect and Vasomotor Symptoms in the Study of Women's Health Across the Nation (SWAN) Daily Hormone Study

    PubMed Central

    Gibson, Carolyn J.; Thurston, Rebecca C.; Bromberger, Joyce T.; Kamarck, Thomas; Matthews, Karen A.

    2011-01-01

    Objective Vasomotor symptoms (VMS) are common during the menopausal transition. Negative affect is consistently associated with self-reported VMS, but interpretation of this relationship is limited by infrequent measurement and retrospective recall of VMS. Using prospective data from daily diaries, we examined the daily association between negative affect and reported VMS, as well as temporal associations between negative affect and next day VMS, and VMS and next day negative affect. Methods Data were derived from the third wave of the Daily Hormone Study (DHS) (n=625). DHS is a substudy of the Study of Women's Health Across the Nation (SWAN), a multi-site community-based prospective cohort study of the menopausal transition. Participants reported VMS and affect in daily diaries for 12–50 days. Multilevel mixed models were used to determine the associations between reported VMS and negative affect, adjusted by antidepressant use, age, education, menopausal status, self-reported health, and race/ethnicity drawn from annual SWAN visits. Results VMS were reported by 327 women (52.3%). Negative affect was positively associated with VMS (OR 1.76, 95% CI 1.43–2.17, p<.001) in cross-sectional analyses. Negative affect, adjusted by same day VMS, was not predictive of next day VMS (OR 1.11, 95% CI .85–1.35, p=.55), whereas VMS, adjusted by same day negative affect, was predictive of negative affect the next day (OR 1.27, 95% CI 1.03–1.58, p=.01). Conclusions Negative affect was more likely to be reported on the same day and the day after VMS. Potential mechanisms underlying this relationship include negative cognitive appraisal, sleep disruption, and unmeasured third factors. PMID:21900850

  15. Bazedoxifene and Conjugated Equine Estrogen: A Combination Product for the Management of Vasomotor Symptoms and Osteoporosis Prevention Associated with Menopause.

    PubMed

    Umland, Elena M; Karel, Lauren; Santoro, Nanette

    2016-05-01

    Bazedoxifene (BZA), a third-generation selective estrogen receptor modulator (SERM), has been combined with conjugated equine estrogen (CE) to create a tissue selective estrogen complex (TSEC) for the management of vasomotor symptoms (VMS) and the prevention of osteoporosis (OP) associated with menopause. Both of these outcomes of menopause contribute to significant negative effects on quality of life and increases in utilization of health care resources and dollars. Current treatment modalities for VMS and OP include estrogen therapy that requires the use of progestin in women who have a uterus to reduce the risk of endometrial hyperplasia and resultant cancer. However, progestin use results in nuisance bleeding as well as a further increased risk of breast cancer when combined with estrogen. And while SERMs can be used to prevent OP, their use alone has been shown to increase hot flashes. The combination of BZA and CE does not require progestin treatment with CE as the BZA component acts as an antagonist on endometrial tissue. The U.S. Food and Drug Administration approval of BZA/CE in 2013 was based on a series of five phase 3 studies known as the Selective estrogens, Menopause And Response to Therapy (SMART) trials. These trials, in their entirety, evaluated the impact of BZA/CE on VMS frequency and severity, bone mineral density, bone turnover markers, vaginal symptoms, lipid profiles, sleep, quality of life, breast density, and endometrial safety. The approved dose of BZA/CE is 20 mg BZA and 0.45 mg CE. Although this TSEC manages VMS while opposing breast and endometrial proliferation, preventing bone resorption, and improving lipid profiles, long-term experience with BZA/CE is currently lacking. PMID:27027527

  16. Effects of Stellate Ganglion Block on Vasomotor Symptoms: Findings from a Randomized, Controlled Clinical Trial in Postmenopausal Women

    PubMed Central

    Walega, David R.; Rubin, Leah H.; Banuvar, Suzanne; Shulman, Lee P.; Maki, Pauline M.

