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Sample records for invasive coronary vasomotor

  1. Lack of correlation between noninvasive stress tests and invasive coronary vasomotor dysfunction in patients with nonobstructive coronary artery disease.

    PubMed

    Cassar, Andrew; Chareonthaitawee, Panithaya; Rihal, Charanjit S; Prasad, Abhiram; Lennon, Ryan J; Lerman, Lilach O; Lerman, Amir

    2009-06-01

    Despite a nonobstructive coronary angiogram, many patients may still have an abnormal coronary vasomotor response to provocation and to myocardial demand during stress. The ability of noninvasive stress tests to predict coronary vasomotor dysfunction in patients with nonobstructive coronary artery disease is unknown. All patients with nonobstructive coronary artery disease who had invasive coronary vasomotor assessment and a noninvasive stress test (exercise ECG, stress echocardiography, or stress nuclear imaging) within 6 months of the cardiac catheterization with provocation at our institution were identified (n=376). Coronary vasomotor dysfunction was defined as a percentage increase in coronary blood flow of coronary flow reserve ratio of coronary vasomotor dysfunction in these patients. On invasive testing, 233 patients (63%) had coronary vasomotor dysfunction, of which 187 patients (51%) had endothelium-dependent dysfunction, 109 patients (29%) had endothelium-independent dysfunction, and 63 patients (17%) had both. On noninvasive stress testing, 157 (42%) had a positive imaging study and 56 (15%) a positive ECG stress test. The noninvasive stress tests had limited diagnostic accuracy for predicting coronary vasomotor dysfunction (41% sensitivity [95% CI, 34 to 47] and 57% specificity [95% CI, 49 to 66]), endothelium-dependent dysfunction (41% sensitivity [95% CI, 34 to 49] and 58% specificity [95% CI, 50 to 65]), or endothelium-independent dysfunction (46% sensitivity [95% CI, 37 to 56] and 61% specificity [95% CI, 54 to 67]). The exercise ECG test was more specific but less sensitive than the imaging tests. This study suggests that a negative noninvasive stress test does not rule out coronary vasomotor

  2. Vasomotor responses of newly developed coronary collateral vessels.

    PubMed

    Kinn, J W; Altman, J D; Chang, M W; Bache, R J

    1996-08-01

    Well-developed coronary collateral vessels contain an abundant muscular media and can undergo active vasomotion. However, early after coronary occlusion, coronary collateral vessels are thin walled with little smooth muscle, suggesting that vasomotor capability might be limited. Consequently, this study determined whether newly developed coronary collateral vessels have active vasomotor activity and whether endothelial function in these newly developed vessels is impaired. Retrograde blood flow was measured as an index of coronary collateral blood flow approximately 2 wk after embolic occlusion of the anterior descending coronary artery of dogs. Agonists were administered into the left main coronary artery to reach collaterals originating from the left coronary system. Baseline retrograde blood flow was 25.1 +/- 2.7 ml/min and increased to 36.7 +/- 3.7 ml/min after nitroglycerin (6 micrograms.kg-1.min-1, P < 0.05). Cyclooxygenase blockade with indomethacin (5 mg/kg i.v.) decreased retrograde collateral blood flow to 16.8 +/- 2.3 ml/min (P < 0.05). Subsequent administration of acetylcholine increased retrograde flow to 29.4 +/- 3.7 ml/min (P < 0.05), indicating intact endothelium-mediated vasodilation. Inhibition of nitric oxide synthase with NG-nitro-L-arginine further decreased coronary collateral retrograde flow to 12.0 +/- 2.8 ml/min (P < 0.05) and markedly blunted the response to acetylcholine. These findings demonstrate substantial vasomotor capability even early during coronary collateral development and indicate that both nitric oxide and cyclooxygenase-dependent endothelial mechanisms are intact.

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

    PubMed

    Ong, Peter; Athanasiadis, Anastasios; Sechtem, Udo

    2016-08-18

    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.

  4. VASOMOTOR SYMPTOMS AND CORONARY ARTERY CALCIUM IN POSTMENOPAUSAL WOMEN

    PubMed Central

    Allison, Matthew A.; Manson, JoAnn E.; Aragaki, Aaron; Langer, Robert D.; Rossouw, Jacques; Curb, David; Martin, Lisa W.; Phillips, Lawrence; Stefanick, Marcia L.; Cochrane, Barbara B.; Sarto, Gloria; Barnhart, Janice; O’Sullivan, Mary Jo; Johnson, Karen C.; Gass, Margery; Trevisan, Maurizio; Woods, Nancy F.

    2011-01-01

    Objective We assessed whether vasomotor symptoms (VMS) were associated with coronary artery calcium (CAC) and how hormone therapy may influence this association. Methods Subjects were a subset of women aged 50 to 59 and a history of hysterectomy that enrolled in the Women’s Health Initiative (WHI) clinical trial of estrogen alone and underwent a computed tomography scan of the chest at the end of the trial to determine CAC. Participants provided information about VMS (hot flashes and/or night sweats), as well as HT use, on self-administered questionnaires at trial baseline. Results The sample consisted of 918 women with a mean (SD) age of 55.1 (2.8) years at WHI randomization and 64.8 (2.9) years at CAC ascertainment. The prevalence of a CAC score > 0 was 46%, while the prevalence of a CAC score ≥ 10 and > 100 was 39 and 19%, respectively. At randomization, 77% reported a history of any VMS at any time prior to or at enrollment in the WHI while 20% reported any VMS only present at enrollment. Compared to those without a history of any VMS and after adjustment for potential confounders, a history of any VMS at any time up to and including WHI enrollment was associated with a significantly reduced odds for CAC > 0 (Odds Ratio 0.66, 95% CI 0.45 – 0.98). Moreover, as duration of HT increased the inverse association between any VMS and CAC moved toward the null. Conclusion A history of any VMS was significantly associated with a reduced odds for CAC independent of traditional CVD risk factors and other relevant covariates. This association appears to be influenced by duration of hormone therapy. PMID:20651617

  5. 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

  6. Variable coronary vasomotor responses to acetylcholine in patients with normal coronary arteriograms: evidence for localised endothelial dysfunction.

    PubMed Central

    Tousoulis, D.; Davies, G.; Lefroy, D. C.; Haider, A. W.; Crake, T.

    1996-01-01

    OBJECTIVE: The vasomotor responses of the epicardial coronary arteries to acetylcholine were examined in patients with normal coronary arteries and chest pain. DESIGN: Quantitative angiography was used to measure minimum lumen diameter of proximal and distal coronary artery segments at baseline, during intracoronary infusion of acetylcholine (10(-7) - 10(-3) mol/l), and following an intracoronary bolus (2 mg) of isosorbide dinitrate. PATIENTS: Coronary arteriograms were obtained in 15 patients (mean (SEM) age 48 (10) years) with normal coronary arteries and chest pain. MAIN RESULTS: In response to the low concentrations of acetylcholine (10(-7) - 10(-6) mol/1) 20 (61%) distal and 11 (41%) proximal segments showed dilatation (group 1), whereas 13 (39%) distal segments and 14 (52%) proximal segments showed constriction (group 2) (P < 0.05 v group 1). In group 1, the maximum dilatation induced by acetylcholine in the proximal and distal segments was 7.83 (1.19)% and 11.6 (2.2)% respectively. In group 2, the maximum constriction at higher concentration was 16.55 (3.3)% and 33.11 (11.63)% in the proximal and distal segments respectively. The two different patterns of the vasomotor response coexisted in eight (53%) of the 15 patients. Intracoronary isosorbide dinitrate caused a greater increase in the coronary luminal diameter of distal segments than in proximal segments in group 1 (25.63 (5.16)% v 12.43 (3.48)%, P < 0.01) but not in group 2 (12.65 (2.53)% v 10.82 (3.33)%. CONCLUSIONS: Constriction and dilatation may occur in proximal and distal coronary artery segments, suggesting local areas of endothelial dysfunction, in response to acetylcholine in patients with chest pain and angiographically normal coronary arteries. Images PMID:8800989

  7. Coronary vasomotor and cardiac electrophysiologic effects of diadenosine polyphosphates and nonhydrolyzable analogs in the guinea pig.

    PubMed

    Stavrou, B M; Lawrence, C; Blackburn, G M; Cohen, T; Sheridan, D J; Flores, N A

    2001-05-01

    Platelet activation in heart disease is important owing to the effects of platelet-derived compounds on myocardial perfusion and cardiac electrophysiology. Diadenosine polyphosphates are secreted from platelets and present in the myocardium, but their electrophysiologic and vasomotor effects are incompletely understood. We used isolated guinea-pig hearts to study the effects of diadenosine triphosphate (Ap3A), tetraphosphate (Ap4A), pentaphosphate (Ap5A), and hexaphosphate (Ap6A) (10 pM-0.1 mM), comparing their actions to those of adenosine, adenosine triphosphate, and non-hydrolyzable Ap4A and Ap5A analogs. Diadenosine polyphosphates (0.1 nM-0.1 microM) transiently reduced coronary perfusion pressure, which recovered during the continued presence of the compounds. At concentrations greater than 0.1 microM effects were maximal and sustained (perfusion pressure decreased from 36.5+/-3.4 to 18.6+/-2.5 mm Hg, p < 0.001, with 1 microM Ap4A). The changes in action potential duration and refractory period developed slowly but were maintained (0.1 nM-1 microM). With 1 nM Ap4A, action potential duration increased from 170.6+/-2.6 to 187.3+/-3.8 ms, p < 0.05, and refractory period increased from 138.5+/-1.6 to 147.9+/-2.0 ms, p < 0.05. Ap4A and its analog reduced QRS duration (from 24.7+/-1.1 to 13.9+/-1.6 ms with 1 microM Ap4A, p < 0.05). P2-purinergic (adenosine triphosphate) receptor antagonism (suramin) reduced perfusion pressure but was without electrophysiologic effect. Other changes in coronary perfusion pressure and electrophysiologic variables associated with Ap4A were not seen in the presence of suramin. P1-(adenosine) antagonism (8-[p-sulfophenyl]theophylline) attenuated the electrophysiologic effects only. Diadenosine polyphosphates have potent cardiac electrophysiologic and coronary vasomotor effects via purinergic receptors, suggesting an important role during platelet activation in acute coronary syndromes.

  8. Validation of a new method for non-invasive assessment of vasomotor function.

    PubMed

    Ellins, Elizabeth A; New, Karl J; Datta, Dev B N; Watkins, Suzanne; Haralambos, Kate; Rees, Alan; Aled Rees, D; Halcox, Julian P J

    2016-04-01

    Reactive hyperaemia induces a slowing of pulse wave velocity (PWV) in conduit arteries of healthy subjects (flow-mediated slowing (FMS)). This could be an alternative method for assessing peripheral vasomotor function to the gold standard method of flow-mediated dilatation (FMD) a more expensive and technically demanding technique. We aimed to assess the reproducibility of FMS in healthy participants and to test its ability to detect differences in vasomotor function in patients with familial hypercholesterolaemia (FH) and post-lipoprotein apheresis (LA) treatment. Altogether 25 healthy participants were studied on two occasions to assess reproducibility of FMS. In a case control study of 22 patients with FH and matched healthy controls, FMD and FMS were compared. An intervention study in 12 patients with FH looked at the impact of a single LA treatment on FMS assessed pre and post treatment. FMS demonstrated good reproducibility (coefficient of variation (CoV) 7.3%). Patients with FH had reduced FMS in comparison to matched healthy controls (FMS% FH -15.13 ± 5.04% vs controls -18.41 ± 5.15%, p = 0.023), with no difference in FMD% between the two groups. A single LA treatment significantly improved FMS (pre -18.81 ± 9.84 vs post -24.09 ± 7.61%, p = 0.016). FMS is a reproducible technique, which is able to detect differences in vasomotor function both in a condition associated with endothelial dysfunction and following an acute intervention known to improve endothelial function. This simple technique has potential for accessible assessment of vasomotor function in clinical studies. © The European Society of Cardiology 2015.

  9. [Invasive diagnostic imaging of coronary atherosclerosis].

    PubMed

    Gamou, Tadatsugu; Kawashiri, Masaaki; Tada, Hayato; Hayashi, Kenshi; Yamagishi, Masakazu

    2011-01-01

    Invasive diagnostic imaging technique of coronary atherosclerosis has rapidly developed. For example, intravascular ultrasound(IVUS) is recognized as an essential device for percutaneous coronary intervention to evaluate the vessel wall, vascular lumen and coronary plaque morphologies because of its accuracy for quantitative analysis capability. Recently new imaging modalities such as radio-frequency signal analysis, elastography and contrast harmonic echography have been developed for the evaluation of histological characteristics. Also, optical coherence tomography(OCT), which provides approximately ten-times higher-resolutional cross-section images of the coronary arterial wall in comparison with IVUS, became available in clinical setting. In this article, we review the latest progress of the invasive diagnostic imaging of coronary atherosclerosis.

  10. Influence of exercise and perivascular adipose tissue on coronary artery vasomotor function in a familial hypercholesterolemic porcine atherosclerosis model

    PubMed Central

    Bunker, Aaron K.

    2010-01-01

    Our lab has shown that left circumflex coronary artery (LCX) perivascular adipose tissue (PAT) blunts endothelin-1 (ET-1)-induced maximal contractions in normal pigs on low- and high-fat diets. Other studies report that PAT exerts anticontractile effects on agonist-induced arterial contraction via release of a relaxing factor that acts on the underlying vasculature. The purpose of this study was to test the hypotheses that PAT blunts LCX contraction in familial hypercholesterolemic pigs and that exercise training (Ex) augments this anticontractile effect. Male familial hypercholesterolemic pigs were divided into Ex (n = 13) and sedentary (Sed) (n = 15) groups. LCX reactivity to angiotensin II (ANG II), bradykinin (BK), ET-1, and sodium nitroprusside (SNP) was evaluated in vitro with intact or removed PAT in Sed and Ex familial hypercholesterolemic pigs. LCX relaxation induced by BK and SNP was not altered by Ex or PAT removal. LCX contractions stimulated by ANG II and ET-1 were not significantly altered by Ex or PAT removal across doses; however, Ex did act to significantly reduce ET-1 maximal contractions in familial hypercholesterolemic pig LCX compared with Sed familial hypercholesterolemic pig LCX, independent of PAT (P < 0.05). We conclude that LCX PAT in Sed and Ex familial hypercholesterolemic pigs exerts no substantial anticontractile influence over LCX vasomotor responses to endogenous constrictors such as ANG II and ET-1. Our results suggest that exercise training significantly reduces familial hypercholesterolemic pig LCX maximal contractile responses to the endogenous constrictor ET-1, independent of PAT. PMID:19959766

  11. Atherosclerosis influences the vasomotor response of epicardial coronary arteries to exercise.

    PubMed Central

    Gordon, J B; Ganz, P; Nabel, E G; Fish, R D; Zebede, J; Mudge, G H; Alexander, R W; Selwyn, A P

    1989-01-01

    We studied the vasomotion of epicardial coronary arteries during exercise and tested the hypotheses that abnormal vasoconstriction is related to the presence of atherosclerosis and may be related to endothelial dilator dysfunction. During cardiac catheterization quantitative coronary angiography was performed in 21 patients during supine bicycle exercise. 21 of 28 smooth, angiographically normal vessel segments dilated (14.0 +/- 1.8%) during exercise; four smooth segments did not change whereas only three constricted. In contrast, 15 of 16 vessel segments with irregularities constricted in response to exercise (17.0 +/- 0.1%) with only one segment dilating. All 10 stenotic segments constricted to exercise (23 +/- 4%). Six patients also received intracoronary acetylcholine before exercise to test endothelium-dependent dilator function. In five of six patients all nine vessel segments showed the same directional response to acetylcholine and exercise. Three irregular and two stenotic segments constricted with acetylcholine (51 +/- 21%) and exercise (9.0 +/- 0.6%). In contrast, four smooth segments dilated to acetylcholine (19 +/- 6%) and exercise (9 +/- 1%). Both exercise and acetylcholine generally dilated smooth but constricted irregular and stenosed coronary segments. It appears likely that atherosclerosis plays an important role in the abnormal vasomotion of diseased coronary arteries during exercise and the pattern of abnormality suggests impairment of vasodilator function. Images PMID:2723067

  12. Adaptation of vasomotor function of human coronary arterioles to the simultaneous presence of obesity and hypertension.

    PubMed

    Fulop, Tibor; Jebelovszki, Eva; Erdei, Nora; Szerafin, Tamas; Forster, Tamas; Edes, Istvan; Koller, Akos; Bagi, Zsolt

    2007-11-01

    We hypothesized that simultaneous presence of obesity and hypertension activates adaptive vascular mechanisms affecting dilations of human coronary arterioles. Agonist-induced dilations were assessed in isolated pressurized coronary arterioles from patients (n=38) who underwent cardiac surgery. Among normotensives we found that dilations to bradykinin (BK) and the NO-donor, sodium-nitroprusside (SNP) were reduced in obese subjects (BK, 10(-7) mol/L, lean: 90+/-4%, obese: 64+/-7%; SNP, 10(-6) mol/L, lean: 89+/-7%, obese: 76+/-5%). However, among hypertensives, both BK- and SNP-induced dilations were significantly enhanced in obese patients, when compared with lean individuals (BK, lean: 71+/-7%, obese: 85+/-3%; SNP, lean: 60+/-6%, obese: 83+/-2%). Correspondingly, in hypertensive patients, but not in those of normotensives, a positive correlation was found between body mass index (BMI) and BK-induced (P=0.036, r=0.46), and also SNP-evoked (P=0.031, r=0.44) coronary dilations. Moreover, in additional 55 hypertensive patients flow-mediated (FMD) and nitroglycerin (NTG)-induced dilations of the brachial artery were assessed. In obese hypertensive individuals, FMD- and NTG-induced dilations were greater (FMD: 6.2+/-0.7%, NTG: 17.2+/-0.9%), than in lean hypertensive patients (FMD: 3.7+/-0.6%, NTG: 13.6+/-1.1%). Correspondingly, FMD- and NTG-induced dilations were positively correlated with BMI (P=0.020, r=0.31 and P=0.033, r=0.29, respectively). These findings are the first to suggest that obesity may lead to activation of adaptive vascular mechanisms to enhance the dilator function of coronary and peripheral arterial vessels in hypertensive patients.

  13. Late gadolinium enhancement on cardiac magnetic resonance predicts coronary vasomotor abnormality and myocardial lactate production in patients with chronic heart failure.

    PubMed

    Uemura, Tomoaki; Yamamuro, Megumi; Kaikita, Koichi; Takashio, Seiji; Utsunomiya, Daisuke; Hirakawa, Kyoko; Nakayama, Mina; Sakamoto, Kenji; Yamamoto, Eiichiro; Tsujita, Kenichi; Kojima, Sunao; Hokimoto, Seiji; Yamashita, Yasuyuki; Ogawa, Hisao

    2016-12-01

    Myocardial fibrosis and microvascular dysfunction are key determinants of outcome in heart failure (HF); we examined their relationship in patients with HF. Our study included 61 consecutive patients with HF but without coronary stenosis. All underwent gadolinium-enhanced cardiac magnetic resonance to evaluate late gadolinium enhancement (LGE) and an acetylcholine (ACh) provocation test to evaluate microvascular dysfunction. During the ACh provocation test, we sampled blood simultaneously from the coronary sinus and aortic root to compare lactate concentrations. We quantified coronary blood flow volume using an intracoronary Doppler-tipped guidewire. We detected LGE in 34 patients (LGE-positive); 27 were LGE-negative. Coronary blood flow volume increased significantly after the ACh provocation test only in LGE-negative patients (before vs. after ACh, 47.5 ± 36.8 vs. 69.2 ± 48.0 ml/min, respectively; p = 0.004). The myocardial lactate extraction ratio (LER) significantly decreased after the ACh test in both groups (LGE-negative, p = 0.001; LGE-positive, p < 0.001), significantly more so in the LGE-positive group (p = 0.017). Multivariate logistic regression analysis showed that a post-ACh LER < 0 (indicating myocardial lactate production) was a significant predictor of LGE-positivity (odds ratio 4.54; 95 % confidence interval 1.38-14.93; p = 0.013). In the LGE-positive group, an LGE volume greater than the median significantly predicted a post-ACh LER of <0 (p = 0.042; odds ratio 6.02; 95 % confidence interval 1.07-33.86). ACh-provoked coronary vasomotor abnormality is closely correlated with myocardial fibrosis in patients with HF but without organic coronary stenosis. Coronary vasomotor abnormalities in fibrotic myocardium may worsen HF.

  14. 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.

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

    NASA Astrophysics Data System (ADS)

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

  16. 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

  17. Non-invasive coronary wave intensity analysis.

    PubMed

    Broyd, Christopher J; Rigo, Fausto; Davies, Justin

    2017-07-01

    Wave intensity analysis is calculated from simultaneously acquired measures of pressure and flow. Its mathematical computation produces a profile that provides quantitative information on the energy exchange driving blood flow acceleration and deceleration. Within the coronary circulation it has proven most useful in describing the wave that originates from the myocardium and that is responsible for driving the majority of coronary flow, labelled the backward decompression wave. Whilst this wave has demonstrated valuable insights into the pathogenic processes of a number of disease states, its measurement is hampered by its invasive necessity. However, recent work has used transthoracic echocardiography and an established measures of central aortic pressure to produce coronary flow velocity and pressure waveforms respectively. This has allowed a non-invasive measure of coronary wave intensity analysis, and in particular the backward decompression wave, to be calculated. It is anticipated that this will allow this tool to become more applicable and widespread, ultimately moving it from the research to the clinical domain.

  18. Influence of the endothelium, nitric oxide and serotonergic receptors on coronary vasomotor responses evoked by ergonovine in conscious dogs

    PubMed Central

    Karila-Cohen, Daniel; Delpy, Eric; Dubois-Randé, Jean-Luc; Puybasset, Louis; Hittinger, Luc; Giudicelli, Jean-François; Berdeaux, Alain

    1999-01-01

    The respective contributions of coronary vascular endothelium, nitric oxide (NO) and serotonergic receptors to the effects of ergonovine on large and small coronary arteries were investigated in conscious dogs. In seven dogs with an endothelium intact, ergonovine (30–1000 μg, i.v.) induced a biphasic response on large coronary artery with an early and transient vasodilatation (up to +2.9±0.5% from 3310±160 μm, P<0.01) followed by a sustained vasoconstriction (down to −4.9±0.5%, P<0.001) which occurred simultaneously with a sustained increase in coronary blood flow (CBF) (up to +100±26% from 28±4 ml min−1, P<0.001). After endothelium removal (balloon angioplasty), the ergonovine-induced vasodilatation was abolished and vasoconstriction potentiated (−6.4±0.9% after vs −4.9±0.5% before endothelium removal, P<0.01). After blockade of NO synthesis by Nω-nitro-L-arginine (30 mg kg−1) in four other dogs, the early vasodilatation induced by ergonovine was abolished but the delayed vasoconstriction as well as the increase in CBF remained unchanged. Both ketanserin and methiothepin (0.3 mg kg−1) abolished the early vasodilatation and reduced the delayed vasoconstriction induced by ergonovine. Ketanserin decreased and methiothepin abolished the reduction in coronary resistance induced by ergonovine. Thus, the complex interactions between vascular endothelium and serotonergic receptors to ergonovine-induced constriction of large coronary arteries might explain the induction of coronary spasms in patients with endothelial dysfunction. PMID:10433513

  19. [Vasomotor rhinitis and vasomotor tests (author's transl)].

    PubMed

    Wayoff, M; Moneret-Vautrin, J; Gazel, P

    1978-03-01

    The classification of types of vasomotor rhinitis remains controversial. Too frequently, the presence of salvoes of sneezing leads to a diagnosis of allergy. The authors point out the only relatively accuracy of skin tests and show that marked local histamine liberation may occur in the absence of allergy. They have perfected a battery of vasomotor tests using nicotinic acid, histamine, 48/80 and acetylcholine. On this basis, they propose a pragmatic clinical classification of types of vasomotor rhinitis. Underlying tendency to tetany is the most common aetiology, going hand in hand with increased histamine sensitivity.

  20. 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.

  1. Effective radiation doses associated with non-invasive versus invasive assessment of coronary anatomy and physiology.

    PubMed

    Toth, G G; Ntalianis, A; Ntarladimas, Y; de Booij, M; De Winter, O; Barbato, E; Pilet, B; Van Mieghem, C; Wijns, W; De Bruyne, B

    2015-06-01

    To compare the effective radiation dose (ERD) needed to obtain information on coronary anatomy and physiology by a non-invasive versus an invasive diagnostic strategy. Knowledge of anatomy and physiology is needed for management of patients with coronary artery disease (CAD). There is, however, a growing concern about detrimental long-term effects of radiation associated with diagnostic procedures. In a total of 671 patients with suspected CAD, we compared the ERD needed to obtain anatomical and physiological information through a non-invasive strategy or an invasive strategy. The non-invasive strategy consisted of coronary computed tomography angiography (CCTA) and single photon emission computed tomography (SPECT). The invasive strategy included coronary angiography (CA) and fractional flow reserve (FFR) measurement. In 464 patients, the data were acquired in Period 2009 and in 207 the data were acquired in Period 2011 (after each period, the CCTA- and the CA-equipment had been upgraded). For the Period 2009 total ERD of the non-invasive approach was significantly larger compared to the invasive approach (28.45 ± 5.37 mSv versus 15.79 ± 7.95 mSv, respectively; P < 0.0001). For Period 2011, despite the significant decrease in ERD for both groups (P<0.0001 for both), the ERD remained higher for the non-invasive approach compared to the invasive approach (16.67 ± 10.45 mSv vs. 10.36 ± 5.87 mSv, respectively; P < 0.0001). Simulation of various diagnostic scenarios showed cumulative radiation dose is the lowest when a first positive test is followed by an invasive strategy. To obtain anatomic and physiologic information in patients with suspected CAD, the combination of CA and FFR is associated with lower ERD than the combination of CCTA and SPECT. © 2014 Wiley Periodicals, Inc.

  2. Coronary CT angiography with prospective ECG-triggering: an effective alternative to invasive coronary angiography

    PubMed Central

    2012-01-01

    Despite the tremendous contributions of coronary CT angiography to coronary artery disease, radiation dose associated with coronary CT angiography has raised serious concerns in the literature, as the risk of developing radiation-induced malignancy is not negligible. Various dose-saving strategies have been implemented, with some of the strategies resulting in significant dose reduction. Of these strategies, prospective ECG-triggering is one of the most effective techniques with resultant effective radiation dose similar to or even lower than that of invasive coronary angiography. Prospective ECG-triggered coronary CT angiography has been reported to have high diagnostic accuracy in the diagnosis of coronary artery disease with image quality comparable to that of retrospective ECG-gating, but with significantly reduced radiation dose. Successful performance of prospective ECG-triggering is determined by strict exclusion criteria and careful patient preparation. The aim of this article is to provide an overview of the diagnostic applications of coronary CT angiography with prospective ECG-triggering with focus on radiation dose reduction. Radiation dose measurements are discussed with aim of allowing accurate dose estimation. Diagnostic value of prospective ECG-triggered coronary CT angiography in patients with different heart rate is discussed. Finally, current status and future directions are highlighted. PMID:24282694

  3. Coronary competitive reverse flow: Imaging findings at CT angiography and correlation with invasive coronary angiography.

    PubMed

    Li, Minghua; Liu, Shuyong; Zhang, Jiayin; Lu, Zhigang; Wei, Meng; Chun, Eun-Ju; Lu, Bin

    2015-01-01

    To study the imaging features of coronary competitive reverse flow and incidence of a "reverse attenuation gradient" in coronary CT angiography (CTA) with correlation to invasive coronary angiography (ICA). Patients who had undergone coronary CTA and ICA within 2 weeks were retrospectively identified in our database and reviewed. All cases with ICA-confirmed competitive reverse flow or chronic total occlusions (CTOs) were included for further analysis. The "reverse attenuation gradient sign" was defined as a reverse intraluminal opacification gradient of vessels which showed higher opacification in more distal compared with proximal segments. ICA findings were recorded and served as the reference to identify the clinical implications of this sign. In total, 134 patients (mean age, 68.1 ± 11.3 years; range, 38-90 years; 104 men) were included in our study. ICA revealed 11 cases of coronary competitive reverse flow and 123 cases of CTO. A reverse attenuation gradient sign was present in 9 of 11 patients (82%) with coronary competitive reverse flow and 72 of 123 (59%) chronically occluded coronary arteries. Myocardial bridges, distal collateral filling, as well as direct visualization of collateral connection were all more frequent in cases with coronary competitive reverse flow group compared with cases with a CTO. The reverse attenuation gradient sign distal to an upstream coronary severe stenosis indicates the presence of competitive collateral flow. Coronary CTA is able to correctly detect coronary competitive collateral flow and differentiate it from CTOs. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  4. Clinical experience with minimally invasive reoperative coronary bypass surgery.

    PubMed

    Subramanian, V A

    1996-01-01

    To minimize the risk of standard and reoperative coronary artery bypass, we developed a minimally invasive approach. In this study we have evaluated the effectiveness of this technique. Between April 1994 and September 1995, 12 men and 6 women, aged 55-84 years (mean, 69 years) with chronic stable angina (4) and recent post-myocardial infarction unstable angina (14), with left ventricular ejection fractions ranging 17-60% (mean 37%), underwent reoperative coronary artery bypass grafting using 7-cm mini-left and right anterior thoracotomy and subxiphoid incisions. Coronary artery anastomoses were carried out on beating hearts with local coronary occlusion. Ischemic preconditioning, beta and calcium channel blockers and the maintenance of mean arterial pressure at 75-80 mm Hg, were used as adjuncts for myocardial protection. The internal mammary artery was isolated under direct vision up to the second rib with excision of the fourth costal cartilage. Coronary artery target sites were the left anterior descending in 12, right coronary artery in 4, obtuse marginal in 3, posterior descending in 1 and diagonal branch in 1 patient. Arterial grafts (mammary, right gastroepiploic, radial), either as single or composite grafts, were used liberally. Preoperative risk factors included congestive heart failure (7), chronic renal insufficiency (5), second reoperation (2), third reoperation (1), cerebrovascular disease (5), prior angioplasty (8) and preoperative intra-aortic balloon pumping in two patients. There was no perioperative mortality with minimal morbidity. Twelve patients underwent patency study of the grafts 48-72 h postoperatively. Ten of the twelve grafts were patent; one internal mammary artery graft to the left anterior descending coronary artery (<1.5 mm) early in our series was occluded and one additional left internal mammary graft had a kink several centimeters away from the anastomosis, which was successfully opened by angioplasty. At a mean follow

  5. Stress testing and non-invasive coronary angiography in patients with suspected coronary artery disease: time for a new paradigm

    PubMed Central

    Arbab-Zadeh, Armin

    2012-01-01

    Diagnosis and management of coronary artery disease represents major challenges to our health care system, affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease was possible only through cardiac catheterization and invasive coronary angiography. To avoid the risks of an invasive procedure, stress testing is often employed for an initial assessment of patients with suspected coronary artery disease, serving as a gatekeeper for cardiac catheterization. With the emergence of non-invasive coronary angiography, the question arises if such a strategy is still sensible, particularly, in view of only a modest agreement between stress testing results and the presence of coronary artery disease established by cardiac catheterization. Much data in support of the diagnostic accuracy and prognostic value of non-invasive coronary angiography by computed tomography have emerged within the last few years. These data challenge the role of stress testing as the initial imaging modality in patients with suspected coronary artery disease. This article reviews the clinical utility, limitations, as well as the hazards of stress testing compared with non-invasive coronary artery imaging by computed tomography. Finally, the implications of this review are discussed in relation to clinical practice. PMID:22690295

  6. Latest-generation catheterization systems enable invasive submillisievert coronary angiography.

    PubMed

    Kuon, E; Weitmann, K; Hummel, A; Dörr, M; Reffelmann, T; Riad, A; Busch, M C; Felix, S B; Hoffmann, W; Empen, K

    2015-05-01

    The radiation risk of patients undergoing invasive cardiology remains considerable and includes skin injuries and cancer. To date, submillisievert coronary angiography has not been considered feasible. In 2011, we compared results from 100 consecutive patients undergoing elective coronary angiography using the latest-generation flat-panel angiography system (FPS) with results from examinations by the same operator using 106 historic controls with a conventional image-intensifier system (IIS) that was new in 2002. The median patient exposure parameters were measured as follows: dose-area product (DAP) associated with radiographic cine acquisitions (DAP(R)) and fluoroscopy (DAP(F)) scenes, radiographic frames and runs, and cumulative exposure times for radiography and fluoroscopy. On the FPS as compared to the traditional IIS, radiographic detector entrance dose levels were reduced from 164 to 80 nGy/frame and pulse rates were lowered from 12.5/s to 7.5/s during radiography and from 25/s to 4/s during fluoroscopy. The cardiologist's performance patterns remained comparable over the years: fluoroscopy time was constant and radiography time even slightly increased. Overall patient DAP decreased from 7.0 to 2.4 Gy × cm(2); DAP(R), from 4.2 to 1.7 Gy × cm(2); and DAP(F), from 2.8 to 0.6 Gy × cm(2). Time-adjusted DAP(R)/s decreased from 436 to 130 mGy × cm(2) and DAP(F)/s, from 21.6 to 4.4 mGy × cm(2). Cumulative patient skin dose with the FPS amounted to 67 mGy, and the median (interquartile range) of effective dose was 0.5 (0.3 … 0.7) mSv. Consistent application of radiation-reducing techniques with the latest-generation flat-panel systems enables submillisievert coronary angiography in invasive cardiology.

  7. The use of echocardiography for the non-invasive evaluation of coronary artery disease.

    PubMed

    Sirtori, Cesare R; Labombarda, Fabien; Castelnuovo, Samuela; Perry, Rebecca

    2017-03-01

    In the Western world, there are now millions of patients who undergo clinical procedures that evaluate coronary artery status each year. Methods span from direct imaging using angiography, computerized tomography, to nuclear magnetic imaging as well as to functional studies, such as positron emission tomography. These techniques have provided significant information to physicians, but there is still need for an improved accessibility. Angiographic methods are expensive and expose the patient to significant amounts of radiation, undesirable in younger patients. Among the novel technologies for coronary diagnostics, transthoracic echocardiography (TTE) of coronary arteries has provided an important alternative, particularly in everyday practice. Diagnostic arterial TTE can allow determination of the coronary wall lumen in at least three major coronary segments (left main [LM], left arterial descending [LAD] and right coronary artery [RCA]). Coronary wall thickness using the LAD has been preliminarily shown to be related to the risk of coronary events. Since it is well ascertained that coronary lesions found in any location indicate that at least 80% of the coronary tree is affected, this is very important clinical information. Evaluation of coronary status by TTE is a novel technology providing important information in ischemic syndromes, in cases of coronary malformations and other coronary diseases. KEY MESSAGES Coronary evaluation can be carried out by a variety of both invasive and non-invasive methods, many requiring radiation exposure or patient immobility. Transthoracic echocardiography (TTE) of the coronaries can, in particular, evaluate the coronary wall thickness, and this may be directly related to the coronary disease risk. TTE is a useful method for the monitoring of coronary flow reserve and can allow the detection of coronary malformations.

  8. Patient Acceptance of Noninvasive and Invasive Coronary Angiography

    PubMed Central

    Schönenberger, Eva; Schnapauff, Dirk; Teige, Florian; Laule, Michael; Hamm, Bernd; Dewey, Marc

    2007-01-01

    Background Noninvasive angiography using multislice computed tomography (MSCT) is superior to magnetic resonance imaging (MRI) for detection of coronary stenoses. We compared patient acceptance of these two noninvasive diagnostic tests and invasive conventional coronary angiography (Angio). Methods and Findings A total of 111 consecutive patients with suspected coronary artery disease underwent MSCT, MRI, and Angio. Subsequently, patient acceptance of the three tests was evaluated with questionnaires in all patients. The main acceptance variables were preparation and information prior to the test, degree of concern, comfort, degree of helplessness, pain (on visual analog scales), willingness to undergo the test again, and overall satisfaction. Preparation for each test was not rated significantly differently, whereas patients were significantly more concerned about Angio than the two noninvasive tests (p<0.001). No pain during MSCT, MRI, and Angio as assessed on visual analog scales (0 to 100) was reported by 99, 93, and 31 patients, respectively. Among the 82 patients who felt pain during at least one procedure, both CT (0.9±4.5) and MRI (5.2±16.6) were significantly less painful than Angio (24.6±23.4, both p<0.001). MSCT was considered significantly more comfortable (1.49±0.64) than MRI (1.75±0.81, p<0.001). In both the no-revascularization (55 patients) and the revascularization group (56 patients), the majority of the patients (73 and 71%) would prefer MSCT to MRI and Angio for future imaging of the coronary arteries. None of the patients indicated to be unwilling to undergo MSCT again. The major advantages patients attributed to MSCT were its fast, uncomplicated, noninvasive, and painless nature. Conclusions Noninvasive coronary angiography with MSCT is considered more comfortable than MRI and both MSCT and MRI are less painful than Angio. Patient preference for MSCT might tip the scales in favor of this test provided that the diagnostic accuracy of MSCT

  9. Vasomotor symptoms and metabolic syndrome.

    PubMed

    Tuomikoski, Pauliina; Savolainen-Peltonen, Hanna

    2017-03-01

    A vast majority of menopausal women suffer from vasomotor symptoms, such as hot flushes and night sweats, the mean duration of which may be up to 7-10 years. In addition to a decreased quality of life, vasomotor symptoms may have an impact on overall health. Vasomotor symptoms are associated with overactivity of the sympathetic nervous system, and sympathetic overdrive in turn is associated with metabolic syndrome, which is a known risk factor for cardiovascular disease. Menopausal hot flushes have a complex relationship to different features of the metabolic syndrome and not all data point towards an association between vasomotor symptoms and metabolic syndrome. Thus, it is still unclear whether vasomotor symptoms are an independent risk factor for metabolic syndrome. Research in this area is constantly evolving and we present here the most recent data on the possible association between menopausal vasomotor symptoms and the metabolic syndrome.

  10. Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography.

    PubMed

    Darlington, Meryl; Gueret, Pascal; Laissy, Jean-Pierre; Pierucci, Antoine Filipovic; Maoulida, Hassani; Quelen, Céline; Niarra, Ralph; Chatellier, Gilles; Durand-Zaleski, Isabelle

    2015-07-01

    To determine the costs and cost-effectiveness of a diagnostic strategy including computed tomography coronary angiography (CTCA) in comparison with invasive conventional coronary angiography (CA) for the detection of significant coronary artery disease from the point of view of the healthcare provider. The average cost per CTCA was determined via a micro-costing method in four French hospitals, and the cost of CA was taken from the 2011 French National Cost Study that collects data at the patient level from a sample of 51 public or not-for-profit hospitals. The average cost of CTCA was estimated to be 180 (95 % CI 162-206) based on the use of a 64-slice CT scanner active for 10 h per day. The average cost of CA was estimated to be 1,378 (95 % CI 1,126-1,670). The incremental cost-effectiveness ratio of CA for all patients over a strategy including CTCA triage in the intermediate risk group, no imaging test in the low risk group, and CA in the high risk group, was estimated to be 6,380 (95 % CI 4,714-8,965) for each additional correctly classified patient. This strategy correctly classifies 95.3 % (95 % CI 94.4-96.2) of all patients in the population studied. A strategy of CTCA triage in the intermediate-risk group, no imaging test in the low-risk group, and CA in the high-risk group, has good diagnostic accuracy and could significantly cut costs. Medium-term and long-term outcomes need to be evaluated in patients with coronary stenosis potentially misclassified by CTCA due to false negative examinations.

  11. Non-diagnostic coronary artery calcification and stenosis: a correlation of coronary computed tomography angiography and invasive coronary angiography.

    PubMed

    Engel, Leif-Christopher; Thai, Wai-Ee; Medina-Zuluaga, Hector; Karolyi, Mihaly; Sidhu, Manavjot S; Maurovich-Horvat, Pal; Margey, Ronan; Pomerantsev, Eugene; Abbara, Suhny; Ghoshhajra, Brian B; Hoffmann, Udo; Liew, Gary Y

    2017-05-01

    Background Heavy coronary artery calcification (CAC) impairs diagnostic accuracy of coronary computed tomography angiography (cCTA) and is considered to be a major limitation. Purpose To investigate the effect of non-evaluable CAC seen on cCTA on clinical decision-making by determining the degree of subsequent invasive testing and to assess the relationship between non-evaluable segments containing CAC and significant stenosis as seen in invasive coronary angiography (ICA). Material and Methods The study comprised of 356 patients who underwent cCTA and subsequent ICA within 2 months between 2005 and 2009. Clinical reports were reviewed to identify the indications for referral to ICA. In a subset of 68 patients where non-diagnostic CAC on cCTA and significant stenosis on ICA were present in the same segment, we correlated and analyzed the underlying stenosis severity of the lesion on ICA to the cCTA. Lesions with CAC were analyzed in a standardized fashion by application of reading rules. Results Non-diagnostic CAC on cCTA prompted ICA in 5.6% of patients. CAC occurred at the site of maximum stenosis in segments with stenosis <50% (95.9% [47/49]), 50-69% (82.4% [28/34]), 70-99% (64.5% [31/48]), and 100% (33.3% [1/3]). At the point of maximum calcium deposit, non-obstructive disease was present in 61.2%. Application of reading rules resulted in a 44% reduction in non-diagnostic cCTA reads. Conclusion Severe CAC may prompt further investigation with ICA. There is less CAC with increasing lesion severity at the point of maximum stenosis. Additional application of reading rules improved non-diagnostic cCTA reads.

  12. Utilization of cardiac computed tomography angiography and outpatient invasive coronary angiography in Ontario, Canada.

    PubMed

    Roifman, Idan; Rezai, Mohammad R; Wijeysundera, Harindra C; Chow, Benjamin J W; Wright, Graham A; Tu, Jack V

    2015-01-01

    Cardiac computed tomography angiography (coronary CTA) has emerged as a non-invasive method of diagnosing coronary artery disease. The extent of utilization and uptake of this technology since initiation of its funding by the government of Ontario is unknown. The aim of our study was to examine coronary CTA utilization and the rates of elective invasive coronary angiography and revascularization before and after funding initiation. We studied all coronary CTAs performed on adults in Ontario after initiation of funding. We also used an interrupted time series analysis to compare the average monthly rates of invasive angiography and revascularization before and after initiation of funding. There was an initial steep increase in age-and sex-standardized rates of coronary CTA from 5.0 to 11.4/100,000 over the first two quarters after funding initiation. Afterwards, there was a gradual increase in utilization from 11.4 to 17.1/100,000 over two subsequent calendar years. There was a significant reduction in both the mean monthly outpatient invasive coronary angiography (from 20.7 to 19.9 per 100,000 (p = 0.0004)) and revascularization (from 4.9 to 4.4 per 100,000 (p < 0.0001)) rates in the three years following introduction of the coronary CTA billing code as compared to the three prior to its introduction. Since the introduction of coronary CTA funding in Ontario, there has been a steady and controlled increase in its utilization. The increasing use of coronary CTA was associated with a reduction in both the rates of invasive angiography and revascularization. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  13. Non-invasive prediction of hemodynamically significant coronary artery stenoses by contrast density difference in coronary CT angiography.

    PubMed

    Hell, Michaela M; Dey, Damini; Marwan, Mohamed; Achenbach, Stephan; Schmid, Jasmin; Schuhbaeck, Annika

    2015-08-01

    Coronary computed tomography angiography (CTA) allows the detection of obstructive coronary artery disease. However, its ability to predict the hemodynamic significance of stenoses is limited. We assessed differences in plaque characteristics and contrast density difference between hemodynamically significant and non-significant stenoses, as defined by invasive fractional flow reserve (FFR). Lesion characteristics of 59 consecutive patients (72 lesions) in whom invasive FFR was performed in at least one coronary artery with moderate to high-grade stenoses in coronary CTA were evaluated by two experienced readers. Coronary CTA data sets were acquired on a second-generation dual-source CT scanner using retrospectively ECG-gated spiral acquisition or prospectively ECG-triggered axial acquisition mode. Plaque volume and composition (non-calcified, calcified), remodeling index as well as contrast density difference (defined as the percentage decline in luminal CT attenuation/cross-sectional area over the lesion) were assessed using a semi-automatic software tool (Autoplaq). Additionally, the transluminal attenuation gradient (defined as the linear regression coefficient between intraluminal CT attenuation and length from the ostium) was determined. Differences in lesion characteristics between hemodynamically significant (invasively measured FFR ≤0.80) and non-significant lesions (FFR >0.80) were determined. Mean patient age was 64±11 years with 44 males (75%). 21 out of 72 coronary artery lesions (29%) were hemodynamically significant according to invasive FFR. Mean invasive FFR was 0.66±0.12 vs. 0.91±0.05 for hemodynamically significant versus non-significant lesions. Hemodynamically significant lesions showed a significantly greater percentage of non-calcified plaque compared to non-hemodynamically relevant lesions (51.3±15.3% vs. 43.6±16.5%, p=0.021). Contrast density difference was significantly increased in hemodynamically relevant lesions (26.0±20.2% vs

  14. Safety of Routine Invasive Versus Selective Invasive Therapy in Women with Non-ST-Elevation Acute Coronary Syndrome.

    PubMed

    Bavry, Anthony A; Elgendy, Islam Y; Mahmoud, Ahmed; Jadhav, Manoj P; Huo, Tianyao; Limacher, Marian C; Pepine, Carl J

    2016-06-01

    Prior studies suggested that a routine invasive approach in the management of non-ST-elevation acute coronary syndrome (NSTE-ACS) is beneficial in men, but the data are less conclusive in women. One study conducted exclusively in women found that routine invasive therapy was associated with a markedly increased risk of major bleeding. This pilot randomized controlled trial compared the safety of a routine invasive versus a selective invasive strategy among women. Women with NSTE-ACS and an additional high-risk characteristic were randomized to a routine invasive versus a selective invasive strategy. The primary outcome was the risk of major bleeding. The secondary outcome was the first occurrence of all-cause death, myocardial infarction, stroke, re-hospitalization for ACS, or major bleeding within 6 months. Twenty-three women were assigned to routine invasive therapy and 17 to selective invasive therapy. Twenty-seven women (68%) had elevated troponin T (mean 0.33 ng/mL) and/or creatinine kinase-MB (mean 23 ng/mL). The risk of major bleeding was similar with both approaches (P = 0.99). At 6 months, the secondary outcome occurred in 9% of the routine invasive group versus 18% of the selective invasive group (risk ratio = 0.49, 95% confidence interval 0.09-2.63, P = 0.63). This pilot study demonstrated that a routine invasive approach is safe in women. There was suggestion of benefit from routine invasive therapy compared with selective invasive therapy. These data could be used to design an appropriately powered trial to determine the optimal management strategy among women with NSTE-ACS.

  15. 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

  16. 5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome.

    PubMed

    Damman, Peter; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; de Winter, Robbert J

    2010-03-02

    We present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial. Long-term outcomes may be relevant to decide treatment strategy for patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and elevated troponin T. We randomly assigned 1,200 patients to an early invasive or selective invasive strategy. The outcomes were the composite of death or myocardial infarction (MI) and its individual components. Risk stratification was performed with the FRISC (Fast Revascularization in InStability in Coronary artery disease) risk score. At 5-year follow-up, revascularization rates were 81% in the early invasive and 60% in the selective invasive group. Cumulative death or MI rates were 22.3% and 18.1%, respectively (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.00 to 1.66, p = 0.053). No difference was observed in mortality (HR: 1.13, 95% CI: 0.80 to 1.60, p = 0.49) or MI (HR: 1.24, 95% CI: 0.90 to 1.70, p = 0.20). After risk stratification, no benefit of an early invasive strategy was observed in reducing death or spontaneous MI in any of the risk groups. In patients presenting with NSTE-ACS and elevated troponin T, we could not demonstrate a long-term benefit of an early invasive strategy in reducing death or MI. (Invasive versus Conservative Treatment in Unstable coronary Syndromes [ICTUS]; ISRCTN82153174). Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. [Minimally invasive robotic coronary bypass on the beating heart using da Vinci S system].

    PubMed

    Gao, Chang-qing; Yang, Ming; Wang, Gang; Wu, Yang; Zhao, Yue; Li, Li-xia; Wang, Jia-li; Xiao, Cang-song; Zhou, Qi

    2009-04-15

    To summarize the experience of minimally invasive robotic coronary bypass on beating heart using da Vinci S in China. Fifty-six patients underwent selected robotic coronary bypass on beating heart from April 2007 to December 2008. All the patients had history of angina and the coronary arteriography showed severe stenosis in the left anterior descending artery (LAD), of which 10 cases had right coronary artery or left circumflex coronary (LCX) stenosis. The age was 33 to 74 years old, with a mean of (55.8 +/- 9.4) years old. The weight was (71.4 +/- 13.2) kg. All the patients had good lung function and had no medical history of pleurisy and thoracic surgery. CT scan of double internal thoracic artery (ITA) was routinely checked preoperatively. The procedures included: (1) The robotically assisted endoscopic atraumatic coronary artery bypass surgery. The approach was via a small left anterior thoracotomy (6 to 8 cm) after robotic ITA was taken down. The ITA was manually anastomosed to the LAD or LCX on beating heart. (2) Totally endoscopic coronary bypass graft on beating heart. After ITA harvesting, the endo stabilizer was inserted via the fourth port in the xiphoid area under endoscopic vision. The left ITA to the LAD grafting was done using U-clips on beating heart in a totally endoscopic manner using da Vinci S system through 4 ports. For all patients the ITA flow was checked by the Doppler flowmeter after anastomosis was completed. After the surgery was completed, the thoracic port was checked carefully to avoid bleeding. The operating procedures and a variety of clinical parameters were recorded and analyzed. (3) Stent placement after robotic surgery in a hybrid manner. The graft patency rate was evaluated by CT or arteriography. All patients successfully accepted robotic minimally invasive coronary bypass on the beating heart using da Vinci S surgical system without complications. The mean graft flow was (23.2 +/- 16.7) ml/min. And there was no surgical

  18. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease.

    PubMed

    Shirai, Kazuyuki; Lansky, Alexandra J; Mehran, Roxana; Dangas, George D; Costantini, Costantino O; Fahy, Martin; Slack, Steven; Mintz, Gary S; Stone, Gregg W; Leon, Martin B

    2004-04-15

    The purpose of this study was to compare the clinical outcomes of stenting and minimally invasive coronary artery bypass grafting (MIDCAB) in patients with proximal left anterior descending (LAD) coronary artery disease. The Patency, Outcome, Economics of Minimally invasive direct coronary bypass (POEM) study demonstrated that MIDCAB had similar safety and long-term efficacy for LAD revascularization compared with conventional coronary artery bypass grafting. Although LAD stenting is superior to conventional balloon angioplasty, whether it is comparable to MIDCAB is not known. We identified a matched population of 429 consecutive patients with 1-vessel disease who underwent elective proximal LAD stenting and compared their clinical outcomes with those of the 152 patients in the MIDCAB group of the POEM study. The in-hospital event rate was similar in both groups, except for a shorter length of hospital stay with LAD stenting compared with MIDCAB (2.68 vs 4.07 days, p <0.0001). At 6-month follow-up, the incidence of death and Q-wave myocardial infarction or that of cerebrovascular accident was not significantly different between these 2 groups. However, target vessel revascularization was significantly higher with LAD stenting than MIDCAB (13.3% vs 6.6%, p = 0.045). In the subgroup of patients without diabetes, all clinical events were similar in both groups, and the benefit of a shorter hospital stay associated with stenting was maintained. Compared with MIDCAB, LAD stenting is associated with higher repeat revascularization rates but offers the advantage of shorter hospitalization. For nondiabetics with proximal LAD disease, stenting may be the revascularization strategy of choice.

  19. Multidetector CT coronary angiography for patient triage to invasive coronary angiography: Performance and cost in ambulatory patients with equivocal or suspected inaccurate noninvasive stress tests.

    PubMed

    Menon, Madhav; Lesser, John R; Hara, Hidehiko; Birkett, Richard; Knickelbine, Thomas; Longe, Terry; Flygenring, Bjorn; Henry, Jason; Schwartz, Robert

    2009-03-01

    Multidetector-CT angiography (MDCTA) differs from noninvasive stress tests by directly imaging coronary anatomy. The utility of MDCTA for invasive triage is undefined however. We evaluated MDCTA triage to invasive coronary angiography in outpatients with indeterminate or suspected inaccurate stress tests, and estimated cost savings by MDCTA in this role. Consecutive MDCTA patients were retrospectively compared with noninvasive stress tests if performed within 6 months of MDCTA. Twelve-month clinical follow up was obtained for patients not undergoing invasive angiography, and cost using MDCTA for triage to invasive coronary angiography was calculated. MDCTA was performed in 385 patients who had noninvasive stress testing. Stress tests include included treadmill (n = 37), stress echo (n = 178), and nuclear perfusion imaging (n = 170). Invasive angiography was performed in 57 (14.8%). MDCTA compared to CA showed positive and negative predictive values of 94%/100% respectively for lesions found by invasive QCA. Stress testing compared to MDCTA showed positive/negative predictive values of 100%/67% for treadmill exercise, 60%/54% for stress echo, and 59%/55% of nuclear perfusion examinations respectively. One year clinical follow up in 314 patients showed no coronary events in 98% (309) of patients. Triage to invasive angiography by MDCTA showed a 4-fold cost reduction. MDCTA shows excellent performance as a triage for invasive angiography in patients with stress tests that are equivocal or thought inaccurate. A negative CTA confers good 12-month prognosis. Substantial cost savings may accrue using MDCTA in this triage role.

  20. Non-invasive imaging in coronary artery disease including anatomical and functional evaluation of ischaemia and viability assessment

    PubMed Central

    Pakkal, M; Raj, V; Mccann, G P

    2011-01-01

    Coronary artery disease has an important impact on the morbidity and mortality statistics and health economics worldwide. Diagnosis of coronary artery disease is important in risk stratification and guides further management. Invasive coronary angiography is the traditional method of imaging the coronary arteries and remains the gold standard. It detects luminal stenosis but provides little information about the vessel wall or plaques. Besides, not all anatomical lesions are functionally significant. This has lent itself to a wide variety of imaging techniques to identify and assess a flow-limiting stenosis. The approach to diagnosis of coronary artery disease is broadly based on anatomical and functional imaging. Coronary CT and MRI of coronary arteries provide an anatomical assessment of coronary stenosis. Coronary calcium score and coronary CT assess subclinical atherosclerosis by assessing the atherosclerotic plaque burden. The haemodynamic significance of a coronary artery stenosis can be assessed by stress radioisotope studies, stress echocardiography and stress MRI. The more recent literature also focuses on plaque assessment and identification of plaques that are likely to give rise to an acute coronary syndrome. There is an explosion of literature on the merits and limitations of the different imaging modalities. This review article will provide an overview of all the imaging modalities in the diagnosis of coronary artery disease. PMID:22723535

  1. [MINIMALLY INVASIVE MULTIVESSEL CORONARY ARTERY BYPASS GRAFTING VIA SMALL LEFT THORACOTOMY].

    PubMed

    Sakaguchi, Taichi

    2016-03-01

    Although a minithoracotomy approach has several advantages over a sternotomy approach in terms of superior cosmesis and faster recovery, coronary artery bypass grafting (CABG) via sternotomy has been the gold standard for revascularization in multivessel coronary artery disease. Recently, nonsternotomy approaches, including the minimally invasive cardiac surgery CABG (MICS-CABG) via small left thoracotomy, have emerged as safe, effective alternatives. Excellent clinical results have been reported including equivalent mid-term graft patency as compared with a sternotomy approach. Successful use of bilateral internal thoracic arteries in MICS-CABG has also been reported. Although the durability of this approach and its impact on long-term survival have yet to be confirmed, and there is a certain technical learning curve, MICS-CABG will be one important option to treat multivessel coronary artery disease.

  2. Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial.

    PubMed

    Napp, Adriane E; Haase, Robert; Laule, Michael; Schuetz, Georg M; Rief, Matthias; Dreger, Henryk; Feuchtner, Gudrun; Friedrich, Guy; Špaček, Miloslav; Suchánek, Vojtěch; Fuglsang Kofoed, Klaus; Engstroem, Thomas; Schroeder, Stephen; Drosch, Tanja; Gutberlet, Matthias; Woinke, Michael; Maurovich-Horvat, Pál; Merkely, Béla; Donnelly, Patrick; Ball, Peter; Dodd, Jonathan D; Quinn, Martin; Saba, Luca; Porcu, Maurizio; Francone, Marco; Mancone, Massimo; Erglis, Andrejs; Zvaigzne, Ligita; Jankauskas, Antanas; Sakalyte, Gintare; Harań, Tomasz; Ilnicka-Suckiel, Malgorzata; Bettencourt, Nuno; Gama-Ribeiro, Vasco; Condrea, Sebastian; Benedek, Imre; Čemerlić Adjić, Nada; Adjić, Oto; Rodriguez-Palomares, José; Garcia Del Blanco, Bruno; Roditi, Giles; Berry, Colin; Davis, Gershan; Thwaite, Erica; Knuuti, Juhani; Pietilä, Mikko; Kępka, Cezary; Kruk, Mariusz; Vidakovic, Radosav; Neskovic, Aleksandar N; Díez, Ignacio; Lecumberri, Iñigo; Geleijns, Jacob; Kubiak, Christine; Strenge-Hesse, Anke; Do, The-Hoang; Frömel, Felix; Gutiérrez-Ibarluzea, Iñaki; Benguria-Arrate, Gaizka; Keiding, Hans; Katzer, Christoph; Müller-Nordhorn, Jacqueline; Rieckmann, Nina; Walther, Mario; Schlattmann, Peter; Dewey, Marc

    2017-07-01

    More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). In this trial, patients with a low-to-intermediate pretest probability (10-60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. The DISCHARGE trial will assess the comparative effectiveness of CT and ICA. • Coronary artery disease (CAD) is a major cause of morbidity and mortality. • Invasive coronary angiography (ICA) is the reference standard for detection of CAD. • Noninvasive computed tomography angiography excludes CAD with high sensitivity. • CT may effectively reduce the approximately 2 million negative ICAs in Europe. • DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

  3. Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography.

    PubMed

    Yang, Xia; Yu, Qiang; Dong, Wei; Fu, Zhen-Hong; Yang, Jun-Jue; Guo, Jun; Chen, Yun-Dai

    2016-10-01

    To investigate the performance of dual-source computed tomography (DSCT) using high-pitch spiral (HPS) mode for coronary stents patency. We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography (ICA), while DSCT were conducted using HPS mode. There was no significant impact of age, body mass index or heat rate (HR) on image quality (P > 0.05), while HR variability had a slight impact on that (P < 0.05). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DSCT in detection of in-stent restenosis (ISR) based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant difference on sensitivity, specificity, PPV and NPV between diameter ≥ 3.0 mm group (93.3%, 97.9%, 87.5%, and 98.9%) and diameter < 3.0 mm group (80%, 93.3%, 80.0%, and 93.3%) (P < 0.05), and that between stent number ≥ 3 group (82.3%, 77.8%, 66.7%, and 60%) with < 3 group (97.3%, 80%, 96.5%, and 75%). The effective dose of DSCT (1.4 ± 0.5 mSv) is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv (P < 0.01)]. DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR < 65 beats/min.

  4. Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography

    PubMed Central

    Yang, Xia; Yu, Qiang; Dong, Wei; Fu, Zhen-Hong; Yang, Jun-Jue; Guo, Jun; Chen, Yun-Dai

    2016-01-01

    Objective To investigate the performance of dual-source computed tomography (DSCT) using high-pitch spiral (HPS) mode for coronary stents patency. Methods We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography (ICA), while DSCT were conducted using HPS mode. Results There was no significant impact of age, body mass index or heat rate (HR) on image quality (P > 0.05), while HR variability had a slight impact on that (P < 0.05). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DSCT in detection of in-stent restenosis (ISR) based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant difference on sensitivity, specificity, PPV and NPV between diameter ≥ 3.0 mm group (93.3%, 97.9%, 87.5%, and 98.9%) and diameter < 3.0 mm group (80%, 93.3%, 80.0%, and 93.3%) (P < 0.05), and that between stent number ≥ 3 group (82.3%, 77.8%, 66.7%, and 60%) with < 3 group (97.3%, 80%, 96.5%, and 75%). The effective dose of DSCT (1.4 ± 0.5 mSv) is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv (P < 0.01)]. Conclusion DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR < 65 beats/min. PMID:27928222

  5. [Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndromes].