    2014-01-01

    Objective Uncontrolled intervention studies, including studies involving breast cancer survivors, have demonstrated improvements in vasomotor symptoms (VMS) following stellate ganglion blockade (SGB) with local anesthetic. This study presents the first randomized, sham-controlled trial of SGB for the treatment of VMS. Methods Participants included 40 postmenopausal women aged 30 to 70 years with moderate-to-severe VMS. The design was a randomized, sham-controlled trial comparing the effect of SGB versus sham injection on the frequency of total and moderate-to-severe VMS as measured by daily diaries. Image-guided SGB was performed with 0.5% bupivacaine 5 mL. Sham injection of saline was performed in the subcutaneous tissue in the neck. VMS were recorded at baseline and for six months thereafter. Objective VMS were recorded using ambulatory sternal skin conductance monitoring over a 24-hour period at baseline and 3-month follow-up. Results There were no significant group differences in overall VMS frequency, but the frequency of moderate-to-very severe VMS was reduced more in the active compared to sham treatment group, RR 0.50, CI 0.35–0.71, p<0.001. The frequency of objective VMS was also reduced to a greater degree in the SGB group compared to the sham group (RR 0.71, CI 0.64–0.99, p<0.05). There were no study-related serious adverse events. Conclusions SGB may provide an effective treatment for VMS in women who seek non-hormonal therapies due to safety concerns and personal preference. The finding that SGB significantly reduces objectively measured VMS provides further evidence of efficacy. A larger trial is warranted to confirm these findings. PMID:24496086

  17. Detecting gas‐induced vasomotor changes via blood oxygenation level‐dependent contrast in healthy breast parenchyma and breast carcinoma

    PubMed Central

    Wallace, Tess E.; Patterson, Andrew J.; Abeyakoon, Oshaani; Bedair, Reem; Manavaki, Roido; McLean, Mary A.; O'Connor, James P.B.; Graves, Martin J.

    2016-01-01

    Purpose To evaluate blood oxygenation level‐dependent (BOLD) contrast changes in healthy breast parenchyma and breast carcinoma during administration of vasoactive gas stimuli. Materials and Methods Magnetic resonance imaging (MRI) was performed at 3T in 19 healthy premenopausal female volunteers using a single‐shot fast spin echo sequence to acquire dynamic T 2‐weighted images. 2% (n = 9) and 5% (n = 10) carbogen gas mixtures were interleaved with either medical air or oxygen in 2‐minute blocks, for four complete cycles. A 12‐minute medical air breathing period was used to determine background physiological modulation. Pixel‐wise correlation analysis was applied to evaluate response to the stimuli in breast parenchyma and these results were compared to the all‐air control. The relative BOLD effect size was compared between two groups of volunteers scanned in different phases of the menstrual cycle. The optimal stimulus design was evaluated in five breast cancer patients. Results Of the four stimulus combinations tested, oxygen vs. 5% carbogen produced a response that was significantly stronger (P < 0.05) than air‐only breathing in volunteers. Subjects imaged during the follicular phase of their cycle when estrogen levels typically peak exhibited a significantly smaller BOLD response (P = 0.01). Results in malignant tissue were variable, with three out of five lesions exhibiting a diminished response to the gas stimulus. Conclusion Oxygen vs. 5% carbogen is the most robust stimulus for inducing BOLD contrast, consistent with the opposing vasomotor effects of these two gases. Measurements may be confounded by background physiological fluctuations and menstrual cycle changes. J. Magn. Reson. Imaging 2016;44:335–345. PMID:26898173

  18. [Noninvasive diagnostic of coronary artery disease].

    PubMed

    Zuber, Michel; Zellweger, Michael; Bremerich, Jens; Auf der Mauer, Christoph; Buser, Peter T

    2009-04-01

    investigator independent, does not apply any biologically hazardous energy and has the largest potential for tissue characterization due to its high contrast resolution. It therefore is an excellent technique to investigate all the aspects of coronary artery disease. Its availability is increasing, however in order to fully utilize its large potential an optimal collaboration among -specialist (cardiologists, radiologists, physicists) is mandatory. Cardiac CT has evolved as an excellent method for the depiction of the coronary arteries. Due to its high spatial and time resolution it provides high quality luminography of the coronaries and newer technique are also -investigating plaque composition of diseased coronary arteries. Overestimation of coronary artery stenosis in calcified vessels is an inherent problem of the technique and the risk of radiation exposure has to be weighted against the benefit of non-invasively depicting the coronary arteries. It will be the future task of all specialists in this field to define the most efficient and cost-effective way to apply these excellent techniques for the investigation of all the different aspects of patients with coronary artery disease. PMID:19358135

  19. [Acute coronary syndromes: epidemiology].