    PubMed

    Baeza Román, Anna; Latour Pérez, Jaime; de Miguel Balsa, Eva; Pino Izquierdo, Karel; Coves Orts, Francisco Javier; García Ochando, Luis; de la Torre Fernández, Maria José

    2014-05-20

    In the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy. Retrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression. We analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel. The fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  6. Exploring Coronary Circulatory Response to Stenosis and Its Association with Invasive Physiologic Indices Using Absolute Myocardial Blood Flow and Coronary Pressure.

    PubMed

    Lee, Joo Myung; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Tong, Yaliang; Kim, Chee Hae; Bang, Ji-In; Suh, Minseok; Paeng, Jin Chul; Cheon, Gi Jeong; Koo, Bon-Kwon

    2017-08-29

    Background -Although invasive physiologic assessment for coronary stenosis has become a standard practice to guide treatment strategy, coronary circulatory response and changes in invasive physiologic indices, according to different anatomical and hemodynamic lesion severity, have not been fully demonstrated in patients with coronary artery disease. Methods -One hundred fifteen patients with left anterior descending artery stenosis who underwent both (13)N-ammonia positron emission tomography (PET) and invasive physiologic measurement were analyzed. Myocardial blood flow (MBF) measured using PET and invasively measured coronary pressures were used to calculate microvascular resistance (MVR) and stenosis resistance. Results -With progressive worsening of angiographic stenosis severity, both resting and hyperemic trans-stenotic pressure gradient and stenosis resistance increased (P<0.001 for all) and hyperemic MBF (P<0.001) and resting MVR (P=0.012) decreased. Resting MBF (P=0.383) and hyperemic MVR (P=0.431) were not changed and maintained stable. Both fractional flow reserve (FFR) and instantaneous wave free ratio (iFR) decreased as angiographic stenosis severity, stenosis resistance, and trans-stenotic pressure gradient increased, and hyperemic MBF decreased (all P values<0.001). When the presence of myocardial ischemia was defined by both low hyperemic MBF and low coronary flow reserve (CFR), the diagnostic accuracy of FFR and iFR did not differ, regardless of cut-off values of hyperemic MBF and CFR. Conclusions -This study demonstrated how the coronary circulation changes in response to increasing coronary stenosis severity using (13)N-ammonium PET-derived MBF and invasively measured pressure data. Currently used resting and hyperemic pressure-derived invasive physiologic indices have similar patterns of relationships to the different anatomic and hemodynamic lesion severity. Clinical Trial Registration -URL: https://clinicaltrials.gov Unique Identifier: NCT

  7. Exercise for vasomotor menopausal symptoms.

    PubMed

    Daley, Amanda; Stokes-Lampard, Helen; Macarthur, Christine

    2011-05-11

    Evidence suggests that many perimenopausal and early postmenopausal women will experience menopause symptoms, hot flushes being the most common. Symptoms caused by fluctuating levels of oestrogen may be alleviated by HRT but there has been a marked global decline in its use due to concerns about the risks and benefits of HRT; consequently many women are now seeking alternatives. As large numbers of women are choosing not to take HRT, it is increasingly important to identify evidence based lifestyle modification interventions that have potential to reduce vasomotor menopausal symptoms. To examine the effectiveness of any type of exercise intervention in the management of vasomotor menopausal symptoms (hot flushes and night sweats) in perimenopausal and postmenopausal women. Searches of the following electronic bibliographic databases were performed to identify randomised controlled trials (RCTs): Cochrane Menstrual Disorders and Subfertility Group Specialised trials register; Cochrane Library (CENTRAL) (Wiley Internet interface), MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Science Citation Index and Social Science Citation Index (Web of Science), CINAHL (Ovid) and SPORT Discus. Searches included dates up until 16-24 March 2010. RCTs in which any type of exercise intervention were compared no treatment/control or other treatments in the management of menopausal vasomotor symptoms in symptomatic perimenopausal/postmenopausal women. Six studies were deemed eligible for inclusion. Three authors independently extracted data from eligible studies. Three meta-analyses according to comparator the group were performed. In the comparison of exercise versus no treatment/control (three studies), the non-significant effect size Standardised Mean Difference (SMD) for vasomotor symptoms was -0.14 (95% CI: -0.54 to 0.26); SMD was -0.04, -0.25, -0.38. For the analysis of exercise versus HRT (three studies), the non-significant SMD was 0.49 (95% CI: -0.27 to 1.26); SMD across

  8. Clinical Effect and Prognosis of Off-Pump Minimally Invasive Direct Coronary Artery Bypass

    PubMed Central

    Yang, Ming; Xiao, Lian-Bo; Gao, Zhi-Sheng; Zhou, Ji-Wu

    2017-01-01

    Background Coronary artery bypass grafting (CABG) is a common procedure to circumvent the obstruction of coronary arteries when stents are unsuitable. CABG is a very traumatic surgery that requires redirecting blood flow to an external pump. Thus, this procedure has many risks during and after surgery, and minimizing these risks would greatly benefit the patients. Material/Methods We selected 126 patients with coronary artery syndrome and who were unsuitable for stent percutaneous coronary intervention. The observation group received minimally invasive direct coronary artery bypass (MIDCAB), while the control group was treated with off-pump CABG. Results Blood markers and echocardiography before and after treatment improved equally in both groups. Neither group exhibited obvious adverse reactions, or liver and kidney function damage. However, surgical bleeding and postoperative observation days were significantly reduced in the MIDCAB group. Death and cardiac shock at the end of follow-up were significantly lower in the MIDCAB group. Conclusions Overall, the clinical benefits of MIDCAB and OP-CABG were similar, but MIDCAB significantly reduced postoperative hospital stay and intraoperative blood transfusion, and improved clinical prognosis. PMID:28257412

  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. Simultaneous Non-Invasive Assessment of Systemic and Coronary Endothelial Function Iantorno et al: Cardiac MRI and Endothelial Function

    PubMed Central

    Schär, Michael; Krishnaswamy, Rupa; Soleimanifard, Sahar; Steinberg, Angela; Stuber, Matthias; Gerstenblith, Gary; Weiss, Robert G.

    2016-01-01

    Background Normal endothelial function is a measure of vascular health and dysfunction a predictor of coronary events. Nitric Oxide (NO)-mediated coronary artery endothelial function (CEF), as assessed by vasomotor reactivity during isometric handgrip exercise (IHE), was recently quantified noninvasively with MRI. Because the internal mammary artery (IMA) is often visualized during coronary MRI we propose the strategy of simultaneously assessing systemic and coronary endothelial function noninvasively by MRI during IHE. Methods and Results Changes in cross-sectional area (CSA) and blood flow (BF) in the right coronary artery (RCA) and the IMA in 25 CAD patients and 26 healthy subjects during IHE were assessed using 3T MRI. In 8 healthy subjects a NO synthase inhibitor was infused to evaluate the role of NO in the IMA-IHE response. Inter-observer IMA-IHE reproducibility was good for CSA (R=0.91) and BF (R=0.91). In healthy subjects, CSA and BF of the IMA increased during IHE and these responses were significantly attenuated by L-NMMA (p<0.01 vs. placebo). In CAD patients, the RCA did not dilate with IHE and dilation of the IMA was less than that of the healthy subjects (p=0.01). The BF responses of both the RCA and IMA to IHE were also significantly reduced in CAD patients. Conclusions MRI-detected IMA responses to IHE primarily reflect NO-dependent endothelial function, are reproducible and reduced in CAD patients. Endothelial function in both coronary and systemic (IMA) arteries can now be measured noninvasively with the same imaging technique and promises novel insights into systemic and local factors affecting vascular health. PMID:26919997

  11. 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. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  12. Improved Cardiac Risk Assessment with Non-Invasive measures of Coronary flow reserve

    PubMed Central

    Murthy, Venkatesh L.; Naya, Masanao; Foster, Courtney R.; Hainer, Jon; Gaber, Mariya; Di Carli, Gilda; Blankstein, Ron; Dorbala, Sharmila; Sitek, Arkadiusz; Pencina, Michael J.; Di Carli, Marcelo F.

    2012-01-01

    Background Impaired vasodilator function is an early manifestation of coronary artery disease and may precede angiographic stenosis. It is unknown whether non-invasive assessment of coronary vasodilator function in patients with suspected or known coronary artery disease (CAD) carries incremental prognostic significance. Methods and Results 2783 consecutive patients referred for rest/stress PET were followed for a median of 1.4 years (inter-quartile range: 0.7–3.2 years). The extent and severity of perfusion abnormalities were quantified by visual evaluation of myocardial perfusion images (MPI). Rest and stress myocardial blood flow (MBF) were calculated using factor analysis and a 2-compartment kinetic model, and were used to compute coronary flow reserve (CFR=stress/rest MBF). The primary endpoint was cardiac death. Overall 3-year cardiac mortality was 8.0%. The lowest tertile of CFR (<1.5) was associated with a 5.6-fold increase in the risk of cardiac death (95%CI 2.5–12.4, p<0.0001) compared to the highest tertile. Incorporation of CFR into cardiac death risk assessment models resulted in an increase in the c-index from 0.82 (95%CI 0.78–0.86) to 0.84 (95%CI 0.80–0.87, p=0.02) and in a net reclassification improvement (NRI) of 0.098 (95%CI 0.025–0.180). Addition of CFR resulted in correct reclassification of 34.8% of intermediate risk patients (NRI=0.487, 95%CI 0.262–0.731). Corresponding improvements in risk assessment for mortality from any cause were also demonstrated. Conclusions Non-invasive quantitative assessment of coronary vasodilator function using PET is a powerful, independent predictor of cardiac mortality in patients with known or suspected CAD and provides meaningful incremental risk stratification over clinical and gated MPI variables. PMID:22007073

  13. Effects of position change on lumbar pain and discomfort of Korean patients after invasive percutaneous coronary intervention: a RCT study

    PubMed Central

    Cha, Nam Hyun; Sok, Sohyune

    2016-01-01

    [Purpose] This study sought to examine the effects of position change on lumbar pain and discomfort of Korean patients after invasive percutaneous coronary intervention. [Subjects and Methods] The participants consisted of 48 patients (experimental: n=24, control: n=24) who underwent invasive coronary intervention (Percutaneous Coronary Intervention) in K hospital, Seoul, Korea. A randomized controlled trial design was used. Position changes as the experimental treatment were sequenced as follows: supine position for one hour after removal of the catheter; 30-degree bed-elevated lateral position for one hour; 30-degree bed elevation for one hour; and finally 30-degree bed-elevated lateral position for one hour. The thirty degree bed-elevated lateral position was intended to press on the surgical site. Measures used were the general characteristics form, Visual Analogue Scale for lumbar pain, and discomfort scale. [Results] There were significant differences on lumbar pain and discomfort of Korean patients after invasive coronary intervention between the experimental and control groups. [Conclusion] Position change was an effective intervention for decreasing lumbar pain and discomfort of Korean patients after invasive coronary intervention. Health professionals need to consider an array of methods including position change for patients after invasive coronary intervention. PMID:27821926

  14. Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio and non-invasive coronary flow reserve.

    PubMed

    Meimoun, P; Clerc, J; Ardourel, D; Martis, S; Djou, U; Botoro, T; Boulanger, J; Elmkies, F; Zemir, H

    2016-11-01

    Assessment of the functional significance of left anterior descending coronary artery (LAD) stenosis of intermediate severity is challenging and often based on fractional flow reserve (FFR). The instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, and non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography are also potentially useful. A direct comparison of FFR, IFR, and non-invasive CFR has never been performed. Our objective was to test the usefulness of non-invasive CFR by comparison to invasive FFR and IFR in patients with LAD stenosis of angiographic intermediate severity and stable coronary artery disease.

  15. 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

  16. Non-invasive prediction of angiographic progression of coronary artery disease by dipyridamole-stress echocardiography.

    PubMed

    Rodriguez, O; Picano, E; Fedele, S; Morelos, M; Marzilli, M; Ungi, I

    2001-05-01

    Coronary angiography is the currently accepted standard means for assessing progression of coronary artery disease. A dipyridamole-echocardiography test (DET) might provide an alternative non-invasive functional imaging method for this purpose. To assess whether variations in results of serial DET match variations in angiographic assessments of coronary artery disease. From the Pisa Institute of Clinical Physiology stress-echocardiography data bank (1983-1998), we selected 60 patients satisfying the inclusion criteria of coronary angiography and DET having each been performed and interpreted twice independently and within 1 week. The second angiographic and stress-echocardiographic assessment was performed 45+/-31 months after the initial one. Angiographic progressors were defined a priori as patients with any progression of stenosis to occlusion and those with any stenosis > 30% with > 20% progression of stenosis measured by visual and quantitative coronary angiography. Stress-echocardiography progressors were defined as those patients who had previously had a negative test of a test having a positive result and those patients who had positive results of tests both in initial testing and in a second session of testing with the latter having a peak wall-motion-score index > 0.12 (on a scale of 1, normal to 4, dyskinetic in a 16-segment model) larger than the former. Of the 60 patients, 44 were angiographic 'progressors' and 16 were 'non progressors'. Stress-echocardiographic responses were concordant with angiographic identification for 39 of 44 progressors and 15 of 16 non-progressors, with an overall concordance of 90%. Measurement of dipyridamole-stress-echocardiographic response allows one to separate angiographic progressors and non-progressors efficiently, simply by taking into account the presence, extent and severity of stress-induced abnormalities of wall motion.

  17. Routine invasive versus selective invasive strategies for Non-ST-elevation acute coronary syndromes: An Updated meta-analysis of randomized trials.

    PubMed

    Elgendy, Islam Y; Kumbhani, Dharam J; Mahmoud, Ahmed N; Wen, Xuerong; Bhatt, Deepak L; Bavry, Anthony A

    2016-11-01

    To perform an updated systematic review comparing a routine invasive strategy with a selective invasive strategy for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) in the era of stents and antiplatelet therapy. Recent meta-analyses comparing both strategies have shown conflicting results. Electronic databases were searched for randomized trials that compared a routine invasive strategy (i.e., routine coronary angiography +/- revascularization) versus a selective invasive strategy (i.e., medical stabilization and coronary angiography +/- revascularization if objective evidence of ischemia or refractory ischemia) in patients with NSTE-ACS. Summary odds ratios (OR) were primarily constructed using Peto's model. Twelve trials with 9,650 patients were included. Compared with a selective invasive strategy, a routine invasive strategy was associated with a reduction in the composite of all-cause mortality or myocardial infarction (MI) [OR: 0.86, 95% confidence interval (CI) 0.77-0.96] at a mean follow-up of 39 months, primarily due to a reduction in the risk of MI (OR: 0.78, 95% CI: 0.68-0.88). The risk of all-cause mortality was non-significantly reduced with a routine invasive strategy (OR: 0.88, 95% CI: 0.77-1.01). The risk of recurrent angina was reduced with a routine invasive strategy (OR: 0.55, 95% CI: 0.49-0.62), as well as the risk of future revascularization procedures (OR: 0.35, 95% CI: 0.30-0.39). In patients with NSTE-ACS, a routine invasive strategy reduced the risk of ischemic events, including the risk of mortality or MI. Routine invasive therapy reduced the risk of recurrent angina and future revascularization procedures. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  18. [Comparative assessment of ct-bypass angiography and invasive coronary angiography in patients after coronary bypass surgery in the late postoperative period].

    PubMed

    Men'kov, I A; Trufanov, G E; Zhelezniak, I S; Rud', S D; Kniazev, E A

    2013-10-01

    The aim of the study was to evaluate the diagnostic accuracy of ct-bypass angiography in the evaluation of significant stenosis and occlusion of grafts, recipient and nongrafted vessels in patients after coronary bypass surgery in the late postoperative period. Ct-bypass angiography was performed on 64-slice ct scanner with a slice thickness of 0.5 mm and a gantry rotation time of 0.4 s. All results were compared with quantitative invasive coronary angiography. 43 patients with 113 grafts were included in the study. Sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy for the evaluation of significant stenosis were 94%, 95%, 88%, 98%, 95%, respectively. Diagnostic accuracy for the evaluation of significant stenosis in the recipient and nongrafted vessels were 91% and 90%, respectively. The diagnostic accuracy for the evaluation graft occlusion, recipient and nongrafted vessels was 100%, 100% and 98%, respectively. Ct-bypass angiography allows accurate non-invasive assessment of significant stenosis and occlusion of coronary bypass grafts and native coronary arteries in patients after coronary bypass surgery in the late postoperative period.

  19. Impact of Calcium Score on Agreement Between Multidetector Computed Tomography and Invasive Coronary Angiography.

    PubMed

    de Agustín, José Alberto; Gómez de Diego, José Juan; Marcos-Alberca, Pedro; Mahía, Patricia; Rodrigo, José Luis; Luaces, María; Núñez-Gil, Iván Javier; Ferreiros, Joaquín; Bustos, Ana; Cabeza, Beatriz; García-Fernández, Miguel Ángel; Macaya, Carlos; Pérez de Isla, Leopoldo

    2017-05-18

    Multidetector computed tomography (MDCT) has been demonstrated as a feasible alternative to invasive coronary angiography (ICA). However, contradictory results have been reported regarding the effect of coronary artery calcium score (CS) on the diagnostic accuracy of MDCT. Our aim was to assess the agreement of MDCT and ICA and to evaluate the influence of CS on this agreement. We enrolled 266 consecutive patients who underwent evaluation with 64-slice MDCT and ICA. Standard CS software tools were used to calculate the Agatston score. Stenosis was qualitatively classified as mild, moderate, or severe by 1 blinded observer and the results were compared with those of ICA, which was used as the gold standard. The mean age of the patients was 65.4 ± 11.2 years, and 188 patients (70.3%) were men. A total of 484 segments with coronary stenosis ≥ mild were qualitatively evaluated and quantified with MDCT. Noninvasive measurements were concordant with ICA in 402 stenoses (83.05%; Kappa, 0.684), with no significant differences between vessels and with no statistically significant influence of CS on this agreement (OR, 0.93; 95%CI, 0.76-1.09; P = .21). Multidetector computed tomography had high sensitivity, specificity, positive predictive value, and negative predictive value on a per-segment, per-vessel, and per-patient basis. Non-ICA using MDCT showed good agreement with ICA in the qualitative quantification coronary stenosis and CS had no significant impact on this agreement. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  20. Procedural success of CTO recanalization: Comparison of the J-CTO score determined by coronary CT angiography to invasive angiography.

    PubMed

    Li, Yuehua; Xu, Nan; Zhang, Jiayin; Li, Minghua; Lu, Zhigang; Wei, Meng; Lu, Bin; Zhang, Yang

    2015-01-01

    The J-CTO score is based on invasive angiography, combines several parameters of chronic total coronary occlusions (CTO), and is well established to predict the likelihood of success of percutaneous recanalization. The purpose of this study was to evaluate and validate a J-CTOCT score derived from coronary computed tomography angiography (coronary CTA). Between April 2011 and December 2014, 159 consecutive patients were retrospectively included. All had at least one CTO in invasive angiography, had coronary CTA performed at an interval of no more than one week from invasive angiography, and had an attempt at percutaneous coronary intervention (PCI) following coronary CTA In parallel to the angiographic J-CTO score, the J-CTOCT score was determined by awarding one point each for a blunt vessel stump, bending > 45°, occlusion length ≥ 20 mm, presence of calcium covering > 50% of any vessel cross-section within the occlusion, or a previously failed attempt at PCI. a. Both scores were compared regarding their ability to predict successful recanalization. A total of 171 CTO lesions were analyzed. Intraobserver (k = 0.814, p < 0.001) and interobserver agreement (k = 0.771, p < 0.001) for calculation of the J-CTOCT score were close. The mean occlusion length measured by coronary CTA was significantly shorter than in invasive angiography (27.6 ± 14.8 mm vs. 37.2 ± 18.8 mm, p < 0.001). The J-CTOCT score (mean: 1.9 ± 1.4) correlated closely to the angiographic J-CTO score (mean: 1.8 ± 1.3, r = 0.856, p < 0.001), and in 122/171 lesions (71%), the scores were identical. Both J-CTOCT score (area under curve: 0.882, p < 0.001) and angiographic J-CTO score (area under curve: 0.868, p < 0.001) yielded similarly high predictive value for successful guidewire crossing within 30 min (p = 0.496). While the length of coronary occlusions in coronary CTA is significantly shorter than in invasive angiography, a J-CTOCT score determined by coronary CTA closely correlates to the

  1. [Predictors of the use of the early invasive strategy in women with non-ST-elevation acute coronary syndrome].

    PubMed

    de Miguel-Balsa, E; Baeza-Román, A; Pino-Izquierdo, K; Latour-Pérez, J; Coves-Orts, F J; Alcoverro-Pedrola, J M; Pavía-Pesquera, M C; Felices-Abad, F; Calvo-Embuena, R

    2014-11-01

    To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation (NSTE-ACS). A retrospective cohort study was made. Crude and adjusted analysis of the performance of the early invasive strategy using logistic regression. Coronary Units enrolled in 2010 - 2011 in the ARIAM-SEMICYUC registry. A total of 440 women with NSTE-ACS were studied. Sixteen patients were excluded due to insufficient data, together with 58 patients subjected to elective coronary angiography (> 72 h). Demographic parameters, coronary risk factors, previous medication, comorbidity. Clinical, laboratory, hemodynamic and electrocardiographic data of the episode. Women treated conservatively were of older age, had oral anticoagulation, diabetes, previous coronary lesions, and heart failure (p<0.005), increased baseline bleeding and ischemic risk (p=0.05) and a higher heart rate upon admission (p<0.05). After adjustment, only age > 80 years (OR 0.48, 95% CI 0.27 to 0.82, p=0.009), known coronary lesions (OR 0.47, 95% CI 0.26-0.84, p=0.011), and heart rate (OR 0.98, 95% CI 0.97-0.99, p=0.003) were independently associated to conservative treatment. Smoking (OR 2.50, 95% CI 1.20 to 5.19, p=0.013) and high-risk electrocardiogram (OR 2.96, 95% CI 1.72 to 4.97, p<0.001) were associated to the early invasive strategy. The exclusion of early deaths (<24 h) did not alter these results. In women with NSTE ACS, smoking and a high-risk electrocardiogram upon admission were independent factors associated to the early invasive strategy. Previous coronary lesions, age > 80 years and increased heart rate were independent factors associated to conservative treatment. Copyright © 2012 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  2. Non-invasive coronary angiography with multi-detector computed tomography: comparison to conventional X-ray angiography.

    PubMed

    Schoenhagen, Paul; Stillman, Arthur E; Halliburton, Sandy S; Kuzmiak, Stacie A; Painter, Tracy; White, Richard D

    2005-02-01

    Selective coronary angiography introduced clinical coronary imaging in the late 1950s. The angiographic identification of high-grade coronary lesions in patients with acute and chronic symptomatic coronary artery disease (CAD) led to the development of surgical and percutaneous coronary revascularization. However, the fact that CAD remains the major cause of death in North America and Europe demonstrates the need for novel, complementary diagnostic strategies. These are driven by the need to characterize both increasingly advanced disease stages but also early, asymptomatic disease development. Complex revascularization techniques for patients with advanced disease stages will initiate a growing demand for 3-dimensional coronary imaging and integration of imaging modalities with new mechanical therapeutic devices. An emerging focus is atherosclerosis imaging with the goal to identify subclinical disease stages as the basis for pharmacological intervention aimed at disease stabilization or reversal. Non-invasive coronary imaging with coronary multidetector computed tomographic angiography (MDCTA) allows both assessment of luminal stenosis and subclinical disease of the arterial wall. Its complementary role in the assessment of early and advanced stages of CAD is increasingly recognized.

  3. 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.

  4. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.

    PubMed

    Valgimigli, Marco; Gagnor, Andrea; Calabró, Paolo; Frigoli, Enrico; Leonardi, Sergio; Zaro, Tiziana; Rubartelli, Paolo; Briguori, Carlo; Andò, Giuseppe; Repetto, Alessandra; Limbruno, Ugo; Cortese, Bernardo; Sganzerla, Paolo; Lupi, Alessandro; Galli, Mario; Colangelo, Salvatore; Ierna, Salvatore; Ausiello, Arturo; Presbitero, Patrizia; Sardella, Gennaro; Varbella, Ferdinando; Esposito, Giovanni; Santarelli, Andrea; Tresoldi, Simone; Nazzaro, Marco; Zingarelli, Antonio; de Cesare, Nicoletta; Rigattieri, Stefano; Tosi, Paolo; Palmieri, Cataldo; Brugaletta, Salvatore; Rao, Sunil V; Heg, Dik; Rothenbühler, Martina; Vranckx, Pascal; Jüni, Peter

    2015-06-20

    It is unclear whether radial compared with femoral access improves outcomes in unselected patients with acute coronary syndromes undergoing invasive management. We did a randomised, multicentre, superiority trial comparing transradial against transfemoral access in patients with acute coronary syndrome with or without ST-segment elevation myocardial infarction who were about to undergo coronary angiography and percutaneous coronary intervention. Patients were randomly allocated (1:1) to radial or femoral access with a web-based system. The randomisation sequence was computer generated, blocked, and stratified by use of ticagrelor or prasugrel, type of acute coronary syndrome (ST-segment elevation myocardial infarction, troponin positive or negative, non-ST-segment elevation acute coronary syndrome), and anticipated use of immediate percutaneous coronary intervention. Outcome assessors were masked to treatment allocation. The 30-day coprimary outcomes were major adverse cardiovascular events, defined as death, myocardial infarction, or stroke, and net adverse clinical events, defined as major adverse cardiovascular events or Bleeding Academic Research Consortium (BARC) major bleeding unrelated to coronary artery bypass graft surgery. The analysis was by intention to treat. The two-sided α was prespecified at 0·025. The trial is registered at ClinicalTrials.gov, number NCT01433627. We randomly assigned 8404 patients with acute coronary syndrome, with or without ST-segment elevation, to radial (4197) or femoral (4207) access for coronary angiography and percutaneous coronary intervention. 369 (8·8%) patients with radial access had major adverse cardiovascular events, compared with 429 (10·3%) patients with femoral access (rate ratio [RR] 0·85, 95% CI 0·74-0·99; p=0·0307), non-significant at α of 0·025. 410 (9·8%) patients with radial access had net adverse clinical events compared with 486 (11·7%) patients with femoral access (0·83, 95% CI 0·73-0·96; p

  5. Alternative complement pathway activation during invasive coronary procedures in acute myocardial infarction and stable angina pectoris.

    PubMed

    Horváth, Zsófia; Csuka, Dorottya; Vargova, Katarina; Kovács, Andrea; Leé, Sarolta; Varga, Lilian; Préda, István; Tóth Zsámboki, Emese; Prohászka, Zoltán; Kiss, Róbert Gábor

    2016-12-01

    The effect of invasive percutaneous coronary procedures on complement activation has not been elucidated. We enrolled stable angina patients with elective percutaneous coronary intervention (SA-PCI, n=24), diagnostic coronary angiography (CA, n=52) and 23 patients with ST segment elevation myocardial infarction and primary PCI (STEMI-PCI). Complement activation products (C1rC1sC1inh, C3bBbP and SC5b-9) were measured on admission, 6 and 24h after coronary procedures. The alternative pathway product, C3bBbP significantly and reversibly increased 6h after elective PCI (baseline: 7.81AU/ml, 6h: 16.09AU/ml, 24h: 4.27AU/ml, p<0.01, n=23) and diagnostic angiography (baseline: 6.13AU/ml, 6h: 12.08AU/ml, 24h: 5.4AU/ml, p<0.01, n=52). Six hour C3bBbP values correlated with post-procedural CK, creatinine level and the applied contrast material volume (r=0.41, r=0.4, r=0.3, p<0.05, respectively). In STEMI-PCI, baseline C3bBbP level was higher, compared to SA-PCI or CA patients (11.33AU/ml vs. 7.81AU/ml or 6.13AU/ml, p<0.001). Similarly, the terminal complex (SC5b-9) level was already elevated at baseline compared to SA-PCI group (3.49AU/ml vs. 1.87AU/ml, p=0.011). Complement pathway products did not increase further after primary PCI. Elective coronary procedures induced transient alternative complement pathway activation, influenced by the applied contrast volume. In STEMI, the alternative complement pathway is promptly activated during the atherothrombotic event and PCI itself had no further detectable effect.

  6. Minimally invasive coronary bypass surgery: postoperative pain management using intermittent bupivacaine infiltration.

    PubMed

    Borges, M F; Coulson, A S

    1998-04-01

    Minimally invasive direct coronary artery bypass grafting (MIDCAB) is becoming a popular adjunct to standard cardiac bypass surgery in selected patients with accessible single or double vessel disease. However, the limited anterior thoracotomy used to access the heart involves trauma to the muscle tissue during removal of the fourth costal cartilage and a small piece of connected rib, perhaps leading to more severe postoperative pain compared with patients undergoing routine sternotomy. Intrathecal opioids can be used but have limited therapeutic duration and there is concern regarding anticoagulation. We present a case where soft tissue catheters were placed into the depths of the surgical wounds and pain was diminished greatly by intermittent regular infiltration with bupivacaine.

  7. Contemporary invasive imaging modalities that identify and risk-stratify coronary plaques at risk of rupture.

    PubMed

    Brown, Adam J; Costopoulos, Charis; West, Nick Ej; Bennett, Martin R

    2015-01-01

    Atherosclerotic plaque rupture is responsible for the majority of myocardial infarctions, with ruptured plaques exhibiting specific morphological features, including large lipid cores, thinner overlying fibrous caps and micro-calcifications. Contemporary imaging modalities are increasingly able to characterize plaques, potentially leading to the identification of precursor lesions that are at high risk of rupture. Observational studies using invasive imaging consistently find that plaques responsible for an acute coronary event display these high-risk morphological features, and recent prospective imaging studies have now established links between baseline plaque characteristics and future cardiovascular events. Despite these promising advances, subsequent overall event rates remain too low for clinical utility. Novel technologies are now required to refine and improve our ability to identify and risk-stratify lesions at risk of rupture, if plaque-based risk evaluation is ever to become reality.

  8. Minimally Invasive Coronary Angiography with Monochromatic X-Rays Developmental Studies Utilizing Synchrotron Radiation.

    NASA Astrophysics Data System (ADS)

    Otis, John Noel

    Iodine-containing compounds are used as contrast agents in obtaining X-ray images of blood vessels for medical diagnosis. If the X-ray contrast produced by iodine can be enhanced sufficiently relative to that produced by the intervening body tissues, it becomes possible to obtain images of arteries by introducing the contrast agent into the venous circulation rather than through an arterial catheter directly into the vessel under examination. This prospect is attractive because invasion of the arterial system is the chief cause of the medical complications that are encountered in the application of current angiographic procedures. An imaging system that shows promise of accomplishing this goal for examination of the coronary arteries has been developed for operation in an X-ray beam at the Stanford Synchrotron Radiation Laboratory. Iodine-selective contrast enhancement is achieved by logarithmic subtraction of two images of the same field. One of these images is formed by monochromatic X-rays of energy just above the characteristic iodine K-absorption edge at 33.17 keV, the other by X-rays of energy just below the edge. The computer-controlled imaging system acquires digitized images line by line while scanning the subject through a stationary X-ray beam of linear profile. At present, only synchrotron radiation can provide monochromatic X-ray beams of intensity sufficient to image the small and rapidly moving coronary arteries. Preliminary studies of static phantoms and in vivo studies of dogs establish the feasibility of using synchrotron radiation as the X-ray source for iodine-selective imaging with sensitivity and speed adequate for providing sharp images of coronary arteries after intravenous introduction of contrast agent. Application of the method to human subjects began with imaging studies of three patients in May, 1986.

  9. Early Invasive Versus Initial Conservative Strategies for Women with Non-ST-Elevation Acute Coronary Syndromes: A Nationwide Analysis.

    PubMed

    Elgendy, Islam Y; Mahmoud, Ahmed N; Mansoor, Hend; Bavry, Anthony A

    2017-09-01

    Studies conducted largely in men have shown improved outcomes with an early invasive strategy with non-ST-elevation acute coronary syndrome. In contrast, data have been less conclusive in women, with some trials demonstrating potential harm. This study aims to assess whether an early invasive strategy in women is associated with better outcomes in real-world data. Women admitted with a primary diagnosis of non-ST-elevation myocardial infarction or unstable angina were identified from the National Inpatient Sample years 2012 and 2013. The incidence of in-hospital mortality in women with non-ST-elevation acute coronary syndrome undergoing an early invasive strategy versus an initial conservative strategy was compared using a propensity score-matched analysis. Among 372,080 women with non-ST-elevation acute coronary syndrome, 153,680 (41.3%) were managed with an early invasive strategy and 218,400 (58.7%) were managed with an initial conservative strategy. Propensity score-matched 19,965 women were treated with an early invasive strategy, and 20,009 women were treated with an initial conservative strategy. The risk of in-hospital mortality was lower with an early invasive strategy (2.1% vs 3.8%; odds ratio [OR], 0.55; 95% confidence interval [CI], 0.49-0.62). This benefit was noted in women presenting with non-ST-segment elevation myocardial infarction (OR, 0.52; 95% CI, 0.46-0.58) and was not observed in women with unstable angina (OR, 5.14; 95% CI, 0.47-56.9), Pinteraction = .06. A propensity-adjusted analysis yielded similar results (OR, 0.51; 95% CI, 0.45-0.57). In this large contemporary observational analysis of women with non-ST-elevation acute coronary syndrome, an early invasive strategy was associated with lower in-hospital mortality. This benefit was observed in women presenting with non-ST-elevation myocardial infarction but not with unstable angina. These findings provide evidence supporting the guideline recommendations for an early invasive strategy in

  10. A myocardial perfusion imaging system using a multifocal collimator for detecting coronary artery disease: validation with invasive coronary angiography.

    PubMed

    Ogino, Yutaka; Horiguchi, Yoriko; Ueda, Tomohiro; Shiomori, Tomofumi; Kanna, Masahiko; Kawaminami, Tomoko; Iinuma, Naoki; Sudo, Yuta; Morita, Yukiko

    2015-05-01

    Myocardial perfusion imaging (MPI) systems using a multifocal collimator can reduce scan time substantially compared with conventional MPI systems. In this study, we evaluated the diagnostic accuracy of multifocal collimator SPECT/CT in coronary artery disease (CAD) detection by comparing it with coronary artery angiography (CAG). We retrospectively analyzed 50 consecutive patients who had undergone CAG and stress (201)Tl MPI multifocal collimator SPECT/CT within a 3-month period. A summed difference score (SDS) was calculated for each vascular territory from the MPI images. On CAG, a stenotic coronary artery was defined as one with luminal narrowing of ≥75 % with quantitative coronary angiography software. We analyzed the diagnostic accuracy of coronary artery stenosis detection using the definition that a coronary artery territory was ischemic when the SDS per vessel was ≥2. We generated receiver operating characteristic (ROC) curves to evaluate the usefulness of SDS per vascular territory to find coronary artery stenoses. The area under the ROC curve was 0.86 and cut-off value was 2. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to detect stenoses were 85, 83, 66, 94 and 84 %, respectively. We confirmed the high accuracy of imaging with multifocal collimator SPECT/CT for detection of angiographically significant CAD.

  11. A comparison of radiation doses between state-of-the-art multislice CT coronary angiography with iterative reconstruction, multislice CT coronary angiography with standard filtered back-projection and invasive diagnostic coronary angiography.

    PubMed

    Gosling, O; Loader, R; Venables, P; Roobottom, C; Rowles, N; Bellenger, N; Morgan-Hughes, G

    2010-06-01

    To accurately compare the radiation dose between prospectively gated cardiac multidetector CT (with and without iterative reconstruction) and diagnostic invasive coronary angiography using the latest International Commission on Radiological Protection 103 (ICRP) tissue weightings. A retrospective analysis of consecutive patients presenting to a university teaching hospital for investigation of coronary artery disease. Radiation doses for each technique were calculated using computational Monte Carlo modelling of a standard Cristy phantom rather than the application of previously published conversion factors. While these have frequently been used in other studies, they are based on out-dated ICRP tissue weightings (ICRP 60) and are for the whole chest rather than for structures irradiated in cardiac imaging. In order to allow a comparison, doses were calculated and expressed in terms of effective dose in millisieverts (mSv). From a population presenting for angiography within a clinical service, the median radiation dose from cardiac CT with standard filtered back-projection (84 patients, 5.4 mSv) was comparable with the dose from invasive diagnostic coronary angiography (94 patients, 6.3 mSv). The dose for cardiac CT using iterative reconstruction was significantly lower (39 patients, 2.5 mSv). The median effective dose from cardiac CT with standard filtered back-projection was comparable with the effective dose from invasive coronary angiography, even with application of the most contemporary ICRP tissue weightings and use of cardiac specific volumes. Cardiac CT scanning incorporating iterative reconstruction resulted in a significant reduction in the effective dose.

  12. Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial.

    PubMed

    Hoedemaker, Niels P G; Damman, Peter; Woudstra, Pier; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; de Winter, Robbert J

    2017-04-18

    The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an early invasive strategy was found at 1 and 5 years. The aim of this study was to determine the 10-year clinical outcomes of an early invasive strategy versus a selective invasive strategy in patients with NSTE-ACS and an elevated cardiac troponin T. The ICTUS trial was a multicenter, randomized controlled clinical trial that included 1,200 patients with NSTE-ACS and an elevated cardiac troponin T. Enrollment was from July 2001 to August 2003. We collected 10-year follow-up of death, myocardial infarction (MI), and revascularization through the Dutch population registry, patient phone calls, general practitioners, and hospital records. The primary outcome was the 10-year composite of death or spontaneous MI. Additional outcomes included the composite of death or MI, death, MI (spontaneous and procedure-related), and revascularization. Ten-year death or spontaneous MI was not statistically different between the 2 groups (33.8% vs. 29.0%, hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.97 to 1.46; p = 0.11). Revascularization occurred in 82.6% of the early invasive group and 60.5% in the selective invasive group. There were no differences in additional outcomes, except for a higher rate of death or MI in the early invasive group compared with the rates for the selective invasive group (37.6% vs. 30.5%; HR: 1.30; 95% CI: 1.07 to 1.58; p = 0.009), driven by a higher rate of procedure-related MI in the early invasive group (6.5% vs. 2.4%; HR: 2.82; 95% CI: 1.53 to 5.20; p = 0.001). In patients with NSTE-ACS and elevated cardiac troponin T levels, an early invasive strategy has no benefit over a selective invasive strategy in reducing the 10-year composite outcome of

  13. Cost analysis of non-invasive fractional flow reserve derived from coronary computed tomographic angiography in Japan.

    PubMed

    Kimura, Takeshi; Shiomi, Hiroki; Kuribayashi, Sachio; Isshiki, Takaaki; Kanazawa, Susumu; Ito, Hiroshi; Ikeda, Shunya; Forrest, Ben; Zarins, Christopher K; Hlatky, Mark A; Norgaard, Bjarne L

    2015-01-01

    Percutaneous coronary intervention (PCI) based on fractional flow reserve (FFRcath) measurement during invasive coronary angiography (CAG) results in improved patient outcome and reduced healthcare costs. FFR can now be computed non-invasively from standard coronary CT angiography (cCTA) scans (FFRCT). The purpose of this study is to determine the potential impact of non-invasive FFRCT on costs and clinical outcomes of patients with suspected coronary artery disease in Japan. Clinical data from 254 patients in the HeartFlowNXT trial, costs of goods and services in Japan, and clinical outcome data from the literature were used to estimate the costs and outcomes of 4 clinical pathways: (1) CAG-visual guided PCI, (2) CAG-FFRcath guided PCI, (3) cCTA followed by CAG-visual guided PCI, (4) cCTA-FFRCT guided PCI. The CAG-visual strategy demonstrated the highest projected cost ($10,360) and highest projected 1-year death/myocardial infarction rate (2.4 %). An assumed price for FFRCT of US $2,000 produced equivalent clinical outcomes (death/MI rate: 1.9 %) and healthcare costs ($7,222) for the cCTA-FFRCT strategy and the CAG-FFRcath guided PCI strategy. Use of the cCTA-FFRCT strategy to select patients for PCI would result in 32 % lower costs and 19 % fewer cardiac events at 1 year compared to the most commonly used CAG-visual strategy. Use of cCTA-FFRCT to select patients for CAG and PCI may reduce costs and improve clinical outcome in patients with suspected coronary artery disease in Japan.

  14. Cost implication of an early invasive strategy on weekdays and weekends in patients with acute coronary syndromes.

    PubMed

    Lamy, Andre; Tong, Wesley R; Bainey, Kevin; Gafni, Amiram; Rao-Melacini, Purnima; Mehta, Shamir R

    2015-03-01

    Early invasive intervention is associated with shorter length of stay (LOS) and similar outcomes in a delayed strategy in lower-risk patients with non-ST segment elevation acute coronary syndromes (NSTEACS), but is superior in higher-risk patients. However, early invasive intervention might be constrained by the need to mobilize the on-call team on weekends. We evaluated costs associated with an early vs delayed invasive intervention strategy, including patients who present on weekends. Health care utilization was extracted from the Timing of Intervention in Acute Coronary Syndromes (TIMACS) trial for Canadian patients from case report forms. Only direct costs were considered and only hospitalization events were included. Canadian unit costs were applied to health care resources consumed for all patients. Sensitivity and subgroup analyses were performed. Early invasive intervention reduced LOS costs by $2808 (95% confidence interval [CI], $4,629-$987). Total costs per Canadian patient for early invasive intervention were $16,579 (95% CI, $14,949-$18,209) compared with $19,517 (95% CI, $17,897-$21,136) for the delayed invasive approach. This resulted in a savings of $2938 (95% CI, $5236-$640). Findings were confirmed using bootstrap simulation. Sensitivity analyses confirmed savings regardless of proportion of cases done on weekends. All subgroup costs favoured early intervention. Early invasive strategy was cost-saving, even on weekends, for Canadian NSTEACS patients because of significant LOS savings. Because many high-risk NSTEACS patients receive delayed intervention because of weekend catheterization laboratory status, these findings support opening catheterization laboratories on weekends to facilitate the use of early invasive intervention. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  15. Ultrafast Track Robotic-Assisted Minimally Invasive Coronary Artery Surgical Revascularization.

    PubMed

    Tarola, Christopher L; Al-Amodi, Hussein A; Balasubramanian, Sankar; Fox, Stephanie A; Harle, Christopher C; Iglesias, Ivan; Sridhar, Kumar; Teefy, Patrick J; Chu, Michael W A; Kiaii, Bob B

    2017-10-04

    Contemporary anesthetic techniques have enabled shorter sedation and early extubation in off-pump and minimally invasive coronary artery bypass (CABG) surgery. Robotic-assisted CABG represents the optimal surgical approach for ultrafast track anesthesia, with patients able to bypass the cardiac surgical intensive care unit with recovery in the postanesthesia care unit (PACU) and inpatient ward. In-hospital postoperative outcomes from ninety patients who underwent either elective or urgent robotically-assisted CABG at our institution were reviewed. These patients were carefully selected by a multidisciplinary team to undergo fast-track anesthesia: extubation in the operating room, 4-hour recovery in the postanesthesia care unit and transfer to the inpatient ward. Intrathecal, paravertebral local, and patient-controlled anesthesia techniques were used to facilitate transition to oral analgesics. Average patient age was 61 ± 9 years. Sixty-six patients (73%) were male. Seventy cases were elective, and 20 patients required urgent revascularization. All patients underwent intraoperative angiography after graft construction, which revealed Fitzgibbon class A grafts. There were no in-hospital mortalities. One patient required re-exploration for bleeding, through the same minimally invasive incision, did not require conversion to sternotomy for bleeding, and was transferred to the intensive care unit postexploration for bleeding for standard postoperative care. Postoperative complications were limited to one superficial wound infection. The mean hospital length of stay was 3.5 ± 1.17 days. In patients undergoing robotic-assisted CABG, ultrafast-track cardiac surgery with immediate postprocedure extubation and transfer to the inpatient ward has been demonstrated to be safe with no increase in perioperative morbidity or mortality. It requires a dedicated heart team with a carefully selected group of patients. Avoiding cardiac surgical intensive care unit expedites recovery

  16. Impact of computed tomography myocardial perfusion following computed tomography coronary angiography on downstream referral for invasive coronary angiography, revascularization and, outcome at 12 months.

    PubMed

    van Rosendael, Alexander R; Dimitriu-Leen, Aukelien C; de Graaf, Michiel A; van Zwet, Erik W; Jukema, J Wouter; Bax, Jeroen J; Kroft, Lucia J; Scholte, Arthur J

    2017-05-29

    The aim of this study was to assess the impact of adding stress computed tomography (CT) myocardial perfusion (CTP) to coronary CT angiography (CTA) on downstream referral for invasive coronary angiography (ICA), revascularization, and outcome in patients presenting with new-onset chest pain. Three hundred and eighty-four patients were referred for cardiac CT. Patients with lesions ≥50% stenosis underwent subsequently stress CTP. Perfusion scans were considered abnormal if a defect was observed in ≥ 1 segment. Downstream performance of ICA, revascularization, and the occurrence of major cardiovascular events (death, non-fatal myocardial infarction, and unstable angina requiring urgent revascularization) were assessed within 12 months. In total, 119 patients showed ≥50% stenosis on coronary CTA; stress CTP was normal in 61 patients, abnormal in 38 patients and was not performed in 20 patients. After normal stress CTP, 19 (31%) patients underwent ICA and 9 (15%) underwent revascularization. After abnormal stress CTP, 36 (95%) patients underwent ICA and 29 (76%) revascularizations were performed. Multivariable analyses showed a five-fold reduction in likelihood of proceeding to ICA when a normal stress CTP was added to a coronary CTA showing obstructive CAD. Major cardiovascular event rates at 12 months for patients with obstructive CAD and normal stress CTP (N = 61) were low: 1 myocardial infarction, 1 urgent revascularization, and 1 non-cardiac death. The performance of stress CTP in patients with obstructive CAD at coronary CTA in the same setting is feasible and reduces the referral rate for ICA and revascularization. Secondly, the occurrence of major cardiovascular events at 12 months follow-up in patients with normal stress CTP is low.

  17. (F)Utility of invasive haemodynamic measurements to guide percutaneous intervention in chronic coronary artery disease.

    PubMed

    Seiler, Christian

    2015-01-01

    Percutaneous coronary intervention (PCI) in chronic stable coronary artery disease has not been shown to reduce the incidence of myocardial infarction or death. There is, however, evidence that the outcome from PCI is dependent on the amount of myocardial ischaemia. This review provides an overview of coronary circulatory pathophysiology and focuses on fractional flow reserve from a semantical, conceptual and practical point of view.

  18. A Comparison of Third-Generation Semi-Invasive Arterial Waveform Analysis with Thermodilution in Patients Undergoing Coronary Surgery

    PubMed Central

    Broch, Ole; Renner, Jochen; Gruenewald, Matthias; Meybohm, Patrick; Schöttler, Jan; Steinfath, Markus; Malbrain, Manu; Bein, Berthold

    2012-01-01

    Uncalibrated semi-invasive continous monitoring of cardiac index (CI) has recently gained increasing interest. The aim of the present study was to compare the accuracy of CI determination based on arterial waveform analysis with transpulmonary thermodilution. Fifty patients scheduled for elective coronary surgery were studied after induction of anaesthesia and before and after cardiopulmonary bypass (CPB), respectively. Each patient was monitored with a central venous line, the PiCCO system, and the FloTrac/Vigileo-system. Measurements included CI derived by transpulmonary thermodilution and uncalibrated semi-invasive pulse contour analysis. Percentage changes of CI were calculated. There was a moderate, but significant correlation between pulse contour CI and thermodilution CI both before (r2 = 0.72, P < 0.0001) and after (r2 = 0.62, P < 0.0001) CPB, with a percentage error of 31% and 25%, respectively. Changes in pulse contour CI showed a significant correlation with changes in thermodilution CI both before (r2 = 0.52, P < 0.0001) and after (r2 = 0.67, P < 0.0001) CPB. Our findings demonstrated that uncalibrated semi-invasive monitoring system was able to reliably measure CI compared with transpulmonary thermodilution in patients undergoing elective coronary surgery. Furthermore, the semi-invasive monitoring device was able to track haemodynamic changes and trends. PMID:22919321

  19. A comparison of third-generation semi-invasive arterial waveform analysis with thermodilution in patients undergoing coronary surgery.

    PubMed

    Broch, Ole; Renner, Jochen; Gruenewald, Matthias; Meybohm, Patrick; Schöttler, Jan; Steinfath, Markus; Malbrain, Manu; Bein, Berthold

    2012-01-01

    Uncalibrated semi-invasive continous monitoring of cardiac index (CI) has recently gained increasing interest. The aim of the present study was to compare the accuracy of CI determination based on arterial waveform analysis with transpulmonary thermodilution. Fifty patients scheduled for elective coronary surgery were studied after induction of anaesthesia and before and after cardiopulmonary bypass (CPB), respectively. Each patient was monitored with a central venous line, the PiCCO system, and the FloTrac/Vigileo-system. Measurements included CI derived by transpulmonary thermodilution and uncalibrated semi-invasive pulse contour analysis. Percentage changes of CI were calculated. There was a moderate, but significant correlation between pulse contour CI and thermodilution CI both before (r(2) = 0.72, P < 0.0001) and after (r(2) = 0.62, P < 0.0001) CPB, with a percentage error of 31% and 25%, respectively. Changes in pulse contour CI showed a significant correlation with changes in thermodilution CI both before (r(2) = 0.52, P < 0.0001) and after (r(2) = 0.67, P < 0.0001) CPB. Our findings demonstrated that uncalibrated semi-invasive monitoring system was able to reliably measure CI compared with transpulmonary thermodilution in patients undergoing elective coronary surgery. Furthermore, the semi-invasive monitoring device was able to track haemodynamic changes and trends.

  20. Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease: Two-year follow-up of a new hybrid procedure compared with "on-pump" double bypass grafting.

    PubMed

    de Cannière, D; Jansens, J L; Goldschmidt-Clermont, P; Barvais, L; Decroly, P; Stoupel, E

    2001-10-01

    Percutaneous transluminal coronary angioplasty (PTCA) or surgery can be chosen as first-line therapies in multiple-vessel coronary disease. A mammary-to-left anterior descending (LAD) graft is the most important statistical determinant of a favorable outcome after coronary artery bypass grafting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CABG in terms of patency rates. Our purpose was to compare a combination of minimally invasive direct coronary artery bypass (MIDCAB) and PTCA with double CABG as a treatment for double-vessel coronary artery disease involving the proximal LAD. Two matched groups of 20 patients with double-vessel coronary disease undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, complications, hospital costs, quality of life, and 2-year follow-up of ischemia are reported. All bypasses were patent at early control. Three adverse events were noted in group 1 and 17 in group 2. The hybrid-procedure group exhibited a shorter intensive care unit stay, fewer blood products transfused, less pain, better early quality of life, faster return to work, and similar cost. Three patients required a second PTCA in group 1, one of which for restenosis. At 2 years all the patients are asymptomatic with no residual ischemia. We conclude from this pilot study that the hybrid procedure is feasible and appears to be a safe therapy for double-vessel coronary artery disease and that it appears to generate less perioperative morbidity than classic double CABG does. Therefore we believe that there is room to undertake prospective randomized studies on a larger-scale basis.

  1. Reducing radiation exposure during invasive coronary angiography and percutaneous coronary interventions implementing a simple four-step protocol.

    PubMed

    Seiffert, Moritz; Ojeda, Francisco; Müllerleile, Kai; Zengin, Elvin; Sinning, Christoph; Waldeyer, Christoph; Lubos, Edith; Schäfer, Ulrich; Sydow, Karsten; Blankenberg, Stefan; Westermann, Dirk

    2015-06-01

    With an increasing number of complex and repeated percutaneous coronary interventions (PCI), radiation-induced hazards for patients and operators remain an important issue in fluoroscopy-guided procedures. Our objective was to evaluate radiation exposure during coronary angiographic procedures and assess the efficacy of a four-step program to reduce radiation exposure during coronary angiography (CAG) and PCI. A retrospective single-center analysis was performed in patients undergoing CAG or PCI in the first 6 months of 2012 vs. the first 6 months of 2014 (n = 3,107 procedures). During 2013, a four-step protocol was established in our hospital. It contained measures to reduce radiation exposure, including a frame rate reduction from 15 to 7.5 frames per second, the use of fluoroscopy storage, strict use of beam collimation, and repeat training on radiation safety. After adjustment for confounding variables, a dose-area product (DAP) reduction of 54.2% was observed subsequent to implementation of the four-step protocol. Independent predictors of DAP were age [odds ratio (OR) 1.01], body surface area (OR 5.47), prior coronary artery bypass grafting (OR 1.44), radial access (OR 1.16), PCI (OR 2.36), female gender (OR 0.91), and the implementation of the four-step program (OR 0.46). A simple four-step protocol led to a significant reduction in radiation exposure in diagnostic and interventional coronary procedures without significant drawbacks in image quality. Hence, radiation safety programs are of paramount importance and should be established to improve patient and operator safety with regard to radiation-induced hazards.

  2. [Early invasive strategy in non-ST-segment elevation acute coronary syndrome. The paradox continues].

    PubMed

    Latour-Pérez, J; Fuset-Cabanes, M P; Ruano Marco, M; del Nogal Sáez, F; Felices Abad, F J; Cuñat de la Hoz, J

    2012-03-01

    Observational studies have reported a paradoxical inverse relationship between the use of an early invasive strategy (EIS) and the risk of events in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS). The study objectives are: 1) to examine the association between baseline risk in patients with NSTE ACS and the use of EIS; and 2) to identify some of the factors independently associated to the use of EIS. Retrospective cohort study. Intensive care units participating in the SEMICYUC ARIAM Registry. Consecutive patients admitted with a diagnosis of NSTE-ACS within 48 hours of evolution between the months of April-July 2010. None. Coronary angiography with or without angioplasty within 72 hours, risk stratification using the GRACE scale. We analyzed 543 patients with NSTE-ACS, of which 194 were of low risk, 170 intermediate risk and 179 high risk. The EIS was used in 62.4% of the patients at low risk, in 60.2% of those with intermediate risk, and in 49.7% of those at high risk (p for tendency 0.0144). The EIS was used preferentially in patients with low severity and comorbidity. In the logistic regression model, EIS was independently associated to the availability of a catheterization laboratory (OR 2.22 [CI 95% 1.55 to 3.19]), the presence of ST changes on ECG (OR 1.80 [1.23 to 2.64]), or the existence of a low risk of bleeding (OR 0.76 [0.66 to 0.88)]. Conversely, EIS was less prevalent in patients with diabetes (OR 0.60 [0.41 to 0.88]) or tachycardia upon admission (OR 0.54 [0 36 to 0.82]). In 2010 there remained a lesser relative use of EIS in patients at high risk, due in part to an increased risk of bleeding in these patients. Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  3. 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

    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.

  4. Genetic Regulation of Endothelial Vasomotor Function

    PubMed Central

    Kim, Seung Kyum; Massett, Michael P.

    2016-01-01

    The endothelium plays an important role in the regulation of vasomotor tone and the maintenance of vascular integrity. Endothelial dysfunction, i.e., impaired endothelial dependent dilation, is a fundamental component of the pathogenesis of cardiovascular disease. Although endothelial dysfunction is associated with a number of cardiovascular disease risk factors, those risk factors are not the only determinants of endothelial dysfunction. Despite knowing many molecules involved in endothelial signaling pathways, the genetic contribution to endothelial function has yet to be fully elucidated. This mini-review summarizes current evidence supporting the genetic contribution to endothelial vasomotor function. Findings from population-based studies, association studies for candidate genes, and unbiased large genomic scale studies in humans and rodent models are discussed. A brief synopsis of the current studies addressing the genetic regulation of endothelial responses to exercise training is also included. PMID:27932996

  5. Orthostatic vasomotor response in spinal man.

    PubMed

    Krebs, M; Ragnarrson, K T; Tuckman, J

    1983-04-01

    The cardiovascular adaptation of tetraplegics to the upright position has been previously demonstrated to be deficient. Presumably this is due to the interruption of the spinal pathways linking supraspinal control centres with the peripheral sympathetic motor neurons. Review of previous studies of this phenomenon reveals that vasomotor responses have been determined primarily from blood flow measurements in the extremities. Contradictory conclusions have been drawn. Study of the visceral circulation, in particular renal blood flow, could shed more light on this poorly understood area. Renal clearance tests were carried out on seven healthy controls and eight chronic, clinically complete tetraplegic patients. Renal blood flow, mean arterial pressure, and total renal vascular resistance in both supine and passive head-up tilt positions were calculated from collected data. Renal blood flow and total renal vascular resistance showed significant decrease and increase respectively during tilting in controls and tetraplegic subjects. Although the renal circulation is autoregulated, postural change causes profound alteration of the renal blood flow mediated through the haemodynamic effects of the renal nerves. Sympathetic renal vasoconstriction is mediated by the carotid sinus reflex through the vasomotor centre in the brainstem. In the absence of supraspinal influence the renal vasculature is shown to respond to an orthostatic stimulus with a vigorous vasoconstriction. The adaptation of spinal man to the upright position may involve the recovery of a spinal vasomotor reflex involving the splanchnic circulation.

  6. 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

  7. Rationale, design and goals of the HeartFlow assessing diagnostic value of non-invasive FFRCT in Coronary Care (ADVANCE) registry.

    PubMed

    Chinnaiyan, Kavitha M; Akasaka, Takashi; Amano, Tetsuya; Bax, Jeroen J; Blanke, Philipp; De Bruyne, Bernard; Kawasaki, Tomohiro; Leipsic, Jonathon; Matsuo, Hitoshi; Morino, Yoshihiro; Nieman, Koen; Norgaard, Bjarne L; Patel, Manesh R; Pontone, Gianluca; Rabbat, Mark; Rogers, Campbell; Sand, Neils Peter; Raff, Gilbert

    Coronary CT angiography (CTA) is a reliable tool for the detection of coronary artery disease (CAD) that conveys significant prognostic information. It does not provide data on the hemodynamic significance of a given lesion, particularly in intermediate-grade stenosis. Fractional flow reserve by CT (FFRCT) can accurately predict the hemodynamic significance of coronary lesions. The primary objective of this registry is to determine whether the integration of FFRCT as an adjunct to coronary CTA will lead to a significant change in the management of CAD in patients with stable angina. The ADVANCE Registry is a multi-center, prospective registry designed to evaluate utility, clinical outcomes and resource utilization following FFRCT-guided treatment in clinically stable, symptomatic patients diagnosed with CAD by coronary CTA. Approximately 5000 patients will be enrolled from up to 50 sites in Europe, USA, Canada and Asia. Requirement for enrollment is the presence of atherosclerosis on coronary CTA. For each enrolled patient, a clinical management review committee will use data from coronary CTA and FFRCT to determine the management plan using the following criteria: (a) optimal medical therapy, (b) percutaneous coronary intervention, (c) coronary artery bypass graft surgery, or (d) more information required. The primary endpoint of the registry is the reclassification rate between the management plan based on coronary CTA alone versus CTA plus FFRCT. The secondary endpoints of the registry include the evaluation of the rate of invasive coronary angiography (ICA), revascularization, major adverse coronary events, resource utilization, cumulative radiation dose exposure and the rate of ICA without obstructive CAD at 3-year follow-up. The ADVANCE registry is designed to assess the real-world impact of FFRCT on the clinical management of stable CAD when used along with coronary CTA. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier

  8. Diagnostic Performance of Coronary CT Angiography, Stress Dual-Energy CT Perfusion, and Stress Perfusion Single-Photon Emission Computed Tomography for Coronary Artery Disease: Comparison with Combined Invasive Coronary Angiography and Stress Perfusion Cardiac MRI

    PubMed Central

    Chung, Hyun Woo; Hwang, Hweung Kon; So, Young; Yi, Jeong Geun; Lee, Eun Jeong

    2017-01-01

    Objective To investigate the diagnostic performance of coronary computed tomography angiography (CCTA), stress dual-energy computed tomography perfusion (DE-CTP), stress perfusion single-photon emission computed tomography (SPECT), and the combinations of CCTA with myocardial perfusion imaging (CCTA + DE-CTP and CCTA + SPECT) for identifying coronary artery stenosis that causes myocardial hypoperfusion. Combined invasive coronary angiography (ICA) and stress perfusion cardiac magnetic resonance (SP-CMR) imaging are used as the reference standard. Materials and Methods We retrospectively reviewed the records of 25 patients with suspected coronary artery disease, who underwent CCTA, DE-CTP, SPECT, SP-CMR, and ICA. The reference standard was defined as ≥ 50% stenosis by ICA, with a corresponding myocardial hypoperfusion on SP-CMR. Results For per-vascular territory analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 96, 96, 68, 93, and 68%, respectively, and specificities were 72, 75, 89, 85, and 94%, respectively. The areas under the receiver operating characteristic curve (AUCs) were 0.84 ± 0.05, 0.85 ± 0.05, 0.79 ± 0.06, 0.89 ± 0.04, and 0.81 ± 0.06, respectively. For per-patient analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 100, 100, 89, 100, and 83%, respectively; the specificities were 14, 43, 57, 43, and 57%, respectively; and the AUCs were 0.57 ± 0.13, 0.71 ± 0.11, 0.73 ± 0.11, 0.71 ± 0.11, and 0.70 ± 0.11, respectively. Conclusion The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR. PMID:28458600

  9. Diagnostic Performance of Coronary CT Angiography, Stress Dual-Energy CT Perfusion, and Stress Perfusion Single-Photon Emission Computed Tomography for Coronary Artery Disease: Comparison with Combined Invasive Coronary Angiography and Stress Perfusion Cardiac MRI.

    PubMed

    Chung, Hyun Woo; Ko, Sung Min; Hwang, Hweung Kon; So, Young; Yi, Jeong Geun; Lee, Eun Jeong

    2017-01-01

    To investigate the diagnostic performance of coronary computed tomography angiography (CCTA), stress dual-energy computed tomography perfusion (DE-CTP), stress perfusion single-photon emission computed tomography (SPECT), and the combinations of CCTA with myocardial perfusion imaging (CCTA + DE-CTP and CCTA + SPECT) for identifying coronary artery stenosis that causes myocardial hypoperfusion. Combined invasive coronary angiography (ICA) and stress perfusion cardiac magnetic resonance (SP-CMR) imaging are used as the reference standard. We retrospectively reviewed the records of 25 patients with suspected coronary artery disease, who underwent CCTA, DE-CTP, SPECT, SP-CMR, and ICA. The reference standard was defined as ≥ 50% stenosis by ICA, with a corresponding myocardial hypoperfusion on SP-CMR. For per-vascular territory analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 96, 96, 68, 93, and 68%, respectively, and specificities were 72, 75, 89, 85, and 94%, respectively. The areas under the receiver operating characteristic curve (AUCs) were 0.84 ± 0.05, 0.85 ± 0.05, 0.79 ± 0.06, 0.89 ± 0.04, and 0.81 ± 0.06, respectively. For per-patient analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 100, 100, 89, 100, and 83%, respectively; the specificities were 14, 43, 57, 43, and 57%, respectively; and the AUCs were 0.57 ± 0.13, 0.71 ± 0.11, 0.73 ± 0.11, 0.71 ± 0.11, and 0.70 ± 0.11, respectively. The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR.

  10. Long-term prognosis of chronic kidney disease in non-ST elevation acute coronary syndrome treated with invasive strategy.

    PubMed

    Roldán Torres, Ildefonso; Salvador Mercader, Inmaculada; Cabadés Rumbeu, Claudia; Díez Gil, José Luis; Ferrando Cervelló, José; Monteagudo Viana, Marta; Fernández Galera, Rubén; Mora Llabata, Vicente

    Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTEACS). However, the information available on this specific population, is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTEACS managed with invasive strategy. We conduct a prospective registry of patients with NSTEACS and coronary angiography. CKD was defined as a glomerular filtration rate < 60ml/min/1,73m(2). The composite primary end-point was cardiac death and non fatal cardiovascular readmission. We estimated the cumulative probability and hazard rate (HR) of combined primary end-point at 3-years according to the presence or absence of CKD. We included 248 p with mean age of 66.9 years, 25% women. CKD was present at baseline in 67 patients (27%). Patients with CKD were older (74.9 vs. 63.9 years; P<.0001) with more prevalence of hypertension (89.6 vs. 66.3%; P<.0001), diabetes (53.7 vs. 35.9%; P=.011), history of heart failure (13.4 vs. 3.9%; P=.006) and anemia (47.8 vs. 16%; P<.0001). No differences in the extent of coronary artery disease. CKD was associated with higher cumulative probability (49.3 vs. 28.2%; log-rank P=.001) and HR of the primary combined end-point (HR: 1.94; CI95%: 1.12-3.27; P=.012). CKD was an independent predictor of adverse cardiovascular outcomes at 3-years (HR: 1.66; CI95%: 1.05-2.61; P=.03). In NSTEACS patients treated with invasive strategie CKD is associated independently with an increased risk of adverse cardiovascular outcomes at 3years. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  11. 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

  12. 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

  13. 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.

  14. [A successful case of minimally invasive direct coronary artery bypass (MIDCAB) followed by PTCA].

    PubMed

    Nishina, T; Matsuda, K; Nomoto, S; Nishimura, K; Koshiji, T; Sato, T; Ueyama, K; Nonaka, M; Ban, T

    1998-02-01

    A 70-year-old man who developed angina pectoris underwent cardiac catheterization, which showed total occlusion of the left anterior descending coronary artery (LAD), associated with 75% stenosis of the right coronary artery (RCA) and 90% stenosis of the small circumflex coronary artery (CX). The LAD received good collateral flow from the RCA. The patient was scheduled to undergo the MIDCAB for the LAD using the internal thoracic artery (ITA), combined with percutaneous transluminal coronary angioplasty (PTCA) for the RCA subsequently. A left anterior submammarian skin incision of 10 cm in length was made. The fifth costal cartilage was removed. The left ITA was directly harvested from the chest wall from the 4th to 7th intercostal space, and was anastomosed to the midportion of the LAD without cardiopulmonary bypass. The patient was quickly recovered after the operation. On the 8th postoperative day, the patient successfully underwent the PTCA for the RCA after the ITA-LAD graft had been verified to be patent. The MIDCAB could be indicated for multivessel coronary disease in conjunction with the PTCA.

  15. Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

    PubMed Central

    Pizarro, Carmen; Herweg-Steffens, Neele; Buchenroth, Martin; Schulte, Wolfgang; Schaefer, Christian; Hammerstingl, Christoph; Werner, Nikos; Nickenig, Georg; Skowasch, Dirk

    2016-01-01

    Background In acute exacerbation of COPD, increased plasma levels of cardiac troponin are frequent and associated with increased mortality. Thus, we aimed at prospectively determining the diagnostic value of coronary angiography in patients with exacerbated COPD and concomitantly elevated cardiac troponin. Patients and methods A total of 88 patients (mean age 72.9±9.2 years, 56.8% male) hospitalized for acute exacerbation of COPD with elevated plasma troponin were included. All patients underwent coronary angiography within 72 hours after hospitalization. Complementary 12-lead electrocardiogram, transthoracic echocardiography, pulmonary function, and angiological testing were performed. Results Coronary angiography objectified the presence of ischemic heart disease (IHD) in 59 patients (67.0%), of whom 34 patients (38.6% of total study population) underwent percutaneous coronary intervention. Among these 34 intervened patients, the vast majority (n=26, 76.5%) had no previously known IHD, whereas only eight out of 34 patients (23.5%) presented an IHD history. Patients requiring coronary intervention showed significantly reduced left ventricular ejection fraction (45.8%±13.1% vs 55.1%±13.3%, P=0.01) and a significantly more frequent electrocardiographic ST-segment depression (20.6% vs 7.4%, P=0.01). Neither additional laboratory parameters for inflammation and myocardial injury nor lung functional measurements differed significantly between the groups. Conclusion Angiographically confirmed IHD that required revascularization occurred in 38.6% of exacerbated COPD patients with elevated cardiac troponin. In this considerable portion of patients, coronary angiography emerged to be of diagnostic and therapeutic value. PMID:27695304

  16. Invasive cardiac procedure use and mortality among South Asian and Chinese Canadians with coronary artery disease.

    PubMed

    Quan, Hude; Khan, Nadia; Li, Bing; Humphries, Karin H; Faris, Peter; Galbraith, P Diane; Graham, Michelle; Knudtson, Merril L; Ghali, William A

    2010-01-01

    Previous studies evaluated cardiac procedure use and outcome over the short term, with relatively few Asian patients included. To determine the likelihood of undergoing percutaneous coronary intervention and coronary artery bypass grafting, and survival during 10.5 years of follow-up after coronary angiography among South Asian, Chinese and other Canadian patients. Using prospective cohort study data from two large Canadian provinces, 3061 South Asian, 1473 Chinese and 77,314 other Canadian patients with angiographically proven coronary artery disease from 1995 to 2004 were assessed, and their revascularization and mortality rates during 10.5 years of follow-up were determined. Compared with other Canadian patients, South Asian and Chinese patients were slightly less likely to undergo revascularization (riskadjusted HR 0.94, 95% CI 0.90 to 0.98 for South Asian patients; and HR 0.94, 95% CI 0.88 to 1.00 for Chinese patients). However, South Asian patients underwent coronary artery bypass grafting (HR 1.00, 95% CI 0.94 to 1.07) and Chinese patients underwent percutaneous coronary intervention (HR 0.96, 95% CI 0.89 to 1.04) as frequently as other Canadian patients. Although the 30-day mortality rate was similar across the three ethnic groups, the mortality rate in the follow-up period was significantly lower for South Asian patients (HR 0.76, 95% CI 0.61 to 0.95) and marginally lower for Chinese patients (HR 0.80, 95% CI 0.60 to 1.07) compared with other Canadian patients. South Asian and Chinese patients used revascularization slightly less but had better survival outcomes than other Canadian patients. The factors underlying the better outcomes for South Asian and Chinese patients warrant further study.

  17. [Early invasive strategy no better than a selective invasive strategy for patients with non-ST-segment elevation acute coronary syndromes and elevated cardiac troponin T levels: long-term follow-up results of the ICTUS trial].

    PubMed

    Windhausen, F; Hirsch, A; Tijssen, J G P; Verheugt, F W A; Cornel, J H; de Winter, R J

    2008-02-23

    To determine whether routine coronary angiography followed by revascularisation where appropriate is better than initial drug treatment in patients with non-ST-segment elevation acute coronary syndromes (nSTE-ACS) and elevated troponin T concentrations. Multicentre randomised clinical trial (www.controlled-trials. com, number: SRCTN82153174). Patients with nSTE-ACS and elevated cardiac troponin were randomly assigned to an early invasive strategy or a selective invasive strategy. The early invasive strategy consisted of coronary angiography and revascularisation as indicated within 48 hours. The selective invasive strategy consisted of initial drug therapy; catheterisation was performed if the patient developed refractory angina or recurrent ischaemia. The main endpoints were a composite of death, recurrent myocardial infarction and rehospitalisation for anginal symptoms within 3 years, and all-cause mortality within 4 years. A total of 1200 patients were enrolled from 42 hospitals in the Netherlands. The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive group. After 3 years, the cumulative rate for the composite endpoint was 30.0% in the early invasive group and 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI: 0.97-1.50; p = 0.09). The 4-year all-cause mortality rate was similar in both treatment groups (7.9% vs 7.7%; p = 0.62). Long-term follow-up of this trial suggests that an early invasive strategy is not better than a selective invasive strategy in patients with nSTE-ACS and elevated cardiac troponin. Therefore, implementation of either strategy is acceptable in these patients.

  18. Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: comparison of accuracy, radiation dose and cost versus invasive coronary angiography.

    PubMed

    Pontone, Gianluca; Andreini, Daniele; Bertella, Erika; Cortinovis, Sarah; Mushtaq, Saima; Foti, Claudia; Annoni, Andrea; Formenti, Alberto; Baggiano, Andrea; Conte, Edoardo; Ballerini, Giovanni; Fiorentini, Cesare; Bartorelli, Antonio L; Pepi, Mauro

    2013-09-10

    The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT. Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost. The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B. The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Impact of Early Invasive Approach on Outcomes of Patients With Acute Coronary Syndrome and Baseline Anemia: Analysis From the ACSIS Registry.

    PubMed

    Sudarsky, Doron; Sudarsky, Merav; Matezky, Shlomi; Goldenberg, Ilan; Farcas, Ateret; Nikolsky, Eugenia

    2015-08-01

    Anemia in patients with acute coronary syndromes (ACS) is strongly related to the increased risk of bleeding and mortality. Whether benefit of early invasive strategy exceeds the risk of bleeding in these patients is unknown. To assess impact of early coronary angiography on outcomes of patients with ACS and baseline anemia. Biennial Israeli ACS registry (ACSIS) prospectively collects data from all 26 public hospitals. The endpoints included rates of in-hospital major bleeding, as well as 30-day and 1-year mortality. Anemia at baseline was present in 1,464 of 5,600 patients with ACS (26.1%). Coronary angiography within index hospitalization was performed less frequently in patients with anemia (76.6% vs. 90.8%, P < 0.001). Non-performance of coronary angiography was associated with older age and higher prevalence of comorbidities. Among patients with anemia who underwent coronary angiography, the majority (95.5%) had obstructive coronary disease, of whom 77.8% were triaged to revascularization. Performance of coronary angiography was associated with significantly lower (P < 0.0001) rates of mortality at 30 days (5.7% vs. 15.6%) and at 1 year (11.9% vs. 34.1%). Major bleeding occurred with similar incidence in groups with and without coronary angiography (3.1% vs. 3.8%, respectively; P = 0.54). By multivariable analysis, performance of coronary angiography was an independent predictor of lower 1-year mortality (hazard ratio [95%CI] = 0.30 [0.21, 0.44]. In the setting of ACS, despite the presence of baseline anemia, early coronary angiography with subsequent revascularization, when indicated, was associated with improved clinical outcomes including 1-year mortality without significant increase in rates of major bleeding. © 2015, Wiley Periodicals, Inc.

  20. Invasive treatment of non-ST-segment elevation acute coronary syndrome: cardiac catheterization/revascularization for all?

    PubMed

    Swahn, Eva; Alfredsson, Joakim

    2014-03-01

    Patients admitted to hospital with symptoms and signs of non-ST-segment elevation acute coronary syndromes have different risk profiles and are in need of an individualized approach that takes into consideration not only age and sex but also comorbidities such as diabetes, renal failure, hypertension, heart failure, peripheral artery disease, earlier revascularization, etc. According to evidence-based medicine and as documented in current guidelines, there is currently evidence for early catheterization and, if feasible, revascularization in high-risk patients, especially in men. Nevertheless, because of a lack of definitive evidence, there is uncertainty about treating women in the same way. Because women are usually older and have more comorbidities, they are frailer and revascularization should be indicated with greater caution. There is no evidence that catheterization as such is worse for women than for men; however, for both men and women with low risk, a less invasive approach, such as coronary computed tomography angiography, could be considered as a first diagnostic tool. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  1. 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.

  2. Automated quantitative Rb-82 3D PET/CT myocardial perfusion imaging: normal limits and correlation with invasive coronary angiography.

    PubMed

    Nakazato, Ryo; Berman, Daniel S; Dey, Damini; Le Meunier, Ludovic; Hayes, Sean W; Fermin, Jimmy S; Cheng, Victor Y; Thomson, Louise E J; Friedman, John D; Germano, Guido; Slomka, Piotr J

    2012-04-01

    We aimed to characterize normal limits and to determine the diagnostic accuracy for an automated quantification of 3D 82-Rubidium (Rb-82) PET/CT myocardial perfusion imaging (MPI). We studied 125 consecutive patients undergoing Rb-82 PET/CT MPI, including patients with suspected coronary artery disease (CAD) and invasive coronary angiography, and 42 patients with a low likelihood (LLk) of CAD. Normal limits for perfusion and function were derived from LLk patients. QPET software was used to quantify perfusion abnormality at rest and stress expressed as total perfusion deficit (TPD). Relative perfusion databases did not differ in any of the 17 segments between males and females. The areas under the receiver operating characteristic curve for detection of CAD were 0.86 for identification of ≥50% and ≥70% stenosis. The sensitivity/specificity was 86%/86% for detecting ≥50% stenosis and 93%/77% for ≥70% stenosis, respectively. In regard to normal limits, mean rest and stress left ventricular ejection fraction (LVEF) were 67% ± 10% and 75% ± 9%, respectively. Mean transient ischemic dilation ratio was 1.06 ± 0.14 and mean increase in LVEF with stress was 7.4% ± 6.1% (95th percentile of 0%). Normal limits have been established for 3D Rb-82 PET/CT analysis with QPET software. Fully automated quantification of myocardial perfusion PET data shows high diagnostic accuracy for detecting obstructive CAD.

  3. 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.

  4. Central vasomotor failure in a patient with medulla arteriovenous fistula.

    PubMed

    Lin, Ching-Hwung; Lo, Yuk-Keung; Lin, Yuh-Te; Li, Jie-Yuan; Lai, Ping-Hong; Gau, Yung-Yen

    2006-09-01

    We report on the case of a 60-year-old man who suffered from hiccup, dysphagia and unsteady gait for three months. He was diagnosed with intracranial dural arteriovenous fistula in medulla with retrograde perimedullary vein drainage. He developed quadriplegia, persistent shock status and symptomatic bradycardia immediately after a conventional cerebral angiography study. After excluding cardiogenic, hypovolemic, anaphylactic and septic shock, central vasomotor failure caused by venous thrombosis of the lesion was considered. The patient's central vasomotor failure recovered after continuous dopamine infusion treatment for 42 days. We concluded that venous hypertension with venous thrombosis in rostral ventrolateral medulla (RVLM), a major vasomotor center in the brainstem, was the lesion site. In our case, vasomotor dysfunction caused by an RVLM lesion related to venous thrombosis is considered as causative.

  5. On-line assessment of regional ventricular wall motion by transesophageal echocardiography with color kinesis during minimally invasive coronary artery bypass grafting.

    PubMed

    Kotoh, K; Watanabe, G; Ueyama, K; Uozaki, M; Suzuki, M; Misaki, T; Wakasugi, M; Ito, Y

    1999-05-01

    Our objective was to determine the changes in regional ventricular wall motion during minimally invasive direct coronary artery bypass grafting by color kinesis using transesophageal echocardiography. Minimally invasive coronary artery bypass grafting was performed in 34 patients, during which transesophageal echocardiography was used. Thirteen patients had isolated disease of the left anterior descending artery. Regional ventricular wall motion was analyzed by color kinesis with the SONOS 2500 transesophageal echocardiograph (Hewlett-Packard Co, Andover, Mass). On-line assessment of regional wall motion was continued during the operation. Wall motion abnormalities during ischemia were present in 4 cases, left ventricular mid-anterior hypokinesis in 3 cases, and left ventricular apical-lateral hypokinesis in 1 case. In all cases, wall motion was maintained after bypass. In patients with total coronary occlusion, changes in wall motion did not occur during anastomosis. Color kinesis allowed us to evaluate the change in regional ventricular wall motion induced by myocardial ischemia during minimally invasive coronary artery bypass grafting both objectively and quantitatively.

  6. Minimally invasive autopsy employing post-mortem CT and targeted coronary angiography: evaluation of its application to a routine Coronial service.

    PubMed

    Roberts, Ian S D; Traill, Zoe C

    2014-01-01

    Post-mortem imaging is a potential alternative to traditional medicolegal autopsy. We investigate the reduction in number of invasive autopsies required by use of post-mortem CT ± coronary angiography. A total of 120 adult deaths referred to the Coroner were investigated by CT, with coronary angiography employed only for the second series of 60 cases, in order to determine the added value of angiography. The confidence of imaging cause of death was classified as definite (no autopsy), probable, possible or unascertained. Invasive autopsy was not required in 38% of cases without coronary angiography and 70% of cases with angiography. Full autopsy, including brain dissection, was required in only 9% of cases. There was complete agreement between autopsy and radiological causes of death in the cases with a 'probable' imaging cause of death, indicating that cases for which imaging provides an accurate cause of death without autopsy were identified correctly. In two patients, CT demonstrated unsuspected fractures, not detected at subsequent autopsy. A two-thirds reduction in the number of invasive coronial autopsies can be achieved by use of post-mortem CT plus coronary angiography. At the same time, use of post-mortem CT may improve accuracy of diagnosis, particularly for traumatic deaths. © 2013 John Wiley & Sons Ltd.

  7. Completeness of revascularization and its impact on the outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease.

    PubMed

    Pineda, Andrés M; Chandra, Ramesh; Gowani, Saqib A; Santana, Orlando; Mihos, Christos G; Kirtane, Ajay J; Stone, Gregg W; Kurlansky, Paul; Smith, Craig R; Beohar, Nirat

    2016-09-01

    A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease. Limited data exist on degree of the completeness of revascularization achieved with this approach and its impact on outcomes. A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated. Coronary angiograms were reviewed by two cardiologists blinded to outcomes and were then categorized into two groups: complete or incomplete revascularization, which was defined as ≥1 major epicardial coronary arteries of at least 2.0 mm diameter with ≥70% untreated obstruction after the index PCI and before MIVS. Complete and incomplete revascularization was achieved in 105 (76%) and 33 (24%) patients, respectively. The patients with incomplete revascularization had a lower ejection fraction, a higher STS score, and more prior myocardial infarctions and multi-vessel coronary artery disease. There were no differences in the post-operative complications, 30-day mortality, or 3-year survival (84 vs. 83%, P = 0.68). After a median follow-up of 29 months, incompletely revascularized patients had a higher incidence of acute coronary syndrome (2.9 vs. 12.9%, P = 0.05). In patients undergoing a staged approach of PCI followed by MIVS, incomplete revascularization did not significantly impact the short or mid-term survival, but was associated with an increased incidence of acute coronary syndrome at follow-up. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  8. 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.

  9. Invasive measurement of coronary microvascular resistance in patients with acute myocardial infarction treated by primary PCI.

    PubMed

    Amier, Raquel P; Teunissen, Paul F A; Marques, Koen M; Knaapen, Paul; van Royen, Niels

    2014-01-01

    Up to 40% of patients with acute myocardial infarction develop microvascular obstruction (MVO) despite successful treatment with primary percutaneous coronary intervention (PCI). The presence of MVO is linked to negative remodelling and left ventricular dysfunction, leading to decreased long-term survival, increased morbidity and reduced quality of life. The acute obstruction and dysfunction of the microvasculature can potentially be reversed by pharmacological treatment in addition to the standard PCI treatment. Identifying patients with post-PCI occurrence of MVO is essential in assessing which patients could benefit from additional treatment. However, at present there is no validated method to identify these patients. Angiographic parameters like myocardial blush grade or corrected Thrombolysis In Myocardial Infarction (TIMI) flow do not accurately predict the occurrence of MVO as visualised by MRI in the days after the acute event. Theoretically, acute MVO can be detected by intracoronary measurements of flow and resistance directly following the PCI procedure. In MVO the microvasculature is obstructed or destructed and will therefore display a higher coronary microvascular resistance (CMVR). The methods for intracoronary assessment of CMVR are based on either thermodilution or Doppler-flow measurements. The aim of this review is to present an overview of the currently available methods and parameters for assessing CMVR, with special attention given to their use in clinical practice and information provided by clinical studies performed in patients with acute myocardial infarction.

  10. Early Invasive Strategy and In-Hospital Survival Among Diabetics With Non-ST-Elevation Acute Coronary Syndromes: A Contemporary National Insight.

    PubMed

    Mahmoud, Ahmed N; Elgendy, Islam Y; Mansoor, Hend; Wen, Xuerong; Mojadidi, Mohammad K; Bavry, Anthony A; Anderson, R David

    2017-03-18

    There are limited data on the merits of an early invasive strategy in diabetics with non-ST-elevation acute coronary syndrome, with unclear influence of this strategy on survival. The aim of this study was to evaluate the in-hospital survival of diabetics with non-ST-elevation acute coronary syndrome treated with an early invasive strategy compared with an initial conservative strategy. The National Inpatient Sample database, years 2012-2013, was queried for diabetics with a primary diagnosis of non-ST-elevation acute coronary syndrome defined as either non-ST-elevation myocardial infarction or unstable angina (unstable angina). An early invasive strategy was defined as coronary angiography±revascularization within 48 hours of admission. Propensity scores were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on >50 baseline characteristics and hospital presentations. Incidence of in-hospital mortality was compared in both groups. In a cohort of 363 500 diabetics with non-ST-elevation acute coronary syndrome, 164 740 (45.3%) were treated with an early invasive strategy. Propensity scoring matched 21 681 diabetics in both arms. Incidence of in-hospital mortality was lower with an early invasive strategy in both the unadjusted (2.0% vs 4.8%; odds ratio [OR], 0.41; 95% CI, 0.39-0.42; P<0.0001) and propensity-matched models (2.2% vs 3.8%; OR, 0.57; 95% CI, 0.50-0.63; P<0.0001). The benefit was observed across various subgroups, except for patients with unstable angina (Pinteraction=0.02). An early invasive strategy may be associated with a lower incidence of in-hospital mortality in patients with diabetes. The benefit of this strategy appears to be superior in patients presenting with non-ST-elevation myocardial infarction compared with unstable angina. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  11. Variation in Arterial Access for Invasive Coronary Procedures in New Zealand: A National Analysis (ANZACS-QI 5).

    PubMed

    Barr, P; Smyth, D; Harding, S A; El-Jack, S; Williams, M J A; Devlin, G; Stewart, J; Flynn, C; Lee, M; Kerr, A J

    2016-05-01

    Radial arterial access (RA) and femoral arterial access (FA) rates for invasive coronary angiography (ICA) vary widely internationally. The European Society of Cardiology (ESC) suggests default RA is feasible. We aim to investigate the variation in RA rates across all New Zealand public hospitals. Patient characteristics, procedural details, and inpatient outcome data were collected in the All New Zealand Acute Coronary Syndrome - Quality Improvement (ANZACS-QI) registry on consecutive patients undergoing ICA over five months. Of the 5894 ICAs 81% were via RA. Hospitals averaged 25 - 176 procedures/month (46.5% - 96.4% via RA). Operators averaged 17 procedures/month. Those performing more than 20 ICAs/month had RA rates between 61% - 99%. Of the 75 operators, 69% met the ESC recommendation. After multivariable adjustment higher operator (RR 1.12, CI 1.09 - 1.30) and hospital (RR 1.21, CI 1.15 - 1.28) volume were independent predictors of RA. Those with prior CABG (RR 0.51, CI 0.45 - 0.57), STEMI <12h (RR 0.91, CI 0.87 - 0.96), and female sex (RR 0.96, CI 0.94 - 0.99) were less likely to receive RA. New Zealand has a high RA rate for ICAs. Rates vary substantially between both operators and centres. Radial arterial was highest amongst the highest volume operators and centres. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  12. [Diffuse atherosclerotic disease unmasked by invasive physiologic assessment of coronary flow].

    PubMed

    Sant'Anna, Fernando Mendes; Silva, Expedito E Ribeiro da; Batista, Leonardo Alves; Ventura, Fábio Machado; Barrozo, Carlos Alberto Mussel; Pijls, Nico H J

    2005-08-01

    It is known that coronary atherosclerosis is a diffuse process, very little visible at angiography. This article describes a stable angina patient, three months after acute myocardial infarction (AMI), and a severe lesion in anterior descending artery (ADA), evinced by coronariography. Myocardial fractional flow reserve (FFR), obtained through intracoronary pressure measurements, was 0.37 during maximum hyperemia, clearly showing the presence of ischemia. A stent was implanted in ADA and, despite the excellent angiographic result, post-stent FFR was only 0.75, the minimum limit, below which there is ischemia. When the pressure wire (PW) was slowly drawn back from the distal portion of ADA to its proximal portion, a continuous and gradual increase in intracoronary pressure was noted, which clearly indicates diffuse atherosclerosis and not focal stenosis. A gradient was not observed at the stent place. The patient was kept under medical treatment and has been asymptomatic so far.

  13. Initial experience with percutaneous coronary sinus catheter placement in minimally invasive cardiac surgery in an academic center.

    PubMed

    Hanada, Satoshi; Sakamoto, Hajime; Swerczek, Michael; Ueda, Kenichi

    2016-07-11

    Placement of a percutaneous coronary sinus catheter (CSC) by an anesthesiologist for retrograde cardioplegia in minimally invasive cardiac surgery is relatively safe in experienced hands. However, the popularity of its placement remains limited to a small number of centers due to its perceived complexity and potential complications. We retrospectively reviewed all cardiac cases performed by one surgeon between December 2009 and April 2012. The reviewed cases were divided into two groups: cardiac cases with percutaneous CSC placement (CSC group) and cardiac cases without placement (control group). Anesthesia preparation time (APT) was then compared between the CSC group and control group. In the CSC group, cases were further divided into two groups. One group contained cases with an APT of less than 90 min (success group) and the other contained cases with an APT greater than or equal to 90 min or cases with CSC placement failure (delay/failure group). Patients' characteristics, type of surgery, and transesophageal echocardiography (TEE) findings were compared between the two groups (success group vs. delay/failure group) to identify variables associated with prolongation of the APT or CSC placement failure. Percutaneous CSC placement was required in 83 cases (CSC group). The catheter was successfully placed in 74 of those cases. We experienced one complication, coronary sinus injury after multiple attempts at placing the catheter. The mean APT was 102 ± 31 min in the CSC group (n = 81) and 42 ± 15 min in the control group (n = 285). We could not identify any variables associated with prolongation of the APT or catheter placement failure. The success rate of the placement was 89.1 % in our academic center. On average, placing the CSC added approximately one additional hour to the APT. This time is not an accurate representation of true catheter placement time, as it included time for preparation of the CSC, TEE, and fluoroscopy. We experienced

  14. Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

    PubMed

    Tanis, Wilco; Suchá, Dominika; Laufer, Ward; Habets, Jesse; van Herwerden, Lex A; Symersky, Petr; Chamuleau, Steven; Budde, Ricardo P J

    2015-06-01

    Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG). PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test. Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two. MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD. • Retrospective MDCT is increasingly used for prosthetic heart valve dysfunction assessment • In case of PHV reoperation, invasive coronary angiography is also required • MDCT can replace CAG in 50 % of patients without coronary artery disease • When conclusive for coronary assessment, MDCT stenosis rule out is highly accurate • Replacing CAG saves associated risks of distant embolization of thrombi or vegetations.

  15. Non-invasive diagnosis methods of coronary disease based on wavelet denoising and sound analyzing.

    PubMed

    Chen, Tianhua; Zhao, Shuo; Shao, Siqi; Zheng, Siqun

    2017-03-01

    The heart sound is the characteristic signal of cardiovascular health status. The objective of this project is to explore the correlation between Wavelet Transform and noise performance of heart sound and the adaptability of classifying heart sound using bispectrum estimation. Since the wavelet has multi-scale and multi-resolution characteristics, in this paper, the heart sound signal with different frequency ranges is decomposed through wavelet and displayed on different scales of the resolving wavelet result. According to distribution features of frequency of heart sound signals, the interference components in heart sound signal can be eliminated by selecting reconstruction coefficients. Comparing de-noising effects of four wavelets which are haar, db6, sym8 and coif6, the db6 wavelet has achieved an optimal denoising effect to heart sound signals. The de-noising result of contrasting different layers in the db6 wavelet shows that decomposing with five layers in db6 provide the optimal performance. In practice, the db6 wavelet also shows commendable denoising effects when applying to 51 clinical heart signals. Furthermore, through the clinic analyses of 29 normal signals from healthy people and 22 abnormal heart signals from coronary heart disease patients, this method can fairly distinguish abnormal signals from normal signals by applying bispectrum estimation to denoised signals via ARMA coefficients model.

  16. Relationship between non-invasive haemodynamic responses and cardiopulmonary exercise testing in patients with coronary artery disease.

    PubMed

    Sperling, Milena Pelosi Rizk; Caruso, Flávia Cristina Rossi; Mendes, Renata Gonçalves; Dutra, Daniela Bassi; Arakelian, Vivian Maria; Bonjorno, José Carlos; Catai, Aparecida Maria; Arena, Ross; Borghi-Silva, Audrey

    2016-03-01

    Non-invasive assessment of haemodynamic function by impedance cardiography (IC) constitutes an interesting approach to monitor cardiac function in patients with coronary artery disease (CAD). However, such measurements are most often performed at rest, whereas symptoms are also possible during exertion, particularly at higher intensities. In addition, the association between IC during exertion and cardiopulmonary exercise testing (CPX) is not well understood in these patients, which was the aim of this study. Nineteen men (age = 62 ± 6 years) with CAD [left ventricular ejection fraction (LVEF) = 61 ± 10%] underwent a CPX using an incremental protocol on a cycle ergometer, with simultaneous measurement of IC. Cardiac output (CO), stroke volume (SV), cardiac index (CI), peak oxygen consumption (VO2 ), the oxygen uptake efficiency slope (OUES), circulatory power and ventilatory power were determined. Pearson product-moment correlation analysis revealed peak VO2 (r = 0·46) was significantly related to CO. Peak oxygen pulse (0·52) was associated with SV. OUES was associated with resting SV (0·47) and with peak SV (r = 0·52). These findings suggest that IC indices are associated with certain, but not all, established CPX measures in patients with stable CAD. © 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  17. Off-Pump Minimally Invasive Coronary Artery Bypass Grafting With a Heart Positioner: Direct Retraction for a Better Exposure.

    PubMed

    Kikuchi, Keita; Une, Dai; Suzuki, Koutaro; Endo, Yoshiki; Matsuyama, Takayoshi; Osaka, Shin-Ichi; Kurata, Atsushi

    2015-01-01

    Lateral and inferior territories are difficult to expose during off-pump minimally invasive coronary artery bypass grafting (MICS CABG). The use of cardiopulmonary bypass is required at times. We initiated a direct retraction method by using a cardiac positioner for a better exposure, in order to complete off-pump, multivessel MICS CABG safely. We recently initiated multivessel MICS CABG, performed via a 6- to 9-cm left thoracotomy. For distal anastomoses, the lateral pericardial edge was pulled to the chest wall to optimize exposure of the lateral and inferior area. Next, a single- or multisuction cardiac positioner was put on the sides of the target vessel through the small thoracotomy and pulled directly toward the incision. Finally, a distal anastomosis was made with an epicardial stabilizer via the thoracotomy, as in standard off-pump CABG. There was no mortality or conversion to sternotomy. A total of 10 cases were targeted for off-pump multivessel MICS CABG with this approach. Nine were completed, while 1 still required pump assist. The average number of distal anastomoses was 2.8 ± 0.8. Two were successful off-pump quadruple bypass grafting with sequential anastomoses. All patients were discharged and remain well to this day. Most multivessel MICS CABG was feasible without pump assist even at the initiation period. This approach is easy and helpful in providing good exposure of target vessels without requirement of additional incisions.

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

    PubMed

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

    2008-01-01

    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. 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. 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. 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 symptom bother.

  19. Olopatadine 0.6% nasal spray protects from vasomotor challenge in patients with severe vasomotor rhinitis.

    PubMed

    Smith, Peter K; Collins, Joel

    2011-01-01

    Vasomotor rhinitis (VMR) is a hypersensitivity syndrome with heightened reactivity to environmental triggers. Twenty-two patients with severe VMR were treated nasally with either normal saline or 0.6% olopatadine and challenged nasally with a hyperosmolar mannitol solution. Treatment with 0.6% olopatadine resulted in an improvement in instantaneous nasal symptom scores at 5 and 30 minutes (p < 0.01) compared with baseline and at 30 minutes after hyperosmolar challenge compared with saline-pretreated individuals (p < 0.01). There was also an improvement in nasal peak inspiratory flow rate at 30 minutes after hyperosmolar challenge compared with saline-pretreated individuals (p < 0.01). In this patient population 0.6% olopatadine appears to be efficacious in symptom reduction in VMR and protects from hyperosmolar challenge.

  20. Bioidentical hormones for women with vasomotor symptoms.

    PubMed

    Gaudard, Ana Marcia I S; Silva de Souza, Sulani; Puga, Maria E S; Marjoribanks, Jane; da Silva, Edina M K; Torloni, Maria R

    2016-08-01

    Various hormone therapies (HT) are available to treat menopausal vasomotor symptoms. Bioidentical hormones are chemically identical to those produced by the human body, and several types are well-tested and available on prescription. Many women have opted for bioidentical hormone therapy (BHT) on the assumption that it is safer than other forms of HT. We evaluated the evidence. To determine the effectiveness and safety of bioidentical hormones compared to placebo or non-bioidentical hormones for the relief of vasomotor symptoms. In July 2015 we searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), registers of ongoing trials and the reference lists of articles retrieved. Randomised controlled trials (RCTs) comparing bioidentical hormone therapy (BHT) versus placebo or non-bioidentical hormones. We used standard methodological procedures expected by the Cochrane Collaboration. Our primary outcome was vasomotor symptoms (hot flushes and night sweats). We evaluated the overall quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation criteria (GRADE). We included 23 RCTs (5779 participants). Most studies (20/23) included only women with moderate to severe hot flushes. All studies compared unopposed 17 beta-estradiol (beta-estradiol) versus placebo or conjugated equine estrogens (CEE). None of the studies reported night sweats as a separate outcome. BHT patch versus placebo Frequency of hot flushesFour RCTs reported data suitable for analysis. There were fewer hot flushes in the BHT group, with a moderate to large effect size (SMD -0.68, 95% CI -0.83 to -0.53, four RCTs, 793 women, I(2) = 67%, low quality evidence). There was moderate heterogeneity, but a consistent direction of effect. Seven RCTs reported data unsuitable for analysis; all reported a benefit in the intervention group. Symptom intensityTwo RCTs reported analysable data

  1. Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX.

    PubMed

    Andò, Giuseppe; Cortese, Bernardo; Russo, Filippo; Rothenbühler, Martina; Frigoli, Enrico; Gargiulo, Giuseppe; Briguori, Carlo; Vranckx, Pascal; Leonardi, Sergio; Guiducci, Vincenzo; Belloni, Flavia; Ferrari, Fabio; de la Torre Hernandez, Jose Maria; Curello, Salvatore; Liistro, Francesco; Perkan, Andrea; De Servi, Stefano; Casu, Gavino; Dellavalle, Antonio; Fischetti, Dionigi; Micari, Antonio; Loi, Bruno; Mangiacapra, Fabio; Russo, Nunzio; Tarantino, Fabio; Saia, Francesco; Heg, Dik; Windecker, Stephan; Jüni, Peter; Valgimigli, Marco

    2017-05-11

    It remains unclear whether radial access (RA), compared with femoral access (FA), mitigates the risk of acute kidney injury (AKI). The authors assessed the incidence of AKI in patients with acute coronary syndrome (ACS) enrolled in the MATRIX-Access (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial. Among 8,404 patients, 194 (2.3%) were excluded due to missing creatinine values, no or an incomplete coronary angiogram, or previous dialysis. The primary AKI-MATRIX endpoint was AKI, defined as an absolute (>0.5 mg/dl) or a relative (>25%) increase in serum creatinine (sCr). AKI occurred in 634 patients (15.4%) with RA and 712 patients (17.4%) with FA (odds ratio [OR]: 0.87; 95% confidence interval [CI]: 0.77 to 0.98; p = 0.0181). A >25% sCr increase was noted in 633 patients (15.4%) with RA and 710 patients (17.3%) with FA (OR: 0.87; 95% CI: 0.77 to 0.98; p = 0.0195), whereas a >0.5 mg/dl absolute sCr increase occurred in 175 patients (4.3%) with RA versus 223 patients (5.4%) with FA (OR: 0.77; 95% CI: 0.63 to 0.95; p = 0.0131). By implementing the Kidney Disease Improving Global Outcomes criteria, AKI was 3-fold less prevalent and trended lower with RA (OR: 0.85; 95% CI: 0.70 to 1.03; p = 0.090), with stage 3 AKI occurring in 28 patients (0.68%) with RA versus 46 patients (1.12%) with FA (p = 0.0367). Post-intervention dialysis was needed in 6 patients (0.15%) with RA and 14 patients (0.34%) with FA (p = 0.0814). Stratified analyses suggested greater benefit with RA than FA in patients at greater risk for AKI. In ACS patients who underwent invasive management, RA was associated with a reduced risk of AKI compared with FA. (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial.

    PubMed

    Dewey, Marc; Rief, Matthias; Martus, Peter; Kendziora, Benjamin; Feger, Sarah; Dreger, Henryk; Priem, Sascha; Knebel, Fabian; Böhm, Marko; Schlattmann, Peter; Hamm, Bernd; Schönenberger, Eva; Laule, Michael; Zimmermann, Elke

    2016-10-24

     To evaluate whether invasive coronary angiography or computed tomography (CT) should be performed in patients clinically referred for coronary angiography with an intermediate probability of coronary artery disease.  Prospective randomised single centre trial.  University hospital in Germany.  340 patients with suspected coronary artery disease and a clinical indication for coronary angiography on the basis of atypical angina or chest pain.  168 patients were randomised to CT and 172 to coronary angiography. After randomisation one patient declined CT and 10 patients declined coronary angiography, leaving 167 patients (88 women) and 162 patients (78 women) for analysis. Allocation could not be blinded, but blinded independent investigators assessed outcomes.  The primary outcome measure was major procedural complications within 48 hours of the last procedure related to CT or angiography.  Cardiac CT reduced the need for coronary angiography from 100% to 14% (95% confidence interval 9% to 20%, P<0.001) and was associated with a significantly greater diagnostic yield from coronary angiography: 75% (53% to 90%) v 15% (10% to 22%), P<0.001. Major procedural complications were uncommon (0.3%) and similar across groups. Minor procedural complications were less common in the CT group than in the coronary angiography group: 3.6% (1% to 8%) v 10.5% (6% to 16%), P=0.014. CT shortened the median length of stay in the angiography group from 52.9 hours (interquartile range 49.5-76.4 hours) to 30.0 hours (3.5-77.3 hours, P<0.001). Overall median exposure to radiation was similar between the CT and angiography groups: 5.0 mSv (interquartile range 4.2-8.7 mSv) v 6.4 mSv (3.4-10.7 mSv), P=0.45. After a median follow-up of 3.3 years, major adverse cardiovascular events had occurred in seven of 167 patients in the CT group (4.2%) and six of 162 (3.7%) in the coronary angiography group (adjusted hazard ratio 0.90, 95% confidence interval 0.30 to 2.69, P=0.86). 79% of patients

  3. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial

    PubMed Central

    Rief, Matthias; Martus, Peter; Kendziora, Benjamin; Feger, Sarah; Dreger, Henryk; Priem, Sascha; Knebel, Fabian; Böhm, Marko; Schlattmann, Peter; Hamm, Bernd; Schönenberger, Eva; Laule, Michael; Zimmermann, Elke

    2016-01-01

    Objective To evaluate whether invasive coronary angiography or computed tomography (CT) should be performed in patients clinically referred for coronary angiography with an intermediate probability of coronary artery disease. Design Prospective randomised single centre trial. Setting University hospital in Germany. Participants 340 patients with suspected coronary artery disease and a clinical indication for coronary angiography on the basis of atypical angina or chest pain. Interventions 168 patients were randomised to CT and 172 to coronary angiography. After randomisation one patient declined CT and 10 patients declined coronary angiography, leaving 167 patients (88 women) and 162 patients (78 women) for analysis. Allocation could not be blinded, but blinded independent investigators assessed outcomes. Main outcome measure The primary outcome measure was major procedural complications within 48 hours of the last procedure related to CT or angiography. Results Cardiac CT reduced the need for coronary angiography from 100% to 14% (95% confidence interval 9% to 20%, P<0.001) and was associated with a significantly greater diagnostic yield from coronary angiography: 75% (53% to 90%) v 15% (10% to 22%), P<0.001. Major procedural complications were uncommon (0.3%) and similar across groups. Minor procedural complications were less common in the CT group than in the coronary angiography group: 3.6% (1% to 8%) v 10.5% (6% to 16%), P=0.014. CT shortened the median length of stay in the angiography group from 52.9 hours (interquartile range 49.5-76.4 hours) to 30.0 hours (3.5-77.3 hours, P<0.001). Overall median exposure to radiation was similar between the CT and angiography groups: 5.0 mSv (interquartile range 4.2-8.7 mSv) v 6.4 mSv (3.4-10.7 mSv), P=0.45. After a median follow-up of 3.3 years, major adverse cardiovascular events had occurred in seven of 167 patients in the CT group (4.2%) and six of 162 (3.7%) in the coronary angiography group (adjusted hazard

  4. Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials.

    PubMed

    Jobs, Alexander; Mehta, Shamir R; Montalescot, Gilles; Vicaut, Eric; Van't Hof, Arnoud W J; Badings, Erik A; Neumann, Franz-Josef; Kastrati, Adnan; Sciahbasi, Alessandro; Reuter, Paul-Georges; Lapostolle, Frédéric; Milosevic, Aleksandra; Stankovic, Goran; Milasinovic, Dejan; Vonthein, Reinhard; Desch, Steffen; Thiele, Holger

    2017-08-19

    A routine invasive strategy is recommended for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, optimal timing of invasive strategy is less clearly defined. Individual clinical trials were underpowered to detect a mortality benefit; we therefore did a meta-analysis to assess the effect of timing on mortality. We identified randomised controlled trials comparing an early versus a delayed invasive strategy in patients presenting with NSTE-ACS by searching MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. We included trials that reported all-cause mortality at least 30 days after in-hospital randomisation and for which the trial investigators agreed to collaborate (ie, providing individual patient data or standardised tabulated data). We pooled hazard ratios (HRs) using random-effects models. This meta-analysis is registered at PROSPERO (CRD42015018988). We included eight trials (n=5324 patients) with a median follow-up of 180 days (IQR 180-360). Overall, there was no significant mortality reduction in the early invasive group compared with the delayed invasive group HR 0·81, 95% CI 0·64-1·03; p=0·0879). In pre-specified analyses of high-risk patients, we found lower mortality with an early invasive strategy in patients with elevated cardiac biomarkers at baseline (HR 0·761, 95% CI 0·581-0·996), diabetes (0·67, 0·45-0·99), a GRACE risk score more than 140 (0·70, 0·52-0·95), and aged 75 years older (0·65, 0·46-0·93), although tests for interaction were inconclusive. An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in all patients with NSTE-ACS. However, an early invasive strategy might reduce mortality in high-risk patients. None. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Impact of bivalirudin on mortality and bleeding complications in acute coronary syndrome patients undergoing invasive revascularization : A real world experience.

    PubMed

    Rohla, Miklos; Tentzeris, Ioannis; Freynhofer, Matthias K; Farhan, Serdar; Jarai, Rudolf; Egger, Florian; Weiss, Thomas W; Wojta, Johann; Geppert, Alexander; Kastrati, Adnan; Stone, Gregg W; Huber, Kurt

    2016-12-01

    In a retrospective analysis of a prospective single center registry we compared the use of bivalirudin, unfractionated heparin (UFH) monotherapy, UFH + abciximab in 1240 consecutive patients with acute coronary syndrome (ACS) undergoing stent implantation. Bivalirudin was associated with tendentially reduced in-hospital minor or major bleeding rates compared to UFH monotherapy (5.9 % vs. 9.4 % adjusted odds ratio (OR) 0.82, 95 % confidence interval CI 0.45-1.51, p = 0.53) and compared to the pooled UFH group (5.9 % vs. 11.9 %, adjusted OR 0.62, 95 % CI 0.36-1.08, p = 0.09) but with significantly lower bleeding hazards compared to UFH + abciximab (5.9 % vs. 16 %, adjusted OR 0.41, 95 % CI 0.22-0.78, p < 0.01). After 3 years of follow-up, adjusted cardiovascular mortality rates were similar between all groups, particularly between bivalirudin vs. UFH monotherapy (hazard ratio HR 1.12, 95 % CI 0.58-2.16, p = 0.73) and vs. UFH + abciximab (HR 0.91, 95 % CI 0.40-2.10, p = 0.83). Acute or subacute stent thrombosis occurred at a rate of 0.8 % with no significant differences between the groups. This retrospective analysis in a real world situation of medium to high-risk ACS patients undergoing invasive revascularization confirmed the results of most large-scale randomized trials by demonstrating reduced bleeding rates in favor of bivalirudin vs. UFH + GPI but with no significant differences between treatment strategies for long-term all-cause and cardiovascular mortality.

  6. Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry.

    PubMed

    Latour-Pérez, J; Gómez-Tello, V; de-Miguel-Balsa, E; Llamas-Álvarez, A; Carrillo-López, A; Sánchez-Román, J A; Ruíz-Ruíz, J; Martín-Rodríguez, M C; Fernández-González, C J; Fernández-Lozano, J A; Picazos Vicente, C

    2016-01-01

    To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding). The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  7. Non-invasive diagnostic workup of patients with suspected stable angina by combined computed tomography coronary angiography and magnetic resonance perfusion imaging.

    PubMed

    Kirschbaum, Sharon W; Nieman, Koen; Springeling, Tirza; Weustink, Annick C; Ramcharitar, Steve; Mieghem, Carlos van; Rossi, Alexia; Duckers, Eric; Serruys, Patrick W; Boersma, Eric; de Feyter, Pim J; van Geuns, Robert-Jan M

    2011-01-01

    To evaluate additional adenosine magnetic resonance perfusion (MRP) imaging in the diagnostic workup of patients with suspected stable angina with computed tomography coronary angiography (CTCA) as first-line diagnostic modality. Two hundred and thirty symptomatic patients (male, 52%; age, 56 year) with suspected stable angina underwent CTCA. In patients with a stenosis of >50% as visually assessed, MRP was performed and the quantitative myocardial perfusion reserve index (MPRI) was calculated. Coronary flow reserve (CFR) using invasive coronary flow measurements served as the standard of reference. CTCA showed non-significant CAD in 151/230 (66%) patients and significant CAD in 79/230 patients (34%), of whom 50 subsequently underwent MRP and CFR. MRP showed reduced perfusion in 32 patients (64%), which was confirmed by CFR in 27 (84%). All 18 cases of normal MRP (36%) were confirmed by CFR. The positive likelihood ratio of MRP for the presence of functional significant disease in patients with a lesion on CTCA was 4.49 (95% confidence interval [CI] 2.12-9.99). The negative likelihood ratio was 0.05 (95%CI 0.01-0.34). CTCA as first-line diagnostic modality excluded coronary artery disease in a high percentage of patients referred for diagnostic workup of suspected stable angina. MRP made a significant contribution to the detection of functional significant lesions in patients with a positive CTCA.

  8. Exercise to reduce vasomotor and other menopausal symptoms: a review.

    PubMed

    Daley, A J; Stokes-Lampard, H J; Macarthur, C

    2009-07-20

    Many women are reluctant to consider HRT as a therapeutic option for menopausal symptoms and are keen to use non-pharmacological treatments. Evidence from randomised controlled trials (RCTs) concerning the effects of aerobic exercise on vasomotor and other menopausal symptoms is limited but what evidence we do have suggests that aerobic exercise can improve psychological health and quality of life in vasomotor symptomatic women. In addition, several RCTs of middle-aged/menopausal-aged women have found that aerobic exercise can invoke significant improvements in several common menopause-related symptoms (e.g. mood, health-related QoL and insomnia), relative to non-exercise comparison groups. There is some evidence that alternative forms of low intensity exercise such as yoga are beneficial in reducing vasomotor symptoms and improving psychological well-being in menopausal women. Collectively, these RCTs highlight the broader potential that exercise could have for women during the menopause transition. Whilst both the Royal College of Obstetricians and Gynaecologists in the UK and the North American Menopause Society have recommended that women be advised to consider aerobic exercise as a treatment for vasomotor menopausal symptoms, to make any evidence-based conclusions regarding the effectiveness of exercise in managing these symptoms, more high quality research is needed.

  9. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study.

    PubMed

    Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; Verheugt, Freek W A; Cornel, Jan Hein; de Winter, Robbert J

    2007-03-10

    The ICTUS trial was a study that compared an early invasive with a selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS). The study reported no difference between the strategies for frequency of death, myocardial infarction, or rehospitalisation after 1 year. We did a follow-up study to assess the effects of these treatment strategies after 4 years. 1200 patients with nSTE-ACS and an elevated cardiac troponin were enrolled from 42 hospitals in the Netherlands. Patients were randomly assigned either to an early invasive strategy, including early routine catheterisation and revascularisation where appropriate, or to a more selective invasive strategy, where catheterisation was done if the patient had refractory angina or recurrent ischaemia. The main endpoints for the current follow-up study were death, recurrent myocardial infarction, or rehospitalisation for anginal symptoms within 3 years after randomisation, and cardiovascular mortality and all-cause mortality within 4 years. Analysis was by intention-to-treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN82153174. The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive group. After 3 years, the cumulative rate for the combined endpoint was 30.0% in the early invasive group compared with 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI 0.97-1.50; p=0.09). Myocardial infarction was more frequent in the early invasive strategy group (106 [18.3%] vs 69 [12.3%]; HR 1.61; 1.19-2.18; p=0.002). Rates of death or spontaneous myocardial infarction were not different (76 [14.3%] patients in the early invasive and 63 [11.2%] patients in the selective invasive strategy [HR 1.19; 0.86-1.67; p=0.30]). No difference in all-cause mortality (7.9%vs 7.7%; p=0.62) or cardiovascular mortality (4.5%vs 5.0%; p=0.97) was seen within 4 years. Long-term follow-up of

  10. Invasive strategy in non-ST-segment elevation acute coronary syndrome: What should be the benchmark target in the real world patients? Insights from BLITZ-4 Quality Campaign.

    PubMed

    Olivari, Zoran; Chinaglia, Alessandra; Gonzini, Lucio; Falsini, Giovanni; Pilleri, Annarita; Valente, Serafina; Gregori, Gianserafino; Rollo, Raffaele; My, Luigi; Scrimieri, Pietro; Lanzillo, Tonino; Corrado, Luigi; Chiti, Maurizio; Picardi, Elisa

    2016-10-01

    To define a benchmark target for an invasive strategy (IS) rate appropriate for performance assessment in intermediate-to-high risk non-ST-segment elevation acute coronary syndromes (NSTE-ACS). During the BLITZ-4 campaign, which aimed at improving the quality of care in 163 Italian coronary care units, 4923/5786 (85.1%) of consecutive patients admitted with NSTE-ACS with troponin elevation and/or dynamic ST-T changes on the electrocardiogram were managed with IS. The reasons driving the choice (RDC) for a conservative strategy (CS) in the remaining 863 patients were prospectively recorded. In 33.8%, CS was mandatory because of patients refusal, known coronary anatomy or death before coronary angiography; in 52.8% it was clinically justified because of active stroke, bleeding, advanced frailty, severe comorbidities, contraindication to antiplatelet therapy or because they were considered to be at low risk; only in 13.4% the reasons, such as renal failure, advanced age or other, were less stringent. As compared to patients undergoing IS, those in the CS were 12years older and had significantly more severe comorbidities. The in-hospital and 6-month all-cause mortality were 9.0% vs 0.9% and 22.0% vs 3.9% in CS and IS groups respectively (p<0.0001 for both). As the RDC for CS were clinically correct in vast majority of cases the observed 85% invasive strategy rate may be considered as the desirable benchmark target in patients with NSTE-ACS. For the same reason, it remains questionable if the higher rate of IS could have improved the prognosis in CS patients, despite their highly unfavorable prognosis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Randomized comparison of ticagrelor versus prasugrel in patients with acute coronary syndrome and planned invasive strategy--design and rationale of the iNtracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial.

    PubMed

    Schulz, Stefanie; Angiolillo, Dominick J; Antoniucci, David; Bernlochner, Isabell; Hamm, Christian; Jaitner, Juliane; Laugwitz, Karl-Ludwig; Mayer, Katharina; von Merzljak, Barbara; Morath, Tanja; Neumann, Franz-Josef; Richardt, Gert; Ruf, Judith; Schömig, Gisela; Schühlen, Helmut; Schunkert, Heribert; Kastrati, Adnan

    2014-02-01

    In acute coronary syndromes (ACS), a dual antiplatelet regimen with an adenosine diphosphate (ADP) receptor antagonist plus aspirin has become the cornerstone of treatment. The third-generation thienopyridine prasugrel and the cyclopentyl-triazolo-pyrimidine ticagrelor provide a greater, more rapid and consistent platelet inhibition compared to their predecessor clopidogrel. Based on their advantages over clopidogrel in two landmark studies, both drugs received a class I recommendation for their use in ACS patients with and without ST segment elevation. Due to differences in ACS populations and conditions investigated, the relative merits of ticagrelor versus prasugrel in the treatment of ACS patients with planned invasive strategy cannot be reliably estimated from independent trials. To date, no direct head-to-head comparison of ticagrelor and prasugrel in terms of clinical outcome exists. The aim of this multicenter, randomized, open-label trial is to assess whether ticagrelor is superior to prasugrel in ACS patients with planned invasive strategy.

  12. Potential role of blood microRNAs as non-invasive biomarkers for early detection of asymptomatic coronary atherosclerosis in obese children with metabolic syndrome.

    PubMed

    Omran, Ahmed; Elimam, Dalia; He, Fang; Peng, Jing; Yin, Fei

    2012-12-01

    The pandemic of the childhood obesity represent a major public health problem all over the world. This leads to detection of many health conditions that were previously considered an adulthood diseases. The rise in the prevalence of the obesity and overweight among children means that the world will face an explosion in the prevalence of the metabolic syndrome (MS), which increases the risk of atherosclerotic disease and death in adulthood. The atherosclerotic process has proved to develop silently for decades during childhood and adolescence before the cardiovascular complications such as myocardial infarction and stroke occur. This means that obese children especially with MS could have heart attacks and suffer from heart disease in an age when they should be very healthy, but most of these data either derived from autopsy findings or studies that confirmed the presence of peripheral atherosclerosis. Very early detection of coronary atherosclerosis in obese children with metabolic syndrome through a non invasive method will be of great importance, allowing for early therapeutic intervention. The discovery of microRNAs (miRNAs) is considered a major scientific breakthrough in the last years; recent studies have suggested a potentially important role of miRNAs in the control of diversity aspects of cardiac functions in health and disease including coronary atherosclerosis. Moreover, circulating miRNAs profiles recently used as a non-invasive biomarker for diagnosis of multiple cardiovascular diseases. The identification of distinct circulating miRNA profiles may impact the development of specific miRNAs as biomarkers in pediatric cardiovascular diseases. Therefore, we postulate that some of these circulating miRNAs may be a potential biomarker for early non-invasive diagnosis of coronary atherosclerosis in very early asymptomatic stage in obese children with metabolic syndrome, giving an excellent chance to fight against the first killer in the adult population in

  13. N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy.

    PubMed

    Windhausen, Fons; Hirsch, Alexander; Sanders, Gerard T; Cornel, Jan Hein; Fischer, Johan; van Straalen, Jan P; Tijssen, Jan G P; Verheugt, Freek W A; de Winter, Robbert J

    2007-04-01

    New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this study was to assess the association between baseline NT-proBNP levels and outcome in patients who have nSTE-ACS with an elevated cTnT and to determine whether patients with elevated NT-proBNP levels benefit from an early invasive treatment strategy. Baseline samples for NT-proBNP measurements were available in 1141 patients who have nSTE-ACS with an elevated cTnT randomized to an early or a selective invasive strategy. Patients were followed-up for the occurrence of death, myocardial infarction (MI), and rehospitalization for angina. We showed that increased levels of NT-proBNP were associated with several indicators of risk and severe coronary artery disease. Mortality by 1 year was 7.3% in the highest quartile (> or = 1170 ng/L for men, > or = 2150 ng/L for women) compared with 1.1% of patients in the lower 3 quartiles (P < .0001). N-terminal pro-brain natriuretic peptide (highest quartile vs lower 3 quartiles) was a strong independent predictor of mortality (hazard ratio 5.0, 95% CI 2.1-11.6, P = .0002). However, NT-proBNP levels were not associated with the incidence of recurrent MI by 1 year. Furthermore, we could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy in patients with an elevated NT-proBNP level. We confirmed that NT-proBNP is a strong independent predictor of mortality by 1 year but not of recurrent MI in patients who have nSTE-ACS with an elevated cTnT. We could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy.

  14. 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 begins with ...

  15. 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.

  16. Elective minimally invasive coronary artery bypass: Shunt or tournique occlusion? Assessment of a protective role of perioperative left anterior descending shunting on myocardial damage. A prospective randomized study

    PubMed Central

    2012-01-01

    Background To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass. Methods 38 patients were randomly assigned to external tournique occlusion (n = 19) or intraluminal-left anterior descending shunt group (n = 19). Blood samples for cardiac troponin T were collected at 30 minutes prior to, 6 and 24 hours after surgery. Results One patient in external tournique occlusion and two patients in intraluminal-left anterior descending shunt group were excluded from futher analysis due to preoperative cardiac troponin T level above the 99th-percentile. Postoperatively, each six patients in external tournique occlusion (33.3%) and intraluminal-left anterior descending shunt (35.3%) group were above the 99th-percentile. Two patients from each group (external tournique occlusion group 11.1% vs. intraluminal-left anterior descending shunt group 11.8%) had peak values above 10-% coeficient of variation cutoff (p = 1). There were no significant differences in between both groups at all studied timepoints. Conclusion There was no protective effect of intraluminal shunting on myocardial damage compared to short-term tournique occlusion. It is upon the surgeon's discretion which method may preferrably be used to achieve a bloodless field in grafting of the non-occluded left anterior descending in minimally invasive coronary artery bypass. PMID:22809563

  17. Physical activity and sleep among midlife women with vasomotor symptoms

    PubMed Central

    Lambiase, Maya J.; Thurston, Rebecca C.