    PubMed

    Ozkan, Alev Arat

    2013-04-01

    Coronary heart disease is the main cause of death in the world as well as in Turkey. It's not only a health issue but also a social problem with a high economic burden and negative impact on quality of life. The majority of deaths are attributable to acute coronary syndromes (ACS) and their complications.This review summarizes some important facts regarding ACS epidemiology in the world and in Turkey. PMID:27323430

  20. Massive right coronary air embolism in the right coronary artery during left coronary angiography: A case report

    PubMed Central

    PARK, CHANG-BUM; HWANG, HUI-JEONG; CHO, JIN-MAN; JO, BYUNG-HYUN; KIM, CHONG-JIN

    2013-01-01

    Coronary air embolism is one of the inadvertent complications of coronary angiography. We report a case of unexpected massive right coronary air embolism during left coronary angiography with a JL4 diagnostic catheter. This report demonstrates that air embolism may occur in the contralateral coronary artery and therefore complete air aspiration must be ensured during coronary angiography. PMID:23596473

  1. Invasive mammals.

    PubMed

    Moutou, F; Pastoret, P P

    2010-08-01

    Every region of the world is concerned by potential mammal invasions, as humans are already present on all the world's land masses. All these invasions are a result of species introductions by humans for one reason or another. The authors briefly review the known movements and observed consequences of mammal-related invasions. They take examples from all five continents, as well as from a few island systems. The ancient introduction of game species, and later of domestic species, has been followed more recently by movements of commercial species. We are now seeing the emergence of what are known as entertainment species. In a number of cases, such introductions have led to the establishment of new epidemiological cycles that previously might never have been thought possible. According to current indicators, this phenomenon is not on the wane. PMID:20919577

  2. Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus

    PubMed Central

    Schindler, Thomas H.; Facta, Alvaro D.; Prior, John O.; Cadenas, Jerson; Zhang, Xiao-Li; Li, Yanjie; Sayre, James; Goldin, Jonathan

    2016-01-01

    Purpose To determine the relationship between carotid intima–media thickness (IMT), coronary artery calcification (CAC), and myocardial blood flow (MBF) at rest and during vasomotor stress in type 2 diabetes mellitus (DM). Methods In 68 individuals, carotid IMT was measured using high-resolution vascular ultrasound, while the presence of CAC was determined with electron beam tomography (EBT). Global and regional MBF was determined in milliliters per gram per minute with 13N-ammonia and positron emission tomography (PET) at rest, during cold pressor testing (CPT), and during adenosine (ADO) stimulation. Results There was neither a relationship between carotid IMT and CAC (r=0.10, p=0.32) nor between carotid IMT and coronary circulatory function in response to CPT and during ADO (r=−0.18, p=0.25 and r=0.10, p=0.54, respectively). In 33 individuals, EBT detected CAC with a mean Agatston-derived calcium score of 44±18. There was a significant difference in regional MBFs between territories with and without CAC at rest and during ADO-stimulated hyperemia (0.69±0.24 vs. 0.74±0.23 and 1.82±0.50 vs. 1.95±0.51 ml/g/min; p≤0.05, respectively) and also during CPT in DM but less pronounced (0.81±0.24 vs. 0.83±0.23 ml/g/min; p=ns). The increase in CAC was paralleled with a progressive regional decrease in resting as well as in CPT- and ADO-related MBFs (r=−0.36, p≤0.014; r=−0.46, p≤0.007; and r=−0.33, p≤0.041, respectively). Conclusions The absence of any correlation between carotid IMT and coronary circulatory function in type 2 DM suggests different features and stages of early atherosclerosis in the peripheral and coronary circulation. PET-measured MBF heterogeneity at rest and during vasomotor stress may reflect downstream fluid dynamic effects of coronary artery disease (CAD)-related early structural alterations of the arterial wall. PMID:18704406

  3. Vasomotor reactivity comparison in multiple sclerosis patients with white matter lesions and nonmultiple sclerosis subjects with white matter lesions in brain magnetic resonance imaging