    2013-01-01

    Objectives Few studies have examined the relationship between physical activity and sleep among women with vasomotor symptoms. We examined the associations of habitual leisure time and household physical activity with sleep characteristics among women reporting vasomotor symptoms. Methods A subcohort of women (N=52; 27 White, 25 African American) in the Study of Women’s Health across the Nation were assessed over 4 nights for self-reported and actigraphic sleep measurement. Women were between the ages of 54 and 63y, currently experiencing vasomotor symptoms, and were not taking SSRI’s or hormone therapy. The associations between physical activity (leisure time, household) and sleep (diary, actigraphy, global sleep quality), as well as interactions by race and BMI, were assessed using logistic regression and general estimating equations. Results Greater leisure time physical activity was associated with higher odds of rating global sleep quality as good [OR (95% confidence interval)= 8.08 (1.5, 44.5), p=.02]. Greater household physical activity was associated with more favorable diary-reported sleep characteristics, including fewer awakenings during the night [B(SE)=−.14(.06), p=.01]. Exploratory analyses suggest that household physical activity was associated with more favorable sleep characteristics primarily among White and non-obese women. Conclusions Greater levels of habitual physical activity, particularly non-leisure time physical activity, were associated with more favorable sleep characteristics. Considering the potential impact of physical activity on sleep, even at the relatively modest levels characteristic of household physical activity, may be important for women with vasomotor symptoms, a subgroup at high risk for sleep problems. PMID:23531686

  18. Women's willingness to accept perceived risks for vasomotor symptom relief.

    PubMed

    Johnson, F Reed; Ozdemir, Semra; Hauber, Brett; Kauf, Teresa L

    2007-09-01

    Evidence that long-term hormone therapy (HT) may increase the risk of serious adverse events led to a sharp reduction in all HT use, including short-term use for vasomotor symptom relief. We estimated women's willingness to accept adverse event risks in exchange for vasomotor symptom relief when risks are communicated in absolute vs. relative terms. We developed a conjoint survey to elicit preferences across benefit and risk attributes of HT. The survey was administered via the Internet to 523 U.S. women aged 46-60 years. Participants evaluated pairs of hypothetical treatments and indicated preferences using a Likert-based scale. Risks were presented in absolute and relative terms. Satisfaction scores for HT risks and benefits were estimated using random-effects, ordered-probit regression. Maximum acceptable risk (MAR) was calculated as the increase in risk that reduces the satisfaction score for a given level of HT benefit to 0. For both risk versions, the least important attribute (smallest difference in satisfaction scores) was night sweat frequency; heart attack risk was the most important (largest difference in scores). Participants were more willing to accept risks in return for symptom relief when shown absolute vs. relative risks, although differences in MAR were statistically significant only for breast cancer risk. MARs for breast cancer and heart attack exceeded reported rates in most cases. Many women may be willing to accept risks to control vasomotor symptoms. However, describing risks in different, but technically equivalent, ways affects women's willingness to trade risks for benefits.

  19. Prognostic impact of coronary microcirculation abnormalities in systemic sclerosis: a prospective study to evaluate the role of non-invasive tests

    PubMed Central

    2013-01-01

    Introduction Microcirculation dysfunction is a typical feature of systemic sclerosis (SSc) and represents the earliest abnormality of primary myocardial involvement. We assessed coronary microcirculation status by combining two functional tests in SSc patients and estimating its impact on disease outcome. Methods Forty-one SSc patients, asymptomatic for coronary artery disease, were tested for coronary flow velocity reserve (CFR) by transthoracic-echo-Doppler with adenosine infusion (A-TTE) and for left ventricular wall motion abnormalities (WMA) by dobutamine stress echocardiography (DSE). Myocardial multi-detector computed tomography (MDCT) enabled the presence of epicardial stenosis, which could interfere with the accuracy of the tests, to be excluded. Patient survival rate was assessed over a 6.7- ± 3.5-year follow-up. Results Nineteen out of 41 (46%) SSc patients had a reduced CFR (≤2.5) and in 16/41 (39%) a WMA was observed during DSE. Furthermore, 13/41 (32%) patients showed pathological CFR and WMA. An inverse correlation between wall motion score index (WMSI) during DSE and CFR value (r = -0.57, P <0.0001) was observed; in addition, CFR was significantly reduced (2.21 ± 0.38) in patients with WMA as compared to those without (2.94 ± 0.60) (P <0.0001). In 12 patients with abnormal DSE, MDCT was used to exclude macrovasculopathy. During a 6.7- ± 3.5-year follow-up seven patients with abnormal coronary functional tests died of disease-related causes, compared to only one patient with normal tests. Conclusions A-TTE and DSE tests are useful tools to detect non-invasively pre-clinical microcirculation abnormalities in SSc patients; moreover, abnormal CFR and WMA might be related to a worse disease outcome suggesting a prognostic value of these tests, similar to other myocardial diseases. PMID:23302110

  20. Changes in Heart Rate Variability during Vasomotor Symptoms among Midlife Women

    PubMed Central

    Thurston, Rebecca C.; Matthews, Karen A.; Chang, Yuefang; Santoro, Nanette; Barinas-Mitchell, Emma; von Känel, Roland; Landsittel, Doug P.; Jennings, J. Richard

    2015-01-01

    Objective Most midlife women report vasomotor symptoms, yet their physiology remains poorly understood. This study tested whether acute decreases in cardiac vagal control would occur with vasomotor symptoms in a large sample of women monitored during wake and sleep. Methods 215 nonsmoking women ages 40–60 with evidence of vasomotor symptoms were included. Women were free of a history of clinical cardiovascular disease or arrhythmia; or use of insulin, beta blockers, calcium channel blockers, or medications impacting vasomotor symptoms. Women underwent 24 hours of ambulatory monitoring for physiological (sternal skin conductance) and self-report (electronic diary) measurement of vasomotor symptoms; heart rate variability (electrocardiogram); and respiratory rate. Changes in cardiac vagal control as assessed by respiratory sinus arrhythmia during vasomotor symptoms relative to periods preceding and following vasomotor symptoms were tested in linear mixed models. Results Significant decreases in respiratory sinus arrhythmia were observed during physiologically-measured vasomotor symptoms relative to periods preceding (b(SE)=.13(.004), p<.0001) and following the VMS (b(SE)=.13(.004), p<.0001), adjusted for age, race, body mass index, sleep/wake. Decreases were observed for women not aware of their vasomotor symptoms, and persisted controlling for respiration rate. Interactions indicated that respiratory sinus arrhythmia decreases were most pronounced during sleep and for younger women. Conclusions Physiologically-measured vasomotor symptoms were accompanied by an inhibition of cardiac vagal control in a large sample of women. Changes were observed irrespective of whether the vasomotor symptoms were reported, were most pronounced during sleep, and were greatest among younger women. These findings contribute to the understanding of vasomotor symptom physiology. PMID:26926327

  1. ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial.

    PubMed

    Windhausen, Fons; Hirsch, Alexander; Tijssen, Jan G P; Cornel, Jan Hein; Verheugt, Freek W A; Klees, Margriet I; de Winter, Robbert J

    2007-01-01

    We assessed the prognostic significance of the presence of cumulative (Sigma) ST-segment deviation on the admission electrocardiogram (ECG) in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T randomized to a selective invasive (SI) or an early invasive treatment strategy. A 12-lead ECG obtained at admission was available for analysis from 1163 patients. The presence and magnitude of ST-segment deviation was measured in each lead, and absolute ST-segment deviation was summed. The effect of treatment strategy was assessed for patients with or without SigmaST-segment deviation of at least 1 mm. The incidence of death or myocardial infarction (MI) by 1 year in patients with SigmaST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with SigmaST-segment deviation of less than 1 mm (P = .001). Among patients with SigmaST-segment deviation of at least 1 mm, the incidence of death or MI was 21.9% in the early invasive group compared with 14.2% in SI group (P < .01). However, we observed a significantly higher rate of MI after hospital discharge among patients with SigmaST-segment deviation of at least 1 mm randomized to SI who did not undergo angiography compared with patients who underwent angiography before discharge (10.9% vs 2.4%, P = .003). In a forward logistic regression analysis, the presence of ST-segment deviation was an independent predictor for failure of medical therapy (coronary angiography within 30 days after randomization in the SI group) (odds ratio, 1.56; 95% confidence interval, 1.12-2.18; P = .009). Patients with non-ST-elevation acute coronary syndrome and an elevated troponin T and SigmaST-segment deviation of at least 1 mm are at increased risk of death or MI, more often fail on medical therapy, and more often experience a spontaneous MI after discharge when angiography was not performed during initial hospitalization.

  2. Enhanced muscle pump during mild dynamic leg exercise inhibits sympathetic vasomotor outflow

    PubMed Central

    Katayama, Keisho; Ishida, Koji; Saito, Mitsuru; Koike, Teruhiko; Hirasawa, Ai; Ogoh, Shigehiko

    2014-01-01

    Abstract Muscle sympathetic nerve activity (MSNA) is not increased during leg cycling at light and mild intensities, despite activation of central command and the exercise pressor reflex. We determined whether increasing central blood volume and loading the cardiopulmonary baroreceptors modulate sympathetic vasomotor outflow during leg cycling. To this end, we changed the pedaling frequency to enhance skeletal muscle pump. Subjects performed two leg cycle exercises at differential pedal rates of 60 and 80 rpm (60EX and 80EX trials) for two conditions (with and without MSNA measurement). In each trial, subjects completed leg cycling with a differential workload to maintain constant oxygen consumption (VO2). MSNA was recorded via microneurography at the right median nerve of the elbow. Without MSNA measurement, thoracic impedance, stroke volume (SV), and cardiac output (CO) were measured non‐invasively using impedance cardiography. Heart rate and VO2 during exercise did not differ between the 60EX and 80EX trials. Changes in thoracic impedance, SV, and CO during the 80EX trial were greater than during the 60EX trial. MSNA during the 60EX trial was unchanged compared with that at rest (25.8 ± 3.1 [rest] to 28.3 ± 3.4 [exercise] bursts/min), whereas a significant decrease in MSNA was observed during the 80EX trial (25.8 ± 2.8 [rest] to 19.7 ± 2.0 [exercise] bursts/min). These results suggest that a muscle pump‐induced increase in central blood volume, and thereby loading of cardiopulmonary baroreceptors, could inhibit sympathetic vasomotor outflow during mild dynamic leg exercise, despite activation of central command and the exercise pressor reflex. PMID:25347854

  3. Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography.

    PubMed

    Zhang, Long Jiang; Wang, Yining; Schoepf, U Joseph; Meinel, Felix G; Bayer, Richard R; Qi, Li; Cao, Jian; Zhou, Chang Sheng; Zhao, Yan E; Li, Xie; Gong, Jian Bin; Jin, Zhengyu; Lu, Guang Ming

    2016-03-01

    To investigate image quality, radiation dose, and diagnostic performance of prospectively ECG-triggered high-pitch coronary CT angiography (CCTA) at 70 kVp compared to invasive coronary angiography (ICA) as reference standard. Forty-three patients underwent prospectively ECG-triggered high-pitch CCTA at 70 kVp using 30 cc (11 g iodine) contrast medium and ICA. Subjective and objective image quality was evaluated for each CCTA study. CCTA performance for diagnosing ≥50% stenosis was assessed. Results were stratified according to heart rate (HR), body mass index (BMI), Agatston score, and image quality. At CCTA, 94.3% (500/530) of coronary segments were of diagnostic quality. Using ICA as reference standard, sensitivity and accuracy were 100% and 93.0% on a per-patient basis. Per-vessel and per-segment performances were 92.2% and 89.5%; 79.5% and 88.3%, respectively. No differences were found in diagnostic accuracy between different HR, BMI, and calcification subgroups (all P > 0.05) on a per-patient basis. However, low image quality reduced diagnostic accuracy on a per-patient, per-vessel and per-segment basis (all P < 0.05). The mean effective radiation dose was 0.2 ± 0.0 mSv. Our presented protocol results in an effective radiation dose of 0.2 mSv and high diagnostic accuracy for stenosis detection in a selected, non-obese population. Prospectively ECG-triggered high-pitch CCTA at 70 kVp is feasible. This protocol has a high diagnostic accuracy for stenosis detection. The mean effective radiation dose was 0.2 ± 0.0 mSv. Only 30 cc of contrast material is used in this protocol. Low image quality reduced diagnostic accuracy of CCTA.

  4. 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

  5. Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio, and non-invasive coronary flow reserve.

    PubMed

    Meimoun, P; Clerc, J; Ardourel, D; Djou, U; Martis, S; Botoro, T; Elmkies, F; Zemir, H; Luycx-Bore, A; Boulanger, J

    2016-10-17

    To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50-70 % diameter stenosis), were prospectively studied. IFR was calculated as a trans-lesion pressure ratio during the wave-free period in diastole; FFR as distal pressure divided by mean aortic pressure during maximal hyperemia (using 180 μg intracoronary adenosine); and CFR as hyperemic peak LAD flow velocity divided by baseline flow velocity using intravenous adenosine (140 μg/kg/min over 2 min). The mean values of IFR, FFR, and CFR were 0.88 ± 0.07, 0.81 ± 0.09, and 2.4 ± 0.6 respectively. A significant correlation was found between CFR and FFR (r = 0. 68), FFR and IFR (r = 0.6), and between CFR and IFR (r = 0.5) (all, p < 0.01). Using a ROC curve analysis, the best cut-off to detect a significant lesion based on FFR assessment (FFR ≤ 0.8, n = 31) was IFR ≤ 0.88 with a sensitivity (Se) of 74 %, specificity (Sp) of 73 %, AUC 0.81 ± 0.04, accuracy 72 %; and CFR ≤ 2 with a Se = 77 %, Sp = 89 %, AUC 0.88 ± 0.04, accuracy 85 % (all, p < 0.001). In stable patients with LAD stenosis of IS, non-invasive CFR is a useful tool to detect a significant lesion based on FFR. Furthermore, there was a better correlation between CFR and FFR than between CFR and IFR, and a trend to a better diagnostic performance for CFR versus IFR.

  6. Minimally Invasive Extracorporeal Circulation Circuit Is Not Inferior to Off-Pump Coronary Artery Bypass Grafting: Meta-Analysis Using the Bayesian Method.

    PubMed

    Winkler, Bernhard; Heinisch, Paul P; Gahl, Brigitta; Aghlmandi, Soheila; Jenni, Hans Jörg; Carrel, Thierry P

    2017-01-01

    The pathophysiologic side effects of cardiopulmonary bypass have already been identified. Minimally invasive extracorporeal circulation technologies (MiECT) and off-pump coronary artery bypass graft surgery (OPCABG) aim to reduce these problems. This meta-analysis provides a comparison of MiECT and OPCABG in randomized and observational studies. A fully probabilistic, Bayesian approach of primary and secondary endpoints was conducted. MiECT does not give inferior results when compared with OPCABG. However, there is a trend to borderline significantly higher blood loss in this group in randomized controlled trials. The question whether MiECT is equivalent to OPCABG can be answered with the affirmative, but long-term follow-up data are needed to detect any advantage over time. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Quantitative assessment of myocardial blood flow in coronary artery disease by cardiovascular magnetic resonance: comparison of Fermi and distributed parameter modeling against invasive methods.

    PubMed

    Papanastasiou, Giorgos; Williams, Michelle C; Dweck, Marc R; Alam, Shirjel; Cooper, Annette; Mirsadraee, Saeed; Newby, David E; Semple, Scott I

    2016-09-13

    Mathematical modeling of perfusion cardiovascular magnetic resonance (CMR) data allows absolute quantification of myocardial blood flow and can potentially improve the diagnosis and prognostication of obstructive coronary artery disease (CAD), against the current clinical standard of visual assessments. This study compares the diagnostic performance of distributed parameter modeling (DP) against the standard Fermi model, for the detection of obstructive CAD, in per vessel against per patient analysis. A pilot cohort of 28 subjects (24 included in the final analysis) with known or suspected CAD underwent adenosine stress-rest perfusion CMR at 3T. Data were analysed using Fermi and DP modeling against invasive coronary angiography and fractional flow reserve, acquired in all subjects. Obstructive CAD was defined as luminal stenosis of ≥70 % alone, or luminal stenosis ≥50 % and fractional flow reserve ≤0.80. On ROC analysis, DP modeling outperformed the standard Fermi model, in per vessel and per patient analysis. In per patient analysis, DP modeling-derived myocardial blood flow at stress demonstrated the highest sensitivity and specificity (0.96, 0.92) in detecting obstructive CAD, against Fermi modeling (0.78, 0.88) and visual assessments (0.79, 0.88), respectively. DP modeling demonstrated consistently increased diagnostic performance against Fermi modeling and showed that it may have merit for stratifying patients with at least one vessel with obstructive CAD. Clinicaltrials.gov NCT01368237 Registered 6 of June 2011. URL: https://clinicaltrials.gov/ct2/show/NCT01368237.

  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. 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.

  10. Coronary plaque imaging by coronary computed tomography angiography

    PubMed Central

    Sato, Akira

    2014-01-01

    Coronary computed tomography angiography (CTA) has become the useful noninvasive imaging modality alternative to the invasive coronary angiography for detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). With the development of technical aspects of coronary CTA, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology and patients outcomes by coronary CTA. In this review we discuss the coronary plaque morphology estimated by CTA beyond coronary angiography including the comparison to the currently available other imaging modalities used to examine morphological characteristics of the atherosclerotic plaque. Furthermore, this review underlies the value of a combined assessment of coronary anatomy and myocardial perfusion in patients with CAD, and adds to an increasing body of evidence suggesting an added diagnostic value when combining both modalities. We hope that an integrated, multi-modality imaging approach will become the gold standard for noninvasive evaluation of coronary plaque morphology and outcome data in clinical practice. PMID:24876919

  11. Comparison between non-invasive coronary flow reserve and fractional flow reserve to assess the functional significance of left anterior descending artery stenosis of intermediate severity.

    PubMed

    Meimoun, Patrick; Sayah, Smain; Luycx-Bore, Anne; Boulanger, Jacques; Elmkies, Frederic; Benali, Tahar; Zemir, Hamdane; Doutrelan, Luc; Clerc, Jerome

    2011-04-01

    Assessment of the functional significance of left anterior descending coronary artery (LAD) stenosis of intermediate severity (50%-70% diameter stenosis) is challenging. The aim of this study was to compare the value of noninvasive coronary flow reserve (CFR) with that of invasive fractional flow reserve (FFR) in the setting of LAD stenosis of angiographic intermediate severity. Fifty stable consecutive patients (mean age, 63 ± 13 years; 11 women; mean left ventricular ejection fraction, 61 ± 10%) with angiographic proximal LAD stenoses of intermediate severity (55.5 ± 5% diameter stenosis on quantitative coronary angiography), no previous anterior myocardial infarction, and various vascular risk factors were prospectively studied. They underwent FFR assessment with intracoronary bolus adenosine (150 μg), and CFR assessment using intravenous adenosine (140 μg/kg/min over 2 min) in the distal part of the LAD on the same day in nearly all patients. CFR was defined as hyperemic peak diastolic LAD flow velocity divided by baseline flow velocity (normal value >2), and FFR was defined as distal pressure divided by mean aortic pressure during maximal hyperemia (normal value >0.8). The mean FFR and CFR were 0.84 ± 0.07 and 2.7 ± 0.75, respectively, in the whole population. Concordant results between FFR and CFR were seen in 44 patients (88%) and discordant results in six patients (12%). There was a significant correlation between CFR and FFR (r = 0.59, P < .01). A better correlation was found between FFR and percentage LAD diameter stenosis, and lesion length (all P values < .05), than between CFR and the same anatomic markers of stenosis severity (all P values = NS). The sensitivity, specificity, and positive and negative predictive values of CFR >2 to detect a nonsignificant lesion defined by normal FFR were 95%, 69%, 90%, and 82%, respectively. In patients with LAD stenosis of intermediate severity, discordant results between noninvasive CFR and FFR were not

  12. The Role of Antihistamines in the Treatment of Vasomotor Rhinitis

    PubMed Central

    2009-01-01

    Background The pathogenesis of vasomotor rhinitis is not understood. It is unlikely that antihistamines, based on their H1 antagonist activity alone, would be effective in this disorder. Methods Nonetheless, at least one double-blind, placebo-controlled multicenter trial has found that intranasal azelastine relieves symptoms of this disorder better than placebo. The mechanism responsible for its beneficial effect in nonallergic rhinitis is unclear but probably relates to "anti-inflammatory/antiallergic" activities. Results Such mechanisms have been demonstrated for a number of different oral antihistamines, but often the concentrations required in vitro are higher than those that are normally achieved in vivo using recommended dosing. It has been postulated that intranasal administration, which can achieve high local levels, might be a factor responsible for enhancing the "anti-inflammatory/antiallergic" properties. Conclusions Interpreting this information allows one to conclude that antihistamines may be potentially effective agents in vasomotor rhinitis, and are more likely to be so when administered intranasally, despite the fact that data documenting this beneficial effect are sparse. PMID:24228781

  13. Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials.

    PubMed

    Damman, Peter; van Geloven, Nan; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A A; Clayton, Tim; Pocock, Stuart J; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; de Winter, Robbert J

    2012-02-01

    This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate. Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting. Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models. In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN

  14. Growth-differentiation factor 15 for long-term prognostication in patients with non-ST-elevation acute coronary syndrome: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy.

    PubMed

    Damman, Peter; Kempf, Tibor; Windhausen, Fons; van Straalen, Jan P; Guba-Quint, Anja; Fischer, Johan; Tijssen, Jan G P; Wollert, Kai C; de Winter, Robbert J; Hirsch, Alexander

    2014-03-15

    No five-year long-term follow-up data is available regarding the prognostic value of GDF-15. Our aim is to evaluate the long-term prognostic value of admission growth-differentiation factor 15 (GDF-15) regarding death or myocardial infarction (MI) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). This is a subanalysis from the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial, including troponin positive NSTE-ACS patients. The main outcome for the current analysis was 5-year death or spontaneous MI. GDF-15 samples were available in 1151 patients. The prognostic value of GDF-15, categorized into <1200 ng/L, 1200-1800 ng/L and >1800 ng/L, was assessed in unadjusted and adjusted Cox regression models. Adjustments were made for identified univariable risk factors. The additional discriminative and reclassification value of GDF-15 beyond the independent risk factors was assessed by the category-free net reclassification improvement (1/2 NRI(>0)) and the integrated discrimination improvement (IDI) RESULTS: Compared to GDF-15<1200 ng/L, a GDF-15>1800 ng/L was associated with an increased hazard ratio for death or spontaneous MI, mainly driven by mortality. GDF-15 levels were predictive after adjustments for other identified predictors. Additional discriminative value was shown with the IDI, not with the NRI. In patients presenting with NSTE-ACS and elevated troponin T, GDF-15 provides prognostic information in addition to identified predictors for mortality and spontaneous MI and can be used to identify patients at high risk during long-term follow-up. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Transcranial direct current stimulation effects on menopausal vasomotor symptoms.

    PubMed

    Bianchi, Mônia Steigleder; Ferreira, Charles Francisco; Fregni, Felipe; Schestatsky, Pedro; Caumo, Wolnei; Wender, Maria Celeste Osório

    2017-10-01

    To assess the effects of transcranial direct current stimulation (tDCS) compared with tDCS-sham on vasomotor symptoms of postmenopausal women. Postmenopausal women (N = 30), aged between 45 and 68 years, with at least four episodes of vasomotor symptoms per day, were recruited from a specialized outpatient clinic at a tertiary hospital in the south of Brazil and through a media call after inclusion and exclusion criteria were ensured. Active and tDCS-sham were administered over the motor cortex position (anode electrode) and contralateral supraorbital region (cathode electrode) for 10 consecutive days, except weekends. The number and intensity records of hot flashes were evaluated for 7 days before and along 30 days after the intervention. The Women's Health Questionnaire and the Hamilton Depression Rating Scale were applied to assess the quality of life and the depressive symptoms, respectively. The frequencies of hot flashes per day happened in a similar way in both groups, with a reduction in the first 3 weeks after the intervention. There was a return in hot flash frequencies to baseline in the fourth week (week 0: 79.0 ± 6.2 and 75.8 ± 6.0, week 1: 61.6 ± 9.6 and 57.0 ± 7.8, week 2: 56.8 ± 8.9 and 55.9 ± 7.1, week 3: 56.8 ± 8.9 and 54.2 ± 7.2, week 4: 64.9 ± 10.7, 70.1 ± 8.9; tDCS-sham and tDCS groups, respectively). In the tDCS group, a trend towards a conversion of intensive hot flashes into mild ones was observed. Our results suggest that the tDCS technique showed small trends on postmenopausal vasomotor symptoms, justifying searches for more effective methods by which tDCS could reduce hot flashes.

  16. Robotically Assisted Minimally Invasive Off-Pump Coronary Artery Bypass Surgery in a Patient With Permanent Tracheostomy.

    PubMed

    Ramponi, Fabio; Flynn, Campbell D; Wilson, Michael K

    2017-11-01

    Patients with a permanent tracheostomy requiring coronary surgery represent a unique challenge, being at increased risk of sternal wound complications, mediastinitis and stoma necrosis. Several techniques have been described including manubrium sparing sternotomy, thoracoscopic internal mammary harvest and hybrid revascularisation. We report a case of robotic assisted (daVinci(®)Xi™ Surgical System) total arterial off-pump revascularisation in a patient with previous laryngectomy and permanent tracheostomy. The main advantage of this approach was to minimise the risk of postoperative sternal complication and mediastinatis, whilst still providing the prognostic benefit of total arterial grafting and the neurological advantage of the aorta no-touch technique. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

  17. Stress thallium-201/rest technetium-99m sequential dual-isotope high-speed myocardial perfusion imaging validation versus invasive coronary angiography.

    PubMed

    Barone-Rochette, Gilles; Leclere, Mélanie; Calizzano, Alex; Vautrin, Estelle; Céline, Gallazzini-Crepin; Broisat, Alexis; Ghezzi, Catherine; Baguet, Jean Philippe; Machecourt, Jacques; Vanzetto, Gérald; Fagret, Daniel

    2015-06-01

    Recent advances in nuclear myocardial perfusion imaging (MPI) have made it possible to develop a dual-isotope protocol for high-speed acquisition with image quality and radiation delivery comparable to that obtained with conventional single isotope protocols. So far, no study has compared dual-isotope high-speed MPI to invasive coronary angiography (ICA) in a large cohort using a Cadmium-zinc-telluride SPECT system. Over a 1-year period (May 2011 to April 2012), 1366 patients underwent dual-isotope high-speed MPI. Patients with ICA within 3 months after dual-isotope high-speed MPI were included together with patients with a low likelihood of coronary artery disease (CAD) in order to assess normalcy rate. Global summed stress score (SSS) and summed rest score (SRS) were calculated, and ICA results were analyzed independently. The main end point was a patient-based assessment of the diagnostic performance of dual-isotope high-speed MPI in detecting or ruling out significant CAD (>70% reduction in lumen diameter). Inclusion criteria were fulfilled for 214 patients (143 men; age 60 ± 14 years; ICA, n = 104; low likelihood for CAD, n = 110). An exercise stress test was performed in 62% of patients and a pharmacological stress test was performed with either dipyridamole (32%) or dobutamine (6%). Average examination duration was 22.4 ± 4.5 minutes. Mean SSS, SRS, and SDS were 8.0 ± 4.9, 3.1 ± 4.3, and 5.0 ± 3.2, respectively. Prevalence of angiographic CAD was 75%. ICA detected stenosis in the left main trunk, left anterior descending artery, left circumflex artery, and right coronary artery in 4, 33, 31, and 42 patients, respectively. Sensitivity of dual-isotope high-speed MPI was 94%, normalcy rate was 92%, and accuracy was 83% for detecting CAD. Dual-isotope high-speed MPI is reliable at detecting or ruling out CAD. NCT01785589.

  18. Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: Intervention in Older Persons with Acute Coronary Syndrome—Part II

    PubMed Central

    Sheridan, Brett C.; Stearns, Sally C.; Massing, Mark W.; Stouffer, George A.; D’Arcy, Laura P.; Carey, Timothy S.

    2009-01-01

    This is Part II of a two-part article on treatment of acute coronary syndrome in the older population. Part I (published in the October issue of Clinical Geriatrics) analyzed the differential utilization of invasive therapies with respect to age and heart disease. Part II summarizes information from the literature on acute coronary syndrome outcomes from invasive treatments (percutaneous coronary interventions or coronary artery bypass grafting) among older persons. PMID:20607092

  19. Cerebral vasomotor reactivity in reversible cerebral vasoconstriction syndrome.

    PubMed

    Topcuoglu, Mehmet Akif; Chan, Suk-Tak; Silva, Gisele Sampaio; Smith, Eric Edward; Kwong, Kenneth K; Singhal, Aneesh Bhim

    2017-05-01

    Background Altered cerebrovascular tone is implicated in reversible cerebral vasoconstriction syndrome (RCVS). We evaluated vasomotor reactivity using bedside transcranial Doppler in RCVS patients. Methods In this retrospective case-control study, middle cerebral artery (MCA) blood flow velocities were compared at rest and in response to breath-hold in RCVS ( n = 8), Migraineurs ( n = 10), and non-headache Controls ( n = 10). Hyperventilation response was measured in RCVS. Results In RCVS, Breath Holding Index (BHI) was severely reduced in seven of eight patients and 14/16 MCAs; seven of 16 MCAs showed exhausted (BHI < 0.1) or inverted (BHI < 0) vasomotor reactivity. Mean BHI in RCVS (0.23 ± 0.5) was significantly lower than Migraine (1.52 ± 0.57) and Controls (1.51 ± 0.32), p < 0.001. Triphasic velocity responses were seen in all groups. The maximum Vmean decline during the middle negative phase was -15.5 ± 9.2% in RCVS, -15.4 ± 7% in Migraine, and -10.3 ± 5% in Controls ( p = 0.04). In the late positive phase, average Vmean increase was 6.2 ± 14% in RCVS, which was significantly lower ( p < 0.001) than Migraine (30.5 ± 11%) and Controls (30.2 ± 6%). With hyperventilation, RCVS patients showed 23% decrease in Vmean. Conclusion Cerebral arterial tone is abnormal in RCVS, with proximal vasoconstriction and abnormally reduced capacity for vasodilation. Further studies are needed to determine the utility of BHI to diagnose RCVS before angiographic reversibility is established, and to estimate prognosis.

  20. Cardiovascular, cerebrovascular, and hepatic safety of desvenlafaxine for 1 year in women with vasomotor symptoms associated with menopause.

    PubMed

    Archer, David F; Pinkerton, Joann V; Guico-Pabia, Christine J; Hwang, Eunhee; Cheng, Ru-Fong J

    2013-01-01

    A previous trial of the serotonin-norepinephrine reuptake inhibitor desvenlafaxine (administered as desvenlafaxine succinate) raised concerns on potential serious cardiovascular and hepatic events. The current study was designed to estimate these events in desvenlafaxine versus placebo in a larger population followed for 1 year. Healthy postmenopausal women seeking treatment of vasomotor symptoms were randomized to placebo or desvenlafaxine 100 mg/day in a 1-year, multicenter, double-blind study. Safety was monitored throughout. Potential ischemic cardiovascular events (coronary heart disease-related death, new-onset myocardial infarction or unstable angina requiring hospitalization, and unscheduled revascularization procedures) and cerebrovascular events (definite stroke or probable stroke) identified by investigator reports and periodic adverse event review based on Standardized medical dictionary for regulatory activities Query were reviewed by blinded adjudication boards. Hepatic events (aspartate aminotransferase or alanine aminotransferase >5 times the upper limit of normal) were evaluated. A total of 2,118 participants (1,066 desvenlafaxine, 1,052 placebo) took one or more doses of study medication (mean, 280 d). There was one cardiovascular event; a placebo-treated participant was adjudicated to have had a myocardial infarction. One desvenlafaxine-treated participant was adjudicated to have had a probable stroke. Two participants in each treatment group had hepatic events. The excess risk (90% CI) of desvenlafaxine over placebo per 1,000 woman-years was -1.07 (-2.86 to 0.72) for cardiovascular events, 1.11 (-0.68 to 2.9) for cerebrovascular events, and 0.08 (-3.51 to 3.67) for hepatic events. There is no evidence for an increased risk of cardiovascular, cerebrovascular, or hepatic events associated with desvenlafaxine 100 mg/day compared with placebo for the treatment of menopausal vasomotor symptoms.

  1. 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

  2. An Intervention to Control Vasomotor Symptoms for Advanced PC Patients on Hormone Therapy

    DTIC Science & Technology

    2014-08-01

    Symptoms for Advanced PC Patients on Hormone Therapy PRINCIPAL INVESTIGATOR: Michael A. Diefenbach, Ph.D. CONTRACTING ORGANIZATION...Control Vasomotor Symptoms for Advanced PC Patients on Hormone Therapy 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-11-1-0604 5c...NOTES 14. ABSTRACT Vasomotor Symptom (Hot Flashes) is a common side-effect of hormone therapy for prostate cancer survivors who experience a rising

  3. Current operator volumes of invasive coronary procedures in Medicare patients: implications for future manpower needs in the catheterization laboratory.

    PubMed

    Maroney, Justin; Khan, Saba; Powell, Wayne; Klein, Lloyd W

    2013-01-01

    We seek to assess the per-operator volume of diagnostic catheterizations and percutaneous coronary interventions (PCI) among US cardiologists, and its implication for future manpower needs in the catheterization laboratory. The number of annual Medicare PCIs peaked in 2004 and has trended downward since, however the total number of catheterization laboratories nationwide has increased. It is unknown whether these trends have resulted in a dilution of per-operator volumes, and whether the current supply of interventional cardiologists is appropriate to meet future needs. We analyzed the Centers for Medicare and Medicaid Services 2008 Medicare 5% sample file, and extracted the total number of Medicare fee-for-service (Medicare FFS) diagnostic catheterizations and PCIs performed in 2008. We then determined per-physician procedure volumes using National Provider Identifier numbers. There were 1,198,610 Medicare FFS diagnostic catheterizations performed by 11,029 diagnostic cardiologists, and there were 378,372 Medicare FFS PCIs performed by 6,443 interventional cardiologists in 2008. The data reveal a marked difference in the 2008 distribution of diagnostic catheterizations and PCIs among operators. Just over 10% of diagnostic catheterizations were performed by operators performing 40 or fewer Medicare FFS diagnostic catheterizations, contrasted with almost 30% of PCIs performed by operators with 40 of fewer Medicare FFS PCIs. A significant majority of interventional cardiologists (61%) performed 40 or fewer Medicare FFS PCIs in 2008. There is a high percentage of low-volume operators performing PCI, raising questions regarding annual volume recommendations for procedural skill maintenance, and the future manpower requirements in the catheterization laboratory. Copyright © 2012 Wiley Periodicals, Inc.

  4. The coronary circulation in exercise training.

    PubMed

    Laughlin, M Harold; Bowles, Douglas K; Duncker, Dirk J

    2012-01-01

    Exercise training (EX) induces increases in coronary transport capacity through adaptations in the coronary microcirculation including increased arteriolar diameters and/or densities and changes in the vasomotor reactivity of coronary resistance arteries. In large animals, EX increases capillary exchange capacity through angiogenesis of new capillaries at a rate matched to EX-induced cardiac hypertrophy so that capillary density remains normal. However, after EX coronary capillary exchange area is greater (i.e., capillary permeability surface area product is greater) at any given blood flow because of altered coronary vascular resistance and matching of exchange surface area and blood flow distribution. The improved coronary capillary blood flow distribution appears to be the result of structural changes in the coronary tree and alterations in vasoreactivity of coronary resistance arteries. EX also alters vasomotor reactivity of conduit coronary arteries in that after EX, α-adrenergic receptor responsiveness is blunted. Of interest, α- and β-adrenergic tone appears to be maintained in the coronary microcirculation in the presence of lower circulating catecholamine levels because of increased receptor responsiveness to adrenergic stimulation. EX also alters other vasomotor control processes of coronary resistance vessels. For example, coronary arterioles exhibit increased myogenic tone after EX, likely because of a calcium-dependent PKC signaling-mediated alteration in voltage-gated calcium channel activity in response to stretch. Conversely, EX augments endothelium-dependent vasodilation throughout the coronary arteriolar network and in the conduit arteries in coronary artery disease (CAD). The enhanced endothelium-dependent dilation appears to result from increased nitric oxide bioavailability because of changes in nitric oxide synthase expression/activity and decreased oxidant stress. EX also decreases extravascular compressive forces in the myocardium at rest

  5. The coronary circulation in exercise training

    PubMed Central

    Bowles, Douglas K.; Duncker, Dirk J.

    2012-01-01

    Exercise training (EX) induces increases in coronary transport capacity through adaptations in the coronary microcirculation including increased arteriolar diameters and/or densities and changes in the vasomotor reactivity of coronary resistance arteries. In large animals, EX increases capillary exchange capacity through angiogenesis of new capillaries at a rate matched to EX-induced cardiac hypertrophy so that capillary density remains normal. However, after EX coronary capillary exchange area is greater (i.e., capillary permeability surface area product is greater) at any given blood flow because of altered coronary vascular resistance and matching of exchange surface area and blood flow distribution. The improved coronary capillary blood flow distribution appears to be the result of structural changes in the coronary tree and alterations in vasoreactivity of coronary resistance arteries. EX also alters vasomotor reactivity of conduit coronary arteries in that after EX, α-adrenergic receptor responsiveness is blunted. Of interest, α- and β-adrenergic tone appears to be maintained in the coronary microcirculation in the presence of lower circulating catecholamine levels because of increased receptor responsiveness to adrenergic stimulation. EX also alters other vasomotor control processes of coronary resistance vessels. For example, coronary arterioles exhibit increased myogenic tone after EX, likely because of a calcium-dependent PKC signaling-mediated alteration in voltage-gated calcium channel activity in response to stretch. Conversely, EX augments endothelium-dependent vasodilation throughout the coronary arteriolar network and in the conduit arteries in coronary artery disease (CAD). The enhanced endothelium-dependent dilation appears to result from increased nitric oxide bioavailability because of changes in nitric oxide synthase expression/activity and decreased oxidant stress. EX also decreases extravascular compressive forces in the myocardium at rest

  6. Coronary Arteries

    MedlinePlus

    ... and animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...

  7. Treating vasomotor symptoms of menopause: the nurse practitioner's perspective.

    PubMed

    Alexander, Ivy M; Moore, Anne

    2007-03-01

    This article reviews the pathophysiology of vasomotor symptoms (VMS) of menopause and current management options. Current scientific literature. In most menopausal women, loss of ovarian function results in VMS, including hot flashes, night sweats, and mood and sleep disturbances. Hormone therapy (HT) has been the mainstay of VMS treatment for many years, but safety concerns raised by publication of the Women's Health Initiative (WHI) results have dramatically reduced the use of this treatment. Since the WHI published its findings, attention has focused on other novel treatments for menopausal symptoms, including low-dose oral or transdermal HT and agents such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and clonidine. Many women also use complementary and alternative medications to manage VMS, but little evidence from controlled clinical trials supports their efficacy. The increasing number of alternative treatments for VMS requires improvement in patient-provider communication about treatment risks and benefits, individualization of treatment to meet patient needs and attitudes, and careful follow-up to ensure adherence to potentially effective therapy. Nurse practitioners play a leading role in patient evaluation, discussions, and management to help women achieve control over bothersome VMS that dramatically impact their quality of life.

  8. 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

  9. Comparative study of gabapentin and isoflavone in menopausal vasomotor symptoms

    PubMed Central

    Singhal, Savita Rani; Shullai, Wansalan Kuru

    2016-01-01

    Objective: This study was planned to compare the effects of gabapentin and isoflavones in menopausal vasomotor symptoms. Materials and Methods: This prospective comparative study was conducted on 100 patients with complaints of hot flashes, divided into two groups of 50 each. Group I received 900 mg of gabapentin and Group II received 60 mg of isoflavones daily for 3 months. The patients were interviewed to calculate hot flash, global and depression scores and were rescored after 2, 4, 8, and 12 weeks. The primary outcome measure was a change in the hot flash score from baseline. The secondary outcome was an improvement in sleep, depression, and lipid profile. Data were analyzed using Chi-square test and Student's t-test. Results: Both groups showed significant improvement in hot flash score at the end of 12 weeks (82% Group I, 74% Group II; P = 0.076). Statistically significant difference was seen at 12 weeks in sleep quality in favor of gabapentin (P = 0.011) and in depression in favor of isoflavones (0.026). Isoflavone had significant improvement in cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides profiles after 12 weeks (P < 0.001, 0.009, 0.024 and <0.001, respectively) as compared to gabapentin. Conclusion: Isoflavone and gabapentin are equally effective in the treatment of hot flashes; however, isoflavones have better response in patients who have associated with complaints of depression and gabapentin is better who have associated sleep disturbance. PMID:27721641

  10. 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

  11. Vasomotor symptoms, estradiol levels and cardiovascular risk profile in women.

    PubMed

    Gast, Gerrie-Cor M; Samsioe, Göran N; Grobbee, Diederick E; Nilsson, Peter M; van der Schouw, Yvonne T

    2010-07-01

    We investigated whether menopausal vasomotor symptoms (VMS) are related to an adverse cardiovascular risk profile. Furthermore, we examined the association between estradiol levels and VMS, and whether an association between VMS and cardiovascular risk factors can be explained by estradiol levels. We used data from a Swedish population-based sample of 5857 women, aged 50-64 years. Data on VMS and potential confounders were collected by questionnaires. Body mass index (BMI), waist hip ratio (WHR), glucose, blood pressure, lipid profile and estradiol levels were measured. Symptoms of flushing/sweats were reported by 55% and sweats by 31% of all women. Estradiol concentrations were significantly lower in women with VMS. After multivariate adjustment, women with symptoms of sweats had a statistically significantly higher BMI, waist hip ratio, total cholesterol level, LDL level, triglycerides level, glucose level, systolic and diastolic blood pressure. These patterns did not change after correction for estradiol. The associations between flushing/sweats combined and cardiovascular risk factors were less pronounced. Women with VMS have a less favorable cardiovascular risk profile. Although estradiol levels were significantly lower among women with VMS, the increased cardiovascular risk profile cannot be explained by circulating estradiol levels. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  12. Same-day transfer for the invasive strategy of patients with non-ST-segment elevation acute coronary syndrome admitted to spoke hospitals: Data from the Emilia-Romagna Regional Network.

    PubMed

    Campo, Gianluca; Menozzi, Mila; Guastaroba, Paolo; Vignali, Luigi; Belotti, Laura Mb; Casella, Gianni; Berti, Elena; Solinas, Emilia; Guiducci, Vincenzo; Biscaglia, Simone; Pavasini, Rita; De Palma, Rossana; Manari, Antonio

    2016-10-01

    The service strategy (same-day transfer between spoke hospital and hub centre with catheterisation laboratory (cath-lab) facility to perform invasive procedures) has been suggested to improve the management of patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) admitted to spoke hospitals. We used data from a large prospective Italian registry to describe application, performance and outcome of the service strategy in the daily clinical practice. This study was based on an observational, post-hoc analysis of all consecutive NSTEACS patients admitted to spoke non-invasive hospitals of the Emilia-Romagna regional network and receiving coronary artery angiography (CAA)±percutaneous coronary intervention (PCI). We evaluated: application of service strategy, time to cath-lab access, hospital stay length, 30-days occurrence of adverse events. From January 2011-December 2012, 2952 NSTEACS consecutive patients were admitted to spoke non-invasive hospitals and received CAA. Overall, 1765 (60%) patients were managed with a service strategy. After multivariable analysis, service strategy emerged as independent predictor of faster access to cath-lab (within 72 h: hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.9-2.7, p<0.0001; within 24 h: HR 2.8, 95% CI 2.2-3.3, p<0.0001, respectively). Service strategy significantly reduced hospital stay length (-5.5 days, p<0.0001). We estimated a mean of €1590 saved for each patient managed with service strategy. Thirty-day occurrence of adverse events did not differ between patients managed with or without a service strategy. In our daily clinical practice, a service strategy seems to be an effective approach to optimise the invasive management of NSTEACS patients admitted to spoke hospitals. © The European Society of Cardiology 2015.

  13. High-resolution magnetic resonance coronary angiography of the entire heart using a new blood-pool agent, NC100150 injection: comparison with invasive x-ray angiography in pigs.

    PubMed

    Johansson, L O; Nolan, M M; Taniuchi, M; Fischer, S E; Wickline, S A; Lorenz, C H

    1999-01-01

    Recent developments of novel magnetic resonance intravascular contrast agents with low T1 in blood and a long intravascular half-life will rapidly position magnetic resonance coronary angiography (MRCA) at the threshold of clinical application. This article describes the use of one such intravascular contrast agent for noninvasive coronary angiography and comparison with routine invasive x-ray angiography. Six domestic farm pigs with an artificial stenoses at the left circumflex were studied. NC100150 Injection, a new ultra-small superparmagnetic iron oxide (Nycomed Amersham Imaging, Oslo, Norway), was injected using a dose of 5.0 mg Fe/kg body weight. Scanning was done using a 1.5-T Gyroscan ACS-NT. A high-resolution electrocardiogram-triggered scan covering the entire heart was applied. Navigator echoes were used for respiratory triggering. In all animals the location of the stenoses detected with MRCA correlated well with x-ray angiography. The correlation factor between the grade of stenoses determined by MRCA and x-ray angiography was 0.993. MRCA using NC100150 Injection can depict the major coronary arteries and branches well. Decreases in vessel caliber detected by MRCA correlate well with x-ray angiography. The use of such intravascular contrast agents show great promise for clinical applications for noninvasive detection of coronary artery disease in humans.

  14. 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

  15. Independence of connexin expression and vasomotor conduction from sympathetic innervation in hamster feed arteries.

    PubMed

    Looft-Wilson, Robin C; Haug, Sara J; Neufer, P Darrell; Segal, Steven S

    2004-01-01

    Vasomotor responses can travel along the wall of resistance microvessels by two distinct mechanisms: cell-to-cell conduction through gap junctions or the release of neurotransmitter along perivascular nerves. It is unknown whether vascular innervation influences the expression of connexin molecules which comprise gap junctions, or the conduction of vasomotor responses. In feed arteries of the hamster retractor muscle (RFA), the authors tested whether sympathetic denervation would alter the expression of connexin isoforms and the conduction of vasomotor responses. Using intact vessels with sympathetic innervation and those 7-8 days following denervation surgery, mRNA expression was quantified using real-time PCR, cellular localization of Cx protein was characterized using immunohistochemistry, and vasomotor responses to dilator and constrictor stimuli were evaluated in isolated pressurized RFA. Connexin protein localization and mRNA expression were similar between innervated and denervated vessels. mRNA levels were Cx43 = Cx37 > Cx45 > Cx40. Vasodilation to acetylcholine conducted >/=2000 microm along innervated and denervated vessels, as did the biphasic conduction of vasoconstriction and vasodilation in response to KCl. Vasoconstriction to phenylephrine conducted <500 microm and was attenuated (p <.05) in denervated vessels. The profile of connexin expression and the conduction of vasomotor responses are largely independent of sympathetic innervation in feed arteries of the hamster retractor muscle (RFA).

  16. The association between vasomotor symptoms and metabolic health in peri- and postmenopausal women: a systematic review.

    PubMed

    van Dijk, Gabriella M; Maneva, Manuela; Colpani, Veronica; Dhana, Klodian; Muka, Taulant; Jaspers, Loes; Kavousi, Maryam; Franco, Oscar H

    2015-02-01

    The objective of this study was to systematically review studies describing the association between vasomotor symptoms and metabolic syndrome, type 2 diabetes and insulin resistance in peri- and postmenopausal women. A systematic search of studies was performed in EMBASE, MEDLINE, Web-of-science, Scopus, PubMed publisher, Cochrane Library, Google scholar. To identify studies eligible for inclusion, the following criteria were defined: randomised trials, cohort, case-control, and cross-sectional studies investigating the association between vasomotor symptoms and metabolic syndrome, type 2 diabetes and insulin resistance in peri- and postmenopausal women with natural menopause. Methodological quality was assessed using a modified NewCastle Ottawa Assessment Scale. After screening 2660 titles and abstracts, four studies, of which two cohort studies met the criteria of high methodological quality, were included in the review. Because of the heterogeneity and the limited number of studies, there is no sufficient evidence on the potential role of vasomotor symptoms in metabolic health. However, both high-quality cohort studies, with large study populations and adjustment for multiple confounding variables showed positive associations between vasomotor symptoms and insulin resistance and type 2 diabetes mellitus. These findings suggest that there is an association between vasomotor symptoms and metabolic health outcomes. To confirm this and to strengthen the evidence, more high quality longitudinal research on this topic is needed.

  17. Effect of black cohosh (cimicifuga racemosa) on vasomotor symptoms in postmenopausal women: a randomized clinical trial.

    PubMed

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

    2013-06-01

    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. 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. 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. 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.

  18. 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

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

    USDA-ARS?s Scientific Manuscript database

    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 ...

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

    USDA-ARS?s Scientific Manuscript database

    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 ...

  1. 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

  2. Associations of Menopausal Vasomotor Symptoms with Fracture Incidence

    PubMed Central

    Aragaki, Aaron; Cauley, Jane A.; Manson, JoAnn E.; LeBlanc, Erin; Wallace, Robert; Wactawski-Wende, Jean; LaCroix, Andrea; O'Sullivan, Mary Jo; Vitolins, Mara; Watts, Nelson B.

    2015-01-01

    Context: Vasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown. Objective: This study aimed to examine associations of baseline VMS with fracture incidence and BMD. Design: This was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993–2005). Setting: Forty United States clinical centers. Participants: We examined data from Women's Health Initiative Clinical Trial participants (n = 23 573) age 50–79 years not using menopausal hormone therapy, and 4,867 participants of the BMD sub-study. Interventions: None. Main Outcome Measures: We measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9). Results: After adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate/severe VMS (vs no VMS) was 1.78 (95% confidence interval [CI], 1.20–2.64; P = .01). There was no association between VMS and vertebral fracture. VMS severity was inversely associated with BMD during followup (P = .004 for femoral neck, P = .045 for lumbar spine). In repeated measures models, compared with women who reported no VMS, women with moderate/severe VMS had 0.015 g/cm2 lower femoral neck BMD (95% CI, −0.025–−0.005) and 0.016 g/cm2 lower lumbar spine BMD (95% CI, −0.032–−0.004). Conclusions: Women with moderate/severe VMS have lower BMD and increased hip fracture rates. Elucidation of the biological mechanisms underlying these associations may inform the design of preventive strategies for at-risk women prior to occurrence of fracture. PMID:25522264

  3. 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

  4. Obesity and coronary microvascular disease - implications for adipose tissue-mediated remote inflammatory response.

    PubMed

    Bagi, Zsolt; Broskova, Zuzana; Feher, Attila

    2014-05-01

    It is believed that obesity has detrimental effects on the coronary circulation. These include immediate changes in coronary arterial vasomotor responsiveness and the development of occlusive large coronary artery disease. Despite its critical role in regulating myocardial perfusion, the altered behavior of coronary resistance arteries, which gives rise to coronary microvascular disease (CMD) is poorly understood in obesity. A chronic, low-grade vascular inflammation has been long considered as one of the main underlying pathology behind CMD. The expanded adipose tissue and the infiltrating macrophages are the major sources of pro-inflammatory mediators that have been implicated in causing inadequate myocardial perfusion and, in a long term, development of heart failure in obese patients. Much less is known the mechanisms regulating the release of these cytokines into the circulation that enable them to exert their remote effects in the coronary microcirculation. This mini review aims to examine recent studies describing alterations in the vasomotor function of coronary resistance arteries and the role of adipose tissue-derived pro-inflammatory cytokines and adipokines in contributing to CMD in obesity. We provide examples of regulatory mechanisms by which adipokines are released from adipose tissue to exert their remote inflammatory effects on coronary microvessels. We identify some of the important challenges and opportunities going forward.

  5. A retrospective comparative study of minimally invasive extracorporeal circulation versus conventional extracorporeal circulation in emergency coronary artery bypass surgery patients: a single surgeon analysis.

    PubMed

    Rufa, Magdalena; Schubel, Jens; Ulrich, Christian; Schaarschmidt, Jan; Tiliscan, Catalin; Bauer, Adrian; Hausmann, Harald

    2015-07-01

    At the moment, the main application of minimally invasive extracorporeal circulation (MiECC) is reserved for elective cardiac operations such as coronary artery bypass grafting (CABG) and/or aortic valve replacement. The purpose of this study was to compare the outcome of emergency CABG operations using either MiECC or conventional extracorporeal circulation (CECC) in patients requiring emergency CABG with regard to the perioperative course and the occurrence of major adverse cardiac and cerebral events (MACCE). We analysed the emergency CABG operations performed by a single surgeon, between January 2007 and July 2013, in order to exclude the differences in surgical technique. During this period, 187 emergency CABG patients (113 MiECC vs 74 CECC) were investigated retrospectively with respect to the following parameters: in-hospital mortality, MACCE, postoperative hospital stay and perioperative transfusion rate. The mean logistic European System for Cardiac Operative Risk Evaluation was higher in the CECC group (MiECC 12.1 ± 16 vs CECC 15.0 ± 20.8, P = 0.15) and the number of bypass grafts per patient was similar in both groups (MiECC 2.94 vs CECC 2.93). There was no significant difference in the postoperative hospital stay or in major postoperative complications. The in-hospital mortality was higher in the CECC group 6.8% versus MiECC 4.4% (P = 0.48). The perioperative transfusion rate was lower with MiECC compared with CECC (MiECC 2.6 ± 3.2 vs CECC 3.8 ± 4.2, P = 0.025 units of blood per patient). In our opinion, the use of MiECC in urgent CABG procedures is safe, feasible and shows no disadvantages compared with the use of CECC. Emergency operations using the MiECC system showed a significantly lower blood transfusion rate and better results concerning the unadjusted in-hospital mortality. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. 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

  7. Vasomotor symptoms and cardiovascular events in postmenopausal women

    PubMed Central

    Szmuilowicz, Emily D.; Manson, JoAnn E.; Rossouw, Jacques E.; Howard, Barbara V.; Margolis, Karen L.; Greep, Nancy C.; Brzyski, Robert G.; Stefanick, Marcia L.; O'Sullivan, Mary Jo; Wu, Chunyuan; Allison, Matthew; Grobbee, Diederick E.; Johnson, Karen C.; Ockene, Judith K.; Rodriguez, Beatriz L.; Sarto, Gloria E.; Vitolins, Mara Z.; Seely, Ellen W.

    2010-01-01

    Objective Emerging evidence suggests that women with menopausal vasomotor symptoms (VMS) have increased cardiovascular disease (CVD) risk as measured by surrogate markers. We investigated the relationships between VMS and clinical CVD events and all-cause mortality in the Women's Health Initiative Observational Study (WHI-OS). Methods We compared the risk of incident CVD events and all-cause mortality between four groups of women (total N=60,027): (1) No VMS at menopause onset and no VMS at WHI-OS enrollment (no VMS [referent group]); (2) VMS at menopause onset, but not at WHI-OS enrollment (early VMS); (3) VMS at both menopause onset and WHI-OS enrollment (persistent VMS [early and late]); and (4) VMS at WHI-OS enrollment, but not at menopause onset (late VMS). Results For women with early VMS (N=24,753), compared to no VMS (N=18,799), hazard ratios (HRs) and 95% confidence intervals (CIs) in fully-adjusted models were: major CHD, 0.94 (0.84, 1.06); stroke, 0.83 (0.72, 0.96); total CVD, 0.89 (0.81, 0.97); and all-cause mortality, 0.92 (0.85, 0.99). For women with persistent VMS (N=15,084), there was no significant association with clinical events. For women with late VMS (N=1,391) compared to no VMS, HRs and 95% CIs were: major CHD, 1.32 (1.01, 1.71); stroke, 1.14 (0.82, 1.59); total CVD, 1.23 (1.00, 1.52); and all-cause mortality, 1.29 (1.08, 1.54). Conclusions Early VMS were not associated with increased CVD risk. Rather, early VMS were associated with decreased risk of stroke, total CVD events, and all-cause mortality. Late VMS were associated with increased CHD risk and all-cause mortality. The predictive value of VMS for clinical CVD events may vary with onset of VMS at different stages of menopause. Further research examining the mechanisms underlying these associations is needed. Future studies will also be necessary to investigate whether VMS that develop for the first time in the later postmenopausal years represent a pathophysiologic process distinct

  8. Duration of menopausal vasomotor symptoms over the menopause transition.

    PubMed

    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

    2015-04-01

    The expected duration of menopausal vasomotor symptoms (VMS) is important to women making decisions about possible treatments. 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. 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. Total VMS duration (in years) (hot flashes or night sweats) and post-FMP persistence (in years) into postmenopause. 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. 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. Individual characteristics (eg, being premenopausal and having greater negative affective factors when first experiencing

  9. 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

  10. Mechanisms of coronary microvascular adaptation to obesity.

    PubMed

    Bagi, Zsolt

    2009-09-01

    The metabolic syndrome (MetS) is associated with clustering of cardiovascular risk factors in individuals that may greatly increase their risk of developing coronary artery disease. Obesity and related metabolic dysfunction are the driving forces in the prevalence of MetS. It is believed that obesity has detrimental effects on cardiovascular function, but its overall impact on the vasomotor regulation of small coronary arteries is still debated. Emerging evidence indicates that in obesity coronary arteries adapt to hemodynamic changes via maintaining and/or upregulating cellular mechanism(s) intrinsic to the vascular wall. Among other factors, endothelial production of cyclooxygenase-2-derived prostacyclin and reactive oxygen species, as well as increased nitric oxide sensitivity and potassium channel activation in smooth muscle cells, have been implicated in maintaining coronary vasodilator function. This review aims to examine studies that have been primarily focused on alterations in coronary vasodilator function in obesity. A better understanding of cellular mechanisms that may contribute to coronary microvascular adaptation may provide insight into the sequence of pathological events in obesity and may allow the harnessing of these effects for therapeutic purposes.

  11. Relationships Among Non-Invasive Predictors of Sudden Cardiac Death During Mental Stress and Exercise In Coronary Artery Disease Patients With Known Arrhythmic Vulnerability

    DTIC Science & Technology

    2009-12-16

    common symptom of an acute myocardial ischemia is pain in the chest region or angina pectoris . Myocardial infarction is a prolonged ischemic event...CVD is high based on symptom presentation (e.g. angina pectoris ) the ST segment depression is much more likely to be a good indicator of CVD and will...adverse coronary events, such as angina pectoris , MI, and coronary death, in this asymptomatic population (RR = 2.73, p = .04) (Rywik, et al., 2002). In

  12. Regulation of coronary blood flow during exercise.

    PubMed

    Duncker, Dirk J; Bache, Robert J

    2008-07-01

    Exercise is the most important physiological stimulus for increased myocardial oxygen demand. The requirement of exercising muscle for increased blood flow necessitates an increase in cardiac output that results in increases in the three main determinants of myocardial oxygen demand: heart rate, myocardial contractility, and ventricular work. The approximately sixfold increase in oxygen demands of the left ventricle during heavy exercise is met principally by augmenting coronary blood flow (~5-fold), as hemoglobin concentration and oxygen extraction (which is already 70-80% at rest) increase only modestly in most species. In contrast, in the right ventricle, oxygen extraction is lower at rest and increases substantially during exercise, similar to skeletal muscle, suggesting fundamental differences in blood flow regulation between these two cardiac chambers. The increase in heart rate also increases the relative time spent in systole, thereby increasing the net extravascular compressive forces acting on the microvasculature within the wall of the left ventricle, in particular in its subendocardial layers. Hence, appropriate adjustment of coronary vascular resistance is critical for the cardiac response to exercise. Coronary resistance vessel tone results from the culmination of myriad vasodilator and vasoconstrictors influences, including neurohormones and endothelial and myocardial factors. Unraveling of the integrative mechanisms controlling coronary vasodilation in response to exercise has been difficult, in part due to the redundancies in coronary vasomotor control and differences between animal species. Exercise training is associated with adaptations in the coronary microvasculature including increased arteriolar densities and/or diameters, which provide a morphometric basis for the observed increase in peak coronary blood flow rates in exercise-trained animals. In larger animals trained by treadmill exercise, the formation of new capillaries maintains

  13. Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials.

    PubMed

    Damman, Peter; Clayton, Tim; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A A; Hirsch, Alexander; Windhausen, Fons; Swahn, Eva; Pocock, Stuart J; Tijssen, Jan G P; de Winter, Robbert J

    2012-02-01

    To perform a patient-pooled analysis of a routine invasive versus a selective invasive strategy in elderly patients with non-ST segment elevation acute coronary syndrome. A meta-analysis was performed of patient-pooled data from the FRISC II-ICTUS-RITA-3 (FIR) studies. (Un)adjusted HRs were calculated by Cox regression, with adjustments for variables associated with age and outcomes. The main outcome was 5-year cardiovascular death or myocardial infarction (MI) following routine invasive versus selective invasive management. Regarding the 5-year composite of cardiovascular death or MI, the routine invasive strategy was associated with a lower hazard in patients aged 65-74 years (HR 0.72, 95% CI 0.58 to 0.90) and those aged ≥75 years (HR 0.71, 95% CI 0.55 to 0.91), but not in those aged <65 years (HR 1.11, 95% CI 0.90 to 1.38), p=0.001 for interaction between treatment strategy and age. The interaction was driven by an excess of early MIs in patients <65 years of age; there was no heterogeneity between age groups concerning cardiovascular death. The benefits were smaller for women than for men (p=0.009 for interaction). After adjustment for other clinical risk factors the HRs remained similar. The current analysis of the FIR dataset shows that the long-term benefit of the routine invasive strategy over the selective invasive strategy is attenuated in younger patients aged <65 years and in women by the increased risk of early events which seem to have no consequences for long-term cardiovascular mortality. No other clinical risk factors were able to identify patients with differential responses to a routine invasive strategy. Trial registration http://www.controlled-trials.com/ISRCTN82153174 (ICTUS), http://www.controlled-trials.com/ISRCTN07752711 (RITA-3).

  14. Brain stem oxidative stress and its associated signaling in the regulation of sympathetic vasomotor tone.

    PubMed

    Chan, Samuel H H; Chan, Julie Y H

    2012-12-15

    There is now compelling evidence from studies in humans and animals that overexcitation of the sympathetic nervous system plays an important role in the pathogenesis of cardiovascular diseases. An excellent example is neurogenic hypertension, in which central sympathetic overactivation is involved in the development, staging, and progression of the disease, and one of the underlying mechanisms involves oxidative stress in key brain stem sites that are engaged in the regulation of sympathetic vasomotor tone. Using the rostral ventrolateral medulla (RVLM) and nucleus tractus solitarii (NTS) as two illustrative brain stem neural substrates, this article provides an overview of the impact of reactive oxygen species and antioxidants on RVLM and NTS in the pathogenesis of neurogenic hypertension. This is followed by a discussion of the redox-sensitive signaling pathways, including several kinases, ion channels, and transcription factors that underpin the augmentation in sympathetic vasomotor tone. In addition, the emerging view that brain stem oxidative stress is also causally related to a reduction in sympathetic vasomotor tone and hypotension during brain stem death, methamphetamine intoxication, and temporal lobe status epilepticus will be presented, along with the causal contribution of the oxidant peroxynitrite formed by a reaction between nitric oxide synthase II (NOS II)-derived nitric oxide and superoxide. Also discussed as a reasonable future research direction is dissection of the cellular mechanisms and signaling cascades that may underlie the contributory role of nitric oxide generated by different NOS isoforms in the differential effects of oxidative stress in the RVLM or NTS on sympathetic vasomotor tone.

  15. Nonpharmacologic, nonherbal management of menopause-associated vasomotor symptoms: an umbrella systematic review (protocol).

    PubMed

    Goldstein, Karen M; McDuffie, Jennifer R; Shepherd-Banigan, Megan; Befus, Deanna; Coeytaux, Remy R; Van Noord, Megan G; Goode, Adam P; Masilamani, Varsha; Adam, Soheir; Nagi, Avishek; Williams, John W

    2016-04-07

    Vasomotor symptoms such as hot flashes and night sweats are a common concern of perimenopausal and postmenopausal women and are associated with a decreased quality of life. These symptoms can be effectively managed with hormone therapy, but safety concerns limit its use. Thus, understanding the effectiveness of nonpharmacologic therapies such as acupuncture or yoga is critical to managing these common symptoms in older women. Our review seeks to address the following question: In women with menopause-associated vasomotor symptoms, what are the effects on health-related quality of life, vasomotor symptoms, and adverse events of the following nonpharmacologic, nonherbal interventions as compared with any inactive control or active comparator: (a) acupuncture, (b) yoga, tai chi, and qigong, (c) structured exercise, and (d) meditation, mindfulness-based practices, and relaxation? We describe a protocol for an umbrella review approach, supplemented by evaluating randomized controlled trials (RCTs) published after the most recent good-quality systematic review for each of the eligible interventions. Specific interventions were chosen based on current literature and with input from a technical expert panel and organizational stakeholders. We will conduct a thorough literature search and perform a quality assessment of potentially included systematic reviews and RCTs. Our umbrella review, supplemented by an additional search for eligible RCTs, aims to synthesize existing evidence on the use of nonpharmacologic, nonherbal interventions to manage bothersome vasomotor symptoms in perimenopausal and postmenopausal women. PROSPERO CRD42016029335.

  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. [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.

  18. Invasive Management Strategies and Antithrombotic Treatments in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome in China: Findings From the Improving CCC Project (Care for Cardiovascular Disease in China).

    PubMed

    Yang, Qing; Wang, Ying; Liu, Jing; Liu, Jun; Hao, Yongchen; Smith, Sidney C; Huo, Yong; Fonarow, Gregg C; Ma, Changsheng; Ge, Junbo; Taubert, Kathryn A; Morgan, Louise; Guo, Yang; Wang, Wei; Zhou, Yujie; Zhao, Dong

    2017-06-01

    Early invasive strategies and antithrombotic treatments are key treatments of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). Few studies have examined the use of these strategies in patients with NSTE-ACS in China. This study aimed to assess the applications of invasive strategies and antithrombotic treatments in patients with NSTE-ACS and compare their outcomes. A nationwide registry study, Improving CCC (Care for Cardiovascular Disease in China) ACS project, was launched in 2014 as a collaborative study of the American Heart Association and Chinese Society of Cardiology (CSC), with 142 participating hospitals reporting details of clinical management and outcomes of patients with NSTE-ACS. The use of invasive strategies and antithrombotic treatments was examined based on updated guidelines. Major adverse cardiovascular events were analyzed. A total of 9953 patients with NSTE-ACS were enrolled. Angiography was performed in 63.1% of these patients, and 58.2% underwent percutaneous coronary intervention (PCI). However, 40.6% of patients did not undergo early risk assessment, and very-high-risk patients had the lowest proportion of PCI (41.7%). PCI was performed within recommended times in 11.1% of very-high-risk patients and 26.3% of high risk patients. Those who underwent PCI within 2 hours had higher mortality in high-risk and very-high-risk patients who received PCI. Early dual antiplatelet treatment was given in 88.3% of patients. There are notable differences between guideline recommendations and the clinical management of patients with NSTE-ACS in China. The reasons for very-high-risk NSTE-ACS patients not undergoing PCI, and the optimal timing of PCI, require further clarification. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616. © 2017 American Heart Association, Inc.

  19. 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

  20. Hazard identification of particulate matter on vasomotor dysfunction and progression of atherosclerosis.

    PubMed

    Møller, Peter; Mikkelsen, Lone; Vesterdal, Lise Kristine; Folkmann, Janne Kjærsgaard; Forchhammer, Lykke; Roursgaard, Martin; Danielsen, Pernille Høgh; Loft, Steffen

    2011-04-01

    The development and use of nanoparticles have alerted toxicologists and regulators to issues of safety testing. By analogy with ambient air particles, it can be expected that small doses are associated with a small increase in risk of cardiovascular diseases, possibly through oxidative stress and inflammatory pathways. We have assessed the effect of exposure to particulate matter on progression of atherosclerosis and vasomotor function in humans, animals, and ex vivo experimental systems. The type of particles that have been tested in these systems encompass TiO(2), carbon black, fullerene C(60), single-walled carbon nanotubes, ambient air particles, and diesel exhaust particles. Exposure to ambient air particles is associated with accelerated progression of atherosclerosis and vasomotor dysfunction in both healthy and susceptible animal models and humans at risk of developing cardiovascular diseases. The vasomotor dysfunction includes increased vasoconstriction as well as reduced endothelium-dependent vasodilatation; endothelium-independent vasodilatation is often unaffected indicating mainly endothelial dysfunction. Pulmonary exposure to TiO(2), carbon black, and engineered nanoparticles generate vasomotor dysfunction; the effect size is similar to that generated by combustion-derived particles, although the effect could depend on the exposure period and the administered dose, route, and mode. The relative risk associated with exposure to nanoparticles may be small compared to some traditional risk factors for cardiovascular diseases, but superimposed on these and possible exposure to large parts of the population it is a significant public health concern. Overall, assessment of vasomotor dysfunction and progression of atherosclerosis are promising tools for understanding the effects of particulate matter.

  1. Coronary artery ectasia in an adult Noonan syndrome detected on coronary CT angiography.

    PubMed

    Hakim, Fayaz A; Gruden, James F; Panse, Prasad M; Alegria, Jorge R

    2013-12-01

    Coronary ectasia is rare in patients with Noonan syndrome. When suspected during echocardiography more common causes including Kawasaki disease in children and atherosclerosis coronary artery disease in adults should be ruled out. Coronary CT angiogram, a non-invasive imaging tool may be preferred over conventional coronary angiogram in the initial diagnosis and monitoring the progression of coronary ectasia in such patients. Aspirin may be considered to prevent coronary thrombosis. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  2. Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores.

    PubMed

    Cordeiro, M A S; Miller, J M; Schmidt, A; Lardo, A C; Rosen, B D; Bush, D E; Brinker, J A; Bluemke, D A; Shapiro, E P; Lima, J A C

    2006-05-01

    To show an overall diagnostic accuracy > or = 90% for detection of > or = 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 x 0.5-MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. ECG gated 32 x 0.5-MDCTA (32 x 0.5 mm cross sections, 0.35 x 0.35 x 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m2). Native arteries, including > or = 1.5 mm branches, and bypass grafts were screened for > or = 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 x 0.5-MDCTA) was analysed by quantitative coronary angiography. Median Agatston calcium score was 510 (range 3-5066). Sensitivity, specificity, and positive and negative predictive values for detection of > or = 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter-defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). Coronary 32 x 0.5-MDCTA accurately excludes > or = 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%.

  3. 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.

  4. Coronary microembolization.

    PubMed

    Skyschally, Andreas; Leineweber, Kkirsten; Gres, Petra; Haude, Michael; Erbel, Raimund; Heusch, Gerd

    2006-09-01

    Atherosclerotic plaque rupture is the key event in the pathogenesis of acute coronary syndromes and it also occurs during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the epicardial coronary artery with subsequent impending myocardial infarction, but may in milder forms result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. This review summarizes the present experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes and highlights the main consequences of coronary microembolization--reduced coronary reserve, microinfarction, inflammation and oxidative modification of contractile proteins, contractile dysfunction and perfusion-contraction mismatch.Furthermore, the review presents the available clinical evidence for coronary microembolization in patients and compares the clinical observations with observations in the experimental model.

  5. Diagnostic performance and comparative cost-effectiveness of non-invasive imaging tests in patients presenting with chronic stable chest pain with suspected coronary artery disease: a systematic overview.

    PubMed

    van Waardhuizen, Claudia N; Langhout, Marieke; Ly, Felisia; Braun, Loes; Genders, Tessa S S; Petersen, Steffen E; Fleischmann, Kirsten E; Nieman, Koen; Hunink, M G Myriam

    2014-01-01

    Several non-invasive imaging techniques are currently in use for the diagnostic workup of adult patients with stable chest pain suspected of having coronary artery disease (CAD). In this paper, we present a systematic overview of the evidence on diagnostic performance and comparative cost-effectiveness of new modalities in comparison to established technologies. A literature search for English language studies from 2009 to 2013 was performed, and two investigators independently extracted data on patient and study characteristics. The reviewed published evidence on diagnostic performance and cost-effectiveness support a strategy of CTCA as a rule out (gatekeeper) test of CAD in low- to intermediate-risk patients since it has excellent diagnostic performance and as initial imaging test is cost-effective under different willingness-to-pay thresholds. More cost-effectiveness research is needed in order to define the role and choice of cardiac stress imaging tests.

  6. A yoga & exercise randomized controlled trial for vasomotor symptoms: Effects on heart rate variability.

    PubMed

    Jones, Salene M W; Guthrie, Katherine A; Reed, Susan D; Landis, Carol A; Sternfeld, Barbara; LaCroix, Andrea Z; Dunn, Andrea; Burr, Robert L; Newton, Katherine M

    2016-06-01

    Heart rate variability (HRV) reflects the integration of the parasympathetic nervous system with the rest of the body. Studies on the effects of yoga and exercise on HRV have been mixed but suggest that exercise increases HRV. We conducted a secondary analysis of the effect of yoga and exercise on HRV based on a randomized clinical trial of treatments for vasomotor symptoms in peri/post-menopausal women. Randomized clinical trial of behavioral interventions in women with vasomotor symptoms (n=335), 40-62 years old from three clinical study sites. 12-weeks of a yoga program, designed specifically for mid-life women, or a supervised aerobic exercise-training program with specific intensity and energy expenditure goals, compared to a usual activity group. Time and frequency domain HRV measured at baseline and at 12 weeks for 15min using Holter monitors. Women had a median of 7.6 vasomotor symptoms per 24h. Time and frequency domain HRV measures did not change significantly in either of the intervention groups compared to the change in the usual activity group. HRV results did not differ when the analyses were restricted to post-menopausal women. Although yoga and exercise have been shown to increase parasympathetic-mediated HRV in other populations, neither intervention increased HRV in middle-aged women with vasomotor symptoms. Mixed results in previous research may be due to sample differences. Yoga and exercise likely improve short-term health in middle-aged women through mechanisms other than HRV. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease: A Meta-Analysis.

    PubMed

    Wolff, Georg; Dimitroulis, Dimitrios; Andreotti, Felicita; Kołodziejczak, Michalina; Jung, Christian; Scicchitano, Pietro; Devito, Fiorella; Zito, Annapaola; Occhipinti, Michele; Castiglioni, Battistina; Calveri, Giuseppe; Maisano, Francesco; Ciccone, Marco M; De Servi, Stefano; Navarese, Eliano P

    2017-01-01

    Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment. We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75-0.90; P<0.001). The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting. © 2017 American Heart Association, Inc.

  8. Effects of estrogen therapy on postmenopausal sleep quality regardless of vasomotor symptoms: a randomized trial.

    PubMed

    Tansupswatdikul, P; Chaikittisilpa, S; Jaimchariyatam, N; Panyakhamlerd, K; Jaisamrarn, U; Taechakraichana, N

    2015-04-01

    To determine the effects of estrogen therapy on objective sleep quality in insomniac postmenopausal women without severe vasomotor symptoms and/or recognized hot flushes during sleep. Study design Randomized, double-blinded, placebo-controlled trial, parallel design (ClinicalTrials.gov Identifier: NCT01501422). Forty insomniac postmenopausal women with no severe vasomotor symptoms and/or recognized hot flushes during sleep were randomized into 2 months' treatment with a 50-μg transdermal estradiol patch or placebo. Sleep quality was determined objectively with wrist actigraphy. Sleep efficiency, total sleep time, wake up after sleep onset and number of awakenings were compared before and after treatment. The Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) questionnaires were used for subjective sleep quality assessment before and after treatment. The study showed no significant difference in sleep efficiency improvement between women having estrogen alone or placebo (median 85.7% vs. 85.2%, respectively, p = 0.71). Similarly, sleep quality scores assessed by ISI and ESS were not significantly different. Estrogen therapy in insomniac postmenopausal women without severe vasomotor symptoms and/or recognized hot flushes during sleep was not found to improve sleep efficiency during the study period.

  9. Non‐invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores

    PubMed Central

    Cordeiro, M A S; Miller, J M; Schmidt, A; Lardo, A C; Rosen, B D; Bush, D E; Brinker, J A; Bluemke, D A; Shapiro, E P

    2006-01-01

    Objective To show an overall diagnostic accuracy ⩾ 90% for detection of ⩾ 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 × 0.5‐MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. Methods ECG gated 32 × 0.5‐MDCTA (32 × 0.5 mm cross sections, 0.35 × 0.35 × 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m2). Native arteries, including ⩾ 1.5 mm branches, and bypass grafts were screened for ⩾ 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 × 0.5‐MDCTA) was analysed by quantitative coronary angiography. Results Median Agatston calcium score was 510 (range 3–5066). Sensitivity, specificity, and positive and negative predictive values for detection of ⩾ 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter‐defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). Conclusions Coronary 32 × 0.5‐MDCTA accurately excludes ⩾ 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%. PMID:16251224

  10. [Acute coronary syndrome -- 2012].

    PubMed

    Becker, Dávid; Merkely, Béla

    2012-12-23

    The acute coronary syndrome is the most severe form of coronary artery disease. It is an immediate threat of life and the mortality rate can be high without proper therapy and patient management. Based on the first ECG, two different forms can be distinguished: acute coronary syndrome with and without ST elevation. Besides adequate medication, management of these patients is an essential part of treatment. In case of ST elevation, coronarography and percutaneous coronary intervention is needed in general, within 24 hours from the onset of symptoms. When ST elevation is not detected on the ECG, individual ischemic risk factors and predictable mortality of the patient may define the necessity and the date of the invasive examination. The Hungarian hemodynamic laboratory network covers almost the whole country and, therefore, practically each patient may receive a state-of-the-art therapy. Although indicators of cardiovascular diseases are still prominent, the mortality rate of myocardial Infarction is decreasing in Hungary due to the well-organized invasive care.

  11. 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

  12. Methods to investigate coronary microvascular function in clinical practice.

    PubMed

    Lanza, Gaetano A; Camici, Paolo G; Galiuto, Leonarda; Niccoli, Giampaolo; Pizzi, Carmine; Di Monaco, Antonio; Sestito, Alfonso; Novo, Salvatore; Piscione, Federico; Tritto, Isabella; Ambrosio, Giuseppe; Bugiardini, Raffaele; Crea, Filippo; Marzilli, Mario

    2013-01-01

    A growing amount of data is increasingly showing the relevance of coronary microvascular dysfunction (CMVD) in several clinical contexts. This article reviews techniques and clinical investigations of the main noninvasive and invasive methods proposed to study coronary microcirculation and to identify CMVD in the presence of normal coronary arteries, also trying to provide indications for their application in clinical practice.

  13. 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

  14. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial.

    PubMed

    Geller, Stacie E; Shulman, Lee P; van Breemen, Richard B; Banuvar, Suzanne; Zhou, Ying; Epstein, Geena; Hedayat, Samad; Nikolic, Dejan; Krause, Elizabeth C; Piersen, Colleen E; Bolton, Judy L; Pauli, Guido F; Farnsworth, Norman R

    2009-01-01

    The aim of this study was to evaluate the safety and efficacy of black cohosh and red clover compared with placebo for the relief of menopausal vasomotor symptoms. This study was a randomized, four-arm, double-blind clinical trial of standardized black cohosh, red clover, placebo, and 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate (CEE/MPA; n = 89). Primary outcome measures were reduction in vasomotor symptoms (hot flashes and night sweats) by black cohosh and red clover compared with placebo; secondary outcomes included safety evaluation, reduction of somatic symptoms, relief of sexual dysfunction, and overall improvement in quality of life. Reductions in number of vasomotor symptoms after a 12-month intervention were as follows: black cohosh (34%), red clover (57%), placebo (63%), and CEE/MPA (94%), with only CEE/MPA differing significantly from placebo. Black cohosh and red clover did not significantly reduce the frequency of vasomotor symptoms as compared with placebo. Secondary measures indicated that both botanicals were safe as administered. In general, there were no improvements in other menopausal symptoms. Compared with placebo, black cohosh and red clover did not reduce the number of vasomotor symptoms. Safety monitoring indicated that chemically and biologically standardized extracts of black cohosh and red clover were safe during daily administration for 12 months.

  15. Safety and Efficacy of Black Cohosh and Red Clover for the Management of Vasomotor Symptoms: A Randomized Controlled Trial

    PubMed Central

    Geller, Stacie E.; Shulman, Lee P.; van Breemen, Richard B.; Banuvar, Suzanne; Zhou, Ying; Epstein, Geena; Hedayat, Samad; Nikolic, Dejan; Krause, Elizabeth C.; Piersen, Colleen E.; Bolton, Judy L.; Pauli, Guido F.; Farnsworth, Norman R.

    2009-01-01

    Objective The aim of this study was to evaluate the safety and efficacy of black cohosh and red clover compared with placebo for the relief of menopausal vasomotor symptoms. Design This study was a randomized, four-arm, double-blind clinical trial of standardized black cohosh, red clover, placebo and 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate (CEE/MPA; n = 89). Primary outcome measures were reduction in vasomotor symptoms (hot flashes and night sweats) by black cohosh and red clover compared with placebo; secondary outcomes included safety evaluation, reduction of somatic symptoms, relief of sexual dysfunction, and overall improvement in quality of life. Results Reductions in number of vasomotor symptoms after 12-month intervention were as follows: black cohosh (34%), red clover (57%), placebo (63%), and CEE/MPA (94%), with only CEE/MPA differing significantly from placebo. Black cohosh and red clover did not significantly reduce the frequency of vasomotor symptoms as compared with placebo. Secondary measures indicated that both botanicals were safe as administered. In general, there were no improvements in other menopausal symptoms. Conclusions Compared with placebo, black cohosh and red clover did not reduce the number of vasomotor symptoms. Safety monitoring indicated that chemically and biologically standardized extracts of black cohosh and red clover were safe during daily administration for 12 months. PMID:19609225

  16. The additional value of patient‐reported health status in predicting 1‐year mortality after invasive coronary procedures: a report from the Euro Heart Survey on Coronary Revascularisation

    PubMed Central

    Lenzen, Mattie J; Reimer, Wilma J M Scholte op; Pedersen, Susanne S; Boersma, Eric; Maier, Willibald; Widimsky, Petr; Simoons, Maarten L; Mercado, Nestor F; Wijns, William

    2007-01-01

    Objective Self‐perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS‐CR) provided an opportunity to explore whether impaired health status was a predictor of 1‐year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods Data from the EHS‐CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self‐report measure of health status, the EuroQol Questionnaire (EQ‐5D) at discharge and information on 1‐year follow‐up, resulting in a study population of 3786 patients. Results The 1‐year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ‐5D as compared with non‐survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self‐care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (⩽60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1‐year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions This analysis shows that impaired health status is associated with a 2–3‐fold increased risk of all‐cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice. PMID:16980515

  17. Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study.

    PubMed

    Chen, Marcus Y; Rochitte, Carlos E; Arbab-Zadeh, Armin; Dewey, Marc; George, Richard T; Miller, Julie M; Niinuma, Hiroyuki; Yoshioka, Kunihiro; Kitagawa, Kakuya; Sakuma, Hajime; Laham, Roger; Vavere, Andrea L; Cerci, Rodrigo J; Mehra, Vishal C; Nomura, Cesar; Kofoed, Klaus F; Jinzaki, Masahiro; Kuribayashi, Sachio; Scholte, Arthur J; Laule, Michael; Tan, Swee Yaw; Hoe, John; Paul, Narinder; Rybicki, Frank J; Brinker, Jeffrey A; Arai, Andrew E; Matheson, Matthew B; Cox, Christopher; Clouse, Melvin E; Di Carli, Marcelo F; Lima, João A C

    2017-07-01

    Purpose To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not

  18. 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.

  19. Unique aspects of the developing lung circulation: structural development and regulation of vasomotor tone

    PubMed Central

    Gao, Yuangsheng; Cornfield, David N.; Stenmark, Kurt R.; Thébaud, Bernard; Abman, Steven H.

    2016-01-01

    Abstract This review summarizes our current knowledge on lung vasculogenesis and angiogenesis during normal lung development and the regulation of fetal and postnatal pulmonary vascular tone. In comparison to that of the adult, the pulmonary circulation of the fetus and newborn displays many unique characteristics. Moreover, altered development of pulmonary vasculature plays a more prominent role in compromised pulmonary vasoreactivity than in the adult. Clinically, a better understanding of the developmental changes in pulmonary vasculature and vasomotor tone and the mechanisms that are disrupted in disease states can lead to the development of new therapies for lung diseases characterized by impaired alveolar structure and pulmonary hypertension. PMID:27942377

  20. Vasomotor Symptoms and Menopause: Findings from the Study of Women’s Health Across the Nation

    PubMed Central

    Thurston, Rebecca C.; Joffe, Hadine

    2011-01-01

    Vasomotor symptoms (VMS), or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. SWAN, one of the largest and most ethnically diverse longitudinal studies of the menopausal transition, has allowed unique insights into VMS. Specifically, SWAN has helped yield important information about the prevalence of, racial/ethnic differences in, risk factors for, and implications of VMS for midlife women’s mental and physical health. Below we review the literature on VMS, emphasizing findings which have emerged from SWAN and new areas of inquiry in the area of VMS. PMID:21961716

  1. [The complications of laser surgery for the treatment of chronic vasomotor rhinitis].

    PubMed

    Timoshenko, P A; Darvish, M S; Rodin, V V

    2013-01-01

    The objective of the present study was to reveal cases of complications developing after laser coagulation of inferior turbinated bones. This treatment was given to 322 patients presenting with vasomotor rhinitis. A surgical ND:YAG laser with a quartz light guide 400 mcm in diameter was used for the purpose. In the majority of the cases, a single irradiation session produced a persistent positive effect, both functional and morphological. At the same time, two patients developed an unusual complication in the form of osteomyelitis of an inferior turbinated bone with its sequestration.

  2. Cardiac CT: atherosclerosis to acute coronary syndrome

    PubMed Central

    Munnur, Ravi Kiran; Cameron, James D.; Ko, Brian S.; Meredith, Ian T.

    2014-01-01

    Coronary computed tomographic angiography (CCTA) is a robust non-invasive method to assess coronary artery disease (CAD). Qualitative and quantitative assessment of atherosclerotic coronary stenosis with CCTA has been favourably compared with invasive coronary angiography (ICA) and intravascular ultrasound (IVUS). Importantly, it allows the study of preclinical stages of atherosclerotic disease, may help improve risk stratification and monitor the progressive course of the disease. The diagnostic accuracy of CCTA in the assessment of coronary artery bypass grafts (CABG) is excellent and the constantly improving technology is making the evaluation of stents feasible. Novel techniques are being developed to assess the functional significance of coronary stenosis. The excellent negative predictive value of CCTA in ruling out disease enables early and safe discharge of patients with suspected acute coronary syndromes (ACS) in the Emergency Department (ED). In addition, CCTA is useful in predicting clinical outcomes based on the extent of coronary atherosclerosis and also based on individual plaque characteristics such as low attenuation plaque (LAP), positive remodelling and spotty calcification. In this article, we review the role of CCTA in the detection of coronary atherosclerosis in native vessels, stented vessels, calcified arteries and grafts; the assessment of plaque progression, evaluation of chest pain in the ED, assessment of functional significance of stenosis and the prognostic significance of CCTA. PMID:25610801

  3. No clear clinical benefit of using mini-invasive extracorporeal circulation in coronary artery bypass grafting in low-risk patients.

    PubMed

    Svitek, Vladimir; Lonsky, Vladimir; Mandak, Jiri; Krejsek, Jan; Kolackova, Martina; Brzek, Vladimir; Kubicek, Jaroslav; Volt, Martin; Bartos, Michael; Harrer, Jan

    2009-11-01

    Current research is engaged in innovative technologies of extracorporeal circulation (ECC) systems in an effort to eliminate negative effects. Some studies have shown that, due to the complexity of technical settings of mini-ECC, they invoke a weaker immune response compared to classic ECC. The clinical benefits of using these systems have not been clearly proven yet. A group of 54 patients who were indicated for elective coronary surgery were randomised into two groups - Group A (patients operated on using classic ECC - open modification) and Group B (patients operated on using mini-ECC). The concentrations of IL-6, PMN elastase and MCP-1 in both groups were monitored per- and postoperatively, along with the postoperative clinical course. The groups did not differ in the basic pre- and peroperative characteristics. We recorded a lower priming for mini-ECC (p < 0.001) and significantly reduced hemodilution during ECC. There were no differences in the clinical outcome in either group. Serum concentrations of monitored markers of immune reaction towards ECC showed higher activity during standard ECC. New technologies used in mini-systems have proven to lower activation of the immune system, which can be monitored using kinetics of proinflammatory mediators. In spite of these comparable laboratory results, we did not find differences in short-term clinical results when comparing both these groups of low-risk patients.

  4. [The treatment of allergic vasomotor rhinitis: diagnostic problems and local immunotherapy].

    PubMed

    Motta, G; Salzano, F A; Motta, S

    1995-06-01

    Treatment of allergic vasomotor rhinitis is to be regarded with the factors that modify the symptomatology. In fact must be considered the morphological changes (septum deviation, adenoids, turbinates hypertrophy, polyps) infections (bacteria, chlamydiae, micetes) and specific allergens. Identification of allergens and sensitization threshold is to be studied; then specific hyposensitization will be assessed. In the present study, 68 subjects having nasal reactivity have been observed and underwent to different ways of treatment: 18 with permanent stenosis identified by rhinomanometry and not modified with vasoconstrictors were operated; 25 of the 50 patients with normal nasal cavities showed contemporary infections: after a specific antimicrobic or antimycotic treatment, a clear improvement was obtained documented by rhinomanometry before and after nasal stimulations. The 50 patients with normal morphology underwent a local hyposensitization against the allergens. As a matter of fact: a) in all cases a clear improvement was obtained in phase of increasing; b) after one year of maintainance just 13 over 50 (26%) returned to previous conditions. The Authors remark how local immunotherapy by the nasal way give good possibilities in a high percentage of cases in the following conditions: correct clinical evaluation, especially concerning the identification of factors determining vasomotor rhinitis; employment of precise techniques for diagnosis; observation of clinical data and results turning out from instrumental investigations, especially concerning the nasal provocation test evaluated by rhinomanometry.

  5. What causes hot flushes? The neuroendocrine origin of vasomotor symptoms in the menopause.

    PubMed

    Rossmanith, Winfried G; Ruebberdt, Wiebke

    2009-05-01

    Vasomotor symptoms (VMS) such as hot flushes and night sweats are frequently encountered during menopause and can greatly reduce the quality of life. These symptoms are causally related to decreasing estradiol concentrations, mainly in the serum and subsequently also in the hypothalamic temperature regulating centre. The lack of estrogens alters neurotransmitter activity, especially in the serotonergic and noradrenergic pathways. Because sex steroids act as potent neuromodulators, the substitution of ovarian sex steroids by hormone replacement therapy is the most effective treatment option for VMS. When contraindications exist for the use of sex steroids, steroid-free drugs are a possible alternative. A better understanding of the physiology of thermoregulation, thermoregulatory dysfunction and adaptive processes of the brain may facilitate the development of new therapeutic approaches. Such drugs could then be used to treat vasomotor disorders even when the use of steroid hormones is contraindicated. This review article summarises our knowledge on the mechanisms of temperature regulation and describes deviations from this regulation during altered sex steroid conditions. Our current knowledge on neuroendocrinology of thermoregulation may serve as a basis for the use of steroid-free pharmacological intervention.

  6. Frequency components of systolic blood pressure variability reflect vasomotor and cardiac sympathetic functions in conscious rats.

    PubMed

    Yoshimoto, Takahiko; Eguchi, Kunihiro; Sakurai, Hiroki; Ohmichi, Yusuke; Hashimoto, Tatsuyuki; Ohmichi, Mika; Morimoto, Atsuko; Yamaguchi, Yoshiko; Ushida, Takahiro; Iwase, Satoshi; Sugenoya, Junichi; Kumazawa, Takao

    2011-09-01

    In this study, after confirming the suppression of autonomic nervous function by isoflurane anesthesia using autonomic antagonists, we pharmacologically investigated the involvement of vasomotor and cardiac sympathetic functions in systolic blood pressure variability (SBPV) frequency components in conscious rats at rest and during exposure to low-ambient temperature (LT-exposure, 9°C for 90 min). Under unanesthesia, phentolamine administration (α-adrenoceptor antagonist, 10 mg/kg) decreased the mid-frequency component (MF 0.33-0.73 Hz) and inversely increased the high-frequency component (HF 1.3-2.5 Hz). The increased HF was suppressed by subsequent treatment with atenolol (β-adrenoceptor antagonist, 10 mg/kg), but not with atropine (muscarinic receptor antagonist, 10 mg/kg). Moreover, phentolamine administration after atenolol decreased MF, but did not increase HF. LT-exposure increased MF and HF; however, phentolamine pretreatment suppressed the increased MF during LT-exposure, and atenolol pretreatment dose-dependently decreased the increased HF. These results suggest that MF and HF of SBPV may reflect α-adrenoceptor-mediated vasomotor function and β-adrenoceptor-mediated cardiac sympathetic function, respectively, in the conscious state.

  7. Efficacy of continuous sequential transdermal estradiol and norethindrone acetate in relieving vasomotor symptoms associated with menopause.

    PubMed

    Notelovitz, M; Cassel, D; Hille, D; Furst, K W; Dain, M P; VandePol, C; Skarinsky, D

    2000-01-01

    This study was undertaken to evaluate the efficacy and tolerability of a combination estradiol plus norethindrone acetate transdermal delivery system given in a continuous sequential regimen with transdermal estradiol versus placebo in the treatment of vasomotor symptoms of menopause. This was a 12-week double-blind trial of 220 healthy postmenopausal women with > or = 8 moderate to severe hot flushes and sweating episodes per day. Women were randomly assigned to wear transdermal placebo patches or a transdermal patch releasing 50 microg/d 17beta-estradiol alone (Vivelle) for days 1 to 14 of each cycle and a combination patch releasing 50 microg/d 17beta-estradiol plus 1 of 3 dosage levels (140, 250, or 400 microg/d) of norethindrone acetate (CombiPatch) for days 15 through 28. There was a significant (P <.001) reduction by the second week in the mean number of daily hot flushes from baseline to end point with all 3 doses of estradiol plus norethindrone acetate compared with placebo. Significant (P <.001) reductions in the mean intensity of hot flushes and sweating were also noted with estradiol plus norethindrone acetate compared with placebo. The incidences of adverse events with all 3 doses of estradiol plus norethindrone acetate and with placebo were comparable. An estradiol plus norethindrone acetate transdermal delivery system administered in a continuous sequential regimen with transdermal estradiol was well tolerated and effective for the treatment of moderate to severe vasomotor symptoms in postmenopausal women.

  8. 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

  9. Vasomotor symptoms and cardiometabolic risk factors in menopausal women: a MONET Group study.

    PubMed

    Abdulnour, J; Stacey, D; Dionne, I J; Brochu, M; Doucet, É; Prud'homme, D

    2016-08-01

    Conflicting results have been reported concerning the prevalence of cardiometabolic risk factors in women experiencing vasomotor symptoms (VMS). To compare cardiometabolic risk factors between women with and without VMS during the menopause transition and to determine the influence of physical activity on the prevalence of VMS. Yearly assessment of women transitioning through menopause included self-reported VMS (hot flushes and night sweats), body composition and fat distribution, fasting glucose, insulin and lipids, and physical activity levels. Eighty-five of the 102 premenopausal women at baseline were included (age: 49.9 ± 2.0 years; body mass index: 23.2 ± 2.2 kg/m(2)). According to linear mixed model analyses, no statistically significant differences were observed for fat mass, lean body mass, body fat distribution indices and cardiometabolic risk factors, when comparing symptomatic vs. asymptomatic women. Neither physical activity levels nor intensity were associated with the prevalence of VMS. Our results suggest that women transitioning through menopause who reported VMS did not show greater deteriorations in body composition, body fat distribution and cardiometabolic risk factors. Furthermore, physical activity levels were not associated with lower prevalence of vasomotor symptoms in the present cohort.

  10. Vasomotor and urogenital problems at midlife: a study on rural and urban women in India.

    PubMed

    Dasgupta, Doyel; Ray, Subha

    2015-01-01

    During the transition to menopause, women experience symptoms which vary widely. This variation is attributed not only to the hormonal change, but also to the effect of socio-demographic and reproductive factors. The present research aimed to (a) find out the rural-urban difference in experiencing menopausal problems at peri-menopausal and post-menopausal stages and (b) to identify the factors associated with these problems. In total, 1400 Bengali speaking, Hindu women, aged 40-55 years were selected from rural and urban areas of West Bengal. Data on socio-demographic and reproductive variables and menopausal problems were collected using appropriate tools. Bivariate analysis finds a rural-urban difference for vasomotor, urinary and vaginal problems (p ≤ 0.05). Multivariate analysis revealed socio-demographic and reproductive factors were significantly (p ≤ 0.005) associated with vasomotor (age at menarche, menopausal and residential status, duration of breastfeeding, menstrual discharge type, use of OCP, sterilization and BMI), urinary (ages at menarche and marriage, menstrual bleeding length, use of OCP, menopausal status, monthly household expenditure and BMI) and vaginal (type of menstrual discharge, menopausal status, educational level, monthly household expenditure and BMI) problems for this study group. Socio-demographic and reproductive factors seem to be significantly associated with menopausal problems. Residential status appears to be a confounder variable for menopausal problems.

  11. Coronary flow capacity: concept, promises, and challenges.

    PubMed

    van de Hoef, Tim P; Echavarría-Pinto, Mauro; Escaned, Javier; Piek, Jan J

    2017-07-01

    The vasodilator capacity of the coronary circulation is an important diagnostic and prognostic characteristic, and its accurate assessment is therefore an important frontier. The coronary flow capacity (CFC) concept was introduced to overcome the limitations associated with the use of coronary flow reserve (CFR) for this purpose, which are related to the sensitivity of CFR to physiological alterations in systemic and coronary hemodynamics. CFC was developed from positron emission tomography, and was subsequently extrapolated to invasive coronary physiology. These studies suggest that CFC is a robust framework for the identification of clinically relevant coronary flow abnormalities, and improves identification of patients at risk for adverse events over the use of CFR alone. This Review will discuss the concept of CFC, its promises in the setting of ischaemic heart disease, and its challenges both in theoretical and practical terms.

  12. 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

  13. Coronary collaterals.

    PubMed

    Gorlin, R

    1976-01-01

    Coronary collaterals are probably enlargements of pre-existing channels which respond to local vasodilators and which function whenever pressure differences exist across them. Thus, in human coronary atherosclerosis collaterals are only seen when there is a severe intervening arterial obstruction (in excess of 75%). Coronary collaterals follow epicardial and intramycardial pathways, and the intermediary connections may be at vessels of highly varying caliber. The flow potential of most collateral pathways in man is possibly adequate for segmental myocardial function at lower than normal demands but clearly is inadequate for most, if not all, stressful interventions. In the last analysis, coronary collaterals in man are more an indication of severe regional ischemia (present or potential) than a sign of biological "compensation'' for a perfusion deficit.

  14. Physiology of thermoregulatory dysfunction and current approaches to the treatment of vasomotor symptoms.

    PubMed

    Deecher, Darlene C

    2005-04-01

    Vasomotor symptoms (VMS), including hot flushes and night sweats, are the most common symptoms associated with menopause. Although the physiology of hot flushes is not fully defined, understanding the complex thermoregulatory circuitry that underlies VMS is important for the development of new therapies. This circuitry is composed of three distinct, yet interconnected, components: core body temperature, neurochemical messaging and peripheral vasculature. Evidence suggests that multiple physiological systems, including the neuroendocrine system, are important in the maintenance of thermoregulatory control. Causative roles of declining ovarian steroid levels in initiating thermoregulatory dysfunction are well documented. This paper reviews the physiology involved in the underlying thermoregulatory dysfunction that presumably causes VMS and discusses how this physiology relates to current and future VMS treatment options.

  15. 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

  16. Coronary Artery Bypass Grafting

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...

  17. Protein kinase CK2 increases glutamatergic input in the hypothalamus and sympathetic vasomotor tone in hypertension.

    PubMed

    Ye, Zeng-You; Li, De-Pei; Li, Li; Pan, Hui-Lin

    2011-06-01

    Increased glutamatergic input in the paraventricular nucleus (PVN) is important for high sympathetic outflow in hypertension, but the associated molecular mechanisms remain unclear. Here, we determined the role of protein kinase CK2 (formerly casein kinase II) in increased N-methyl-d-aspartate receptor (NMDAR) activity in spinally projecting PVN neurons and sympathetic vasomotor tone in spontaneously hypertensive rats (SHRs). The selective CK2 inhibitors 5,6-dichloro-1-β-d-ribofuranosylbenzimidazole (DRB) or 4,5,6,7-tetrabromobenzotriazole (TBB) significantly decreased the frequency of miniature EPSCs (mEPSCs) of labeled PVN neurons in SHRs but not in Wistar-Kyoto (WKY) normotensive rats. Also, DRB abolished the inhibitory effect of the NMDAR antagonist AP5 on the frequency of mEPSCs in SHRs. Treatment with DRB or TBB significantly reduced the amplitude of evoked NMDA-EPSCs but not AMPA-EPSCs in SHRs. Furthermore, DRB significantly decreased the firing activity of PVN neurons in SHRs but not in WKY rats. The membrane protein level of CK2α in the PVN, but not brainstem and prefrontal cortex, was significantly higher in SHRs than in WKY rats. Lowering blood pressure with celiac ganglionectomy in SHRs did not alter the increased CK2α level and the effects of DRB on mEPSCs and NMDA-EPSCs. In addition, intracerebroventricular injection of DRB not only significantly reduced blood pressure and lumbar sympathetic nerve discharges but also eliminated the inhibitory effect of AP5 microinjected into the PVN on sympathetic nerve activity in SHRs. Our findings suggest that augmented CK2 activity critically contributes to increased presynaptic and postsynaptic NMDAR activity in the PVN and elevated sympathetic vasomotor tone in essential hypertension.

  18. 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

  19. Efficacy and tolerability of desvenlafaxine succinate treatment for menopausal vasomotor symptoms: a randomized controlled trial.

    PubMed

    Speroff, Leon; Gass, Margery; Constantine, Ginger; Olivier, Sophie

    2008-01-01

    To compare efficacy and safety of desvenlafaxine succinate (desvenlafaxine) with placebo for the treatment of vasomotor symptoms. This randomized, double-blind, placebo-controlled trial enrolled 707 healthy, postmenopausal women experiencing 50 or more moderate-to-severe hot flushes per week. Participants randomly received desvenlafaxine 50, 100, 150, or 200 mg or placebo daily. Trial duration was 52 weeks. Primary outcomes were change from baseline in average daily number of moderate-to-severe hot flushes and in daily hot flush severity score at weeks 4 and 12. Six hundred twenty women with an average of 11 moderate-to-severe hot flushes per day at baseline completed at least one on-therapy evaluation for primary efficacy end points; 519 participants completed 12 weeks of treatment, and 368 completed the study. Desvenlafaxine 100 mg/d achieved a significantly greater reduction compared with placebo in average daily number of hot flushes at weeks 4 (P=.013) and 12 (P=.005), reaching a 64% decrease from baseline at week 12, and the 75% responder rate was significantly higher for desvenlafaxine 100 mg (50%) compared with placebo (29%; P=.003; number needed to treat=4.7) at week 12. Average daily severity of hot flushes was significantly lower in the desvenlafaxine 100-mg group compared with placebo at week 12 (P=.020). Desvenlafaxine-treated women reported significantly more treatment-emergent adverse events than placebo-treated women during the first week of therapy only. Desvenlafaxine is an effective nonhormonal treatment for vasomotor symptoms in postmenopausal women. Its tolerability profile is consistent with that of other serotonin-norepinephrine reuptake inhibitors. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00421031 I.

  20. 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.

  1. Effects of physical activity on vasomotor symptoms: examination using objective and subjective measures.

    PubMed

    Elavsky, Steriani; Gonzales, Joaquin U; Proctor, David N; Williams, Nancy; Henderson, Victor W

    2012-10-01

    Physical activity (PA) is essential for successful aging and for the prevention and management of common chronic diseases. The empirical support for the beneficial effects of PA on vasomotor symptoms has, however, been mixed. The purpose of this study was to assess the effects of acute aerobic exercise and daily PA on menopausal vasomotor symptoms. Community-dwelling midlife women (N = 121; age range, 40-60 y) not using hormone therapy were recruited for a 15-day daily diary study. Women completed psychological, cardiorespiratory fitness, body composition, and hormonal status screening followed by a 15-day prospective assessment in a "real-life" setting using a personal digital assistant. Participants also completed a 30-minute moderate-intensity aerobic exercise bout on a treadmill between days 5 and 8. Daily PA was assessed objectively through accelerometry, and all symptomatic women (n = 92) completed two 24-hour Biolog sternal skin conductance recordings of hot flashes (HFs)-one at baseline and one immediately after treadmill exercise. Both total objective (P = 0.054) and total subjective (P < 0.05) HFs decreased after the acute exercise bout. At the between-person level, daily PA was not associated with self-reported HFs. However, at the within-person level, performing more moderate physical activity than usual was associated with more self-reported HFs in women with lower fitness levels. Moderate aerobic exercise decreases objective and subjective HFs 24 hours after exercise; however, in women with lower fitness levels, more daily moderate PA leads to more self-reported symptoms.

  2. 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

  3. Vasomotor and sexual symptoms in older Australian women: a cross-sectional study.

    PubMed

    Zeleke, Berihun M; Bell, Robin J; Billah, Baki; Davis, Susan R

    2016-01-01

    To determine the prevalence and severity of vasomotor symptoms (VMS) and sexual symptoms in community-dwelling older women, and to explore factors associated with VMS. Population-based cross-sectional study. Not applicable. A total of 1,548 women aged 65-79 years. None. The presence and self-rated severity of VMS (hot flashes, night sweats, or sweating), and sexual symptoms (intimacy, desire, and vaginal dryness) were determined with the use of the Menopause Quality of Life (MenQOL) questionnaire. All items of the vasomotor and the sexual MenQOL domains were completed by 1,532 and 1,361 of the study participants, respectively. Menopausal hormone therapy (MHT) use was reported by 6.2% of the women, and 6.9% reported using vaginal estrogen. Among the 1,426 women not using MHT, at least 1 VMS was reported by 32.8%. The prevalence of VMS rated as moderately to severely bothersome was 3.4%. A total of 54.4% of currently partnered women had sexual symptoms, and 32.5% reported vaginal dryness during intercourse in the past month. In the multivariate analysis, factors significantly associated with VMS were age, obesity, being a caregiver for another person, and bilateral oophorectomy. VMS and vaginal atrophy symptoms are common in community-dwelling older women, but they are predominantly untreated. The degree of distress caused by sexual symptoms among older women needs further exploration. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Suture-induced right coronary artery stenosis.

    PubMed

    Seltmann, Martin; Achenbach, Stephan; Muschiol, Gerd; Feyrer, Richard

    2010-01-01

    An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site. Invasive angiography confirmed the stenosis, and percutaneous intervention was successfully performed.

  5. Role of K+ ATP channels and adenosine in the regulation of coronary blood flow during exercise with normal and restricted coronary blood flow.

    PubMed Central

    Duncker, D J; van Zon, N S; Ishibashi, Y; Bache, R J

    1996-01-01

    Regulation of coronary vasomotor tone during exercise is incompletely understood. We investigated the contributions of K+ ATP channels and adenosine to the coronary vasodilation that occurs during exercise in the normal heart and in the presence of a coronary artery stenosis. Dogs that were chronically instrumented with a Doppler flow probe, hydraulic occluder, and indwelling catheter on the left anterior descending coronary artery were exercised on a treadmill to produce heart rates of approximately 200 beats/min. By graded inflation of the occluder to produce a wide range of coronary stenosis severities, we determined the coronary pressure-flow relation. K+ atp channel blockade with intracoronary glibenclamide (10-50 microgram/kg per min) decreased coronary blood flow during exercise at coronary pressures within and below the autoregulatory range, indicating that coronary K+ ATP channel activation is critical for producing coronary vasodilation with either normal arterial inflow or when flow is restricted by a coronary artery stenosis. Adenosine receptor blockade with intravenous 8-phenyltheophylline (5 mg/kg) had no effect on coronary flow at pressures within the autoregulatory range but decreased flow at pressures < 55 mmHg. In contrast, in the presence of K+ ATP channel blockade, the addition of adenosine receptor blockade further decreased coronary flow even at coronary pressures in the autoregulatory range, indicating increased importance of the vasodilator influence of endogenous adenosine during exercise when K+ atp channels are blocked. Intracoronary adenosine (50 microgram/kg per min) increased coronary flow at perfusion pressures both within and below the autoregulatory range. In contrast, selective K+ ATP channel activation with intracoronary pinacidil (0.2-5.0 microgram/kg per min) increased flow at normal but not at lower coronary pressures (< 55 mmHg). This finding demonstrates that not all K+ ATP channels are activated during exercise at pressures

  6. MRI in coronary artery disease.

    PubMed

    Barkhausen, Jörg; Hunold, Peter; Waltering, Kai-Uwe

    2004-12-01

    Diagnosis of coronary artery disease (CAD) is a major challenge for medical imaging, because CAD is the leading cause of death in developed nations. Several non-invasive tests are used in clinical routine for the detection of CAD. However, due to limited sensitivity and specificity, the reliable diagnosis as well as the exclusion of CAD can only be established by catheter angiography. In patients with known CAD, therapeutic decisions require accurate information on myocardial function, ischemia and viability. Recently, magnetic resonance (MR) imaging has emerged as a non-invasive cardiac imaging technique that provides information on cardiac morphology, cardiac function, myocardial viability, and coronary morphology. This review discusses technical aspects and the clinical impact of different MR techniques.

  7. Quantification of left coronary bifurcation angles and plaques by coronary computed tomography angiography for prediction of significant coronary stenosis: A preliminary study with dual-source CT

    PubMed Central

    Cui, Yue; Zeng, Wenjuan; Yu, Jie; Lu, Jing; Hu, Yuannan; Diao, Nan; Liang, Bo; Han, Ping; Shi, Heshui

    2017-01-01

    Purpose To evaluate the diagnostic performance of left coronary bifurcation angles and plaque characteristics for prediction of coronary stenosis by dual-source CT. Methods 106 patients suspected of coronary artery disease undergoing both coronary computed tomography angiography (CCTA) and invasive coronary angiography (CAG) within three months were included. Left coronary bifurcation angles including the angles between the left anterior descending artery and left circumflex artery (LAD-LCx), left main coronary artery and left anterior descending artery (LM-LAD), left main coronary artery and left circumflex artery (LM-LCx) were measured on CT images. CCTA plaque parameters were calculated by plaque analysis software. Coronary stenosis ≥ 50% by CAG was defined as significant. Results 106 patients with 318 left coronary bifurcation angles and 126 vessels were analyzed. The bifurcation angle of LAD-LCx was significantly larger in left coronary stenosis ≥ 50% than stenosis < 50%, and significantly wider in the non-calcified plaque group than calcified. Multivariable analyses showed the bifurcation angle of LAD-LCx was an independent predictor for significant left coronary stenosis (OR = 1.423, P = 0.002). In ROC curve analysis, LAD-LCx predicted significant left coronary stenosis with a sensitivity of 66.7%, specificity of 78.4%, positive predictive value of 85.2% and negative predictive value of 55.8%. The lipid plaque volume improved the diagnostic performance of CCTA diameter stenosis (AUC: 0.854 vs. 0.900, P = 0.045) in significant coronary stenosis. Conclusions The bifurcation angle of LAD-LCx could predict significant left coronary stenosis. Wider LAD-LCx is related to non-calcified lesions. Lipid plaque volume could improve the diagnostic performance of CCTA for coronary stenosis prediction. PMID:28346530

  8. Safety, efficacy and patient acceptability of drospirenone and estradiol in the treatment of menopausal vasomotor symptoms: a review

    PubMed Central

    Carranza-Lira, Sebastián

    2009-01-01

    During menopause vasomotor symptoms are one of the main complaints about which women seek medical advice. For symptom control, several therapies have been used, among which hormone therapy has produced good results. One of these is estrogen monotherapy, which unfortunately may induce endometrial hyperplasia in women with an intact uterus. A progestin must be added to avoid this risk. Progestins may induce several secondary effects such as breast tenderness, hirsutism, edema and unfavorable lipid profile modifications. Recently a new progestin called drospirenone has been synthesized and used in combination with estradiol for the treatment of postmenopausal women. This progestin is derived from spironolactone, and lacks estrogenic, androgenic and glucocorticoid activities. Several studies have evaluated safety, efficacy and patient tolerability, and have shown a good profile in all these parameters. All studies agree that the combination of estradiol 1 mg plus drospirenone 2 mg is a good choice for postmenopausal women with vasomotor symptoms. PMID:19503766

  9. Vasomotor effect after acute intoxication with bupivacaine and levobupivacaine in rats via intraperitoneal route analyzed via digital infrared imaging.

    PubMed

    Carstens, Angelo Manoel Grande; Tambara, Elizabeth Milla; Matias, Jorge Eduardo Fouto; Brioschi, Marcos Leal; Colman, Daniel; Carstens, Márcio Grande

    2011-01-01

    The study of the vasomotor effect of local anesthetics (LA) is of paramount importance for the analysis of the occurrence of cardiotoxic and neurotoxic effects, and drug interactions. In order to find a safer drug than racemic bupivacaine, this study aimed to analyze digital infrared imaging of acute vasomotor effect of bupivacaine and levobupivacaine in rats intraperitoneally. We used 30 male Wistar rats distributed into three groups (n=10) and subjected to an intraperitoneal injection of LA. In Group C (control) 1 mL 0.9% saline was injected intraperitoneally. In Group B (bupivacaine), intraperitoneal injection of 0.5% of racemic bupivacaine (S50-R50), dose of 20 mg.kg⁻¹ of body weight. In Group L (levobupivacaine), intraperitoneal injection of levobupivacaine 0.5% enantiomeric excess (S75-R25) in dose of 20 mg.kg⁻¹ of body weight. The procedure was thermographicly continuously filmed from the time of pre-injection until 30 minutes after injection. The results of the recordings were analyzed in graphical form, verifying the maximum temperature of each rat and the average temperature of the system that housed the animal. The results of graphic analysis showed no difference between Group L and Group C, and the average temperature remained stable throughout the experiment in both groups. In Group B, there was a phenomenon of temperature increase after intraperitoneal injection of bupivacaine. The results demonstrated that the vasomotor effect of the acute toxicity of levobupivacaine was similar to Group C with saline, through macroscopic studies by infrared digital filmmaking, and that there were vasomotor changes (vasoconstriction), with bupivacaine intoxication in relation to both Group C and Group L. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

  10. Mind-body interventions for vasomotor symptoms in healthy menopausal women and breast cancer survivors. A systematic review.

    PubMed

    Stefanopoulou, Evgenia; Grunfeld, Elizabeth Alice

    2016-11-11

    Mind-body therapies are commonly recommended to treat vasomotor symptoms, such as hot flushes and night sweats (HFNS). The purpose of this systematic review was to evaluate the available evidence to date for the efficacy of different mind-body therapies to alleviate HFNS in healthy menopausal women and breast cancer survivors. Randomized controlled trials (RCTs) were identified using seven electronic search engines, direct searches of specific journals and backwards searches through reference lists of related publications. Outcome measures included HFNS frequency and/or severity or self-reported problem rating at post-treatment. The methodological quality of all studies was systematically assessed using predefined criteria. Twenty-six RCTs met the inclusion criteria. Interventions included yoga (n = 5), hypnosis (n = 3), mindfulness (n = 2), relaxation (n = 7), paced breathing (n = 4), reflexology (n = 1) and cognitive behavioural therapy (CBT) (n = 4). Findings were consistent for the effectiveness of CBT and relaxation therapies for alleviating troublesome vasomotor symptoms. For the remaining interventions, although some trials indicated beneficial effects (within groups) at post-treatment and/or follow up, between group findings were mixed and overall, methodological differences across studies failed to provide convincing supporting evidence. Collectively, findings suggest that interventions that include breathing and relaxation techniques, as well as CBT, can be beneficial for alleviating vasomotor symptoms. Additional large, methodologically rigorous trials are needed to establish the efficacy of interventions on vasomotor symptoms, examine long-term outcomes and understand how they work.

  11. The effect of inferior turbinate outfracture on nasal resistance to airflow in vasomotor rhinitis assessed by rhinomanometry.

    PubMed

    Thomas, P L; John, D G; Carlin, W V

    1988-02-01

    Twenty-eight patients with nasal obstruction due to vasomotor rhinitis were assessed using anterior rhinomanometry before and six weeks after the operation of out-fracture and amputation of the posterior ends of the inferior turbinates. It was found that the operation did not significantly improve the nasal airway. Though just over half the patients had an objective improvement in nasal airflow, only half of this group reported a subjective improvement in their symptoms.

  12. Maintenance of the efficacy of desvenlafaxine in menopausal vasomotor symptoms: a 1-year randomized controlled trial.

    PubMed

    Pinkerton, JoAnn V; Archer, David F; Guico-Pabia, Christine J; Hwang, Eunhee; Cheng, Ru-Fong J

    2013-01-01

    The purpose of this study was to assess the 1-year maintenance of the efficacy of desvenlafaxine 100 mg/day (administered as desvenlafaxine succinate) established on week 12 in a 1-year, double-blind, randomized, placebo-controlled trial in postmenopausal women seeking treatment of bothersome vasomotor symptoms. Primary efficacy endpoints were changes in hot flush (HF) frequency and severity on weeks 12, 26, and 52 in an efficacy substudy population (≥50 moderate and severe HFs per week at baseline). Secondary endpoints were Greene climacteric scale, patient global impression symptom rating, and patient global impression of change scores (weeks 12, 26, and 52) for the main study efficacy population. Safety was assessed throughout the trial. The mean baseline HF frequency (efficacy substudy population, n = 365) was 12 moderate and severe HFs per day; the mean baseline severity score was 2.4. At 1 year, women treated with desvenlafaxine maintained the efficacy established on week 12. Desvenlafaxine reduced HF frequency by 7.47 moderate and severe HFs per day on week 12 (adjusted mean difference from placebo, -2.48; 95% CI, -3.47 to -1.50; P < 0.001) and by 7.70 moderate and severe HFs per day on month 12 (adjusted mean difference from placebo, -2.86; 95% CI, -4.14 to -1.57; P < 0.001). Desvenlafaxine reduced the mean severity score by 0.63 on week 12 (placebo, -0.30; P < 0.001) and by 0.75 on month 12 (placebo, -0.44; P = 0.003). Reductions in Greene Climacteric Scale total score (main study efficacy population, n = 1,950) were significantly greater for desvenlafaxine than for placebo on months 3, 6, and 12 (all P < 0.001). Treatment-emergent adverse event rates were 84% for desvenlafaxine and 79% for placebo (P = 0.006). Full safety results are reported separately. The treatment efficacy of desvenlafaxine 100 mg/day achieved on week 12 in postmenopausal women with vasomotor symptoms is maintained for 1 year.

  13. Menopause is associated with self-reported poor sleep quality in women without vasomotor symptoms.

    PubMed

    Hung, Hao-Chang; Lu, Feng-Hwa; Ou, Horng-Yih; Wu, Jin-Shang; Yang, Yi-Ching; Chang, Chih-Jen

    2014-08-01

    The aim of this study was to investigate the relationship between menopause and self-reported sleep quality in Chinese women without vasomotor symptoms. Cross-sectional data were collected from a decoded database of the National Cheng Kung University Hospital. Menopause was defined as absence of menses for at least 12 months or a history of hysterectomy and oophorectomy. Self-reported sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates poorer self-reported sleep quality, and a global PSQI score greater than 5 differentiates poor sleepers from good sleepers. Of the 1,088 women recruited, 353 (32.4%) were in postmenopause status. Postmenopausal women had higher mean (SD) global PSQI scores (8.0 [3.3] vs. 6.1 [2.2], P < 0.001) and a greater prevalence of poor sleepers (73.1% vs. 60.8%, P < 0.001) compared with premenopausal women. Multivariate linear regression analysis showed that menopause (β = 1.532; 95% CI, 1.135 to 1.949; P < 0.001) and snoring (β = 0.764; 95% CI, 0.299 to 1.228; P = 0.001) were positively associated with global PSQI scores, whereas long sleep duration (β = -0.791; 95% CI, -1.113 to -0.468; P < 0.001) was negatively associated with global PSQI scores. Multivariate logistic regression analyses showed that menopause (odds ratio, 1.453; 95% CI, 1.030 to 2.051; P < 0.05), long sleep duration (odds ratio, 0.545; 95% CI, 0.418 to 0.710; P < 0.001), and snoring (odds ratio, 2.022; 95% CI, 1.312 to 3.116; P = 0.001) were independent predictors of poor sleepers. Postmenopausal women without vasomotor symptoms have significantly higher global PSQI scores and a higher risk of being poor sleepers than premenopausal women. In addition, menopause and snoring are associated with an increased risk of poor self-reported sleep quality independently of cardiometabolic factors and lifestyle, whereas long sleep duration is associated with a decreased risk of poor self-reported sleep quality.