    PubMed Central

    Khorvash, Fariborz; Masaeli, Ali; Shaygannejad, Vahid; Saadatnia, Mohammad

    2016-01-01

    Background: It has been recognized a close relationship between multiple sclerosis (MS) lesions and the cerebral vasculature. In this study, we observed cerebrovascular vasomotor reactivity difference between the MS patients and the non-MS migraine individuals. Materials and Methods: This prospective study was conducted on 40 patients with MS referring to Neurology Clinic of Isfahan Al-Zahra Hospital in 2012. The patients were compared with the same number of non-MS migraine individuals. Both groups had white matter lesions in brain magnetic resonance imaging. To evaluate the rate of cerebral artery vasomotor reactivity, transcranial Doppler device was used, and breath-holding index (BHI) was separately calculated for each middle cerebral artery. Main flow velocity (MFV) was determined by continuously recording of a period of 5 min of breathing the air in the room. The obtained data were analyzed using SPSS software version 18 and t-test, Chi-square and analysis of variance tests. Results: The mean values of MFV at rest was not significantly different between cases and control groups (46.21 ± 4.20 vs. 44.69 ± 4.34, P = 0.115) but difference between cases and control groups in MFV apnea was significant (59.11 ± 5.10 vs. 55.35 ± 6.03, P = 0.004). BHI in the control group was 0.79 ± 0.26 and in the case group was 0.93 ± 0.20 and these differences was found to be significant (P < 0.05). Conclusion: The mean of BHI and cerebral vasomotor reactivity in MS patients was more than the non-MS migraine individuals, although the mechanism of this process still remains unknown. PMID:26962525

  4. Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry

    PubMed Central

    Gebhard, Catherine; Fuchs, Tobias A.; Stehli, Julia; Gransar, Heidi; Berman, Daniel S.; Budoff, Matthew J.; Achenbach, Stephan; Al-Mallah, Mouaz; Andreini, Daniele; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk-Jae; Chinnaiyan, Kavitha M.; Chow, Benjamin J. W.; Cury, Ricardo C.; Delago, Augustin; Gomez, Millie J.; Hadamitzky, Martin; Hausleiter, Joerg; Hindoyan, Niree; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Lin, Fay Y.; Maffei, Erica; Pontone, Gianluca; Raff, Gilbert; Shaw, Leslee J.; Villines, Todd C.; Dunning, Allison M.; Min, James K.; Kaufmann, Philipp A.

    2015-01-01

    Aims Coronary computed tomographic angiography (CCTA) has become an important tool for non-invasive diagnosis of coronary artery disease (CAD). Coronary dominance can be assessed by CCTA; however, the predictive value of coronary dominance is controversially discussed. The aim of this study was to evaluate the prevalence and prognosis of coronary dominance in a large prospective, international multicentre cohort of patients undergoing CCTA. Methods and results The study population consisted of 6382 patients with or without CAD (47% females, 53% males, mean age 56.9 ± 12.3 years) who underwent CCTA and were followed over a period of 60 months. Right or left coronary dominance was determined. Right dominance was present in 91% (n = 5817) and left in 9% (n = 565) of the study population. At the end of follow-up, outcome in patients with obstructive CAD (>50% luminal stenosis) and right dominance was similar compared with patients with left dominance [hazard ratio (HR) 0.46, 95% CI 0.16–1.32, P = 0.15]. Furthermore, no differences were observed for the type of coronary dominance in patients with non-obstructive CAD (HR 0.95, 95% CI 0.41–2.21, P = 0.8962) or normal coronary arteries (HR 1.04, 95% CI 0.68–1.59, P = 0.9). Subgroup analysis in patients with left main disease revealed an elevated hazard of the combined endpoint for left dominance (HR 6.45, 95% CI 1.66–25.0, P = 0.007), but not for right dominance. Conclusion In our study population, survival after 5 years of follow-up did not differ significantly between patients with left or right coronary dominance. Thus, assessment of coronary vessel dominance by CCTA may not enhance risk stratification in patients with normal coronary arteries or obstructive CAD, but may add prognostic information for specific subpopulations. PMID:25744341

  5. Syphilitic aortitis causing bilateral coronary ostial stenosis.

    PubMed

    Hosoba, Soh; Suzuki, Tomoaki; Koizumi, Yusuke; Asai, Tohru

    2011-02-01

    Coronary ostial stenosis in otherwise normal coronary vessels is a rare complication of syphilitic aortitis. A 47-year-old man with no coronary risk factors developed severe isolated ostial stenosis in the left main coronary artery and right coronary artery. He underwent coronary artery bypass grafting using the bilateral internal thoracic arteries and gastroepiploic artery and recovered uneventfully. PMID:21345777