  14. Vasomotor sympathetic neural control is maintained during sustained upright posture in humans

    PubMed Central

    Fu, Qi; Shook, Robin P; Okazaki, Kazunobu; Hastings, Jeffrey L; Shibata, Shigeki; Conner, Colin L; Palmer, M Dean; Levine, Benjamin D

    2006-01-01

    Vasomotor sympathetic activity plays an important role in arterial pressure maintenance via the baroreflex during acute orthostasis in humans. If orthostasis is prolonged, blood pressure may be supported additionally by humoral factors with a possible reduction in sympathetic baroreflex sensitivity. We tested the hypothesis that baroreflex control of muscle sympathetic nerve activity (MSNA) decreases during prolonged upright posture. MSNA and haemodynamics were measured supine and during 45 min 60 deg upright tilt in 13 healthy individuals. Sympathetic baroreflex sensitivity was quantified using the slope of the linear correlation between MSNA and diastolic pressure during spontaneous breathing. It was further assessed as the relationship between MSNA and stroke volume, with stroke volume derived from cardiac output (C2H2 rebreathing) and heart rate. Total peripheral resistance was calculated from mean arterial pressure and cardiac output. We found that MSNA increased from supine to upright (17 ± 8 (s.d.) versus 38 ± 12 bursts min−1; P < 0.01), and continued to increase to a smaller degree during sustained tilt (39 ± 11, 41 ± 12, 43 ± 13 and 46 ± 15 bursts min−1 after 10, 20, 30 and 45 min of tilt; between treatments P < 0.01). Sympathetic baroreflex sensitivity increased from supine to upright (−292 ± 180 versus −718 ± 362 units beat−1 mmHg−1; P < 0.01), but remained unchanged as tilting continued (−611 ± 342 and −521 ± 221 units beat−1 mmHg−1 after 20 and 45 min of tilt; P = 0.49). For each subject, changes in MSNA were associated with changes in stroke volume (r = 0.88 ± 0.13, P < 0.05), while total peripheral resistance was related to MSNA during 45 min upright tilt (r = 0.82 ± 0.15, P < 0.05). These results suggest that the vasoconstriction initiated by sympathetic adrenergic nerves is maintained by ongoing sympathetic activation during sustained (i.e. 45 min) orthostasis without obvious changes in vasomotor sympathetic neural

  15. 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

  16. Minimally invasive atherectomy with a virtual 3-Fr sheathless guiding catheter and a 0.9-mm excimer laser catheter for the treatment of coronary in-stent restenosis: a case report.

    PubMed

    Hashimoto, Sho; Takahashi, Akihiko; Mizuguchi, Yukio; Yamada, Takeshi; Taniguchi, Norimasa; Hata, Tetsuya

    2016-10-01

    A 50-year-old man underwent percutaneous coronary intervention for stent restenosis in his left anterior descending artery. After insertion of a 5-Fr sheathless guiding catheter through the right radial artery, optical coherence tomography (OCT) revealed a circumferential dense fibrotic plaque in the distal part of the stent. Therefore, we performed excimer laser coronary atherectomy using a 0.9-mm concentric catheter and dilatation with a drug-coated balloon catheter. Subsequent OCT revealed a circumferential reduction of the neointimal material. The patient's clinical course was uneventful, and he was discharged 2 days after the percutaneous coronary intervention without any access site complications.

  17. Transesophageal echocardiographic assessment of coronary stenosis: a decade of experience.

    PubMed

    Biederman, R W; Sorrell, V L; Nanda, N C; Voros, S; Thakur, A C

    2001-01-01

    Coronary artery imaging is routinely obtained invasively at cardiac catheterization through coronary angiography. This remains the gold standard, but with advances in ultrasound technology, electron beam computed tomography, and magnetic resonance imaging, newer noninvasive methodologies are achieving greater success at imaging the coronary anatomy. This review is meant to highlight the important accomplishments from transesophageal echocardiographic (TEE) investigations that have studied the coronary arteries. The specific technique for optimally imaging the coronaries with high frequency transducers, color and conventional Doppler, in addition to contrast-enhanced methods, will be analyzed. Importantly, this article serves as a reminder to echocardiographers and cardiologists that excellent, clinically relevant information of the coronary arteries can be obtained routinely during TEE. This technique is part of the trend noted by the other authors in this special edition; that is, echocardiography is becoming the gold standard of the new millennium for many diagnostic areas, even coronary angiography.

  18. Objective cognitive performance is related to subjective memory complaints in midlife women with moderate to severe vasomotor symptoms.

    PubMed

    Drogos, Lauren L; Rubin, Leah H; Geller, Stacie E; Banuvar, Suzanne; Shulman, Lee P; Maki, Pauline M

    2013-12-01

    Memory complaints increase as women transition from the premenopausal stage to the postmenopausal stage. We explored the extent to which subjective memory complaints were associated with objective cognitive test performance, affective symptoms, and menopausal symptoms in midlife women with moderate to severe vasomotor symptoms. We predicted that subjective memory complaints would be related to affective symptoms and lower performance on tests of memory and attention. Sixty-eight midlife women (mean age, 53 y; 54% African American) with at least 35 hot flashes per week completed the Memory Functioning Questionnaire, a battery of objective cognitive tests, a menopausal symptom inventory, and mood questionnaires. Linear regression analyses were conducted to examine predictors (symptoms and objective cognitive scores) of ratings on each of four Memory Functioning Questionnaire subscales and a validated single-item rating of current memory. Negative affect and delayed verbal memory predicted a single-item rating of current memory. Negative affect and poorer scores on tests of attention and working memory predicted Frequency of Forgetting. Lower positive affect, higher vasomotor symptoms, and increased age predicted lower Retrospective Memory Functioning. Increased age predicted Use of Mnemonics. These findings strengthen the growing body of evidence indicating that women with memory complaints during the menopausal transition have an accurate appraisal of their memory function and that their complaints relate to affect and, to a lesser extent, vasomotor symptoms. Given that cognitive performance is within the reference range, these findings suggest that women can detect subtle changes in memory performance during the menopausal transition.

  19. 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

    2016-01-01

    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.

  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

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

    2015-01-01

    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). 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. 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. 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. 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.

  1. Coronary arteriography and angioplasty

    SciTech Connect

    King, S.B.; Douglas, J.S.

    1985-01-01

    This book explores biomedical radiography of the heart. Topics considered include six bench marks in the history of cardiac catheterization; normal coronary anatomy; anomalies of the coronary arteries; pathoanotomy of the coronary arteries and complications; indications, limitations, and risks of coronary arteriography and left ventriculography; catheterization techniques in coronary arteriography and left ventriculography: the Sones technique; catheterization techniques in coronary arteriography and left ventriculography: the Judkins technique; modification of Judkins catheters; catheterization techniques in coronary arteriography and left ventriculography multipurpose technique; new views in coronary arteriography; quantitative evaluation of left ventricular function; complications of coronary arteriography: management during and following the procedure; interpretation of coronary arteriograms and left ventriculograms; prevalence and distribution of disease in patients catheterized for suspected coronary disease at Emory University Hospital; the Cardiac Catheterization Laboratory; selection for surgery or percutaneous transluminal coronary angioplasty; intracoronary thrombolysis; and percutaneous transluminal coronary angioplasty.

  2. Vitamin C Deficiency Reduces Muscarinic Receptor Coronary Artery Vasoconstriction and Plasma Tetrahydrobiopterin Concentration in Guinea Pigs

    PubMed Central

    Skovsted, Gry Freja; Tveden-Nyborg, Pernille; Lindblad, Maiken Marie; Hansen, Stine Normann

    2017-01-01

    Vitamin C (vitC) deficiency is associated with increased cardiovascular disease risk, but its specific interplay with arteriolar function is unclear. This study investigates the effect of vitC deficiency in guinea pigs on plasma biopterin status and the vasomotor responses in coronary arteries exposed to vasoconstrictor/-dilator agents. Dunkin Hartley female guinea pigs (n = 32) were randomized to high (1500 mg/kg diet) or low (0 to 50 mg/kg diet) vitC for 10–12 weeks. At euthanasia, coronary artery segments were dissected and mounted in a wire-myograph. Vasomotor responses to potassium, carbachol, sodium nitroprusside (SNP), U46619, sarafotoxin 6c (S6c) and endothelin-1 (ET-1) were recorded. Plasma vitC and tetrahydrobiopterin were measured by HPLC. Plasma vitC status reflected the diets with deficient animals displaying reduced tetrahydrobiopterin. Vasoconstrictor responses to carbachol were significantly decreased in vitC deficient coronary arteries independent of their general vasoconstrictor/vasodilator capacity (p < 0.001). Moreover, in vitC deficient animals, carbachol-induced vasodilator responses correlated with coronary artery diameter (p < 0.001). Inhibition of cyclooxygenases with indomethacin increased carbachol-induced vasoconstriction, suggesting an augmented carbachol-induced release of vasodilator prostanoids. Atropine abolished carbachol-induced vasomotion, supporting a specific muscarinic receptor effect. Arterial responses to SNP, potassium, S6c, U46619 and ET-1 were unaffected by vitC status. The study shows that vitC deficiency decreases tetrahydrobiopterin concentrations and muscarinic receptor mediated contraction in coronary arteries. This attenuated vasoconstrictor response may be linked to altered production of vasoactive arachidonic acid metabolites and reduced muscarinic receptor expression/signaling. PMID:28671625

  3. [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.

  4. 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

  5. H2S Prevents Cyclosporine A-Induced Vasomotor Alteration in Rats.

    PubMed

    Ping, Na-Na; Mi, Yan-Ni; Liu, Dong-Zheng; Zhang, Sai; Chen, Jing-Guo; Cao, Yong-Xiao

    2017-07-01

    Cyclosporine A (CsA) induces hypertension after transplantation. Hydrogen sulfide (H2S) was found to have hypotensive/vasoprotective effects in the cardiovascular system. The present study aims to investigate the role of H2S on CsA-induced vascular function disorder in rats. Rats were subcutaneously injected with CsA 25 mg/kg for 21 days. Blood pressure was measured by the tail-cuff method. Vasomotion was determined using a sensitive myograph. Western blotting and immunohistochemistry were used to quantify the protein expression of endothelin type A (ETA) receptor and essential MAPK pathway molecules. Vascular superoxide anion production and serum contents of malondialdehyde were determined. The results showed that sodium hydrosulfide (NaHS), a H2S donor, significantly attenuated the increase of blood pressure and contractile responses, and the upregulation of ETA receptor induced by CsA. In addition, NaHS could restore the CsA decreased acetylcholine-induced vasodilatation. Furthermore, NaHS blocked the CsA-induced elevation of reactive oxygen species level, extracellular signal-regulated kinase and p38 MAPK activities. In conclusion, H2S prevents CsA-induced vasomotor dysfunction. H2S attenuates CsA-induced ETA receptor upregulation, which may be associated with MAPK signal pathways. H2S ameliorates endothelial-dependent relaxation, which may be through antioxidant activity.

  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. Role of cuneiform nucleus in regulation of sympathetic vasomotor tone in rats.

    PubMed

    Shafei, Mohammad Naser; Nasimi, Ali; Alaei, Hojatallah; Pourshanazari, Ali Asghar; Hosseini, Mahmoud

    2012-06-01

    The cuneiform nucleus (CnF) is a sympathoexcitatory area involved in the central cardiovascular regulation. Its role in the maintaining vasomotor tone has, however, not yet been clarified. In the present study the effects of cobalt chloride (CoCl(2)) a nonselective synapse blocker and NMDA and non-NMDA glutamate receptors on resting mean arterial blood pressure and heart rate of CnF have been evaluated. CoCl(2), AP5 (an NMDA receptor antagonist) and CNQX (an AMPA/kinase receptor antagonist) (100nl) were microinjected into the CnF of anesthetized rats. The blood pressure and heart rate were recorded throughout the experiment. The responses of blood pressure and heart rate were compared with the pre-injection (paired t-test) and control (independent t-test) values. Microinjection of CoCl(2), AP5 and CNQX did not change the basal blood pressure and heart rate. In conclusion, our present study indicates that the CnF is not important in the regulation of cardiovascular tone. Copyright © 2011. Published by Elsevier Ireland Ltd.

  8. Complementary and alternative medicine use for vasomotor symptoms among women who have discontinued hormone therapy.

    PubMed

    Kupferer, Elizabeth M; Dormire, Sharon L; Becker, Heather

    2009-01-01

    To explore the use and perceived usefulness of complementary and alternative medicine therapies and nonhormonal conventional medicine alternatives to treat vasomotor symptoms occurring after withdrawal from hormone therapy. Retrospective, single cross sectional descriptive study. Study volunteers were recruited via a direct mailed questionnaire sent to a sample of women throughout the United States. Additional respondents were recruited through flyers and postcards advertising the study placed with permission at several health care provider offices and other locations. A sample of 563 menopausal women who had discontinued the use of hormone therapy completed a questionnaire describing their experiences with the use of complementary and alternative medicine. Responses to an investigator developed survey. Nearly half of the women surveyed used complementary and alternative medicine. The most common choices of complementary and alternative medicine were (a) multivitamins and calcium, (b) black cohosh, (c) soy supplements and food, (d) antidepressants, (e) meditation and relaxation, (f) evening primrose oil, (g) antihypertensives, and (h) homeopathy. Of the alternative therapies that were used by at least 5% of the sample, antidepressants were perceived as the most useful. With the increased adoption of complementary and alternative medicine, it is important for health care providers to be familiar with the various methods so they are comfortable discussing the benefits and risks with their patients to assist them in making informed decisions.

  9. 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.

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

    PubMed

    Westcott, Erika B; Segal, Steven S

    2013-04-01

    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. Although 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. © 2013 John Wiley & Sons Ltd.

  11. Effect of baseline vascular tone on vasomotor responses in cat lip.

    PubMed Central

    Karita, K; Izumi, H

    1995-01-01

    1. Parasympathetic vasodilator and sympathetic vasoconstrictor responses were monitored using laser Doppler measurement of red cell flux in the lips of anaesthetized and artificially ventilated cats. 2. Three relationships were investigated: (i) that between the reflex parasympathetic vasodilator response induced by lingual nerve (LN) stimulation and baseline red cell flux (BRCF) levels adjusted by repetitive stimulation of the cervical sympathetic nerve (CSN) at various frequencies; (ii) that between the sympathetic vasoconstrictor response elicited by CSN stimulation and the adjusted BRCF levels; and (iii) that between the vasomotor response evoked by simultaneous stimulation of the LN and CSN and the adjusted BRCF levels. 3. The amplitude of the parasympathetic vasodilator response increased as BRCF decreased. In contrast, the amplitude of the sympathetic vasoconstrictor response increased in line with BRCF. 4. Simultaneous activation of the parasympathetic and sympathetic nerves induced a blood flow decrease at high BRCF levels but an increase at low levels. 5. The tendency for the skin of cold subjects to vasodilate and that of warm ones to vasoconstrict in response to various types of stimuli discussed in the light of the present findings. PMID:7738856

  12. Cerebral vasomotor reactivity assessment using Transcranial Doppler and MRI with apnea test

    PubMed Central

    Herrera Campos, C.R.; Beltramini, G.C.; Avelar, W.M.; Lima, F.O.; Li, L.M.

    2016-01-01

    Differently from previous studies that used Transcranial Doppler (TCD) and functional MRI (fMRI) for cerebral vasomotor reactivity (CVR) assessment in patients with carotid stenosis (CS), we assessed CVR using an identical stimulus, the Breath-Holding Test (BHT). We included 15 patients with CS and 7 age-matched controls to verify whether fMRI responded differently to BHT between groups and to calculate the agreement rate between tests. For TCD, impaired CVR was defined when the mean percentage increase on middle cerebral artery velocities was ≤31% on 3 consecutive 30-s apnea intercalated by 4-min normal breathing intervals. For fMRI, the percent variation on blood oxygen level-dependent (BOLD) signal intensity in the lentiform nucleus (LN) ipsilateral to the CS (or both LNs for controls) from baseline breathing to apnea was measured. The Euclidian differences between the series of each subject and the series of controls and patients classified it into normal or impaired CVR. We found different percent variations on BOLD-signal intensities between groups (P=0.032). The agreement was good in Controls (85.7%; κ=0.69) and overall (77.3%; κ=0.54). We conclude that BHT was feasible for CVR assessment on fMRI and elicited different BOLD responses in patients and controls, with a good overall agreement between the tests. PMID:27783807

  13. 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.

  14. Effects of sympathetic histamine on vasomotor responses of blood vessels in rabbit ear to electrical stimulation.

    PubMed

    Chen, Ying-Ying; Lv, Jun; Xue, Xiao-Yan; He, Gong-Hao; Zhou, Ying; Jia, Min; Luo, Xiao-Xing

    2010-06-01

    To investigate the effects of histamine receptor antagonists on vasoconstriction induced by electrical stimulation (ES) on posterior auricular nerve, and to explore the pre- and post-synaptic effects of sympathetic histamine on the vasomotor responses of vascular smooth muscle in rabbit ear. ES was applied to posterior auricular nerves of the whole rabbit ear at 10 Hz, 20 Hz and 40 Hz, respectively. Besides, the whole ear was perfused with different histamine receptor antagonists under constant perfusion pressure, and the changes in the flow rate of perfusate were observed. The flow rate of venous outflow was decreased by ES at all the 3 frequencies. The ES-induced vasoconstriction at 20 Hz and 40 Hz could be partly inhibited by H(1) receptor antagonist chlorpheniramine (P < 0.05). After exhaustion of histamine in mast cells by pretreatment with specific mast cell degranulator compound 48/80, chlorpheniramine could still inhibit the ES-induced flow rate reduction. In contrast, H(2) receptor antagonist cimetidine could enhance the 40-Hz ES-induced flow rate reduction (P < 0.05). Moreover, ES-induced vasoconstriction at the 3 frequencies could all be enhanced by H(3) receptor antagonist thioperamide (P < 0.05). Stimulation on the auricular nerve may evoke histamine release from sympathetic nerves rather than from mast cells. Moreover, the functions of sympathetic histamine vary from pre-synaptic modulation to post-synaptic vasoconstriction or vasodilatation, via activation of different histamine receptors.

  15. 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.

  16. Diagnostic performance of image navigated coronary CMR angiography in patients with coronary artery disease.

    PubMed

    Henningsson, Markus; Shome, Joy; Bratis, Konstantinos; Vieira, Miguel Silva; Nagel, Eike; Botnar, Rene M

    2017-09-11

    The use of coronary MR angiography (CMRA) in patients with coronary artery disease (CAD) remains limited due to the long scan times, unpredictable and often non-diagnostic image quality secondary to respiratory motion artifacts. The purpose of this study was to evaluate CMRA with image-based respiratory navigation (iNAV CMRA) and compare it to gold standard invasive x-ray coronary angiography in patients with CAD. Consecutive patients referred for CMR assessment were included to undergo iNAV CMRA on a 1.5 T scanner. Coronary vessel sharpness and a visual score were assigned to the coronary arteries. A diagnostic reading was performed on the iNAV CMRA data, where a lumen narrowing >50% was considered diseased. This was compared to invasive x-ray findings. Image-navigated CMRA was performed in 31 patients (77% male, 56 ± 14 years). The iNAV CMRA scan time was 7 min:21 s ± 0 min:28 s. Out of a possible 279 coronary segments, 26 segments were excluded from analysis due to stents or diameter less than 1.5 mm, resulting in a total of 253 coronary segments. Diagnostic image quality was obtained for 98% of proximal coronary segments, 94% of middle segments, and 91% of distal coronary segments. The sensitivity and specificity was 86% and 83% per patient, 80% and 92% per vessel and 73% and 95% per segment. In this study, iNAV CMRA offered a very good diagnostic performance when compared against invasive x-ray angiography. Due to the short and predictable scan time it can add clinical value as a part of a comprehensive CAD assessment protocol.

  17. Bioabsorbable scaffolds for the treatment of obstructive coronary artery disease: the next revolution in coronary intervention?

    PubMed

    Patel, Niket; Banning, Adrian P

    2013-09-01

    Conventional drug eluting stents allow predictable long-term relief from coronary obstruction in most cases. However, rigid permanent metallic stents alter flow dynamics, abolish vascular reactivity, limit the potential for maximal vasodilation and promote ongoing inflammation and abnormalities of endothelial function. It is hypothesised that they may contribute to mal-apposition of stent struts, accelerated atheroma within the stented segment and perhaps very late stent thrombosis. Dramatic advances in bioabsorbable materials and technology have delivered the potential for a fully absorbable scaffold, which is able to mechanically support the coronary artery, and elute a drug, for a predetermined time period and is then fully absorbed in to the vascular wall. This could permit the 'normalisation' of vascular function, with a number of potential advantages including true normalisation of vasomotor function, restoration of physiological responses to stress/exercise and completion of the vascular response to stenting, without the long-term consequences related to inflammation, accelerated atherosclerosis and thrombosis. Currently, over 16 different scaffolds are at varying stages of development. This review summarises the rationale for the development of absorbable scaffolds and the principal clinical research data.

  18. Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

    PubMed Central

    Costa Filho, Francisco Flávio; Chaves, Áurea Jacob; Ligabó, Lourenço Teixeira; dos Santos, Eduardo Moreira; da Silva, Danillo Taiguara; Puzzi, Marcelo Aguiar; Braga, Sérgio Luiz; Abizaid, Alexandre; Sousa, Amanda GMR

    2015-01-01

    Background Guidelines recommend that in suspected stable coronary artery disease (CAD), a clinical (non-invasive) evaluation should be performed before coronary angiography. Objective We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD. Methods We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests. Results A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77), age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26), diabetes (OR, 2.01; CI 95%, 1.40 - 2.90), dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07), typical angina (OR, 2.92; CI 95%, 1.77 - 4.83) and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27). Conclusions In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography. PMID:26312552

  19. Vasomotor menopausal symptoms are not associated with incidence of breast cancer in a population-based cohort of mid-aged women.

    PubMed

    Johanneke van den Berg, M; Mishra, Gita D; van der Schouw, Yvonne T; Herber-Gast, Gerrie-Cor M

    2014-03-01

    Recently, two case-control studies showed that vasomotor menopausal symptoms (VMS), i.e. hot flushes (HF) and night sweats (NS), are associated with a decreased risk of breast cancer. Until now, however, no prior studies have prospectively examined the association between VMS and breast cancer incidence. We investigated this in a population-based cohort of mid-aged women in Australia. We included 11,297 women without a history of breast cancer aged 47-52 years from the Australian Longitudinal Study on Women's Health, surveyed every 3 years from 1998 to 2010. Information regarding first invasive breast cancer events and date of diagnosis was obtained from cancer registries. We determined the association between HF and NS and breast cancer occurrence before the subsequent survey, using time-dependent cox regression analysis, adjusting for time-varying lifestyle factors. At baseline 33.1% of the women reported experiencing HF and 24.6% reported NS. During a mean follow-up of 13.7 years, 348 cases of breast cancer occurred. VMS were not associated with breast cancer; adjusted hazard ratios were 1.09; 95% confidence interval (CI) 0.87-1.35 for HF and 1.06; 95% CI 0.84-1.33 for NS. No significant interactions were found between each of body mass index, alcohol use, current hormone therapy use, menopausal status and VMS and breast cancer (p-values>0.05). We did not find an association between VMS and breast cancer incidence. Research in this area is scarce and additional large prospective population-based studies are required to confirm or refute these findings. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Multimodality Imaging of Left Circumflex Artery to Coronary Sinus Fistula

    PubMed Central

    Sze, Tan Ling; Abdul Aziz, Yang Faridah; Abu Bakar, Norzailin; Mohd Sani, Fadhli; Oemar, Hamid

    2015-01-01

    Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. Patients with this condition are usually asymptomatic. However, cardiac failure may occur later in life due to progressive enlargement of the fistula. Diagnosis is traditionally made by echocardiogram and conventional angiogram. However with the advantage of new technologies such as computed tomography (CT) coronary angiography, the course and communications of these fistulae can be delineated non-invasively and with greater accuracy. We report a case of a left circumflex artery fistula to the coronary sinus which was suspected on echocardiogram and the diagnosis was clinched on ECG-gated CT. PMID:25793089

  1. Coronary computed tomographic angiography: current and future uses

    PubMed Central

    Kantor, Birgit; Kuzo, Ronald S.; Gerber, Thomas C.

    2009-01-01

    Coronary computed tomographic angiography (CCTA) is a direct but minimally invasive method of visualizing coronary arteries. Acceptable indications for this technique include the assessment of suspected or known coronary artery anomalies, the evaluation of chest pain syndromes in patients with non diagnostic stress tests or who are unable to exercise, and exclusion of an ischemic etiology in patients with unexplained left ventricular dysfunction. Assessment of coronary stents with a diameter of <3.0 mm and imaging of asymptomatic patients with a goal of establishing prognosis are currently not accepted indications for CCTA. PMID:20011235

  2. 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…

  3. 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…

  4. Influence of the amount of myocardium subtended to a coronary stenosis on the index of microcirculatory resistance. Implications for the invasive assessment of microcirculatory function in ischemic heart disease.

    PubMed

    Echavarría-Pinto, Mauro; van de Hoef, Tim P; Nijjer, Sukhjinder; Gonzalo, Nieves; Nombela-Franco, Luis; Ibañez, Borja; Sen, Sayan; Petraco, Ricardo; Jimenez-Quevedo, Pilar; Nuñez-Gil, Ivan J; Cerrato, Enrico; Salinas, Pablo; Quirós, Alicia; Garcia-Garcia, Hector M; Fernandez-Ortiz, Antonio; Macaya, Carlos; Davies, Justin; Piek, Jan; Escaned, Javier

    2017-05-09

    The index of microcirculatory resistance (IMR) is growingly used to quantify microcirculatory function. However, in normal coronary arteries, resistance increases with the branching structure of the coronary tree, which suggest that IMR could be influenced by the amount of downstream myocardial mass (MM). We aimed to evaluate the influence of the amount of MM subtended to an intermediate stenosis on the IMR. IMR, fractional flow reserve and coronary flow reserve (CFR) were measured in 123 coronary arteries (102 patients) with intermediate stenosis. Jeopardized MM was estimated with the Myocardial Jeopardy Index (MJI). MM was inversely associated with IMR (R2=0.16, p<0.001). Differently, CFR was MM-independent (R2=0.0). Vessels with IMR ≥30 U subtended lower amounts of MM than vessels with IMR<30 [MJI: 13.0% (Q1-3, 12.5-18.2%) vs 20.4% (Q1-3, 15.10-25.5%), p<0.001], and at multivariate analyses, MM, aortic pressure, minimum lumen diameter and age were independent IMR predictors (R2=0.24, p<0.001). Vessels with IMR ≥30 U and preserved CFR supplied the smallest MM amounts, suggesting an anatomically reduced but functionally preserved vascular bed. The amount of myocardium subtending to a coronary stenosis is inversely associated with the IMR, while is not associated with the CFR.

  5. Cardiovascular, hemodynamic, neuroendocrine, and inflammatory markers in women with and without vasomotor symptoms.

    PubMed

    Gordon, Jennifer L; Rubinow, David R; Thurston, Rebecca C; Paulson, Julia; Schmidt, Peter J; Girdler, Susan S

    2016-11-01

    Vasomotor symptoms (VMS) may be associated with an increased risk of cardiovascular disease. One candidate mechanism may involve alterations in physiological responses to stress. The current study therefore examined the relationship between self-reported VMS bother and cardiovascular, hemodynamic, neuroendocrine, and inflammatory responses to an acute psychosocial stress protocol. One hundred eighty-six women in the menopausal transition or early postmenopausal stage (age 45-60 y) provided the data for this article. Subjective hot flash and night sweat bother were assessed using the Greene Climacteric Scale. Women also underwent a stressor battery involving a speech and a mental arithmetic task while cardiovascular, hemodynamic, neuroendocrine, and inflammatory responses were assessed. Repeated measures regression analyses were used to examine the relationship between self-reported VMS and physiologic responses to the stressor. In multivariate analyses adjusting for potential confounders, self-reported hot flash bother was associated with lower overall cardiac index and stroke volume index and higher overall vascular resistance index and levels of the inflammatory cytokine interleukin-6. Hot flash bother also tended to be associated with higher overall cortisol levels and higher baseline levels of plasma norepinephrine. Night sweat bother, on the other hand, was associated with higher overall cortisol levels and tended to be associated with higher interleukin-6. Self-reported VMS bother is associated with an unfavorable hemodynamic and neuroendocrine profile characterized by increased hypothalamic-pituitary-adrenal axis and central sympathetic activation, inflammation, and vasoconstriction. Further research investigating this profile in relation to VMS, and the potential health implications of this association, is warranted.

  6. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years.

    PubMed

    Gartoulla, Pragya; Worsley, Roisin; Bell, Robin J; Davis, Susan R

    2015-07-01

    This study aims to determine the prevalence and severity of menopausal symptoms in older postmenopausal women and, hence, the need for treatment options for women of this age. This is a cross-sectional questionnaire-based study conducted between October 2013 and March 2014 among 2,020 women aged 40 to 65 years and living independently across Australia. The main outcome measures were the prevalence of moderate to severe vasomotor symptoms (VMS), as measured by the Menopause-Specific Quality of Life Questionnaire, and the current use of prescription therapy for menopausal symptoms. The prevalence of moderate to severe VMS was as follows: 2.8% in premenopausal women, 17.1% in perimenopausal women, 28.5% in postmenopausal women younger than 55 years, 15.1% in postmenopausal women aged 55 to 59 years, and 6.5% in postmenopausal women aged 60 to 65 years. Prescription therapy for menopausal symptoms was used by 135 women: 120 (5.9%) women using hormone therapy and 15 (0.7%) women using nonhormonal medication. The factors positively associated with moderate to severe VMS were smoking (odds ratio, 1.6; 95% CI, 1.1-2.3; P < 0.05) and a body mass index of 25 to 29.9 kg/m(2) (odds ratio, 1.7; 95% CI, 1.1-2.5; P < 0.05); education beyond high school was inversely associated (odds ratio, 0.7; 95% CI, 0.5-0.9; P < 0.05). In this large, representative, community-based sample of women, there is a high prevalence of untreated moderate to severe VMS even in women aged 60 to 65 years. The use of vaginal estrogen and nonhormonal prescription therapy with proven efficacy for treatment of menopausal symptoms is strikingly low, suggesting that menopause remains an undertreated condition.

  7. Association of Menopausal Vasomotor Symptoms With Increased Bone Turnover During the Menopausal Transition

    PubMed Central

    Crandall, Carolyn J; Tseng, Chi-Hong; Crawford, Sybil L; Thurston, Rebecca C; Gold, Ellen B; Johnston, Janet M; Greendale, Gail A

    2011-01-01

    The purpose of this study was to determine the longitudinal association between menopausal vasomotor symptoms (VMS) and urinary N-telopeptide level (NTX) according to menopausal stage. We analyzed data from 2283 participants of the Study of Women's Health Across the Nation, a longitudinal community-based cohort study of women aged 42 to 52 years at baseline. At baseline and annually through follow-up visit 8, participants provided questionnaire data, urine samples, serum samples, and anthropometric measurements. Using multivariable repeated-measures mixed models, we examined associations between annually assessed VMS frequency and annual NTX measurements. Our results show that mean adjusted NTX was 1.94 nM of bone collagen equivalents (BCE)/mM of creatinine higher among early perimenopausal women with any VMS than among early perimenopausal women with no VMS (p < .0001). Mean adjusted NTX was 2.44 nM BCE/mM of creatinine higher among late perimenopausal women with any VMS than among late perimenopausal women with no VMS (p = .03). Among premenopausal women, VMS frequency was not significantly associated with NTX level. When NTX values among women with frequent VMS (≥6 days in past 2 weeks) were expressed as percentages of NTX values among women without frequent VMS, the differences were 3% for premenopausal women, 9% for early perimenopausal women, 7% for late perimenopausal women, and 4% for postmenopausal women. Adjustment for serum follicle-stimulating hormone (FSH) level greatly reduced the magnitudes of associations between VMS and NTX level. We conclude that among early perimenopausal and late perimenopausal women, those with VMS had higher bone turnover than those without VMS. Prior to the final menstrual period, VMS may be a marker for risk of adverse bone health. © 2011 American Society for Bone and Mineral Research. PMID:20878774

  8. Impact of the severity of vasomotor symptoms on health status, resource use, and productivity.

    PubMed

    Whiteley, Jennifer; Wagner, Jan-Samuel; Bushmakin, Andrew; Kopenhafer, Lewis; Dibonaventura, Marco; Racketa, Jill

    2013-05-01

    The current study characterizes health-related quality of life, work productivity, and resource use among postmenopausal women by severity of vasomotor symptoms (VMS). Participants were selected from the 2010 US National Health and Wellness Survey. Women aged 40 to 75 years who did not report a history of menstrual bleeding or spotting for 1 year were eligible for analysis (N = 3,267). Cohorts of women with no VMS (n = 1,740), mild VMS (n = 931), moderate VMS (n = 462), and severe VMS (n = 134) were compared after controlling for demographic and health characteristics. Outcome measures were assessed using linear models and included health status, work productivity within the past 7 days, and healthcare resource use within the past 6 months. The mean age of women experiencing severe VMS was 57.92 years. After demographic and health characteristics had been controlled for, women experiencing severe and moderate VMS reported significantly lower mean health status scores compared with women with no symptoms (P < 0.0001). The mean number of menopause symptom-related physician visits was significantly greater among women with severe, moderate, or mild symptoms than among women with no symptoms (P < 0.0001). Among employed women experiencing VMS, women with severe and moderate symptoms had adjusted presenteeism of 24.28% and 14.3%, versus 4.33% in women with mild symptoms (P < 0.001), and activities of daily living impairment of 31.66% and 17.06%, versus 6.16% in women with mild symptoms (P < 0.0001). In postmenopausal women, a greater severity of VMS is significantly associated with lower levels of health status and work productivity, and greater healthcare resource use.

  9. Effects of Testosterone and Estradiol Deficiency on Vasomotor Symptoms in Hypogonadal Men

    PubMed Central

    Lee, Hang; Webb, Matthew L.; Joffe, Hadine; Finkelstein, Joel S.

    2016-01-01

    Context: The hormonal basis of vasomotor symptoms (VMS) in hypogonadal men is incompletely understood. Objective: To determine the contributions of testosterone and estradiol deficiency to VMS in hypogonadal men. Design: Two randomized trials were conducted sequentially between September 2004 and April 2011. Controls were recruited separately. Setting: A single-site academic medical center. Participants: Healthy men ages 20–50, with normal serum testosterone levels. Intervention: Cohort 1 (n = 198, 81% completion) received goserelin acetate every 4 weeks to suppress gonadal steroids and were randomized to placebo or 1.25, 2.5, 5, or 10 g of testosterone gel daily for 16 weeks. Cohort 2 (n = 202, 78% completion) received the same regimen as cohort 1 plus anastrozole to block aromatization of testosterone. Controls (n = 37, 89% completion) received placebos for goserelin acetate and testosterone. Main Outcome Measures: Incidence of visits with VMS. This was a preplanned secondary analysis. Results: VMS were reported at 26% of visits in cohort 1, and 35% of visits in cohort 2 (P = .02), demonstrating an effect of estradiol deficiency. When adjacent estradiol level groups in cohort 1 were compared, the largest difference in VMS incidence was observed between the 5–9.9 and 10–14.9 pg/mL groups (38% vs 16%, P < .001). In cohort 2, the 10-g testosterone group differed significantly from placebo (16% vs 43%, P = .048) after adjustment for small differences in estradiol levels, indicating that high testosterone levels may suppress VMS. Conclusions: Estradiol deficiency is the key mediator of VMS in hypogonadal men. At high levels, testosterone may have a suppressive effect. PMID:27300575

  10. Laboratory and Ambulatory Evaluation of Vasomotor Symptom Monitors from the MsFLASH Network

    PubMed Central

    Carpenter, Janet S.; Newton, Katherine M.; Sternfeld, Barbara; Joffe, Hadine; Reed, Susan D.; Ensrud, Kristine E.; Milata, Jennifer L.

    2011-01-01

    Objective To evaluate monitors for assessing vasomotor symptoms (VMS) in laboratory and ambulatory settings prior to use in the MsFLASH network clinical trials testing VMS therapies. Methods This was a 3-phase study: Phase 1 - laboratory testing of the Freedman and prototype Bahr Monitor™; Phase 2 - laboratory testing of the commercial Bahr Monitor™ and Biolog™; and Phase 3 - ambulatory testing of the commercial Bahr Monitor™ and Biolog™. All phases enrolled midlife women with VMS, midlife women without VMS, and young women without VMS. Participants self-reported VMS by pressing event marker buttons. Questionnaires assessed demographics (all phases) and monitor acceptability (phases 2 and 3). Results Phase I testing was stopped due to sensitivity of the Freedman device to ambient humidity changes and lack of analytic software for the prototype Bahr Monitor™. In phases 2 and 3, agreement between event-marked and commercial Bahr or Biolog™-recorded VMS was higher in the laboratory than the ambulatory setting, however, agreement between monitors was poor in 2 of 3 laboratory groups (midlife no VMS and young no VMS) and all ambulatory groups. During ambulatory monitoring, the mean number of Bahr Monitor™ VMS was 16.33 in midlife women with VMS, 9.61 in midlife women without VMS, and 14.63 in young women without VMS (software version March, 2011). The Bahr Monitor™ was more acceptable than the larger Biolog™, but feedback reflected annoyance at having to wear a device that itched and was visible under clothing. Conclusions The Bahr Monitor™ and Biolog™ appear suitable for use in controlled, laboratory conditions over short periods of time. However, the current versions of these monitors may not be suitable for ambulatory clinical trials at this time. PMID:22228321

  11. Randomized placebo- and active-controlled study of desvenlafaxine for menopausal vasomotor symptoms.

    PubMed

    Bouchard, P; Panay, N; de Villiers, T J; Vincendon, P; Bao, W; Cheng, R J; Constantine, G

    2012-02-01

    To evaluate the efficacy and safety of desvenlafaxine (administered as desvenlafaxine succinate) vs. tibolone and placebo for menopausal vasomotor symptoms and the incidence of uterine bleeding. This 12-week, double-blind, randomized, controlled trial was conducted at 35 sites in Europe, two sites in South Africa, and one site in Mexico. Postmenopausal women with ≥50 moderate or severe hot flushes per week (n = 485) were randomized to desvenlafaxine 100 mg/day, tibolone 2.5 mg/day, or placebo. Reduction in the average daily number of moderate and severe hot flushes at weeks 4 and 12 (primary endpoint) was evaluated using analysis of covariance. Safety assessments included incidence of uterine bleeding, adverse events, laboratory values, and vital signs. At week 12, no statistically significant difference was observed in reduction of the average daily number of moderate and severe hot flushes for desvenlafaxine (-5.78) vs. placebo (-5.82; p = 0.921), although time to 50% reduction was significantly less than placebo (13 vs. 26 days, p = 0.006). Hot flush reduction with tibolone (-8.21) was significantly greater than placebo (p < 0.001). Nausea was the most common adverse event with desvenlafaxine, was generally mild to moderate, and resolved within the first 2 weeks. Significantly more subjects experienced bleeding with tibolone (23%) vs. desvenlafaxine (12%; p < 0.024) or placebo (9%; p < 0.001). Desvenlafaxine did not separate from placebo in reducing the number of moderate to severe hot flushes at week 12, although it did allow women to achieve 50% reduction sooner than placebo. Tibolone did separate from placebo, but with smaller than expected effect. The placebo effect was high (57%). Adverse drug reactions were consistent with the known safety profile of desvenlafaxine, and significantly more women who received tibolone experienced episodes of bleeding compared with women who received desvenlafaxine or placebo.

  12. Omega-3 versus isoflavones in the control of vasomotor symptoms in postmenopausal women.

    PubMed

    Palacios, S; Lilue, M; Mejia, A; Menendez, C

    2017-05-31

    Determine the efficacy and tolerability of omega-3 fatty acids versus soybean isoflavones in reducing the vasomotor symptoms (VMSs) frequency in postmenopausal women. A randomized, prospective, two-arm study was performed in healthy postmenopausal women aged 45-65. The two arms were: two capsules/day of omega-3 (425 mg of omega-3/capsule) administered orally (n = 38) and two tablets/day of soybean isoflavones (54.4 mg of isoflavones/tablet) (n = 30), over 16 weeks. The mean baseline frequency of moderate and severe VMSs per week in the omega-3 group was 24.56 and 23.90, respectively, and 19.65 and 19.51 in the isoflavone group. After 4 months, the reduction in moderate and severe hot flashes with omega-3 was significant (p < .001), whereas in the case of isoflavones, there was a significant difference in severe (p = .02) hot flashes after 4 months, but not in moderate hot flashes (p = .077). Omega-3 did not demonstrate significant efficacy differences versus isoflavones over time. The use of omega-3 has a beneficial effect on hot flash reduction after 4 months of treatment. This is comparable to the benefits found with soybean isoflavones after 3-4 weeks and after 4 months in severe hot flash women, but higher than those found with soybean isoflavones in moderate symptom women.

  13. Sleep difficulty mediates effects of vasomotor symptoms on mood in younger breast cancer survivors.

    PubMed

    Vincent, A J; Ranasinha, S; Sayakhot, P; Mansfield, D; Teede, H J

    2014-10-01

    Treatment-induced early menopause occurs in > 80% of premenopausal women diagnosed with breast cancer. This study explored the relationship between vasomotor symptoms (VMS), sleep and mood in women aged 40-51 years with non-metastatic breast cancer. Cross-sectional study using validated questionnaires (Greene Climacteric scale and Hospital Anxiety and Depression Scale, HADS). Women (n = 114) were recruited from the community and hospital outpatient clinics. Frequency determination and structural equation modeling (SEMod) were used to examine the relationship between the latent variables: VMS, anxiety, and depression, and the indicator variable: difficulty sleeping. Participants' mean age was 47 years and 94% became menopausal after breast cancer diagnosis. Difficulty sleeping was reported by 82% of women with 46% reporting (Likert scale) 'quite a bit/extremely'. Most women reported night sweats (77% of women: 47% reporting 'quite a bit/extremely') and hot flushes (84% of women: 50% reporting 'quite a bit/extremely'). HADS scores indicated clinically relevant depression and anxiety in 98% and 99% of women, respectively. SEMod revealed that VMS contributed to difficulty sleeping (standardized coefficient = 0.54; p < 0.001) and difficulty sleeping mediated the relationship between VMS and anxiety (standardized coefficient = 0.34; p = 0.03). However, difficulty sleeping did not have a significant direct impact on depression (standardized coefficient = -0.03; p = 0.8), although anxiety was a strong predictor of depression (standardized coefficient = 0.83; p = 0.015). VMS, sleep and mood disturbance are commonly experienced by younger women with breast cancer. Using SEMod, we demonstrate for the first time that VMS may directly influence sleep in these women. VMS may have an indirect effect on mood, partly mediated by sleep difficulty.

  14. Dynamic responsiveness of the vascular bed as a regulatory mechanism in vasomotor control.

    PubMed

    Zamir, Mair; Norton, Katelyn; Fleischhauer, Arlene; Frances, Maria F; Goswami, Ruma; Usselman, Charlotte W; Nolan, Robert P; Shoemaker, J Kevin

    2009-07-01

    The dynamics of blood supply to a vascular bed depend on lumped mechanical properties of that bed, namely the compliance (C), resistance (R), viscoelasticity (K), and inertance (L). While the study of regulatory mechanisms has so far placed the emphasis largely on R, it is not known how the remaining properties contribute collectively to the play of dynamics in vasomotor control. To examine this question and to establish some benchmark values of these properties, simultaneous measurements of pressure and flow waveforms in the vascular bed of the forearm were obtained from three groups: young healthy individuals, older hypertensives with controlled blood pressure, and older hypertensives with uncontrolled blood pressure. The values of R and C were found to vary within a wide range in each of the three groups to the extent that neither R nor C could be used independently as an indicator of health or age of the subjects tested. However, higher level dynamic properties of the bed, such as the time constants and damping index, which depend on combinations of C,K, and L, and which may reflect measures of the dynamic responsiveness or "sluggishness" of the system, were found to be maintained over a wide range of pulse pressures. These findings support a hypothesis that the pulsatile dynamics of blood supply to a vascular bed are adapted to the individual baseline values of R and C in different subjects with the effect of optimizing the level of dynamic responsiveness to changes in pressure or flow, and that this dynamic property of the vascular bed may be a protected and/or regulated property.

  15. Advancing age produces sex differences in vasomotor kinetics during and after skeletal muscle contraction.

    PubMed

    Bearden, Shawn E

    2007-09-01

    Little is known of the vasomotor responses of skeletal muscle arterioles during and following muscle contraction. We hypothesized that aging leads to impaired arteriolar responses to muscle contraction and recovery. Nitric oxide (NO) availability, which is age dependent, has been implicated in components of these kinetics. Therefore, we also hypothesized that changes in the kinetics of vascular responses are associated with the NO pathway. Groups were young (3 mo), old (24 mo), endothelial NO synthase knockout (eNOS-/-), and N(G)-nitro-L-arginine (L-NA)-treated male and female C57BL/6 mice. The kinetics of vasodilation during and following 1 min of contractions of the gluteus maximus muscle were recorded in second-order (regional distribution) and third-order (local control) arterioles. Baseline, peak (during contraction), and maximal diameters (pharmacological) were not affected by age or sex. The kinetics of dilation and recovery were not different between males and females at the young age. There was a significant slowing of vasodilation at the onset of contractions (approximately 2-fold; P < 0.05) and a significant speeding of recovery ( approximately 5-fold; P < 0.05) in old males vs. old females and vs. young eNOS-/-, and L-NA did not affect the kinetics at the onset of muscle contraction. eNOS-/- mimicked the rapid recovery of old males in second-order arterioles; acute NO production (L-NA) explained approximately 50% of this effect. These data demonstrate fundamental age-related differences between the sexes in the dynamic function of skeletal muscle arterioles. Understanding how youthful function persists in females but not males may provide therapeutic insight into clinical interventions to maintain dynamic microvascular control of nutrient supply with age.

  16. The International Menopause Study of Climate, Altitude, Temperature (IMS-CAT) and vasomotor symptoms.

    PubMed

    Hunter, M S; Gupta, P; Chedraui, P; Blümel, J E; Tserotas, K; Aguirre, W; Palacios, S; Sturdee, D W

    2013-02-01

    To examine the relationship between climate (including altitude, temperature, humidity and annual range of temperature) and experience of hot flushes and night sweats amongst Spanish-speaking mid-aged women living in five urban centers. A total of 896 peri- and postmenopausal women from centers in Chile (Santiago de Chile), Ecuador (Guayaquil and Quito), Panama (Panama City) and Spain (Madrid) completed questionnaires eliciting information about sociodemographics, hot flushes (prevalence, frequency and problem-rating), health and lifestyle (body mass index, diet, exercise, alcohol use) and mood (Women's Health Questionnaire). There was a wide range of altitude and temperature in the participating centers. Of the sample, 58.5% (524/896) were currently experiencing vasomotor symptoms. Prevalence was associated with higher temperatures, while hot flushes were more frequent and problematic for women living in higher temperature and lower altitudes. Hot flush variables were not associated with seasonal variation in temperature. When health and lifestyle variables were included as covariates in regression analyses, prevalence was best predicted by age (younger), poor general health, more depressed mood and anxiety; hot flush frequency by anxiety, temperature, life satisfaction (lower), age (higher), regular strenuous exercise (more strenuous exercise more frequent), and a diet including regular hot spicy food intake. Hot flush problem-rating was best predicted by anxiety, life satisfaction, altitude (lower more problematic), any regular exercise (more exercise less problematic), and depressed mood. In this study of Spanish-speaking women, those living in countries with higher temperatures and lower altitudes reported more frequent and problematic hot flushes.

  17. Dynamic responsiveness of the vascular bed as a regulatory mechanism in vasomotor control

    PubMed Central

    Norton, Katelyn; Fleischhauer, Arlene; Frances, Maria F.; Goswami, Ruma; Usselman, Charlotte W.; Nolan, Robert P.; Shoemaker, J. Kevin

    2009-01-01

    The dynamics of blood supply to a vascular bed depend on lumped mechanical properties of that bed, namely the compliance (C), resistance (R), viscoelasticity (K), and inertance (L). While the study of regulatory mechanisms has so far placed the emphasis largely on R, it is not known how the remaining properties contribute collectively to the play of dynamics in vasomotor control. To examine this question and to establish some benchmark values of these properties, simultaneous measurements of pressure and flow waveforms in the vascular bed of the forearm were obtained from three groups: young healthy individuals, older hypertensives with controlled blood pressure, and older hypertensives with uncontrolled blood pressure. The values of R and C were found to vary within a wide range in each of the three groups to the extent that neither R nor C could be used independently as an indicator of health or age of the subjects tested. However, higher level dynamic properties of the bed, such as the time constants and damping index, which depend on combinations of C,K, and L, and which may reflect measures of the dynamic responsiveness or “sluggishness” of the system, were found to be maintained over a wide range of pulse pressures. These findings support a hypothesis that the pulsatile dynamics of blood supply to a vascular bed are adapted to the individual baseline values of R and C in different subjects with the effect of optimizing the level of dynamic responsiveness to changes in pressure or flow, and that this dynamic property of the vascular bed may be a protected and/or regulated property. PMID:19528260

  18. Safety of veralipride for the treatment of vasomotor symptoms of menopause.

    PubMed

    Valencia, Marcelino Hernández; Arias, María de Jesús Vega; González, Cuauhtémoc Celis; Marín, Imelda Hernández; González, Juan Humberto Martín; Campos, Enrique Rafael Morcate; Rodríguez, María Antonia Basavilvazo; Álvarez, Ignacio Morales; Vargas, María Antonia Valdés; Flores, José Braulio Everardo Otero; Haro, Samuel Santoyo; Bonilla, Manuel Cortes; Escudero, Roberto Bernardo; Campero, Rosalba Alonso

    2014-05-01

    Veralipride is a nonhormonal option for the treatment of vasomotor symptoms of menopause. Incidence of adverse events in a Mexican population and drug compliance according to correct use were evaluated. We carried out a longitudinal, prospective, and analytical study in Mexican women who received veralipride to treat symptoms of menopause from 2011 to 2012. There were 386 treatment cycles; 272 were assigned to dosing schedule 1, which included 20 days of treatment with 10 days of suspension, and 114 were assigned to dosing schedule 2, which included 5 days of treatment and 2 days of suspension. A total of 57 adverse events were registered during the 386-month treatment. For the 20 × 10 dosing schedule, the highest incidence was observed for anxiety (2.2%), drowsiness, and weakness (1.5%); for the 5 × 2 dosing schedule, the highest incidence was observed for drowsiness (5.3%) and headache (2.6%). The Hamilton Depression Rating Scale was used to assess the presence and severity of depression; improvement was noted. The Unified Parkinson's Disease Rating Scale was used to assess neurological movement disorders; no adverse neurological events were detected. Based on the assessments of both women and physicians, the highest frequency was observed for "very satisfied" (45.5% and 52.3%, respectively), followed by "satisfied" (23.9% and 27.3%, respectively). Both dosing schedules show acceptable safety profiles for up to 6 months of use when used according to the contraindications in the current prescribing information for standard use (2012) and recent medical literature.

  19. Vasomotor symptom prevalence is associated with polymorphisms in sex steroid-metabolizing enzymes and receptors.

    PubMed

    Crandall, Carolyn J; Crawford, Sybil L; Gold, Ellen B

    2006-09-01

    The relation of single nucleotide polymorphisms (SNPs) of genes involved in estrogen function to vasomotor symptoms (VMS) has been inadequately explored. We evaluated SNPs in sex steroid-metabolizing genes and estrogen receptors (ERs) for their association with VMS (hot flashes, night sweats, and/or cold sweats) reported by women who were premenopausal or in early perimenopause at baseline. The study population was drawn from participants in the Study of Women's Health Across the Nation (SWAN). African American, Caucasian, Chinese, and Japanese women, 42 to 52 years of age at baseline, who were enrolled in the longitudinal, community-based cohort of SWAN provided questionnaire, interview, weight and height measurements, and serum samples through the sixth annual visit. SNPs associated with the sex steroid hormone pathway were genotyped and available for 1,538 participants. These SNPs were associated with reporting VMS > or =6 days compared with <6 days in the past 2 weeks using race/ethnicity-specific repeated measures logistic regression models. Participants were on average 46 years old at baseline. The prevalence of VMS reporting increased in all racial/ethnic groups from baseline to the sixth annual follow-up visit. After adjustment for covariates, several SNPs encoding genes responsible for estrogen metabolism and ERs were associated with decreased odds of reporting VMS, including the CYP1B1 rs1056836 GC genotype in African American women; 17HSD rs615942 TG, 17HSD rs592389 TG, and 17HSD rs2830 AG genotypes in Caucasian women; and the CYP1A1 rs2606345 AC genotype in Chinese women. We identified race/ethnicity-specific associations between VMS reporting and specific polymorphisms for sex steroid-metabolizing enzymes and sex steroid receptors. Clarification of the mechanisms of the associations and confirmation in other populations is warranted.

  20. Ageing and exercise training alter adrenergic vasomotor responses of rat skeletal muscle arterioles

    PubMed Central

    Donato, Anthony J; Lesniewski, Lisa A; Delp, Michael D

    2007-01-01

    Ageing is associated with increased leg vascular resistance and reductions in leg blood flow during rest and exercise, potentially predisposing older adults to a host of functional and cardiovascular complications. The purpose of these studies was to examine the effects and possible mechanisms of ageing and exercise training on arteriolar adrenergic vasoreactivity. Young and old male Fischer 344 rats were divided into young sedentary (YS), old sedentary (OS), young exercise-trained (YT) or old exercise-trained (OT) groups, where training consisted of chronic treadmill exercise. Isolated soleus (SOL) and gastrocnemius (GAS) muscle arterioles were studied in vitro. Responses to noradrenaline in endothelium-intact and endothelium-denuded arterioles, as well as during nitric oxide synthase (NOS) inhibition were determined. Vasodilator responses to isoproterenol and forskolin were also determined. Results: Noradrenaline-mediated vasoconstriction was increased in SOL arterioles with ageing, and exercise training in old rats attenuated α-adrenergic vasoconstriction in arterioles from both muscle types. Removal of the endothelium and NOS inhibition eliminated these ageing and training effects. Isoproterenol-mediated vasodilatation was impaired with ageing in SOL and GAS arterioles, and exercise training had little effect on this response. Forskolin-induced vasodilatation was not affected by age. The data demonstrate that ageing augments α-adrenergic vasoconstriction while exercise training attenuates this response, and both of these alterations are mediated through an endothelial α-receptor-NOS-signalling pathway. In contrast, ageing diminishes β-receptor-mediated vasodilatation, but this impairment is specific to the smooth muscle. These studies indicate that α- and β-adrenergic mechanisms may serve to increase systemic vascular resistance with ageing, and that the effects of exercise training on adrenergic vasomotor properties could contribute to the beneficial

  1. Ruling out coronary artery disease with noninvasive coronary multidetector CT angiography before noncoronary cardiovascular surgery.

    PubMed

    Catalán, Paz; Leta, Rubén; Hidalgo, Alberto; Montiel, José; Alomar, Xavier; Viladés, David; Barros, Antonio; Pujadas, Sandra; Carreras, Francesc; Padró, Josep M; Cinca, Juan; Pons-Lladó, Guillem

    2011-02-01

    To assess the usefulness of preoperative coronary computed tomographic (CT) angiography in the detection of coronary artery disease (CAD) in nonselected patients scheduled to undergo noncoronary cardiovascular surgery to avoid unnecessary invasive coronary angiography (ICA). The institutional review board approved the study protocol; informed consent was given. This prospective study involved 161 consecutive patients who underwent coronary calcium scoring and coronary CT angiography before undergoing noncoronary cardiovascular surgery. Seven patients were excluded because of contraindications to CT angiography. The major indication of noncoronary cardiovascular surgery was valvular heart disease (121 patients). Follow-up was performed at a median of 20 months to define ischemic events described as acute coronary syndrome or death secondary to acute coronary syndrome, arrhythmias, or cardiac failure. Multivariate analysis was performed to determine predictors of nondiagnostic coronary CT angiography. Kaplan-Meier analysis was performed to evaluate outcome at follow-up. Twenty-one patients did not undergo surgery, which left 133 patients as the study group. Atrial fibrillation was present in 45 of 133 patients. The interquartile range of the Agatston coronary calcium score was 0-471. Coronary CT angiography was diagnostic in 108 of 133 patients. Of these, 93 of 108 had no significant CAD (≤ 50% stenosis), and noncoronary cardiovascular surgery was performed in them without preoperative ICA. No patients in this group had postoperative ischemic events at follow-up. Coronary CT angiography was nondiagnostic in 25 of 133 patients who were referred for preoperative ICA. Multivariate analysis showed Agatston score to be the only independent predictor of nondiagnostic coronary CT angiography (odds ratio = 1.002; 95% confidence interval: 1.001, 1.003; P = .001). The best Agatston score cutoff for diagnostic coronary CT angiography was 579. In nonselected patients scheduled

  2. The role of transdermal estrogen sprays and estradiol topical emulsion in the management of menopause-associated vasomotor symptoms.

    PubMed

    Egras, Amy M; Umland, Elena M

    2010-05-26

    Vasomotor symptoms (VMS) are among the most bothersome complaints of postmenopausal women. To date, the most widely studied and effective treatment for VMS is hormone replacement therapy, consisting of estrogen (in women without a uterus) or estrogen plus progestin (in women with a uterus). Traditionally, oral estrogens have been used for treatment. However, over the years, additional estrogen formulations have been developed including transdermal patches; vaginal rings, creams, and tablets; and injectable preparations. Two newer formulations are transdermal estrogen spray and estradiol topical emulsion. This review evaluates the current literature assessing the use of these two newer formulations for the treatment of VMS associated with menopause.

  3. Effect of impulse vibration and noise on vasomotor function of peripheral blood vessels among pneumatic forge hammer operators.

    PubMed

    Solecki, L

    1995-01-01

    An evaluation of the effect of impulse vibration and noise on vasomotor function of blood vessels among pneumatic forge hammer operators has been presented based on thermal tests (cooling). The study covered the following groups of workers; pneumatic forge hammer operators (I), pneumatic forging hammer operators (II), hammer operator's assistants (III), operators of forging presses and machines (IV) and the control group. The results of the study showed that in groups I and III it was impulse noise not vibration that caused changes in the functioning of peripheral blood vessels.

  4. 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

  5. Coronary flow velocity reserve in three major coronary arteries by transthoracic echocardiography for the functional assessment of coronary artery disease: a comparison with fractional flow reserve.

    PubMed

    Wada, Teruaki; Hirata, Kumiko; Shiono, Yasutsugu; Orii, Makoto; Shimamura, Kunihiro; Ishibashi, Kohei; Tanimoto, Takashi; Yamano, Takashi; Ino, Yasushi; Kitabata, Hironori; Yamaguchi, Tomoyuki; Kubo, Takashi; Imanishi, Toshio; Akasaka, Takashi

    2014-04-01

    Coronary flow velocity reserve (CFVR) measurement in three major coronary arteries by transthoracic echocardiography is a promising and non-invasive method for detecting myocardial ischaemia. Its value when compared with fractional flow reserve (FFR) is unknown. Our aim was to determine the diagnostic accuracy of CFVR in three major coronary arteries for detecting ischaemia compared with FFR. This is a prospective study in 172 vessels of 140 patients with at least one ≥50% stenosis in a major epicardial artery as determined by visual assessment on computed tomography coronary angiography. We performed CFVR measurement by transthoracic echocardiography within 48 h before coronary angiography and FFR measurement. The cut-off value of CFVR was estimated by the receiver operating characteristic (ROC) curve based on that of FFR ≤0.75. The CFVR was 1.86 ± 0.36 in coronary arteries with FFR ≤0.75 (n = 79) and 2.54 ± 0.48 in those with FFR >0.75 (n = 93, P < 0.0001). CFVR with cut-off of 2.2, determined by the ROC curve, was 85% sensitive and 79% specific in predicting the stenotic condition of the coronary artery with FFR ≤0.75 in three major vessels. In each vessel, the sensitivity and specificity were 85 and 78% (left anterior descending coronary artery), 94 and 83% (right coronary artery), and 88 and 88% (left circumflex coronary artery). CFVR was indirect proportional to FFR (r = 0.56, P < 0.0001) and to per cent diameter stenosis (r = 0.26, P = 0.0008). The non-invasive CFVR measurement could be a reliable stenosis-specific method for determining the haemodynamic significance of three major coronary arteries.

  6. Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis.