  6. Noninvasive assessment of coronary collaterals in man by PET perfusion imaging

    SciTech Connect

    Demer, L.L.; Gould, K.L.; Goldstein, R.A.; Kirkeeide, R.L. )

    1990-03-01

    At present, coronary collateralization cannot be identified or assessed noninvasively in patients. In animal studies, coronary collaterals are associated with coronary steal, defined as a regional fall in perfusion during coronary arteriolar vasodilation. To determine the effect of coronary arteriolar vasodilation on collateral bed perfusion in man, myocardial perfusion imaging was performed before and after pharmacologic coronary vasodilation in patients with coronary artery disease (CAD). Regional myocardial activity of {sup 82}Rb or {sup 13}N ammonia was measured by positron emission tomography (PET) at rest and with intravenous dipyridamole/handgrip stress in 28 patients with angiographic collaterals and in 25 control patients with similar CAD severity by quantitative arteriography. Regional myocardial activity decreased after dipyridamole, indicating coronary steal, in 25 of 28 patients with angiographic collaterals and in only 4 of 25 control patients without angiographic collaterals. These findings suggest that developed collaterals are associated with myocardial steal in patients with CAD, allowing potential use of PET for non-invasive identification of coronary collateralization.

  7. Lateral rectus palsy following coronary angiography and percutaneous coronary intervention

    PubMed Central

    Nicholson, Luke; Jones, Ruth; Hughes, David S

    2014-01-01

    We present a rare case of unilateral lateral rectus palsy following an elective coronary angiography and percutaneous coronary intervention in a 78-year-oldwoman. Ophthalmoplegia following coronary angiography is extremely rare and this is the first case of a unilateral lateral rectus palsy following the procedure. PMID:24536054

  8. [Coronary veins and coronary sinus tributary veins in Africans].

    PubMed

    Yangni-Angate, H; Kokoua, A; Kouassi, R; Kassanyou, S; Gnagne, Y; Guessan, G N; Cowppli-Bony, P; Memel, J B

    1995-01-01

    This anatomical study carried out on 40 African adults hearts studied branches of the coronary sinus. By using of injection of the coronary arteries and corrosion of the myocardium, the study identified certain peculiarities of the small coronary vein and the posterior descending interventricular vein in Africans. PMID:8519704

  9. The Artery of Percheron Infarction after Coronary Angiography

    PubMed Central

    Mazek, Haitham; Sherif, Khaled; Suarez, Jose; Wischmeyer, Jason

    2016-01-01

    Coronary angiography is the golden choice for coronary artery disease evaluation and management. However, as with any invasive procedures, there is a risk of complications. We are reporting a case of 69-year-old male with past medical history of cardiac bypass surgery, CHF, hypertension, and hyperlipidemia who was admitted to the hospital to evaluate his chest pain. He had treadmill stress test that showed ischemic induced exercise. Patient underwent coronary angiography that showed proximal complete occlusion of the RCA with a patent graft. At the end of the procedure, the patient did not wake up and remained minimally responsive. An urgent brain MRI was ordered and showed infarctions consistent with an artery of Percheron infarction. Later, patient has improved slowly and was discharged home. We briefly here discuss this rare complication including the risk factor, clinical presentation, and the management. PMID:27213059

  10. Coping with new challenges in acute coronary syndromes

    PubMed Central

    Théroux, Pierre; Labarthe, Benoît

    2006-01-01

    The acute coronary syndromes have become well-established clinical entities and are used as working diagnoses tied in with elaborate investigation and treatment practice guidelines. However, these syndromes remain challenging because their prevalence, morbidity and mortality remain high. Furthermore, these syndromes are demanding on the health care system because an early invasive management strategy is recommended for most patients with these conditions. Coping with these challenges requires the following initiatives: stepping beyond current diagnostic and management algorithms to a better performing risk stratification scheme that considers specific patient risk factors in addition to the disease risk, and a reintegration of acute coronary syndromes into the more global perspective of coronary artery disease; more effective antithrombotic therapy that does not further compromise bleeding risk, or drugs that control thrombogenic stimuli; and medical and revascularization therapies targeted to more specific individual pathophysiologies identified by novel blood markers and imaging techniques. PMID:16929386