    PubMed

    Raphael, Claire E; Keegan, Jennifer; Parker, Kim H; Simpson, Robin; Collinson, Julian; Vassiliou, Vass; Wage, Ricardo; Drivas, Peter; Strain, Stephen; Cooper, Robert; de Silva, Ranil; Stables, Rod H; Di Mario, Carlo; Frenneaux, Michael; Pennell, Dudley J; Davies, Justin E; Hughes, Alun D; Firmin, David; Prasad, Sanjay K

    2016-12-09

    Wave intensity analysis (WIA) of the coronary arteries allows description of the predominant mechanisms influencing coronary flow over the cardiac cycle. The data are traditionally derived from pressure and velocity changes measured invasively in the coronary artery. Cardiovascular magnetic resonance (CMR) allows measurement of coronary velocities using phase velocity mapping and derivation of central aortic pressure from aortic distension. We assessed the feasibility of WIA of the coronary arteries using CMR and compared this to invasive data. CMR scans were undertaken in a serial cohort of patients who had undergone invasive WIA. Velocity maps were acquired in the proximal left anterior descending and proximal right coronary artery using a retrospectively-gated breath-hold spiral phase velocity mapping sequence with high temporal resolution (19 ms). A breath-hold segmented gradient echo sequence was used to acquire through-plane cross sectional area changes in the proximal ascending aorta which were used as a surrogate of an aortic pressure waveform after calibration with brachial blood pressure measured with a sphygmomanometer. CMR-derived aortic pressures and CMR-measured velocities were used to derive wave intensity. The CMR-derived wave intensities were compared to invasive data in 12 coronary arteries (8 left, 4 right). Waves were presented as absolute values and as a % of total wave intensity. Intra-study reproducibility of invasive and non-invasive WIA was assessed using Bland-Altman analysis and the intraclass correlation coefficient (ICC). The combination of the CMR-derived pressure and velocity data produced the expected pattern of forward and backward compression and expansion waves. The intra-study reproducibility of the CMR derived wave intensities as a % of the total wave intensity (mean ± standard deviation of differences) was 0.0 ± 6.8%, ICC = 0.91. Intra-study reproducibility for the corresponding invasive data was 0.0 ± 4

  7. Management of Coronary Artery Calcium and Coronary CTA Findings.

    PubMed

    Thomas, Dustin M; Divakaran, Sanjay; Villines, Todd C; Nasir, Khurram; Shah, Nishant R; Slim, Ahmad M; Blankstein, Ron; Cheezum, Michael K

    Coronary artery calcium (CAC) testing and coronary computed tomography angiography (CTA) have significant data supporting their ability to identify coronary artery disease (CAD) and classify patient risk for atherosclerotic cardiovascular disease (ASCVD). Evidence regarding CAC use for screening has established an excellent prognosis in patients with no detectable CAC, and the ability to risk re-classify the majority of asymptomatic patients considered intermediate risk by traditional risk scores. While data regarding the ideal management of CAC findings are limited, evidence supports statin consideration in patients with CAC > 0 and individualized aspirin therapy accounting for CAD risk factors, CAC severity, and factors which increase a patient's risk of bleeding. In patients with stable or acute symptoms undergoing coronary CTA, a normal CTA predicts excellent prognosis, allowing reassurance and disposition without further testing. When CTA identifies nonobstructive CAD (<50 % stenosis), observational data support consideration of statin use/intensification in patients with extensive plaque (at least four coronary segments involved) and patients with high-risk plaque features. In patients with both nonobstructive and obstructive CAD, multiple studies have now demonstrated an ability of CTA to guide management and improve CAD risk factor control. Still, significant under-treatment of cardiovascular risk factors and high-risk image findings remain, among concerns that CTA may increase invasive angiography and revascularization. To fully realize the impact of atherosclerosis imaging for ASCVD prevention, patient engagement in lifestyle changes and the modification of ASCVD risk factors remain the foundation of care. This review provides an overview of available data and recommendations in the management of CAC and CTA findings.

  8. Recent Advances in Invasive Cardiology

    PubMed Central

    Garbe, George J.

    1987-01-01

    This paper describes recent advances in invasive cardiology that enable the primary-care physician to offer his/her patient a wider range of effective treatments. Major developments in the investigation and management of the acute coronary syndromes, unstable angina and myocardial infarction, have revolutionized the care of patients with these conditions. The primary-care physician must be aware of the treatment modalities, the lines of referral, and strategies for management available in his/her clinical setting to allow prompt application of these modalities. A sampling of exciting advances in other areas of invasive cardiology are also described. PMID:21263906

  9. 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 ...

  10. Invasive Species

    EPA Pesticide Factsheets

    Invasive species have significantly changed the Great Lakes ecosystem. An invasive species is a plant or animal that is not native to an ecosystem, and whose introduction is likely to cause economic, human health, or environmental damage.

  11. Noninvasive assessment of coronary blood flow by transthoracic Doppler echocardiography: basic to practical use in the emergency room.

    PubMed

    Watanabe, Nozomi

    2017-01-23

    Echo Doppler is widely available in the clinical setting, and the feasibility of coronary flow detection in the left anterior descending coronary artery has been reported as >90% with the use of a high-frequency transducer. Coronary flow detection takes only a few minutes by skilled echocardiologists, and this noninvasive technique can provide useful physiological information in patients with various types of coronary artery disease. Coronary flow velocity reserve measurement by echo Doppler is a simple and easy technique. It is available in the echo laboratory as well as in the outpatient clinic, and can be used as an alternative examination to screen for significant coronary stenosis in patients with stable angina. Moreover, physiological information provided by coronary flow velocity reserve can be used in combination with other imaging modalities that can provide anatomical information of the coronary arteries such as coronary computed tomography or coronary angiography. Coronary flow velocity in patients with acute coronary syndrome (ACS) enables rapid noninvasive differentiation of TIMI-III from TIMI-II coronary reperfusion before emergency coronary intervention. Transthoracic coronary flow detection by echo Doppler contributes to the assessment of the coronary reperfusion status in the emergency room for patients with ACS, prior to invasive coronary angiography.

  12. Endogenous adenosine mediates coronary vasodilation during exercise after K(ATP)+ channel blockade.

    PubMed Central

    Duncker, D J; van Zon, N S; Pavek, T J; Herrlinger, S K; Bache, R J

    1995-01-01

    The mechanism of coronary vasodilation produced by exercise is not understood completely. Recently, we reported that blockade of vascular smooth muscle K(ATP)+ channels decreased coronary blood flow at rest, but did not attenuate the increments in coronary flow produced by exercise. Adenosine is not mandatory for maintaining basal coronary flow, or the increase in flow produced by exercise during normal arterial inflow, but does contribute to coronary vasodilation in hypoperfused myocardium. Therefore, we investigated whether adenosine opposed the hypoperfusion produced by K(ATP)+ channel blockade, thereby contributing to coronary vasodilation during exercise. 11 dogs were studied at rest and during exercise under control conditions, during intracoronary infusion of the K(ATP)+ channel blocker glibenclamide (50 micrograms/kg per min), and during intracoronary glibenclamide in the presence of adenosine receptor blockade. Glibenclamide decreased resting coronary blood flow from 45 +/- 5 to 35 +/- 4 ml/min (P < 0.05), but did not prevent exercise-induced increases of coronary flow. Glibenclamide caused an increase in myocardial oxygen extraction at the highest level of exercise with a decrease in coronary venous oxygen tension from 15.5 +/- 0.7 to 13.6 +/- 0.8 mmHg (P < 0.05). The addition of the adenosine receptor antagonist 8-phenyltheophylline (5 mg/kg intravenous) to K(ATP)+ channel blockade did not further decrease resting coronary blood flow but did attenuate the increase in coronary flow produced by exercise. This was accompanied by a further decrease of coronary venous oxygen tension to 10.1 +/- 0.7 mmHg (P < 0.05), indicating aggravation of the mismatch between oxygen demand and supply. These findings are compatible with the hypothesis that K+ATP channels modulate coronary vasomotor tone both under resting conditions and during exercise. However, when K(ATP)+ channels are blocked, adenosine released from the hypoperfused myocardium provides an alternate

  13. Coronary magnetic resonance imaging.

    PubMed

    Manning, Warren J; Nezafat, Reza; Appelbaum, Evan; Danias, Peter G; Hauser, Thomas H; Yeon, Susan B

    2007-02-01

    This article highlights the technical challenges and general imaging strategies for coronary MRI. This is followed by a review of the clinical results for the assessment of anomalous CAD, coronary artery aneurysms, native vessel integrity, and coronary artery bypass graft disease using the more commonly applied MRI methods. It concludes with a brief discussion of the advantages/disadvantages and clinical results comparing coronary MRI with multidetector CT (MDCT) coronary angiography.

  14. Burden of vasomotor symptoms in France, Germany, Italy, Spain, and the United Kingdom.

    PubMed

    Dibonaventura, Marco Dacosta; Chandran, Arthi; Hsu, Ming-Ann; Bushmakin, Andrew

    2013-01-01

    Several studies have documented a significant association between vasomotor symptoms (VMS) and a decrement in health outcomes among postmenopausal women, but these studies have mostly focused on the US. The aim of the current study was to broaden this investigation by examining the burden of VMS symptoms in the European Union with respect to both humanistic and economic outcomes. All women aged 40-75 years who completed the 2010 5EU (France, Germany, Italy, Spain, and the UK) National Health and Wellness Survey were identified as potential respondents and invited to participate in an additional cross-sectional, Internet-based survey. Only postmenopausal women from 5EU were included in the current analyses (n = 3801). VMS was assessed using the Menopausal Rating Scale, and was used in multiple regression models as the primary predictor of health status (EQ-5D-3L), work productivity loss, and the number of physician visits due to menopause. Over half (50.3%) of postmenopausal women experienced either mild (24.6%), moderate (17.6%), or severe (8.1%) VMS. Controlling for confounding variables, mild (b = -0.03, P < 0.05), moderate (b = -0.07, P < 0.05), and severe VMS (b = -0.17, P < 0.05) were each associated with worse health utilities relative to women without VMS. Similarly, increased resource use (b = 1.04-2.39, all P < 0.05), overall work impairment (b = 8.71-19.69, all P < 0.05), and activity impairment (b = 11.22-24.54, all P < 0.05) were also observed as VMS severity increased (with each b representing the difference between each level of severity and the reference category). These results suggest a high prevalence of VMS in Western Europe. These symptoms are also associated with both humanistic and economic outcomes. Improved management of VMS may be able to increase the health status and ability to work productively as well as reduce societal direct costs.

  15. Burden of vasomotor symptoms in France, Germany, Italy, Spain, and the United Kingdom

    PubMed Central

    DiBonaventura, Marco daCosta; Chandran, Arthi; Hsu, Ming-Ann; Bushmakin, Andrew

    2013-01-01

    Background Several studies have documented a significant association between vasomotor symptoms (VMS) and a decrement in health outcomes among postmenopausal women, but these studies have mostly focused on the US. The aim of the current study was to broaden this investigation by examining the burden of VMS symptoms in the European Union with respect to both humanistic and economic outcomes. Methods All women aged 40–75 years who completed the 2010 5EU (France, Germany, Italy, Spain, and the UK) National Health and Wellness Survey were identified as potential respondents and invited to participate in an additional cross-sectional, Internet-based survey. Only postmenopausal women from 5EU were included in the current analyses (n = 3801). VMS was assessed using the Menopausal Rating Scale, and was used in multiple regression models as the primary predictor of health status (EQ-5D-3L), work productivity loss, and the number of physician visits due to menopause. Results Over half (50.3%) of postmenopausal women experienced either mild (24.6%), moderate (17.6%), or severe (8.1%) VMS. Controlling for confounding variables, mild (b = −0.03, P < 0.05), moderate (b = −0.07, P < 0.05), and severe VMS (b = −0.17, P < 0.05) were each associated with worse health utilities relative to women without VMS. Similarly, increased resource use (b = 1.04–2.39, all P < 0.05), overall work impairment (b = 8.71–19.69, all P < 0.05), and activity impairment (b = 11.22–24.54, all P < 0.05) were also observed as VMS severity increased (with each b representing the difference between each level of severity and the reference category). Conclusion These results suggest a high prevalence of VMS in Western Europe. These symptoms are also associated with both humanistic and economic outcomes. Improved management of VMS may be able to increase the health status and ability to work productively as well as reduce societal direct costs. PMID:23737678

  16. A cross-sectional study of equol producer status and self-reported vasomotor symptoms.

    PubMed

    Newton, Katherine M; Reed, Susan D; Uchiyama, Shigeto; Qu, Conghui; Ueno, Tomomi; Iwashita, Soh; Gunderson, Gabrielle; Fuller, Sharon; Lampe, Johanna W

    2015-05-01

    This study aims to evaluate the associations of vasomotor symptom (VMS) frequency, bother, and severity with equol producer status and dietary daidzein intake. This is an observational study. This study included women aged 45 to 55 years, in postmenopause or in the menopausal transition, who had soy food intake of three or more servings per week. Exclusion criteria included severe concurrent disease, pregnancy or planned pregnancy, and current use of oral or transdermal hormones or selective estrogen receptor modulators. After screening, 375 participants completed a 3-day VMS diary and a 24-hour urine collection. Women with a urine daidzein or genistein concentration of 100 ng/mL or higher were included. We evaluated the association of VMS--dichotomized as lower than or equal to versus higher than the mean number of VMS per day (<2.33, ≥ 2.33)--with quartiles of daidzein intake. Overall, 129 (35%) of 365 women were equol producers. The mean (SD) urinary equol excretion was 0.67 (1.57) mg/day (50th percentile, 0 mg/d; 95th percentile, 4.12 mg/d). Among equol producers, the mean (SD) urinary equol excretion was 1.91 (2.15) mg/day (50th percentile, 1.09 mg/d; 95th percentile, 6.27 mg/d). Among equol producers, compared with those in the lowest quartile of dietary daidzein intake (mean, 4.9 mg/d), those in the highest quartile (mean, 28.5 mg/d) were 76% less likely to have VMS higher than the mean number of VMS (odds ratio, 0.24; 95% CI, 0.07-0.83; trend test across all daidzein levels, P = 0.06). Among equol nonproducers, there were no associations between daidzein intake and VMS frequency. There were no differences in VMS bother or severity among equol producers or nonproducers by dietary daidzein level. Among equol producers, higher equol availability attributable to higher soy consumption contributes to decreased VMS.

  17. Vasomotor symptoms are associated with depressive symptoms in community-dwelling older women.

    PubMed

    Zeleke, Berihun M; Bell, Robin J; Billah, Baki; Davis, Susan R

    2017-06-19

    To assess the prevalence of, and factors associated with, moderate-to-severe depressive symptoms in community-dwelling older Australian women. A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on the electoral roll. Depressive symptoms were assessed by the Beck Depression Inventory-II (BDI-II) tool. Vasomotor symptoms (VMS), vulvovaginal atrophy (VVA), and pelvic floor symptoms were assessed using validated questionnaires. Women were provided a comprehensive list of psychotropic medications (antidepressants, benzodiazepines, antipsychotics, and mood stabilizers) to identify their use over the preceding month. In all, 1,534 women completed the BDI-II. Overall, 34.2% (95% confidence interval [CI] 31.8%-36.7%) of women had VMS, 6.3% (95% CI 5.2%-7.7%) had moderate-to-severe depressive symptoms (BDI-II score ≥20), 26.8% (95% CI 24.6%-29.1%) had used any psychotropic medication in the previous month, and 17.5% (95%CI: 15.6-19.5%) had taken an antidepressant.Moderate-to-severe depressive symptoms were more common among women using antidepressants compared with nonusers (16.6% vs 4.3%; P < 0.001). Obesity (adjusted odds ratio [AOR] 2.18, 95% CI 1.17-4.04), living in financially insecure housing (AOR 3.84, 95% CI 2.08-8.08), being a caregiver to another person (AOR 2.39, 95% CI 1.36-4.19), being a smoker (AOR 2.28, 95% CI 1.12-4.66), having VMS (AOR 1.67, 95% CI 1.03-2.62), having pelvic floor dysfunction (AOR 1.78, 95% CI 1.08-2.94), and having vaginal dryness during intercourse (AOR 1.84, 95% CI 1.06-3.22, P < 0.05) were positively and independently associated with moderate-to-severe depressive symptoms. Being currently partnered (AOR 0.57, 95% CI 0.33-0.97) and employed (AOR 0.38, 95% CI 0.16-0.92) were associated with a lower likelihood of depressive symptoms. In older women, depressive symptoms are common and are

  18. 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

  19. Effects of aging and exercise training on spinotrapezius muscle microvascular Po2 dynamics and vasomotor control

    PubMed Central

    McCullough, Danielle J.; Davis, Robert T.; Dominguez, James M.; Stabley, John N.; Bruells, Christian S.

    2011-01-01

    With advancing age, there is a reduction in exercise tolerance, resulting, in part, from a perturbed ability to match O2 delivery to uptake within skeletal muscle. In the spinotrapezius muscle (which is not recruited during incline treadmill running) of aged rats, we tested the hypotheses that exercise training will 1) improve the matching of O2 delivery to O2 uptake, evidenced through improved microvascular Po2 (PmO2), at rest and throughout the contractions transient; and 2) enhance endothelium-dependent vasodilation in first-order arterioles. Young (Y, ∼6 mo) and aged (O, >24 mo) Fischer 344 rats were assigned to control sedentary (YSED; n = 16, and OSED; n = 15) or exercise-trained (YET; n = 14, and OET; n = 13) groups. Spinotrapezius blood flow (via radiolabeled microspheres) was measured at rest and during exercise. Phosphorescence quenching was used to quantify PmO2 in vivo at rest and across the rest-to-twitch contraction (1 Hz, 5 min) transition in the spinotrapezius muscle. In a follow-up study, vasomotor responses to endothelium-dependent (acetylcholine) and -independent (sodium nitroprusside) stimuli were investigated in vitro. Blood flow to the spinotrapezius did not increase above resting values during exercise in either young or aged groups. Exercise training increased the precontraction baseline PmO2 (OET 37.5 ± 3.9 vs. OSED 24.7 ± 3.6 Torr, P < 0.05); the end-contracting PmO2 and the time-delay before PmO2 fell in the aged group but did not affect these values in the young. Exercise training improved maximal vasodilation in aged rats to acetylcholine (OET 62 ± 16 vs. OSED 27 ± 16%) and to sodium nitroprusside in both young and aged rats. Endurance training of aged rats enhances the PmO2 in a nonrecruited skeletal muscle and is associated with improved vascular smooth muscle function. These data support the notion that improvements in vascular function with exercise training are not isolated to the recruited muscle. PMID:21212242

  20. Comparative effects of frovatriptan and sumatriptan on coronary and internal carotid vascular haemodynamics in conscious dogs.

    PubMed

    Carel, I; Ghaleh, B; Edouard, A; Dubois-Rande, J L; Parsons, A A; Giudicelli, J F; Berdeaux, A

    2001-03-01

    The effects of frovatriptan and sumatriptan on internal carotid and coronary vascular haemodynamics were investigated and compared in conscious dogs. Frovatriptan and sumatriptan (0.1 - 100 microg kg(-1)) induced a transient increase in external coronary artery diameter (eCOD) of up to 2.9+/-1.2 and 1.8+/-0.6%, respectively (both P:<0.05). This was followed by a prolonged and dose-dependent decrease in eCOD of up to -5.2+/-1.2 and -5.3+/-0.9% (both P:<0.05), with ED(50) values of 86+/-21 and 489+/-113 micromol kg(-1), respectively. In contrast, only a decrease in the external diameter of the internal carotid artery was observed (-6.0+/-0.6 and -6.2+/-1.4%, both P:<0.05, and ED(50) values of 86+/-41 and 493+/-162 micromol kg(-1), respectively). Frovatriptan was thus 5.7 fold more potent than sumatriptan at the level of both large coronary and internal carotid arteries. After endothelium removal by balloon angioplasty in coronary arteries, the initial dilatation induced by the triptans was abolished and delayed constriction enhanced. The selective antagonist for the 5-HT(1B) receptors SB224289 dose-dependently blocked the effects of sumatriptan on large coronary and internal carotid arteries whereas the selective antagonist for the 5-HT(1D) receptors BRL15572 did not affect any of these effects. In conclusion, frovatriptan and sumatriptan initially dilate and subsequently constrict large coronary arteries in the conscious dog, whereas they directly constrict the internal carotid artery. The vascular endothelium modulates the effects of these triptans on large coronary arteries. Finally, 5-HT(1B) but not 5-HT(1D) receptors are primarily involved in canine coronary and internal carotid vasomotor responses to sumatriptan.

  1. Relationship between /sup 31/P nuclear magnetic resonance spectra and pulmonary vasomotor tone in hypoxic pig lobes

    SciTech Connect

    Buescher, P.; Pillain, R.; Pearse, D.; Eichhorn, G.; Sylvester, J.

    1986-03-01

    To investigate the relationship between lung tissue energy state and vasomotor tone, the authors measured /sup 31/P NMR spectra during repeated exposures to hypoxia in 5 isolated degassed left lower lobes perfused with blood at a constant flow (500ml/min) and left atrial pressure (<0mmHg). Perfusate O/sub 2/ tension (PpO/sub 2/) was changed by varying the gas mixtures (40, 7, 0% O/sub 2/) flowing through a bubble oxygenator in the perfusion circuit. /sup 31/P spectra obtained after stabilization of pulmonary artery pressure (Ppa) at each PpO/sub 2/ revealed peaks for ATP, inorganic phosphate (Pi) phosphomono and diesters (PME and PDE). During 7% O/sub 2/, Ppa and ATP increased but Pi did not change suggesting that lung tissue energy state improved during hypoxic vasoconstriction. During 0% O/sub 2/, there was a reversible deterioration of energy state (high Pi, low ATP). Thus, it appears that lung tissue energy state and vasomotor tone were related, but the precise nature of the relationship remains to be determined.

  2. 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

  3. 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

  4. Contribution of electromechanical coupling between KV and CaV1.2 channels to coronary dysfunction in obesity

    PubMed Central

    Berwick, Zachary C.; Dick, Gregory M.; O’Leary, Heather A.; Bender, Shawn B.; Goodwill, Adam G.; Moberly, Steven P.; Owen, Meredith Kohr; Miller, Steven J.; Obukhov, Alexander G.

    2013-01-01

    Previous investigations indicate that diminished functional expression of voltage-dependent K+ (KV) channels impairs control of coronary blood flow in obesity/metabolic syndrome. The goal of this investigation was to test the hypothesis that KV channels are electromechanically coupled to CaV1.2 channels and that coronary microvascular dysfunction in obesity is related to subsequent increases in CaV1.2 channel activity. Initial studies revealed that inhibition of KV channels with 4-aminopyridine (4AP, 0.3 mM) increased intracellular [Ca2+], contracted isolated coronary arterioles and decreased coronary reactive hyperemia. These effects were reversed by blockade of CaV1.2 channels. Further studies in chronically instrumented Ossabaw swine showed that inhibition of CaV1.2 channels with nifedipine (10 μg/kg, iv) had no effect on coronary blood flow at rest or during exercise in lean swine. However, inhibition of CaV1.2 channels significantly increased coronary blood flow, conductance, and the balance between coronary flow and metabolism in obese swine (P < 0.05). These changes were associated with a ~50 % increase in inward CaV1.2 current and elevations in expression of the pore-forming subunit (α1c) of CaV1.2 channels in coronary smooth muscle cells from obese swine. Taken together, these findings indicate that electromechanical coupling between KV and CaV1.2 channels is involved in the regulation of coronary vasomotor tone and that increases in CaV1.2 channel activity contribute to coronary microvascular dysfunction in the setting of obesity. PMID:23856709

  5. Lean and Obese Coronary Perivascular Adipose Tissue Impairs Vasodilation via Differential Inhibition of Vascular Smooth Muscle K+ Channels.

    PubMed

    Noblet, Jillian N; Owen, Meredith K; Goodwill, Adam G; Sassoon, Daniel J; Tune, Johnathan D

    2015-06-01

    The effects of coronary perivascular adipose tissue (PVAT) on vasomotor tone are influenced by an obese phenotype and are distinct from other adipose tissue depots. The purpose of this investigation was to examine the effects of lean and obese coronary PVAT on end-effector mechanisms of coronary vasodilation and to identify potential factors involved. Hematoxylin and eosin staining revealed similarities in coronary perivascular adipocyte size between lean and obese Ossabaw swine. Isometric tension studies of isolated coronary arteries from Ossabaw swine revealed that factors derived from lean and obese coronary PVAT attenuated vasodilation to adenosine. Lean coronary PVAT inhibited K(Ca) and KV7, but not KATP channel-mediated dilation in lean arteries. In the absence of PVAT, vasodilation to K(Ca) and KV7 channel activation was impaired in obese arteries relative to lean arteries. Obese PVAT had no effect on K(Ca) or KV7 channel-mediated dilation in obese arteries. In contrast, obese PVAT inhibited KATP channel-mediated dilation in both lean and obese arteries. The differential effects of obese versus lean PVAT were not associated with changes in either coronary KV7 or K(ATP) channel expression. Incubation with calpastatin attenuated coronary vasodilation to adenosine in lean but not in obese arteries. These findings indicate that lean and obese coronary PVAT attenuates vasodilation via inhibitory effects on vascular smooth muscle K(+) channels and that alterations in specific factors such as calpastatin are capable of contributing to the initiation or progression of smooth muscle dysfunction in obesity. © 2015 American Heart Association, Inc.

  6. Second reading of coronary angiograms by radiologists

    PubMed Central

    Birnbaum, Leora M; Filion, Kristian B; Joyal, Dominique; Eisenberg, Mark J

    2006-01-01

    BACKGROUND In many hospitals in the provinces of Quebec and Nova Scotia, as well as in some hospitals in the rest of Canada, coronary angiograms are performed and interpreted by invasive cardiologists, and are later reinterpreted and reported by radiologists. OBJECTIVE To evaluate the value of second readings of coronary angiograms by radiologists. METHODS Cardiology and radiology reports of a total of 160 consecutive coronary angiograms were compared from patients at three hospitals. Ten segments of the coronary tree were considered and 1582 segments were included. Agreement between cardiology and radiology interpretations was evaluated using per cent agreement, Pearson correlation and Bland-Altman limits of agreement. Agreement was calculated for each arterial segment and for each hospital. RESULTS Excellent agreement was found between cardiology and radiology interpretations of coronary angiograms. Per cent agreement ranged from 94.9% to 100%, Pearson correlation ranged from 0.83 to 0.97 and Bland-Altman limits of agreement ranged from –18.1 to 19.4. Agreement was similar for each segment and for each hospital. Agreement remained excellent after exclusion of normal angiograms (n=348 segments), with a per cent agreement of 96.3%. Secondary analyses demonstrated a mean time delay of 13 days between angiograms and the subsequent radiology reports. CONCLUSIONS There are minimal differences between the cardiology and radiology interpretations of coronary angiograms. Routine second reading by a radiologist may be redundant. PMID:17151771

  7. Safety and efficacy of dual-axis rotational coronary angiography vs. standard coronary angiography.

    PubMed

    Klein, Andrew J; Garcia, Joel A; Hudson, Paul A; Kim, Michael S; Messenger, John C; Casserly, Ivan P; Wink, Onno; Hattler, Brack; Tsai, Thomas T; Chen, S Y James; Hansgen, Adam; Carroll, John D

    2011-05-01

    To determine the safety and efficacy of dual-axis rotational coronary angiography (DARCA) by directly comparing it to standard coronary angiography (SA). Standard coronary angiography (SA) requires numerous fixed static images of the coronary tree and has multiple well-documented limitations. Dual-axis rotational coronary angiography (DARCA) is a new rotational acquisition technique that entails simultaneous LAO/RAO and cranial/caudal gantry movement. This technological advancement obtains numerous unique images of the left or right coronary tree with a single coronary injection. We sought to assess the safety and efficacy of DARCA as well as determine DARCA's adequacy for CAD screening and assessment. Thirty patients underwent SA following by DARCA. Contrast volume, radiation dose (DAP) and procedural time were recorded for each method to assess safety. For DARCA acquisitions, blood pressure (BP), heart rate (HR), symptoms and any arrhythmias were recorded. All angiograms were reviewed for CAD screening adequacy by two independent invasive cardiologists. Compared to SA, use of DARCA was associated with a 51% reduction in contrast, 35% less radiation exposure, and 18% shorter procedural time. Both independent reviewers noted DARCA to be at least equivalent to SA with respect to the ability to screen for CAD. DARCA represents a new angiographic technique which is equivalent in terms of image quality and is associated with less contrast use, radiation exposure, and procedural time than SA. Copyright © 2011 Wiley-Liss, Inc.

  8. State of the art: pressure wire and coronary functional assessment.

    PubMed

    Echavarría-Pinto, Mauro; Collet, Carlos; Escaned, Javier; Piek, Jan J; Serruys, Patrick W

    2017-08-25

    The pressure wire has revolutionised cardiology by moving the focus of revascularisation from anatomy to physiology. This review provides a comprehensive viewpoint on the foundations of the field of intracoronary physiology, with emphasis on the development and clinical evidence of fractional flow reserve (FFR). Additionally, we critically appraise clinical decision making based on the evolving area of resting coronary physiology. The emerging role of coronary flow reserve and its complementariness with FFR is also discussed, and the importance of the invasive assessment of the coronary microcirculation in outlining prognosis is put into perspective. Overall, this review summarises the capacity of invasive coronary physiology indices to guide revascularisation and to discriminate patients at high risk of an adverse cardiovascular outcome.

  9. 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

  10. 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

  11. Atherosclerosis of coronary blood vessels - local or systemic inflamation?

    PubMed

    Pejkov, Hristo; Kedev, Sasko; Panov, Saso; Srbinovska-Kostovska, Elizabeta; Lang, Irene

    2013-01-01

    The presence of atherosclerotic lesions in the blood vessels is a predisposition for the development and occurrence of acute ischaemic attacks. Bigger atherosclerotic lesions in the coronary blood vessels cause lumen occlusion, which is a cause of acute myocardial infarction. Endothelial dysfunction is defined as an ability of the endothelium to produce vasorelaxing nitric oxide (NO), or deregulation of the other vasoactive substances, such as angiotensin II and endothelin [13]. This definition describes endothelial dysfunction as an improper vasomotor constriction of the vessel, that leads to lumen occlusion of the already existing atherosclerotic lesions. According to the modern model, the development of atherosclerotic plaque and inappropriate endothelial NO production have a synergistic role in patho-physiological and molecular processes in the blood vessels [14]. Lesions in the coronary arteries are deposits of huge quantities of foamy cells and fibrous plaques. The thin fibrous plaques are 10-20% of the total plaque population and are the cause of 80-90% of clinical cases due to their ability to rupture [48]. According to all the results from published studies by far, it has been pointed out that the plaque stability, not the absolute size influences the rupture potential. Elucidating the risk factors that may modify in the atherogenesis and the consequent atherothrombic effect is the first step to this goal.

  12. Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy?

    PubMed

    Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes

    2014-01-01

    Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

  13. 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.

  14. Extreme clinical presentations of venous stasis: coronary sinus thrombosis.

    PubMed

    Kachalia, Amit; Sideras, Panagiotis; Javaid, Mian; Muralidharan, Sethu; Stevens-Cohen, Pilar

    2013-11-01

    Sixty six year old male with history of heart failure was admitted for dysphagia, weight loss. CT scan chest revealed diffuse oesophageal wall thickening. Upper endoscopy, oesophagogram confirmed diagnosis of achalasia. TTE revealed severely reduced biventricular systolic function with LVEF 10%; PASP 75-80 mmHg. Parasternal long views showed dilated coronary sinus with a visible, mobile 2.0 cm thrombus. Pro-thrombotic workup was negative. Coronary sinus thrombosis has been identified as a rare complication to invasive cardiac procedures causing damage to coronary sinus endothelium and in hypercoagulable states.Typically acute thrombosis presents with chest pain, dynamic ECG changes, but chronic development does not present with ischaemic signs due to formation of efficient collateral circulation. We present a case report of stable primary coronary sinus thrombus incidentally diagnosed, secondary to chronic venous stasis in coronary circulation. Currently, there are no guidelines to assist physicians in long term management of such patients and thus warrants further investigations.

  15. Coronary Artery Anomalies

    MedlinePlus

    ... Center for Coronary Artery Anomalies Doctors at the Texas Heart Institute's Center for Coronary Artery Anomalies (CCAA) ... comments. Terms of Use and Privacy Policy © Copyright Texas Heart Institute All rights reserved.

  16. 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)

  17. Coronary artery fistula

    MedlinePlus

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... attaches to one of the chambers of the heart (the atrium or ventricle) or another blood vessel ( ...

  18. 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)

  19. Coronary heart disease

    MedlinePlus

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... buildup of plaque in the arteries to your heart. This may also be called hardening of the ...

  20. 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 ...

  1. Enhanced endothelin-1/Rho-kinase signalling and coronary microvascular dysfunction in hypertensive myocardial hypertrophy.

    PubMed

    Tsai, Shu-Huai; Lu, Guangrong; Xu, Xin; Ren, Yi; Hein, Travis W; Kuo, Lih

    2017-09-01

    Hypertensive cardiac hypertrophy is associated with reduced coronary flow reserve, but its impact on coronary flow regulation and vasomotor function remains incompletely understood and requires further investigation. Left ventricular hypertrophy was induced in mice by transverse aortic coarctation (TAC) for 4 weeks. The left coronary artery blood velocity (LCABV) and myocardium lactate level were measured following the metabolic activation by isoproterenol. Septal coronary arterioles were isolated and pressurized for functional studies. In TAC mice, the heart-to-body weight ratio was increased by 45%, and cardiac fractional shortening and LCABV were decreased by 51 and 14%, respectively. The resting myocardial lactate level was 43% higher in TAC mice. Isoproterenol (5 µg/g, i.p.) increased heart rate by 20% in both groups of animals, but the corresponding increase in LCABV was not observed in TAC mice. The ventricular hypertrophy was associated with elevation of myocardial endothelin-1 (ET-1), increased vascular expression of rho-kinases (ROCKs), and increased superoxide production in the myocardium and vasculature. In coronary arterioles from TAC mice, the endothelial nitric oxide (NO)-mediated dilation to acetylcholine (ACh) was reversed to vasoconstriction and the vasoconstriction to ET-1 was augmented. Inhibition of ROCK by H-1152 alleviated oxidative stress and abolished enhanced vasoconstriction to ET-1. Both H-1152 and superoxide scavenger Tempol abolished coronary arteriolar constriction to ACh in a manner sensitive to NO synthase blocker NG-nitro-L-arginine methyl ester. Myocardial hypertrophy induced by pressure overload leads to cardiac and coronary microvascular dysfunction and ischaemia possibly due to oxidative stress, enhanced vasoconstriction to ET-1 and compromised endothelial NO function via elevated ROCK signalling.

  2. Coronary Embolization Caused by Pleomorphic Lung Carcinoma

    PubMed Central

    Murai, Tadashi; Yonetsu, Taishi; Isobe, Mitsuaki; Kakuta, Tsunekazu

    2016-01-01

    A 73-year-old man who had been transferred to our emergency room due to sudden chest pain was diagnosed with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention was performed. A long, white object which looked like a parasitic worm was retrieved via intracoronary aspiration and revascularization was successfully completed. Contrast computed tomography revealed a huge 7×6 cm mass in the right upper pulmonary lobe with direct pulmonary vein invasion. Histopathologic examination of the aspirated coronary object revealed pleomorphic lung carcinoma. This is an unusual case of STEMI caused by lung tumor embolization via direct pulmonary vein invasion to the left side of the heart. PMID:27980261

  3. Coronary Artery Fistula

    DTIC Science & Technology

    2007-04-01

    ascending aorta and pulmonary artery) and congenital coronary artery stenosis . Most coronary artery fistulas are congenital but may also...MILITARY MEDICINE, 172, 4: xi-xii, 2007 Military Medicine, Vol. 172, 4, April 2007 Radiology Corner Case #11 Coronary Artery Fistula...man with a single episode of vague sub- sternal chest pain was referred for evaluation of possible coronary artery disease. His medical history was

  4. Early severe coronary artery disease and aortic coarctation in a child with familial hypercholesterolaemia.

    PubMed

    Labib, Dina; Soliman, Haytham; Said, Kareem; Sorour, Khaled

    2016-11-30

    An 11-year-old boy presented with easy fatigability, multiple xanthomas, and absent pedal pulsations. Laboratory workup showed severe hypercholesterolaemia and non-invasive imaging revealed 'normally functioning' bicuspid aortic valve and tight aortic coarctation. Coronary angiography showed severe right coronary artery (RCA) stenosis. Medical treatment resulted in significant improvement of dyslipidaemia. We successfully performed balloon dilation and stenting of his coarctation, as well as percutaneous coronary intervention for RCA lesion.

  5. Diagnostic accuracy of noninvasive coronary angiography with 320-detector row computed tomography.

    PubMed

    Nasis, Arthur; Leung, Michael C; Antonis, Paul R; Cameron, James D; Lehman, Sam J; Hope, Sarah A; Crossett, Marcus P; Troupis, John M; Meredith, Ian T; Seneviratne, Sujith K

    2010-11-15

    We sought to evaluate the diagnostic accuracy of noninvasive coronary angiography using 320-detector row computed tomography, which provides 16-cm craniocaudal coverage in 350 ms and can image the entire coronary tree in a single heartbeat, representing a significant advance from previous-generation scanners. We evaluated 63 consecutive patients who underwent 320-detector row computed tomography and invasive coronary angiography for the investigation of suspected coronary artery disease. Patients with known coronary artery disease were excluded. Computed tomographic (CT) studies were assessed by 2 independent observers blinded to results of invasive coronary angiography. A single observer unaware of CT results assessed invasive coronary angiographic images quantitatively. All available coronary segments were included in the analysis, regardless of size or image quality. Lesions with >50% diameter stenoses were considered significant. Mean heart rate was 63 ± 7 beats/min, with 6 patients (10%) in atrial fibrillation during image acquisition. Thirty-three patients (52%) and 70 of 973 segments (7%) had significant coronary stenoses on invasive coronary angiogram. Seventeen segments (2%) were nondiagnostic on computed tomogram and were assumed to contain significant stenoses on an "intention-to-diagnose" analysis. Sensitivity, specificity, and positive and negative predictive values of computed tomography for detecting significant stenoses were 94%, 87%, 88%, and 93%, respectively, by patient (n = 63), 89%, 95%, 82%, and 97%, respectively, by artery (n = 260), and 87%, 97%, 73%, and 99%, respectively, by segment (n = 973). In conclusion, noninvasive 320-detector row CT coronary angiography provides high diagnostic accuracy across all coronary segments, regardless of size, cardiac rhythm, or image quality.

  6. School burnout: increased sympathetic vasomotor tone and attenuated ambulatory diurnal blood pressure variability in young adult women.

    PubMed

    May, Ross W; Sanchez-Gonzalez, Marcos A; Fincham, Frank D

    2015-01-01

    Two studies examined autonomic and cardiovascular functioning that may link school burnout to cardiovascular risk factors in young healthy adult females. Study 1 (N = 136) investigated whether school burnout was related to resting values of blood pressure (BP) and blood pressure variability (BPV) through laboratory beat-to-beat BP assessment. Study 2 (N = 94) examined the link between school burnout and diurnal BPV through ambulatory BP monitoring. Controlling for anxiety and depressive symptomatology, school burnout demonstrated strong positive relationships with indices of cardiac sympathovagal tone, sympathetic vasomotor tone, inefficient myocardial oxygen consumption, increased 24-h ambulatory heart rate and BP, blunted BP diurnal variability, and increased arterial stiffness. These studies establish cardiovascular biomarkers of school burnout and suggest that even in a seemingly healthy sample school burnout may predispose females to increased cardiovascular risk. Several future lines of research are outlined.

  7. Regional Coronary Endothelial Function is Closely Related to Local Early Coronary Atherosclerosis in Patients with Mild Coronary Artery Disease: A Pilot Study

    PubMed Central

    Hays, Allison G.; Kelle, Sebastian; Hirsch, Glenn A.; Soleimanifard, Sahar; Yu, Jing; Agarwal, Harsh K.; Gerstenblith, Gary; Schär, Michael; Stuber, Matthias; Weiss, Robert G.

    2012-01-01

    Background Coronary endothelial function (endoFx) is abnormal in patients with established coronary artery disease (CAD) and was recently shown by MRI to relate to the severity of luminal stenosis. Recent advances in MRI now allow the non-invasive assessment of both anatomic and functional (endoFx) changes that previously required invasive studies. We tested the hypothesis that abnormal coronary endoFx is related to measures of early atherosclerosis such as increased coronary wall thickness (CWT). Methods and Results Seventeen arteries in fourteen healthy adults and seventeen arteries in fourteen patients with non-obstructive CAD were studied. To measure endoFx, coronary MRI was performed before and during isometric handgrip exercise, an endothelial-dependent stressor and changes in coronary cross-sectional area (CSA) and flow were measured. Black blood imaging was performed to quantify CWT and other indices of arterial remodeling. The mean stress-induced change in CSA was significantly higher in healthy adults (13.5%±12.8%, mean±SD, n=17) than in those with mildly diseased arteries (-2.2±6.8%, p<0.0001, n=17). Mean CWT was lower in healthy subjects (0.9±0.2mm) than in CAD patients (1.4±0.3mm, p<0.0001). In contrast to healthy subjects, stress-induced changes in CSA, a measure of coronary endoFx, correlated inversely with CWT in CAD patients (r= -0.73, p=0.0008). Conclusions There is an inverse relationship between coronary endothelial function and local CWT in CAD patients but not in healthy adults. These findings demonstrate that local endothelial-dependent functional changes are related to the extent of early anatomic atherosclerosis in mildly diseased arteries. This combined MRI approach enables the anatomic and functional investigation of early coronary disease. PMID:22492483

  8. Effects of a dietary intervention and weight change on vasomotor symptoms in the Women’s Health Initiative

    PubMed Central

    Kroenke, Candyce H.; Caan, Bette J.; Stefanick, Marcia L.; Anderson, Garnet; Brzyski, Robert; Johnson, Karen C.; LeBlanc, Erin; Lee, Cathy; La Croix, Andrea Z.; Park, Hannah Lui; Sims, Stacy T.; Vitolins, Mara; Wallace, Robert

    2012-01-01

    Objective To evaluate whether a dietary intervention designed to reduce fat intake and increase intake of fruit, vegetables, and whole grains, and weight loss, reduce vasomotor symptoms (VMS, i.e., hot flashes or night sweats) in postmenopausal women. Methods We included 17,473 postmenopausal U.S. women, ages 50–79 at baseline who participated in the Women’s Health Initiative Dietary Modification (DM) trial and were not taking menopausal hormone therapy. Logistic regression was used to evaluate associations. Results In multivariate-adjusted analyses, with simultaneous adjustment for the intervention and weight change, assignment to dietary intervention vs. control arm was significantly (OR=1.14, 95%CI: 1.01–1.28) related to a higher likelihood of symptom elimination among women with VMS at baseline. Additionally, women with symptoms at baseline who lost ≥10 lbs (OR=1.23, 95%CI: 1.05–1.46) or lost ≥10% of their baseline body weight (OR=1.56, 95%CI: 1.21–2.02) between baseline and year 1 were significantly more likely to eliminate VMS compared with those who maintained weight. Upon examining the joint effect of the dietary modification and weight loss, compared to women in the control arm who maintained weight, women who lost substantial weight (≥10%) as a part of the intervention (OR=1.89, 95%CI: 1.39–2.57), but not control arm (OR=1.40, 95%CI: 0.92–2.13), were significantly more likely to end VMS, though these two groups did not differ significantly from each other. Large weight loss (>22 lbs) but not dietary changes were related to elimination of moderate/severe VMS. Conclusions Weight loss as part of a healthy dietary modification may help to eliminate vasomotor symptoms among postmenopausal women. PMID:22781782

  9. Topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on nonhormonal management of vasomotor symptoms.

    PubMed

    Carpenter, Janet S; Laine, Tei; Harrison, Blake; LePage, Meghan; Pierce, Taran; Hoteling, Nathan; Börner, Katy

    2017-10-01

    We sought to depict the topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on the nonhormonal management of menopause-associated vasomotor symptoms released on September 21, 2015, and its associated press release from September 23, 2015. Three data sources were used: online news articles, National Public Radio, and Twitter. For topical diffusion, we compared keywords and their frequencies among the position statement, press release, and online news articles. We also created a network figure depicting relationships across key content categories or nodes. For geospatial diffusion within the United States, we compared locations of the 109 National Public Radio (NPR) stations covering the statement to 775 NPR stations not covering the statement. For temporal diffusion, we normalized and segmented Twitter data into periods before and after the press release (September 12, 2015 to September 22, 2015 vs September 23, 2015 to October 3, 2015) and conducted a burst analysis to identify changes in tweets from before to after. Topical information diffused across sources was similar with the exception of the more scientific terms "vasomotor symptoms" or "vms" versus the more colloquial term "hot flashes." Online news articles indicated media coverage of the statement was mainly concentrated in the United States. NPR station data showed similar proportions of stations airing the story across the four census regions (Northeast, Midwest, south, west; P = 0.649). Release of the statement coincided with bursts in the menopause conversation on Twitter. The findings of this study may be useful for directing the development and dissemination of future North American Menopause Society position statements and/or press releases.

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

    PubMed

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

    2014-07-26

    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.

  11. Lower coronary plaque burden in patients with HIV presenting with acute coronary syndrome

    PubMed Central

    O'Dwyer, E J; Bhamra-Ariza, P; Rao, S; Emmanuel, S; Carr, A; Holloway, C J

    2016-01-01

    Objective Treated HIV infection is associated with a higher incidence of coronary artery disease and myocardial infarction, although the mechanisms remain unclear. We sought to characterise the burden of coronary artery disease in men with HIV using retrospective data from invasive coronary angiograms in patients presenting with acute coronary syndrome (ACS). Methods Demographic and coronary angiographic data were obtained from 160 men with ST elevation myocardial infarction, non-STEMI or high-risk chest pain; 73 HIV-infected cases and 87 age-matched controls. The burden of coronary disease was calculated using the Gensini Angiographic Scoring System by 2 independent cardiologists blinded to HIV status. Results The 2 groups were matched for age, sex and cardiac event subtype and there was no difference in rates of smoking or cholesterol levels. Compared with control participants, patients with HIV had higher usage of antihypertensives (46 (63%) vs 30 (35%), p<0.001) and statins (47 (64%) vs 29 (33%), p<0.001). There was no difference in plaque distribution between both groups; however, the Gensini score was 42% lower in cases with HIV than in controls (p<0.03). C reactive protein was higher in cases with HIV (13.4±15.4 vs 3.7±3.6). Conclusions Men with HIV presenting with ACS paradoxically had a lower burden of coronary plaque than matched controls, despite more aggressive risk factor management, suggesting that plaque vulnerability, rather than total burden of atherosclerosis, may be important in the pathophysiology of coronary artery disease in men with HIV. PMID:28123757

  12. The coronary heart team.

    PubMed

    Yanagawa, Bobby; Puskas, John D; Bhatt, Deepak L; Verma, Subodh

    2017-09-01

    The concept of a Coronary Heart Team has generated increased interest, including support from major practice guidelines. Here, we review the rationale and the published experience of Coronary Heart Teams. A Coronary Heart Team should be led by both cardiology and cardiac surgery with a shared decision-making approach. The team should incorporate data from anatomic and clinical risk prediction models to offer individualized care. Most teams focus on management of complex patients and those with indications for both coronary artery bypass graft and percutaneous coronary intervention. The potential benefits of a Coronary Heart Team include balanced decision-making, greater adherence to evidence-based practice guidelines, as well as promoting greater collegiality and exchange of knowledge between specialties. Single-center series have demonstrated consistency in decision-making by Coronary Heart Teams but prospective data demonstrating improved patient outcomes and/or cost effectiveness are necessary. The concept of a Coronary Heart Team is gaining traction for patients with complex coronary artery disease. There is a growing literature in support of Coronary Heart Teams but comparative and prospective data demonstrating improved patient outcomes are needed.

  13. Aortic valve laceration following coronary angiography and percutaneous coronary intervention.

    PubMed

    Roy, James; Manganas, Con; Youssef, George; Rees, David

    2016-11-01

    Valve complications following coronary angiography and percutaneous coronary interventions are rare. We report a case of an aortic valve laceration following cardiac catheterization and percutaneous coronary intervention, which required surgical valve replacement. © 2016 Wiley Periodicals, Inc.

  14. Coronary fistula associated with double mitral valve disease. A case report.

    PubMed

    Ayala, F; Badui, E; Murillo, H; Almazán, A; Madrid, R; Solorio, S; Verdín, R; Monroy, V

    1996-01-01

    The authors report a case of a 54-year-old white male with a coronary fistula associated with double mitral valve disease. The patient was studied by invasive and non-invasive cardiac methods including coronary angiogram in order to reach the correct diagnosis and to define the successful surgical treatment that included the closure of the fistula, partial resection of the left atrium and insertion of a mechanical mitral valve prosthesis. It is concluded that this case represents a very rare association between coronary fistula and double mitral valve disease.

  15. Coronary CT and the Coronary Calcium Score, the Future of ED Risk Stratification?

    PubMed Central

    Fernandez-Friera, Leticia; Garcia-Alvarez, Ana; Guzman, Gabriela; Garcia, Mario J

    2012-01-01

    Accurate and efficient evaluation of acute chest pain remains clinically challenging because traditional diagnostic modalities have many limitations. Recent improvement in non-invasive imaging technologies could potentially improve both diagnostic efficiency and clinical outcomes of patients with acute chest pain while reducing unnecessary hospitalizations. However, there is still controversy regarding much of the evidence for these technologies. This article reviews the role of coronary artery calcium score and the coronary computed tomography in the assessment of individual coronary risk and their usefulness in the emergency department in facilitating appropriate disposition decisions. The evidence base and clinical applications for both techniques are also described, together with cost- effectiveness and radiation exposure considerations. PMID:22708911

  16. Prognostic Value of Gai's Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis

    PubMed Central

    Zhang, Chuang; Yang, Shuang; Gai, Lu-Yue; Han, Zhi-Qi; Xin, Qian; Yang, Xiao-Bo; Yang, Jun-Jie; Jin, Qin-Hua

    2016-01-01

    Background: The prognostic values of the coronary computed tomography angiography (CCTA) score for predicting future cardiovascular events have been previously demonstrated in numerous studies. However, few studies have used the rich information available from CCTA to detect functionally significant coronary lesions. We sought to compare the prognostic values of Gai's plaque score and the coronary artery calcium score (CACS) of CCTA for predicting functionally significant coronary lesions, using fractional flow reserve (FFR) as the gold standard. Methods: We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients (mean age, 59.6 ± 10.2 years; 76.14% of males) who underwent CCTA, invasive coronary angiography, and invasive FFR measurement. An FFR <0.80 indicated hemodynamically significant coronary stenosis. Lesions were divided into two groups using an FFR cutoff value of 0.80. We compared Gai's plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR. The statistical methods included unpaired t-test, Mann-Whitney U-test, and Spearman's correlation coefficients. Results: Coronary lesions with FFR <0.80 had higher Gai's scores than those with FFR ≥0.80. Gai's score had the strongest correlation with FFR (r = −0.48, P < 0.01) and had a greater area under the curve = 0.72 (95% confidence interval: 0.61–0.82; P < 0.01) than the CACS of whole arteries and a single artery. Conclusions: Both CACS in a single artery and Gai's plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR. However, Gai's plaque score was more predictive of FFR <0.80. Gai's score can be easily calculated in daily clinical practice and could be used when considering revascularization. PMID:27900990

  17. Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotected left main and ostial left anterior descending artery intervention.

    PubMed

    Ko, Brian S; Crossett, Marcus; Seneviratne, Sujith K

    2015-07-01

    Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for unprotected left main percutaneous coronary intervention. Combined coronary computed tomography angiography and adenosine stress computed tomography myocardial perfusion imaging is a non-invasive technique which may provide this information. This is the first report describing its use to assist patient selection and procedural planning prior to elective left main and ostial left anterior descending artery coronary intervention.

  18. Coronary CT Angiography-derived Fractional Flow Reserve.

    PubMed

    Tesche, Christian; De Cecco, Carlo N; Albrecht, Moritz H; Duguay, Taylor M; Bayer, Richard R; Litwin, Sheldon E; Steinberg, Daniel H; Schoepf, U Joseph

    2017-10-01

    Invasive coronary angiography (ICA) with measurement of fractional flow reserve (FFR) by means of a pressure wire technique is the established reference standard for the functional assessment of coronary artery disease (CAD) ( 1 , 2 ). Coronary computed tomographic (CT) angiography has emerged as a noninvasive method for direct assessment of CAD and plaque characterization with high diagnostic accuracy compared with ICA ( 3 , 4 ). However, the solely anatomic assessment provided with both coronary CT angiography and ICA has poor discriminatory power for ischemia-inducing lesions. FFR derived from standard coronary CT angiography (FFRCT) data sets by using any of several advanced computational analytic approaches enables combined anatomic and hemodynamic assessment of a coronary lesion by a single noninvasive test. Current technical approaches to the calculation of FFRCT include algorithms based on full- and reduced-order computational fluid dynamic modeling, as well as artificial intelligence deep machine learning ( 5 , 6 ). A growing body of evidence has validated the diagnostic accuracy of FFRCT techniques compared with invasive FFR. Improved therapeutic guidance has been demonstrated, showing the potential of FFRCT to streamline and rationalize the care of patients suspected of having CAD and improve outcomes while reducing overall health care costs ( 7 , 8 ). The purpose of this review is to describe the scientific principles, clinical validation, and implementation of various FFRCT approaches, their precursors, and related imaging tests. (©) RSNA, 2017.

  19. 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

  20. Coronary revascularisation in women

    PubMed Central

    Mikhail, G W

    2006-01-01

    Coronary heart disease is the leading cause of death in men and women worldwide. It is still considered a disease of men and there has been little recognition of its importance in women. Gender differences exist in acute and chronic ischaemia in terms of clinical manifestations, investigations and treatment. There are clear gender differences in coronary revascularisation with a higher mortality seen in women. At the time a woman presents with coronary artery disease she is older and has more co‐morbid factors. Furthermore, women have smaller coronary arteries making them more difficult to revascularise. In recent years there has been a general trend towards improved outcomes in women undergoing both surgical and percutaneous coronary intervention. The increasing use of drug eluting stents and adjunctive medical treatment as well as the use of off‐pump bypass surgery needs further evaluation in terms of gender differences. This article reviews the current literature on coronary revascularisation in women. PMID:16614263

  1. Exposure to Concentrated Ambient Particles Does Not Affect Vascular Function in Patients with Coronary Heart Disease

    PubMed Central

    Mills, Nicholas L.; Robinson, Simon D.; Fokkens, Paul H. B.; Leseman, Daan L. A. C.; Miller, Mark R.; Anderson, David; Freney, Evelyn J.; Heal, Mathew R.; Donovan, Robert J.; Blomberg, Anders; Sandström, Thomas; MacNee, William; Boon, Nicholas A.; Donaldson, Ken; Newby, David E.; Cassee, Flemming R.

    2008-01-01

    Background Exposure to fine particulate air pollution is associated with increased cardiovascular morbidity and mortality. We previously demonstrated that exposure to dilute diesel exhaust causes vascular dysfunction in humans. Objectives We conducted a study to determine whether exposure to ambient particulate matter causes vascular dysfunction. Methods Twelve male patients with stable coronary heart disease and 12 age-matched volunteers were exposed to concentrated ambient fine and ultrafine particles (CAPs) or filtered air for 2 hr using a randomized, double-blind cross-over study design. We measured peripheral vascular vasomotor and fibrinolytic function, and inflammatory variables—including circulating leukocytes, serum C-reactive protein, and exhaled breath 8-isoprostane and nitrotyrosine—6–8 hr after both exposures. Results Particulate concentrations (mean ± SE) in the exposure chamber (190 ± 37 μg/m3) were higher than ambient levels (31 ± 8 μg/m3) and levels in filtered air (0.5 ± 0.4 μg/m3; p < 0.001). Chemical analysis of CAPs identified low levels of elemental carbon. Exhaled breath 8-isoprostane concentrations increased after exposure to CAPs (16.9 ± 8.5 vs. 4.9 ± 1.2 pg/mL, p < 0.05), but markers of systemic inflammation were largely unchanged. Although there was a dose-dependent increase in blood flow and plasma tissue plasminogen activator release (p < 0.001 for all), CAPs exposure had no effect on vascular function in either group. Conclusions Despite achieving marked increases in particulate matter, exposure to CAPs—low in combustion-derived particles—did not affect vasomotor or fibrinolytic function in either middle-aged healthy volunteers or patients with coronary heart disease. These findings contrast with previous exposures to dilute diesel exhaust and highlight the importance of particle composition in determining the vascular effects of particulate matter in humans. PMID:18560524

  2. 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

  3. Assessment of coronary ischaemia by myocardial perfusion dipyridamole stress technetium-99 m tetrofosmin, single-photon emission computed tomography, and coronary angiography in children with Kawasaki disease: pre- and post-coronary bypass grafting.

    PubMed

    Mostafa, Mostafa S; Sayed, Ashraf O; Al Said, Yasser M

    2015-06-01

    Coronary artery lesions in Kawasaki disease invasively assessed by coronary angiography. Evaluation of myocardial perfusion by single-photon emission computed tomography may identify the haemodynamic significance of coronary lesions. To evaluate diagnostic accuracy of dipyridamole stress technetium-99 m tetrofosmin, single-photon emission computed tomography as a possible alternative to invasive coronary angiography for detection and follow-up of myocardial ischaemia in patients with Kawasaki disease, and pre- and post-coronary bypass grafting. Coronary angiography and single-photon emission computed tomography were performed on 21 patients who were classified into three groups - group I (stenosis), group II (giant aneurysms), and group III (small aneurysms). Of the 21 patients, 16 (groups I and II) patients with myocardial perfusion defects, who underwent coronary bypass grafting, were followed up with single-photon emission computed tomography. In group I, all patients had significant coronary stenosis and 100% of them had perfusion defects in the anterior and septal walls. In group II, all patients had giant aneurysms and 83% of them had inferior and inferolateral perfusion defects. In group III, all patients had small aneurysms and 100% of them had normal perfusion. Pre-coronary bypass grafting myocardial ischaemic defects disappeared in all patients after surgery. Sensitivity, specificity, and accuracy of single-photon emission computed tomography were 94, 100, and 95%, respectively. Technetium-99 m tetrofosmin single-photon emission computed tomography can be applied as an accurate non-invasive diagnostic technique for detecting myocardial perfusion defects with coronary artery lesions, and to show improved or even normalised perfusion of the myocardium in patients after surgical revascularisation.

  4. The clinical utility of bivalirudin in patients with coronary artery disease.

    PubMed

    Garner, William L; Linden, Julie A; Chrysant, George S

    2013-03-01

    Bivalirudin, a direct thrombin inhibitor, is an anticoagulant commonly used in invasive cardiology procedures. It has evolved from relative obscurity, as an anticoagulation option only utilized in rare instances of allergy or resistance to heparin products, to the now preferred antithrombotic anticoagulant in the cardiac catheterization laboratory. On the way to displacing unfractionated heparin as the preferred anticoagulant for percutaneous coronary intervention, multiple studies comparing bivalirudin with heparin have consistently shown equivalent ischemic efficacy endpoints (i.e. cardiovascular death, myocardial infarction, etc.), with significant reductions in bleeding. Bleeding has been directly linked to worse hospital outcomes in cardiac patient's undergoing invasive coronary artery revascularization procedures. More recent bivalirudin studies now demonstrate reductions in mortality, which has led to a paradigm shift to bivalirudin as the anticoagulant choice both in elective and emergent coronary procedures. We present the major studies that have brought bivalirudin to the forefront of coronary artery disease, specifically coronary interventional procedures.

  5. Automated Tuning for Parameter Identification and Uncertainty Quantification in Multi-scale Coronary Simulations.

    PubMed

    Tran, Justin S; Schiavazzi, Daniele E; Ramachandra, Abhay B; Kahn, Andrew M; Marsden, Alison L

    2017-01-05

    Atherosclerotic coronary artery disease, which can result in coronary artery stenosis, acute coronary artery occlusion, and eventually myocardial infarction, is a major cause of morbidity and mortality worldwide. Non-invasive characterization of coronary blood flow is important to improve understanding, prevention, and treatment of this disease. Computational simulations can now produce clinically relevant hemodynamic quantities using only non-invasive measurements, combining detailed three dimensional fluid mechanics with physiological models in a multiscale framework. These models, however, require specification of numerous input parameters and are typically tuned manually without accounting for uncertainty in the clinical data, hindering their application to large clinical studies. We propose an automatic, Bayesian, approach to parameter estimation based on adaptive Markov chain Monte Carlo sampling that assimilates non-invasive quantities commonly acquired in routine clinical care, quantifies the uncertainty in the estimated parameters and computes the confidence in local predicted hemodynamic indicators.

  6. Aortic pulsatility assessed by an oscillometric method is associated with coronary atherosclerosis in elderly people.

    PubMed

    Nakagomi, Atsushi; Okada, Sho; Shoji, Toshihiro; Kobayashi, Yoshio

    2016-12-01

    The aim of this study was to investigate the association of aortic pulsatility assessed by a non-invasive brachial cuff-based method with coronary atherosclerosis. In total, 139 patients undergoing coronary angiography were included in this cross-sectional study. Aortic blood pressure (BP) indices were recorded invasively by a fluid-filled catheter and non-invasively by a brachial cuff-based oscillometric device. Fractional pulse pressure (FPP) was defined as pulse pressure (PP)/mean BP and pulsatility index (PI) as PP/diastolic BP. Aortic FPP and PI in coronary artery disease (CAD) patients were significantly higher than in non-CAD patients in both invasive and non-invasive methods. Multivariate logistic regression analysis demonstrated that non-invasively measured aortic FPP and PI were associated with CAD risk in patients aged ≥70 years [aortic FPP per 0.1 odds ratio (OR) = 1.66, 95% confidence interval (CI) 1.05-2.64; aortic PI per 0.1 OR =1.39, 95% CI 1.02-1.88; all p < 0.05], but were not associated with CAD risk in patients aged <70 years. In linear regression analysis, non-invasively measured aortic FPP and PI correlated with SYNTAX and Gensini scores only in patients aged ≥70 years. Aortic FPP and PI measured non-invasively by a brachial cuff-based oscillometric device were associated with coronary atherosclerosis in elderly patients.

  7. Invasive Candidiasis.

    PubMed

    McCarty, Todd P; Pappas, Peter G

    2016-03-01

    Invasive candidiasis is a collective term that refers to a group of infectious syndromes caused by a variety of species of Candida, 5 of which cause most cases. Candidemia is the most commonly recognized syndrome associated with invasive candidiasis. Certain conditions may influence the likelihood for one species versus another in a specific clinical scenario, and this can have important implications for selection of antifungal therapy and the duration of treatment. Molecular diagnostic technology plays an ever-increasing role as an adjunct to traditional culture-based diagnostics, offering significant potential toward improvement in patient care.

  8. Detection of coronary artery disease by thallium scintigraphy in patients with valvar heart disease.

    PubMed Central

    Huikuri, H V; Korhonen, U R; Heikkilä, J; Takkunen, J T

    1986-01-01

    In patients with valvar heart disease detection of coronary artery disease by conventional non-invasive methods may be difficult. The usefulness of thallium-201 exercise scintigraphy for detecting coronary artery disease was evaluated in 16 patients with aortic stenosis, 17 with aortic regurgitation, nine with mitral stenosis, and six with mitral regurgitation who were investigated by coronary angiography. Only two of 21 patients with greater than or equal to 50% coronary artery obstruction had normal thallium images. Three patients without angiographic evidence of coronary artery stenoses had perfusion defects demonstrated by thallium scintigraphy. Only one patient with greater than or equal to 75% coronary stenosis had a normal thallium scan. Angina pectoris or ST segment depression evoked by exercise test were not useful in distinguishing patients with coronary artery disease from those with normal coronary vessels. These data suggest that thallium exercise scintigraphy may be a useful non-invasive test for detecting coronary artery disease in patients with valvar heart disease. Images Fig. 1 Fig. 2 PMID:3730215

  9. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    PubMed Central

    dos Prazeres, Carlos Eduardo Elias; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

    2013-01-01

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies. PMID:24145392

  10. 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. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Menopausal vasomotor symptoms and incident breast cancer risk in the Study of Women’s Health Across the Nation

    PubMed Central

    Hart, Vicki; Sturgeon, Susan R.; Reich, Nicholas; Sievert, Lynnette Leidy; Crawford, Sybil L.; Gold, Ellen B.; Avis, Nancy E.; Reeves, Katherine W.

    2017-01-01

    Purpose Two case-control studies reported a 50% decreased breast cancer risk among women who experienced menopausal vasomotor symptoms (VMS), but one cohort study found no association. VMS may be triggered by declining estrogen levels during menopause, whereas elevated estrogen levels have been associated with increased breast cancer risk. VMS may thus be indicative of lower susceptibility to breast cancer. Methods We evaluated this relationship in the longitudinal Study of Women’s Health Across the Nation (SWAN), using discrete survival analysis of approximately annual data on VMS and self-reported breast cancer occurrences for up to 13 years of follow-up in 3,098 women who were pre- or early perimenopausal at enrollment. Results Over an average 11.4 years of follow-up, 129 incident breast cancer cases were self-reported, and approximately 50% of participants experienced VMS. Symptomatic women had a reduced risk of breast cancer compared to non-symptomatic women (adjusted HR 0.63, 95% CI 0.39, 1.00). The association was stronger in the subgroup of women who fully transitioned to postmenopause during follow-up (N=67 cases, adjusted HR 0.45, 95% CI 0.26, 0.77). Conclusion VMS appeared to be a marker of reduced breast cancer risk. Future research is needed to understand the biology underlying this relationship. PMID:27680016

  12. 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

  13. Intracranial haemodynamics during vasomotor stress test in unilateral internal carotid artery occlusion estimated by 3-D transcranial Doppler scanner.

    PubMed

    Zbornikova, V; Lassvik, C; Hillman, J

    1995-04-01

    Seventeen patients, 14 males and 3 females, mean age 64 years (range 45-77 years) with longstanding unilateral occlusion of the internal carotid artery and minimal neurological deficit, were evaluated in order to find criteria for potential benefit of extracranial-intracranial by-pass surgery. 3-D transcranial Doppler was used for estimation of mean velocities and pulsatility index in the middle cerebral artery, anterior cerebral artery and posterior cerebral artery before and after iv injection of 1 g acetazolamide. The anterior cerebral artery was the supplying vessel to the occluded side in 16 patients and mean velocities were significantly (p < 0.001) faster on the occluded (59.3 +/- 14.5 cm sec-1) and nonoccluded (91.6 +/- 29.6 cm sec-1, p < 0.05)) side than those found in the middle cerebral artery (39.2 +/- 13.7 and 50.9 +/- 8.5 cm sec-1). In two patients a decrease of mean velocity after acetazolamide was noted in middle cerebral artery indicating 'steal' effect. In another 4 patients, poor vasomotor response was seen with less than 11% of mean velocity increase in the middle cerebral artery. Differences between posterior cerebral artery on the occluded and nonoccluded side were insignificant as well as those between middle and posterior on the occluded side. Resting values of pulsatility index differed significantly (p < 0.01) only between anterior and posterior cerebral artery on the nonoccluded side.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. An International Menopause Society study of climate, altitude, temperature (IMS-CAT) and vasomotor symptoms in urban Indian regions.

    PubMed

    Stefanopoulou, E; Shah, D; Shah, R; Gupta, P; Sturdee, D W; Hunter, M S

    2014-08-01

    To examine the relationships between climate (season, temperature, humidity), lifestyle, health, mood and beliefs and experience of hot flushes and night sweats amongst mid-aged women living in eight urban Indian centers. A total of 717 peri- and postmenopausal women, aged 45-55 years, from urban centers in different regions of India were included. Data were collected during both summer and winter months. Participants completed questionnaires eliciting information about sociodemographics, hot flushes (prevalence, frequency and problem-rating), health and lifestyle (body mass index, diet, exercise, alcohol use), mood (Women's Health Questionnaire) and attributions and beliefs (Menopause Representations Questionnaire). The prevalence of vasomotor symptoms was low, with 34% of the sample reporting hot flushes and/or night sweats. Seasonal variation in temperature was not associated with hot flush prevalence, frequency or problem rating. Hot flush prevalence was mainly associated with higher anxiety and intake of spicy foods, frequency with (older) age and (more) frequent exercise, while hot flushes were more problematic for women who reported poorer general health and more negative beliefs about menopause. In this study of Indian women, seasonal temperature variation did not appear to influence hot flush reporting. Health, mood, beliefs and lifestyle factors appear to explain some, but not all, of the variance in experience of menopausal symptoms.

  15. Noninvasive assessment of coronary vasodilation using cardiovascular magnetic resonance in patients at high risk for coronary artery disease

    PubMed Central

    Nguyen, Patricia K; Meyer, Craig; Engvall, Jan; Yang, Phillip; McConnell, Michael V

    2008-01-01

    Background Impaired coronary vasodilation to both endothelial-dependent and endothelial-independent stimuli have been associated with atherosclerosis. Direct measurement of coronary vasodilation using x-ray angiography or intravascular ultrasound is invasive and, thus, not appropriate for asymptomatic patients or for serial follow-up. In this study, high-resolution coronary cardiovascular magnetic resonance (CMR) was used to investigate the vasodilatory response to nitroglycerine (NTG) of asymptomatic patients at high risk for CAD. Methods A total of 46 asymptomatic subjects were studied: 13 high-risk patients [8 with diabetes mellitus (DM), 5 with end stage renal disease (ESRD)] and 33 age-matched controls. Long-axis and cross-sectional coronary artery images were acquired pre- and 5 minutes post-sublingual NTG using a sub-mm-resolution multi-slice spiral coronary CMR sequence. Coronary cross sectional area (CSA) was measured on pre- and post-NTG images and % coronary vasodilation was calculated. Results Patients with DM and ESRD had impaired coronary vasodilation to NTG compared to age-matched controls (17.8 ± 7.3% vs. 25.6 ± 7.1%, p = 0.002). This remained significant for ESRD patients alone (14.8 ± 7.7% vs. 25.6 ± 7.1%; p = 0.003) and for DM patients alone (19.8 ± 6.3% vs. 25.6 ± 7.1%; p = 0.049), with a non-significant trend toward greater impairment in the ESRD vs. DM patients (14.8 ± 7.7% vs. 19.8 ± 6.3%; p = 0.23). Conclusion Noninvasive coronary CMR demonstrates impairment of coronary vasodilation to NTG in high-risk patients with DM and ESRD. This may provide a functional indicator of subclinical atherosclerosis and warrants clinical follow up to determine prognostic significance. PMID:18513419

  16. Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

    PubMed Central

    Chen, Michael; Qiu, Yiling; Cheng, Susan; Liao, Ronglih

    2015-01-01

    Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow reserve (CFR) in humans. Reduced CFR is accompanied by marked intramyocardial and pericoronary fibrosis and is used as an indication of the severity of dysfunction. This study explores, step-by-step, the real-time changes measured in the coronary flow velocity, CFR and systolic to diastolic peak velocity (S/D) ratio in the setting of an aortic banding model in mice. By using a Doppler transthoracic imaging technique that yields reproducible and reliable data, the method assesses changes in flow in the septal coronary artery (SCA), for a period of over two weeks in mice, that previously either underwent aortic banding or thoracotomy. During imaging, hyperemia in all mice was induced by isoflurane, an anesthetic that increased coronary flow velocity when compared with resting flow. All images were acquired by a single imager. Two ratios, (1) CFR, the ratio between hyperemic and baseline flow velocities, and (2) systolic (S) to diastolic (D) flow were determined, using a proprietary software and by two independent observers. Importantly, the observed changes in coronary flow preceded LV dysfunction as evidenced by normal LV mass and fractional shortening (FS). The method was benchmarked against the current gold standard of coronary assessment, histopathology. The latter technique showed clear pathologic changes in the coronary artery in the form of peri-coronary fibrosis that correlated to the flow changes as assessed by echocardiography. The study underscores the value of using a non-invasive technique to monitor coronary circulation in mouse hearts. The method minimizes redundant use of research animals and demonstrates that advanced ultrasound-based indices, such as CFR and S/D ratios, can serve as viable diagnostic tools in a variety of investigational protocols including drug studies and the study of genetically

  17. [Is coronary artery disease different in women?].

    PubMed

    Schiele, François; Chopard, Romain

    2014-01-01

    Coronary artery disease (CAD) is the primary cause of death in women. Although acute coronary syndrome (ACS) is relatively infrequent in young women, failure to recognize ACS in this population can incur a major risk and registry data show that there is still plenty of room for improvement in this area. Women may suffer from "classical" CAD with development of atherosclerosis with a delay of about 10 years as compared to men, reflecting hormonal protection in women. Besides this classical presentation, angina in women often corresponds to impaired microcirculation, a syndrome known to associate typical angina, demonstrable myocardial ischemia, but no lesions on the coronary angiography. Finally, spasm, spontaneous dissection or coronary thrombosis through endothelial rupture are more frequent in women. The influence of risk factors on the development of CAD is comparable in both women and men. Recent registry studies show that in France, in particular, diabetes, obesity, and smoking are all risk factors that are on the rise in women. In addition, certain other risk factors are more specific to women, namely psycho-social stress. The methods to evaluate risk and detect CAD were mainly developed in male study populations, and these tools thus perform less well in female patients. In case of ACS, women benefit just as much from invasive management, but are at greater risk of iatrogenic complications, particularly with anti-thrombotic therapy or during revascularization procedures.

  18. Coronary involvement in Churg-Strauss syndrome

    PubMed Central

    Dendramis, Gregory; Paleologo, Claudia; Piraino, Davide; Arrotti, Salvatore; Assennato, Pasquale

    2015-01-01

    Systemic autoimmune diseases are themselves a relevant and independent risk factor for atherosclerosis and coronary ectasia. We describe a case of a 58-year-old Caucasian man who was admitted to our department for unstable angina. History of asthma, paranasal sinus abnormality, and peripheral eosinophilia given a high suspicion of Churg-Strauss syndrome (CSS). Diagnosis was performed with 5 of the 6 American College of Rheumatology criteria. The knowledge that CSS is often associated with significant coronary artery involvement and the persistence of chest pain led us to performing immediately a coronary angiography. Coronary angiography showed diffuse ectasic lesions, chronic occlusion of left anterior descending artery with homocoronary collateral circulation from left circumflex artery and subocclusive stenosis in the proximal tract of posterior descending artery. The early recognition of CSS, an aggressive invasive diagnostic approach, and an early appropriate therapy are important to prevent the progressive and permanent cardiac damage in these patients. In the setting of a multidisciplinary approach, careful cardiac assessment is an essential step in CSS, even in mildly symptomatic patients. PMID:26702692

  19. Acute coronary syndromes.

    PubMed

    Lipson, Alan

    2008-07-01

    The mortality rate for coronary artery disease has decreased steadily over the past 25 yeas, attributable to a great extent to advances in medical and mechanical interventions. Nevertheless, mortality rates for acute coronary syndromes remain between 4% and 7%. This article highlights treatment options and the challenge of implementing evidence-based recommendations.

  20. Progress in coronary angioplasty.

    PubMed

    Silverton, P

    1986-10-01

    Angioplasty offers an alternative to bypass grafting for an increasing number of patients with coronary artery disease. Improvements in catheter design and manufacture have been responsible for an enlargement of the indications which now include patients with multiple vessel coronary artery disease and those with acute evolving myocardial infarction. The application of laser technology may assist in the reopening of chronically occluded arteries.

  1. Anomalous origin of the right coronary artery: First familial cases in Asia.

    PubMed

    Motomura, Hideki; Yokokawa, Mari; Fukunaga, Hirofumi; Nakagaki, Mari; Hasuwa, Tomoyuki; Moriuchi, Hiroyuki

    2016-11-01

    Congenital coronary artery abnormalities may cause sudden death, particularly in athletes. Two siblings, aged 10 and 9 years, respectively, were diagnosed with anomalous origin of the right coronary artery on multi-detector computed tomography (MDCT). The right coronary artery arose from the left coronary cusp, and was wedged between the aorta and pulmonary artery. This was also noted on cardiac ultrasonography (UCG), but in general this might not be seen on electrocardiography at rest. Although the surgical indications are unclear in the case of unproven ischemia, early recognition of the condition may reduce risk of the cardiac events during exercise. The majority of proximal coronary artery anomalies can be screened for on UCG, and confirmed on MDCT, which yields more precise clinical details and is less invasive than angiography. This is the first report of familial cases of anomalous origin of the right coronary artery in Asia. © 2016 Japan Pediatric Society.

  2. 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

  3. Impact of radial artery cannulation for coronary angiography and angioplasty on radial artery function.

    PubMed

    Burstein, Jason M; Gidrewicz, Dominica; Hutchison, Stuart J; Holmes, Kate; Jolly, Sanjit; Cantor, Warren J

    2007-02-15

    The radial artery is commonly used as a conduit in coronary artery bypass grafting. No data exist on the effects of radial sheath insertion on radial artery function. Because many patients considered for coronary artery bypass grafting have had previous radial procedures, it is important to understand any effects radial sheath insertion may have on radial artery function. Twenty-two patients who underwent elective coronary angiography or angioplasty with a 6Fr sheath through the right radial artery were studied. Radial artery function was assessed using ultrasound to measure flow-mediated dilation (FMD). Reactive hyperemia was produced by 5-minute cuff inflation on the arm to suprasystolic pressures. Radial artery diameter was measured at rest and 1 minute after cuff deflation. FMD was expressed as percent change in radial diameter compared with at rest. In all cases, the left radial artery was studied as a control. Patients were studied before sheath insertion, immediately after sheath insertion, and 6 weeks after sheath insertion. The FMD of the cannulated arm was 13.2% before sheath insertion versus 3.6% immediately after sheath insertion (p <0.01) and 0.2% (p <0.01) 9 weeks after sheath insertion. In contrast, there were no significant changes in the noncannulated arm at either time point. In conclusion, radial artery sheath insertion for coronary angiography or angioplasty results in immediate and persistent blunting of FMD, suggesting severe vasomotor dysfunction. Radial artery sheath insertion has important effects on radial artery function that must be considered when selecting radial conduits for coronary artery bypass grafting.

  4. Pathophysiology of coronary collaterals.

    PubMed

    Stoller, Michael; Seiler, Christian

    2014-02-01

    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.

  5. 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

  6. 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

  7. Prognostic utility of coronary computed tomographic angiography

    PubMed Central

    Otaki, Yuka; Berman, Daniel S.; Min, James K.

    2013-01-01

    Coronary computed tomographic angiography (CCTA) employing CT scanners of 64-detector rows or greater represents a noninvasive method that enables accurate detection and exclusion of anatomically obstructive coronary artery disease (CAD), providing excellent diagnostic information when compared to invasive angiography. There are numerous potential advantages of CCTA beyond simply luminal stenosis assessment including quantification of atherosclerotic plaque volume as well as assessment of plaque composition, extent, location and distribution. In recent years, an array of studies has evaluated the prognostic utility of CCTA findings of CAD for the prediction of major adverse cardiac events, all-cause death and plaque instability. This prognostic information enhances risk stratification and, if properly acted upon, may improve medical therapy and/or behavioral changes that may enhance event-free survival. The goal of the present article is to summarize the current status of the prognostic utility of CCTA findings of CAD. PMID:23809386

  8. Multicenter Evaluation Of Coronary Dual-Source CT angiography in patients with intermediate Risk of Coronary Artery Stenoses (MEDIC): study design and rationale.

    PubMed

    Marwan, Mohamed; Hausleiter, Jörg; Abbara, Suhny; Hoffmann, Udo; Becker, Christoph; Ovrehus, Kristian; Ropers, Dieter; Bathina, Ravi; Berman, Dan; Anders, Katharina; Uder, Michael; Meave, Aloha; Alexánderson, Erick; Achenbach, Stephan

    2014-01-01

    The diagnostic performance of multidetector row CT to detect coronary artery stenosis has been evaluated in numerous single-center studies, with only limited data from large cohorts with low-to-intermediate likelihood of coronary disease and in multicenter trials. The Multicenter Evaluation of Coronary Dual-Source CT Angiography in Patients with Intermediate Risk of Coronary Artery Stenoses (MEDIC) trial determines the accuracy of dual-source CT (DSCT) to identify persons with at least 1 coronary artery stenosis among patients with low-to-intermediate pretest likelihood of disease. The MEDIC trial was designed as a prospective, multicenter, international trial to evaluate the diagnostic performance of DSCT for the detection of coronary artery stenosis compared with invasive coronary angiography. The study includes 8 sites in Germany, India, Mexico, the United States, and Denmark. The study population comprises patients referred for a diagnostic coronary angiogram because of suspected coronary artery disease with an intermediate pretest likelihood as determined by sex, age, and symptoms. All evaluations are performed by blinded core laboratory readers. The primary outcome of the MEDIC trial is the accuracy of DSCT to identify the presence of coronary artery stenoses with a luminal diameter narrowing of 50% or more on a per-vessel basis. Secondary outcome parameters include per-patient and per-segment diagnostic accuracy for 50% stenoses and accuracy to identify stenoses of 70% or more. Furthermore, secondary outcome parameters include the influence of heart rate, Agatston score, body weight, body mass index, image quality, and diagnostic confidence on the accuracy to detect coronary artery stenoses >50% on a per-vessel basis. The results of the MEDIC trial will assess the clinical utility of coronary CT angiography in the evaluation of patients with intermediate pretest likelihood of coronary artery disease. Copyright © 2014 Society of Cardiovascular Computed

  9. Coronary CT Angiography in Heavily Calcified Coronary Arteries: Improvement of Coronary Lumen Visualization and Coronary Stenosis Assessment With Image Postprocessing Methods

    PubMed Central

    Sun, Zhonghua; Ng, Curtise K.C.; Xu, Lei; Fan, Zhanming; Lei, Jing

    2015-01-01

    Abstract To compare the diagnostic value of coronary CT angiography (CCTA) with use of 2 image postprocessing methods (CCTA_S) and (CCTA_OS) and original data (CCTA_O) for the assessment of heavily calcified plaques. Fifty patients (41 men, 9 women; mean age 61.9 years ± 9.1) with suspected coronary artery disease who underwent CCTA and invasive coronary angiography (ICA) examinations were included in the study. Image data were postprocessed with “sharpen” and smooth reconstruction algorithms in comparison with the original data without undergoing any image postprocessing to determine the effects on suppressing blooming artifacts due to heavy calcification in the coronary arteries. Minimal lumen diameter and degree of stenosis were measured and compared between CCTA_S, CCTA_OS, and CCTA_O with ICA as the reference method. The area under the curve (AUC) by receiver-operating characteristic curve analysis (ROC) was also compared among these 3 CCTA techniques. On a per-vessel assessment, the sensitivity, specificity, positive predictive value and negative predictive value, and 95% confidence interval (CI) were 100% (95% CI: 89%, 100%), 33% (95% CI: 22%, 45%), 41% (95% CI: 30%, 53%), 100% (95% CI: 85%, 100%) for CCTA_O, 94% (95% CI: 79%, 99%), 66% (95% CI: 54%, 77%), 57% (95% CI: 43%, 70%), and 95% (95% CI: 85%, 99%) for CCTA_S, 94% (95% CI: 79%, 99%), 44% (95% CI: 32%, 57%), 44% (95% CI: 32%, 57%), and 97% (95% CI: 79%, 99%) for CCTA_OS, respectively. The AUC by ROC curve analysis for CCTA_S showed significant improvement for detection of >50% coronary stenosis in left anterior descending coronary artery compared to that of CCTA_OS and CCTA_O methods (P < 0.05), with no significance differences for detection of coronary stenosis in the left circumflex and right coronary arteries (P > 0.05). CCTA with “sharpen” reconstruction reduces blooming artifacts from heavy calcification, thus, leading to significant improvement of specificity and positive

  10. Impact of Coronary Calcification on Clinical Management in Patients With Acute Chest Pain.

    PubMed

    Bittner, Daniel O; Mayrhofer, Thomas; Bamberg, Fabian; Hallett, Travis R; Janjua, Sumbal; Addison, Daniel; Nagurney, John T; Udelson, James E; Lu, Michael T; Truong, Quynh A; Woodard, Pamela K; Hollander, Judd E; Miller, Chadwick; Chang, Anna Marie; Singh, Harjit; Litt, Harold; Hoffmann, Udo; Ferencik, Maros

    2017-05-01

    Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network-Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (≥70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%-64%), ACS (1%-44%), downstream testing (4%-72%), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%). Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01084239 and NCT00933400. © 2017 American Heart Association, Inc.

  11. Prospective evaluation of the development of contrast-induced nephropathy in patients with acute coronary syndrome undergoing rotational coronary angiography vs. conventional coronary angiography: CINERAMA study.

    PubMed

    Fernández-Rodríguez, Diego; Grillo-Pérez, José J; Pérez-Hernández, Horacio; Rodríguez-Esteban, Marcos; Pimienta, Raquel; Acosta-Materán, Carlos; Rodríguez, Sara; Yanes-Bowden, Geoffrey; Vargas-Torres, Manuel J; Sánchez-Grande Flecha, Alejandro; Hernández-Afonso, Julio; Bosa-Ojeda, Francisco

    2017-07-19

    Rotational coronary angiography (RCA) requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN) during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine ≥0.5mg/dl or ≥25%) after an acute coronary syndrome. From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA). CIN (primary endpoint), as well as analytical, angiographic and clinical endpoints, were compared between groups. Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0±11.8 years vs. 59.7±12.1 years; p=0.006), a higher proportion of women (44.8 vs. 17.6%; p<0.001), patients with a lower estimated glomerular filtration rate (76±25 vs. 86±27ml/min/1.73 m(2); p=0.001), and patients who underwent fewer coronary angioplasties (p<0.001) compared with the CCA group. Furthermore, the RCA group, received less contrast (113±92 vs. 169±103ml; p<0.001), including in diagnostic procedures (54±24 vs. 85±56ml; p<0.001) and diagnostic-therapeutic procedures (174±64 vs. 205±98ml; p=0.049) compared with the CCA group. The RCA group presented less CIN (4.3 vs. 22.7%; p<0.001) compared to the CCA group, and this finding was maintained in the regression analysis (Adjusted relative risk: 0.868; 95% CI: 0.794-0.949; p=0.002). There were no differences in clinical endpoints between the groups. RCA was associated with lower administration of contrast during invasive coronary procedures in acute coronary syndrome patients, resulting in lower incidence of CIN, in comparison with CCA. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All

  12. Rationale and design of the HeartFlowNXT (HeartFlow analysis of coronary blood flow using CT angiography: NeXt sTeps) study.

    PubMed

    Gaur, Sara; Achenbach, Stephan; Leipsic, Jonathon; Mauri, Laura; Bezerra, Hiram G; Jensen, Jesper Møller; Bøtker, Hans Erik; Lassen, Jens Flensted; Nørgaard, Bjarne Linde

    2013-01-01

    Coronary CT angiography (CTA) is an established noninvasive method for visualization of coronary artery disease. However, coronary CTA lacks physiological information; thus, it does not permit differentiation of ischemia-causing lesions. Recent advances in computational fluid dynamic techniques applied to standard coronary CTA images allow for computation of fractional flow reserve (FFR), a measure of lesion-specific ischemia. The diagnostic performance of computed FFR (FFRCT) compared with invasively measured FFR is not yet fully established. HeartFlowNXT (HeartFlow analysis of coronary blood flow using coronary CT angiography: NeXt sTeps) is a prospective, international, multicenter study designed to evaluate the diagnostic performance of FFRCT for the detection and exclusion of flow-limiting obstructive coronary stenoses, as defined by invasively measured FFR as the reference standard. FFR values ≤ 0.80 will be considered to be ischemia causing. All subjects (N = 270; 10 investigative sites) will undergo coronary CTA (single- or dual-source CT scanners with a minimum of 64 slices) and invasive coronary angiography with FFR. Patients with insufficient quality of coronary CTA will be excluded. Blinded core laboratory interpretation will be performed for FFRCT, invasive coronary angiography, and FFR. Stenosis severity by coronary CTA will be evaluated by the investigative site in addition to a blinded core laboratory interpretation. The primary objective of the study is to determine the diagnostic performance of FFRCT compared with coronary CTA alone to noninvasively determine the presence of hemodynamically significant coronary lesions. The secondary end point comprises assessment of diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFRCT. Copyright © 2013 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  13. 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

  14. Invasive forest species

    Treesearch

    Barbara L. Illman

    2006-01-01

    Nonnative organisms that cause a major change to native ecosystems-once called foreign species, biological invasions, alien invasives, exotics, or biohazards–are now generally referred to as invasive species or invasives. invasive species of insects, fungi, plants, fish, and other organisms present a rising threat to natural forest ecosystems worldwide. Invasive...

  15. Treatment of Angina and Microvascular Coronary Dysfunction

    PubMed Central

    Samim, Arang; Nugent, Lynn; Mehta, Puja K.; Shufelt, Chrisandra; Merz, C. Noel Bairey

    2014-01-01

    Opinion statement Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina, more commonly diagnosed in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease (CAD) on cardiac catheterization. Data from National Heart, Lung and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study has shown that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, or death. The gold standard diagnostic test for MCD is an invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test the endothelial dependent and independent, microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratifying patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce risk of adverse cardiac events, ameliorating symptoms to improve quality of life, and to decrease the morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor managment, including lifestyle counseling regarding smoking cessation, nutrition and physical activity should be initiated. Current pharmacotherapy for MCD can include the treatment of microvascular endothelial dysfunction (statins, angiotensin-converting enzyme inhibitor, low dose aspirin), as well as treatment for angina and myocardial ischemia (beta blockers, calcium channel blockers, nitrates, ranolazine). Additional symptom management techniques can include tri-cyclic medication, enhanced external counterpulsation, autogenic training, and spinal cord stimulation. While our current therapies are effective in the treatment

  16. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome.

    PubMed

    Ghoshhajra, Brian B; Takx, Richard A P; Staziaki, Pedro V; Vadvala, Harshna; Kim, Phillip; Neilan, Tomas G; Meyersohn, Nandini M; Bittner, Daniel; Janjua, Sumbal A; Mayrhofer, Thomas; Greenwald, Jeffrey L; Truong, Quyhn A; Abbara, Suhny; Brown, David F M; Januzzi, James L; Francis, Sanjeev; Nagurney, John T; Hoffmann, Udo

    2017-07-01

    To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %. Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS. • ED Coronary CTA using advanced systems is associated with low radiation exposure. • Negative coronary CTA is associated with low rates of MACE. • CTA in ED patients enables short median time to discharge home. • CTA strategy is characterized by few downstream tests including unnecessary ICA.

  17. Carotid intima media thickness and coronary atherosclerosis linkage in symptomatic intermediate risk patients evaluated by coronary computed tomography angiography.

    PubMed

    Guaricci, Andrea Igoren; Arcadi, Teresa; Brunetti, Natale Daniele; Maffei, Erica; Montrone, Deodata; Martini, Chiara; De Luca, Maria; De Rosa, Fiorella; Cocco, Domenico; Midiri, Massimo; Cademartiri, Filippo; Macarini, Luca; Di Biase, Matteo; Pontone, Gianluca

    2014-10-20

    There is a growing evidence that carotid intima media thickness (CIMT) is associated with coronary artery disease (CAD) and it should be used as a predictor of atherosclerotic burden of coronary arteries. However, these studies have been performed by using invasive coronary angiography (ICA) and in high-risk patients for CAD. The purpose of this study was to evaluate the correlation between CIMT by ultrasound and coronary atherosclerosis in symptomatic intermediate risk patients by coronary computed tomography angiography (CCTA). We enrolled 204 consecutive symptomatic patients (mean age: 61±10; men: 118) and intermediate risk for CAD. All patients underwent CIMT ultrasound evaluation and CCTA. Coronary artery calcium score (CACS), characteristics of plaques, severity of CAD, segment involvement score (SIS) and Gensini's score were assessed and compared with CIMT values. CIMT has been proved as an independent predictor of a number of coronary artery plaques, overall number of mixed and remodeled plaques, presence of obstructive CAD, high SIS and Gensini's score (HR 1.2, CI 1.05-1.42, p 0.01; HR 1.2, CI 1.01-1.41, p 0.03; HR 9.0, CI 1.37-59.7, p 0.02; HR 21.0, CI 2.40-184, p<0.01; HR 1.2, CI 1.08-1.42, p<0.01; HR 1.2, CI 1.08-1.42, p<0.01, respectively). A cut-off value>1.3 was associated with a better positive and negative predictive value (100% and 69%) to predict the combined endpoint of presence and mixed and/or remodeled coronary artery plaques. CIMT is an independent predictor of coronary atherosclerotic burden as detected by CCTA in symptomatic intermediate risk patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. 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

  19. 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

  20. 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. © 2016 Pharmacotherapy Publications, Inc.

  1. Trajectories of Vasomotor Symptoms and Carotid Intima Media Thickness in the Study of Women’s Health Across the Nation

    PubMed Central

    Thurston, Rebecca C.; El Khoudary, Samar R.; Tepper, Ping Guo; Jackson, Elizabeth A.; Joffe, Hadine; Chen, Hsiang-Yu; Matthews, Karen A.

    2015-01-01

    Background and Purpose Emerging work has linked menopausal vasomotor symptoms (VMS) to subclinical cardiovascular disease (CVD) among women. However, VMS are dynamic over time. No studies have considered how temporal patterns of VMS may relate to subclinical CVD. We tested how temporal patterns of VMS assessed over 13 years were related to carotid intima media thickness (IMT) among midlife women. Methods The Study of Women’s Health Across the Nation is a longitudinal cohort study of midlife women. 811 Caucasian, African American, Hispanic, and Chinese participants with a well-characterized final menstrual period completed measures of VMS, a blood draw, and physical measures approximately annually for 13 years. Women underwent a carotid artery ultrasound at study visit 12. Results Four trajectories of VMS were identified by trajectory analysis (consistently high, early onset, late onset, persistently low VMS) and tested in relation to carotid indices in linear regression models. Results indicated that women with early onset VMS had both greater mean IMT [beta, b(standard error, SE)=.03(.01), p=0.03] and greater maximal IMT [b(SE)=.04(.01), p=.008] than women with consistently low VMS, adjusting for demographics and CVD risk factors. Conclusions This is first study to test trajectories of VMS in relation to subclinical CVD. Women with VMS early in the menopause transition had higher mean IMT and maximal IMT than those with consistently low VMS across the transition. Associations were not accounted for by demographic factors nor by CVD risk factors. Results can signal to women in need of early CVD risk reduction. PMID:26578657

  2. Effect of desvenlafaxine on mood and climacteric symptoms in menopausal women with moderate to severe vasomotor symptoms.

    PubMed

    Cheng, R J; Dupont, C; Archer, D F; Bao, W; Racketa, J; Constantine, G; Pickar, J H

    2013-02-01

    To assess effects of desvenlafaxine (administered as desvenlafaxine succinate) on secondary outcomes of mood, climacteric symptoms, and treatment satisfaction in postmenopausal women with moderate to severe menopausal vasomotor symptoms (VMS). A 12-week, multicenter, double-blind, placebo-controlled trial was conducted in postmenopausal women with ≥ 50 moderate to severe hot flushes per week. Participants were randomly assigned to desvenlafaxine 100 mg/day, desvenlafaxine 150 mg/day, or placebo. Secondary outcome efficacy variables included Profile of Mood States (POMS), Greene Climacteric Scale (GCS), and Menopausal Symptoms Treatment Satisfaction Questionnaire (MS-TSQ) scores. Change from baseline in POMS total mood disturbance (TMD) score and subdomain scores were evaluated using analysis of covariance, adjusting for treatment and study site as factors and baseline score. GCS total and subdomain scores were analyzed similarly. Treatment satisfaction was analyzed using the row mean score test. A total of 458 women were enrolled. At week 12, desvenlafaxine 100 mg/day significantly improved POMS TMD scores (p <0.001) and four of six POMS subdomains compared with placebo (all p ≤ 0.005). Women taking desvenlafaxine 100 mg/day experienced significantly greater improvement in GCS total scores (p <0.001) and five of six subdomains (all p ≤ 0.029) compared with placebo. Treatment with desvenlafaxine 100 mg/day resulted in significantly greater treatment satisfaction overall and in six of seven additional MS-TSQ items (all p ≤0.042). Desvenlafaxine 150-mg/day results were similar. Desvenlafaxine treatment improved mood and climacteric symptoms in postmenopausal women with moderate to severe VMS compared with placebo, and more women were satisfied with desvenlafaxine treatment than with placebo.

  3. 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

  4. Psychophysical and Vasomotor Responses of the Oral Tissues: A Nicotine Dose-Response and Menthol Interaction Study.

    PubMed

    Arendt Nielsen, Thomas; Nielsen, Bruno Provstgaard; Wang, Kelun; Arendt-Nielsen, Lars; Boudreau, Shellie A

    2016-05-01

    This study implemented an intra-oral test-platform to assess the sensory, psychophysical, and vasomotor responses to nicotine and menthol, alone or in combination. Two double-blinded, placebo-controlled, randomized, cross-over studies, including healthy nonsmoking participants were performed. Study I: A dose-response relationship (N = 20) between 0, 2, and 4 mg nicotine gum. Study II: An interaction response (N = 22) to 30 mg menthol and 4 mg nicotine alone or in combination. Heart rate, blood pressure, tactile and thermosensory thresholds, intra-oral blood flow and temperature, pain/irritation intensities/locations, McGill Pain Questionnaire, and taste experience were assessed before, during or after the completion of a standardized chewing regime. A dose-response elevation in heart rate was attenuated when nicotine was combined with menthol. Blood flow, temperature, and warm-detection thresholds, as assessed on the tongue, similarly increased for all gums. Pain intensity and taste experiences were similar between nicotine doses. Nicotine attenuated the sweet, cooling, and freshening sensation of menthol. Within the first 4 minutes, menthol reduced the intensity but not the area of nicotine-induced pain and irritation. The 4-mg nicotine dose led to a continued increase in the intensity and area of irritation in the throat post-chewing. Moreover, one-half of participants responded to menthol as an irritant, and these individuals demonstrated larger areas of nicotine-induced irritation in the throat post-chewing. The intra-oral test platform provides a basis to optimize the assessment of nicotine-related taste and sensory experiences and can be used in future studies for profiling nicotine gum. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Sympathetic vasomotor tone is associated with depressive symptoms in young females: a potential link between depression and cardiovascular disease.

    PubMed

    Sanchez-Gonzalez, Marcos A; May, Ross W; Koutnik, Andrew P; Kabbaj, Mohamed; Fincham, Frank D

    2013-12-01

    Although increased sympathetic nervous system (SNS) activity is commonly associated with major depressive disorder (MDD) and cardiovascular disease (CVD), a biomarker linking these two entities remains elusive. We therefore evaluated the relationship between depressive symptoms and cardiovascular modulation by heart rate variability (HRV), brachial blood pressure (BP), ambulatory BP (ABP), and low frequency component of systolic BP variability (LFSBP), a surrogate of sympathetic vasomotor tone. We hypothesized that LFSBP would be the strongest predictor of depressive symptoms compared with HRV and BP measurements. Eighty young healthy female subjects (20.51 ± 2.82 years) were evaluated for depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). Data collection was conducted after a 10-minute resting period. Beat-to-beat BPs were recorded for 5-minute at baseline (BASE) followed by a 3-minute cold pressor test (CPT). ABP was obtained for 24 hours. Hierarchical multiple regression analyses indicated that LFSBP at BASE was a stronger predictor of CES-D variance than BP and HRV indices, with LFSBP uniquely accounting for 8.1% of variance in CES-D scores during laboratory beat-by-beat BP assessments and 44.7% in ABP assessments. Individuals with acute depression scores (n = 12; CES-D ≥ 16) had significantly higher (P < 0.001) mean LFSBP values (6.66 ± 2.54 mm Hg(2)) than the remaining sample (3.32 ± 2.2 mm Hg(2)), whereas no other significant differences were detected in any of the other cardiovascular variables. Cardiovascular responses to CPT did not predict CES-D scores. These findings suggest that LFSBP could be a biomarker of neurovascular functioning with potential clinical implications for understanding the interaction between MDD and CVD.

  6. Laboratory and ambulatory evaluation of vasomotor symptom monitors from the Menopause Strategies Finding Lasting Answers for Symptoms and Health network.

    PubMed

    Carpenter, Janet S; Newton, Katherine M; Sternfeld, Barbara; Joffe, Hadine; Reed, Susan D; Ensrud, Kristine E; Milata, Jennifer L

    2012-06-01

    The aim of this study was to evaluate monitors for assessing vasomotor symptoms (VMS) in laboratory and ambulatory settings before use in the Menopause Strategies Finding Lasting Answers for Symptoms and Health network clinical trials testing VMS therapies. This was a three-phase study. Phase 1 included laboratory testing of the Freedman and prototype Bahr Monitor, phase 2 included laboratory testing of the commercial Bahr Monitor and Biolog, and phase 3 included ambulatory testing of the commercial Bahr Monitor and Biolog. All phases enrolled midlife women with VMS, midlife women without VMS, and young women without VMS. The participants self-reported VMS by pressing event marker buttons. Questionnaires assessed demographics (all phases) and monitor acceptability (phases 2 and 3). Phase I testing was stopped because of sensitivity of the Freedman device to ambient humidity changes and lack of analytic software for the prototype Bahr Monitor. In phases 2 and 3, agreement between event-marked and commercial Bahr Monitor or Biolog-recorded VMS was higher in the laboratory than in the ambulatory setting; however, agreement between monitors was poor in two of three laboratory groups (midlife no VMS and young no VMS) and in all ambulatory groups. During ambulatory monitoring, the mean number of Bahr Monitor VMS was 16.33 in midlife women with VMS, 9.61 in midlife women without VMS, and 14.63 in young women without VMS (software version, March 2011). The Bahr Monitor was more acceptable than the larger Biolog, but feedback reflected annoyance at having to wear a device that itched and was visible under clothing. The Bahr Monitor and Biolog seem suitable for use in controlled laboratory conditions during short periods of time. However, the current versions of these monitors may not be suitable for ambulatory clinical trials at this time.

  7. Sex differences in the modulation of vasomotor sympathetic outflow during static handgrip exercise in healthy young humans.

    PubMed

    Jarvis, Sara S; VanGundy, Tiffany B; Galbreath, M Melyn; Shibata, Shigeki; Okazaki, Kazunobu; Reelick, Miriam F; Levine, Benjamin D; Fu, Qi

    2011-07-01

    Sex differences in sympathetic neural control during static exercise in humans are few and the findings are inconsistent. We hypothesized women would have an attenuated vasomotor sympathetic response to static exercise, which would be further reduced during the high sex hormone [midluteal (ML)] vs. the low hormone phase [early follicular (EF)]. We measured heart rate (HR), blood pressure (BP), and muscle sympathetic nerve activity (MSNA) in 11 women and 10 men during a cold pressor test (CPT) and static handgrip to fatigue with 2 min of postexercise circulatory arrest (PECA). HR increased during handgrip, reached its peak at fatigue, and was comparable between sexes. BP increased during handgrip and PECA where men had larger increases from baseline. Mean ± SD MSNA burst frequency (BF) during handgrip and PECA was lower in women (EF, P < 0.05), as was ΔMSNA-BF smaller (main effect, both P < 0.01). ΔTotal activity was higher in men at fatigue (EF: 632 ± 418 vs. ML: 598 ± 342 vs. men: 1,025 ± 416 a.u./min, P < 0.001 for EF and ML vs. men) and during PECA (EF: 354 ± 321 vs. ML: 341 ± 199 vs. men: 599 ± 327 a.u./min, P < 0.05 for EF and ML vs. men). During CPT, HR and MSNA responses were similar between sexes and hormone phases, confirming that central integration and the sympathetic efferent pathway was comparable between the sexes and across hormone phases. Women demonstrated a blunted metaboreflex, unaffected by sex hormones, which may be due to differences in muscle mass or fiber type and, therefore, metabolic stimulation of group IV afferents.

  8. A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women.

    PubMed

    Blümel, Juan E; Chedraui, Peter; Baron, German; Belzares, Emma; Bencosme, Ascanio; Calle, Andres; Danckers, Luis; Espinoza, Maria T; Flores, Daniel; Gomez, Gustavo; Hernandez-Bueno, Jose A; Izaguirre, Humberto; Leon-Leon, Patricia; Lima, Selva; Mezones-Holguin, Edward; Monterrosa, Alvaro; Mostajo, Desire; Navarro, Daysi; Ojeda, Eliana; Onatra, William; Royer, Monique; Soto, Edwin; Tserotas, Konstantinos; Vallejo, Soledad

    2011-07-01

    The aim of this study was to determine vasomotor symptom (VMS) prevalence, duration, and impact on quality of life in middle-aged women using a validated menopausal tool. The Menopause Rating Scale (MRS) and an itemized questionnaire containing personal sociodemographic data were used to examine 8,373 women aged 40 to 59 years from 22 healthcare centers in 12 Latin American countries. Less than half (48.8%) of all women studied were postmenopausal, 14.7% used hormone therapy (HT), 54.5% presented VMS of any degree, and 9.6% presented severe/bothersome symptoms. The rate of VMS (any degree) significantly increased from one menopausal stage to the next. HT users presented more VMS (any degree) than did nonusers (58.6% vs 53.8%, P = 0.001). When surgical postmenopausal women were compared, non-HT users displayed a higher prevalence of severe VMS (16.1% vs 9.0%, P = 0.0001). The presence of VMS of any degree was related to a more impaired quality of life (higher total MRS score; odds ratio, 4.7; 95% CI, 4.1-5.3). This effect was even higher among women presenting severe VMS. Logistic regression analysis determined that the presence of severe psychological/urogenital symptoms (MRS), lower educational level, natural perimenopause-postmenopause status, nulliparity, surgical menopause, and living at high altitude were significant risk factors for severe VMS. HT use was related to a lower risk. A second regression model determined that surgical menopause, intense psychological/urogenital symptoms, and a history of psychiatric consultation were factors related to severe VMS persisting into the late postmenopausal stage (5 or more years). In this Latin American middle-aged series, VMS prevalence was high, persisting into the late postmenopausal phase in a high rate and severely impairing quality of life. HT use was related to a lower risk of severe VMS.

  9. Easy Placement of Annular Sutures During Minimally Invasive Aortic Valve Replacement.

    PubMed

    Totsugawa, Toshinori; Hiraoka, Arudo; Tamura, Kentaro; Yoshitaka, Hidenori; Sakaguchi, Taichi

    Placing annular sutures at the right coronary cusp is difficult during minimally invasive aortic valve replacement. We propose the partial everting mattress method, whereby a prosthetic valve is implanted in a supra-annular position at the left coronary and noncoronary cusps, with pledgets on the left ventricular side, but in an intra-annular position at the right coronary cusp, with pledgets on the aortic side. Needles can be grasped in forehand pass at all three coronary cusps. Our method enables easy placement of annular stitches even in the small surgical field, without adversely influencing the hemodynamic performance of the prosthesis.

  10. Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspectives from the SCOT-HEART Trial.

    PubMed

    Doris, Mhairi; Newby, David E

    2016-02-01

    Coronary artery disease is the leading cause of death worldwide. Many trials to date have investigated the diagnostic accuracy of coronary computed tomography angiography (CCTA) when compared to the gold standard diagnostic test, invasive coronary angiography. However, whether the use of a non-invasive anatomical test, such as CCTA, can translate into improved patient risk stratification, management and outcome has yet to be established. The Scottish COmputed Tomography of the HEART (SCOT-HEART) trial sought to address these questions and determined whether CCTA, when used in addition to standard care, could aid the diagnosis, further investigation and treatment of patients referred to the cardiology clinic with suspected angina due to coronary heart disease. In this trial, CCTA clarified the diagnosis of angina due to coronary heart disease in a quarter of patients and this led to major alterations in treatment and management that appeared to reduce the risk of subsequent coronary heart disease death or non-fatal myocardial infarction. The SCOT-Heart trial has established that CCTA is a valuable diagnostic test in patients with suspected angina pectoris due to coronary heart disease and leads to greater clarity, more focused appropriate treatments and better coronary heart disease outcomes.

  11. [Patients with vulnerable coronary plaques have higher serum metalloproteinase-1 levels].

    PubMed

    Sánchez Elvira, G; Coma-Canella, I; Artaiz, M; Páramo, J A; Barba, J; Calabuig, J

    2017-04-30

    Most acute coronary syndromes are caused by the fracture of a vulnerable atherosclerotic plaque. These plaques are thin cap fibroatheromas, which can only be detected with invasive coronary imaging techniques. It is necessary to find a non-invasive biomarker of these vulnerable plaques in order to identify patients at risk without a coronary angiography. Metalloproteinase-1 is an enzyme involved in extracellular matrix metabolism which has been correlated with the rupture of atherosclerotic plaques. Its serum levels in patients with vulnerable plaques remain unknown. Patients with suspected stable coronary artery disease undergoing coronary angiography in our hospital were in-cluded. The coronary arteries were studied with optical coherence tomography to detect vulnerable plaques. Blood samples were taken from a peripheral vein and from the coronary sinus, to assess metalloproteinase-1 levels. Fifty-one patients were included, 13 of whom had at least one vulnerable plaque. There were not significant dif-ferences in clinical characteristics, lipid profile or C reactive protein levels, between patients with or without vulnerable plaques. Patients with vulnerable plaques had significant higher metalloproteinase-1 levels both in peripheral (7330±5541 vs 2894±1783 pg/ml, p=0.025) and coronary sinus serum (6012±3854 vs 2707±1252 pg/ml, p=0.047). Patients with vulnerable plaques had significantly higher metalloproteinase-1 serum levels. Further studies with clinical follow up are needed to assess the prognostic value of serum metalloproteinase-1.

  12. [Noninvasive imaging techniques to study coronary artery aneurysms].

    PubMed

    de Agustín, J A; Marcos-Alberca, P; Fernández-Golfín, C; Bordes, S; Pozo, E; Macaya, C; Zamorano, J

    2012-01-01

    Given the growing evidence about the use of membrane-covered stents to treat coronary artery aneurysms, it is fundamental to know the exact anatomy of the aneurysm to enable patients to be selected correctly. Invasive heart catheterization has limitations for diagnostic purposes and can underestimate the size of the aneurysm. In this article, we review the noninvasive diagnostic imaging techniques for the study of coronary artery aneurysms, illustrating the usefulness of each technique. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  13. Comparative effects of frovatriptan and sumatriptan on coronary and internal carotid vascular haemodynamics in conscious dogs

    PubMed Central

    Carel, Ivan; Ghaleh, Bijan; Edouard, Alain; Dubois-Rande, Jean-Luc; Parsons, Andrew A; Giudicelli, Jean-François; Berdeaux, Alain

    2001-01-01

    The effects of frovatriptan and sumatriptan on internal carotid and coronary vascular haemodynamics were investigated and compared in conscious dogs. Frovatriptan and sumatriptan (0.1–100 μg kg−1) induced a transient increase in external coronary artery diameter (eCOD) of up to 2.9±1.2 and 1.8±0.6%, respectively (both P<0.05). This was followed by a prolonged and dose-dependent decrease in eCOD of up to −5.2±1.2 and −5.3±0.9% (both P<0.05), with ED50 values of 86±21 and 489±113 μmol kg−1, respectively. In contrast, only a decrease in the external diameter of the internal carotid artery was observed (−6.0±0.6 and −6.2±1.4%, both P<0.05, and ED50 values of 86±41 and 493±162 μmol kg−1, respectively). Frovatriptan was thus 5.7 fold more potent than sumatriptan at the level of both large coronary and internal carotid arteries. After endothelium removal by balloon angioplasty in coronary arteries, the initial dilatation induced by the triptans was abolished and delayed constriction enhanced. The selective antagonist for the 5-HT1B receptors SB224289 dose-dependently blocked the effects of sumatriptan on large coronary and internal carotid arteries whereas the selective antagonist for the 5-HT1D receptors BRL15572 did not affect any of these effects. In conclusion, frovatriptan and sumatriptan initially dilate and subsequently constrict large coronary arteries in the conscious dog, whereas they directly constrict the internal carotid artery. The vascular endothelium modulates the effects of these triptans on large coronary arteries. Finally, 5-HT1B but not 5-HT1D receptors are primarily involved in canine coronary and internal carotid vasomotor responses to sumatriptan. PMID:11226138

  14. Coronary artery ectasia in Egyptian patients with coronary artery disease.

    PubMed Central

    Waly, H M; Elayda, M A; Lee, V V; el-Said, G; Reul, G J; Hall, R J

    1997-01-01

    We conducted a retrospective study of 45 Egyptian patients with coronary artery ectasia who underwent coronary bypass grafting at our institution between 1980 and 1995. We examined the anatomic distribution and type of coronary ectasia and its association with coronary risk factors in these patients, and evaluated the severity of their coronary artery disease. We compared these findings with those from a group of 230 Egyptian patients who did not have coronary ectasia. These patients also underwent coronary artery bypass grafting between 1980 and 1995 at our institution. Obesity was present in 60% of the patients who had coronary artery ectasia, compared with 42% of patients who did not have ectasia (P < 0.01). Coronary artery ectasia was not related to any coronary risk factors other than obesity. However, patients who had ectasia did have a higher rate of triple-vessel coronary artery disease than did patients without ectasia (82% vs 67%, P < 0.05). Of the coronary vessels affected by ectasia, 43% were left anterior descending arteries. Diffuse disease was noted in 84% of all ectatic segments. We conclude that in this patient population, 2 conditions had a positive correlation with coronary ectasia: obesity and the severity of coronary artery disease. Images PMID:9456489

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

    PubMed

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

    2009-06-01

    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.

  16. Effects of antiaggregant and antiinflammatory doses of aspirin on coronary hemodynamics and myocardial reactive hyperemia in conscious dogs.

    PubMed

    Andrieu, S; Lebret, M; Maclouf, J; Bévérelli, F; Giudicelli, J F; Berdeaux, A

    1999-02-01

    Clinical studies have shown that low doses of aspirin (<300 mg/day) inhibit thromboxane A2 production and platelet aggregation but preserve prostacyclin synthesis. In contrast, high doses of aspirin (>1,000 mg/day) suppress the synthesis of both eicosanoids. Because the consequences of aspirin administration have never been investigated on coronary vasomotor tone in vivo, we investigated the effects of low and high doses of aspirin on systemic and coronary hemodynamics under basal conditions and after myocardial reactive hyperemia in conscious dogs. Dogs were instrumented with a Doppler flow probe and a hydraulic occluder. Coronary blood flow was measured in the conscious state at baseline and during myocardial reactive hyperemia after 10, 20, and 30 s of coronary occlusion. Thromboxane B2 serum concentrations, an index of platelet aggregation, decreased by >90% after long-term i.v. administration of aspirin, 100 mg/day for 7 days (low dose). Neither systemic and coronary hemodynamics nor reactive hyperemia were affected by the drug. After combined administration of this low dose of aspirin and of the nitric oxide synthase (NOS) inhibitor, N(omega)-nitro-L-arginine (L-NNA, 30 mg/kg/day/7 days), reactive hyperemia decreased to the same extent as when L-NNA was administered alone. After administration of a unique high-dose aspirin (1,000 mg, i.v.), myocardial reactive hyperemia was markedly reduced, and this effect was still observed after previous blockade of NOS and cyclooxygenase by L-NNA and diclofenac, respectively. Thus long-term treatment with a low antiaggregant dose of aspirin does not alter the ability of coronary vessels to dilate during myocardial reactive hyperemia in conscious dogs. In contrast, short-term administration of a high antiinflammatory dose of aspirin severely blunts myocardial reactive hyperemia through a mechanism that is independent of both cyclooxygenase and nitric oxide metabolic pathways.

  17. UTP Controls Cell Surface Distribution and Vasomotor Activity of the Human P2Y2 Receptor through an Epidermal Growth Factor Receptor-transregulated Mechanism*

    PubMed Central

    Norambuena, Andrés; Palma, Francisco; Poblete, M. Inés; Donoso, M. Verónica; Pardo, Evelyn; González, Alfonso; Huidobro-Toro, J. Pablo

    2010-01-01

    Extracellular nucleotides transmit signals into the cells through the P2 family of cell surface receptors. These receptors are amply expressed in human blood vessels and participate in vascular tone control; however, their signaling mechanisms remain unknown. Here we show that in smooth muscle cells of isolated human chorionic arteries, the activation of the P2Y2 receptor (P2Y2R) induces not only its partition into membrane rafts but also its rapid internalization. Cholesterol depletion with methyl-β-cyclodextrin reduced the association of the agonist-activated receptor into membrane rafts but did not affect either the UTP-mediated vasoconstrictions or the vasomotor responses elicited by both serotonin and KCl. Ex vivo perfusion of human chorionic artery segments with 1–10 μm UTP, a selective P2Y2R agonist, displaced the P2Y2R localization into membrane rafts within 1 min, a process preceded by the activation of both RhoA and Rac1 GTPases. AG1478, a selective and potent inhibitor of the epidermal growth factor receptor tyrosine kinase activity, not only blocked the UTP-induced vasomotor activity but also abrogated both RhoA and Rac1 activation, the P2Y2R association with membrane rafts, and its internalization. Altogether, these results show for the first time that the plasma membrane distribution of the P2Y2R is transregulated by the epidermal growth factor receptor, revealing an unsuspected functional interplay that controls both the membrane distribution and the vasomotor activity of the P2Y2R in intact human blood vessels. PMID:19996104

  18. Hypertension and stable coronary artery disease: an overview.

    PubMed

    Pedrinelli, Roberto; Ballo, Piercarlo; Fiorentini, Cesare; Galderisi, Maurizio; Ganau, Antonello; Germanò, Giuseppe; Innelli, Pasquale; Paini, Anna; Perlini, Stefano; Salvetti, Massimo; Zacà, Valerio

    2013-08-01

    Systemic hypertension is highly prevalent in stable coronary artery disease, a pervasive comorbidity complicating the diagnostic performance and interpretation of non-invasive provocative tests in chest pain patients because of the ischaemic signals generated, despite normal or near normal coronary arteries, by hearts structurally readapted by long-term exposure to raised systemic blood pressure. Additional and unresolved problems posed by arterial hypertension in patients with stable coronary artery disease regard the benefits of antihypertensive treatment due to reports of irrelevant, if not detrimental, effect of blood pressure (BP) lowering in averting coronary relapses as well as the lack of association between BP levels and incident coronary events in survivors from acute myocardial infarction. Uncertainties extend to BP-independent cardioprotective effects of antihypertensive drugs, although the efficacy of renin-angiotensin system blockers in the long-term prevention of cardiovascular events in stable coronary artery disease patients has been shown by several studies, particularly when combined with amlodipine, a dihydropiridine calcium channel blocker. In contrast, the long-term effect of beta-blockers, the antihypertensive class most used in that clinical category, is not supported by strong evidence except that generated in patients with systolic dysfunction and early postmyocardial infarction recovery periods.

  19. Spontaneous Coronary Artery Dissection

    MedlinePlus

    ... artery dissection (SCAD). It's not yet clear what role these factors play in causing the disease. Common factors include: Female sex. Though spontaneous coronary artery dissection (SCAD) can occur ...

  20. Percutaneous Coronary Intervention

    MedlinePlus

    ... to open coronary arteries that are narrowed or blocked by the buildup of atherosclerotic plaque. PCI may ... that will highlight the blockage. To open a blocked artery, your doctor will insert another catheter over ...

  1. 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

  2. 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 ...

  3. 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 ...

  4. Coronary Calcium Scan

    MedlinePlus

    ... Intramural Research Research Resources Research Meeting Summaries Technology ... complete. A coronary calcium scan uses a special scanner such as an electron beam CT or a multidetector CT (MDCT) machine. ...

  5. [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.

  6. Coronary fistulas: a case series.

    PubMed

    Nada, Fennich; Fedoua, Elouali; Ghita, Saghi; Nadia, Bouzammour; Leila, Haddour; Jamila, Zarzur; Mohamed, Cherti

    2014-01-01

    Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms.

  7. Coronary Fistulas: A Case Series

    PubMed Central

    Fennich, Nada; Elouali, Fedoua; Saghi, Ghita; Bouzammour, Nadia; Haddour, Leila; Zarzur, Jamila; Cherti, Mohamed

    2014-01-01

    Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms. PMID:24501660

  8. Differences by HIV serostatus in coronary artery disease severity and likelihood of percutaneous coronary intervention following stress testing.

    PubMed

    Feinstein, Matthew J; Poole, Brian; Engel Gonzalez, Pedro; Pawlowski, Anna E; Schneider, Daniel; Provias, Tim S; Palella, Frank J; Achenbach, Chad J; Lloyd-Jones, Donald M

    2016-10-13

    HIV-infected persons develop coronary artery disease (CAD) more commonly and earlier than uninfected persons; however, the role of non-invasive testing to stratify CAD risk in HIV is not well defined. Patients were selected from a single-center electronic cohort of HIV-infected patients and uninfected controls matched 1:2 on age, sex, race, and type of cardiovascular testing performed. Patients with abnormal echocardiographic or nuclear stress testing who subsequently underwent coronary angiography were included. Logistic regressions were used to assess differences by HIV serostatus in two co-primary endpoints: (1) severe CAD (≥70% stenosis of at least one coronary artery) and (2) performance