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Circulation Journal : Official Journal... 2014As the link between heart failure (HF) and diabetes mellitus (DM) becomes unignorable, so the need is further increasing for pathological comprehension: What is... (Review)
Review
As the link between heart failure (HF) and diabetes mellitus (DM) becomes unignorable, so the need is further increasing for pathological comprehension: What is "diabetic cardiomyopathy (DMC)?" In response to current concern, the most updated guidelines stated by the ACCF/AHA and by the ESC/EASD take one step further, including the definition of DMC, although it is a matter yet to be completed. For more than 40 years, coronary artery disease and hypertension have been considered as the main causes of diabetes-related cardiac dysfunction. HF was originally considered as a result of reduced left ventricular ejection fraction (HF-REF); however, it has been recognized that HF symptoms are often observed in patients with preserved EF (HF-PEF). DMC includes HF with both reduced and preserved entities independent of coronary stenosis and hypertension. Cardiologists are thus facing a sort of chaos without clear guidelines for the "deadly intersection" of DM and HF. Today, the increasing interest and concern have caused DMC to be revisited and the first step in controlling the chaos around DMC is to organize and analyze all of the available evidence from preclinical and clinical studies. This review aims to illustrate the current concepts of DMC by shedding light on the new molecular mechanisms.āā(Circ Jā2014; 78: 576-583).
Topics: Coronary Stenosis; Diabetic Cardiomyopathies; Heart Failure; Humans; Hypertension; Stroke Volume
PubMed: 24500073
DOI: 10.1253/circj.cj-13-1564 -
Journal of the American Heart... Oct 2022
Topics: Coronary Angiography; Coronary Stenosis; Coronary Vessels; Fractional Flow Reserve, Myocardial; Humans; Percutaneous Coronary Intervention; Technology
PubMed: 36129036
DOI: 10.1161/JAHA.122.027165 -
International Heart Journal 2018
Topics: Coronary Angiography; Coronary Stenosis; Coronary Vessel Anomalies; Coronary Vessels; Humans; Myocardial Revascularization; Sinus of Valsalva
PubMed: 30487380
DOI: 10.1536/ihj.18-540 -
Heart (British Cardiac Society) Sep 2022Cardiac imaging is central to the diagnosis and risk stratification of coronary artery disease, beyond symptoms and clinical risk factors, by providing objective... (Review)
Review
Cardiac imaging is central to the diagnosis and risk stratification of coronary artery disease, beyond symptoms and clinical risk factors, by providing objective evidence of myocardial ischaemia and characterisation of coronary artery plaque. CT coronary angiography can detect coronary plaque with high resolution, estimate the degree of functional stenosis and characterise plaque features. However, coronary artery disease risk is also driven by biological processes, such as inflammation, that are not fully reflected by severity of stenosis, myocardial ischaemia or by coronary plaque features. New cardiac CT techniques can assess coronary artery inflammation by imaging perivascular fat, and this may represent an important step forward in identifying the 'residual risk' that is not detected by plaque or ischaemia imaging. Coronary artery disease risk assessment that incorporates clinical factors, plaque characteristics and perivascular inflammation offers a more comprehensive individualised approach to quantify and stratify coronary artery disease risk, with potential healthcare benefits for prevention, diagnosis and treatment recommendations. Furthermore, identifying new biomarkers of cardiovascular risk has the potential to refine early-life prevention strategies, before atherosclerosis becomes established.
Topics: Computed Tomography Angiography; Constriction, Pathologic; Coronary Angiography; Coronary Artery Disease; Coronary Stenosis; Coronary Vessels; Humans; Inflammation; Myocardial Ischemia; Plaque, Atherosclerotic; Predictive Value of Tests
PubMed: 35022211
DOI: 10.1136/heartjnl-2021-320265 -
Journal of the American College of... Feb 2022
Topics: Coronary Angiography; Coronary Stenosis; Humans
PubMed: 35177195
DOI: 10.1016/j.jacc.2021.11.054 -
PloS One 2020The instantaneous wave-free ratio (iFR) is used for assessing the hemodynamic severity of a lesion, as an alternative to the fractional flow reserve (FFR). We evaluated... (Comparative Study)
Comparative Study
Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve.
The instantaneous wave-free ratio (iFR) is used for assessing the hemodynamic severity of a lesion, as an alternative to the fractional flow reserve (FFR). We evaluated the relationship between iFR and FFR in detail and the clinical significance of iFR in patients with mild to intermediate coronary artery stenosis. We recruited consecutive 323 patients (421 lesions) with lesions exhibiting 30% to 80% diameter stenosis on angiography in whom FFR and iFR were measured. In the total lesions, mean diameter stenosis was 48.6% Ā± 9.0%, and physiological significance, defined by FFR of 0.80 or less or by iFR of 0.92 or less, was observed in 32.5% or 33.5%, respectively. Mismatch between iFR and FFR was observed in 18.1% of the lesions. Clinical factors did not predict FFR value; however, gender, diabetes mellitus, aortic stenosis, anemia, high-sensitivity CRP value, and renal function predicted iFR value. In multivariate logistic analysis after adjustment for FFR value, gender (p < 0.001), diabetes mellitus (p = 0.005), aortic stenosis (p = 0.016), high-sensitivity CRP (p < 0.001), and renal function (p = 0.003) were all independent predictors of iFR value. In Kaplan-Meier analysis, the baseline iFR predicted the subsequent major cardiovascular events (MACE) (hazard ratio, 2.40; 95% CI, 1.16-4.93; p = 0.018) and the results of the iFR-guided strategy for predicting rates of MACE and myocardial infarction/revascularization were superior to those of the FFR-guided strategy. In conclusion, significant clinical factors predicted iFR value, which affected the prognostic capacity. The iFR-guided strategy may be superior in patients with mild to intermediate stenosis.
Topics: Aged; Coronary Angiography; Coronary Stenosis; Female; Fractional Flow Reserve, Myocardial; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis
PubMed: 32760123
DOI: 10.1371/journal.pone.0237275 -
JACC. Cardiovascular Imaging Nov 2022
Topics: Humans; Acute Coronary Syndrome; Constriction, Pathologic; Predictive Value of Tests; Plaque, Atherosclerotic; Coronary Angiography; Coronary Artery Disease; Computed Tomography Angiography; Coronary Stenosis
PubMed: 36357134
DOI: 10.1016/j.jcmg.2022.05.014 -
Cardiology Journal 2020
Topics: Cardiac Catheterization; Clinical Decision-Making; Computed Tomography Angiography; Coronary Angiography; Coronary Stenosis; Coronary Vessels; Fractional Flow Reserve, Myocardial; Humans; Imaging, Three-Dimensional; Models, Cardiovascular; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; Reproducibility of Results
PubMed: 32583402
DOI: 10.5603/CJ.2020.0080 -
Journal of the American College of... Sep 2019The past decades have seen tremendous progress on elucidating mechanisms leading to acute coronary syndrome and sudden cardiac death. Pathology and imaging studies have... (Review)
Review
The past decades have seen tremendous progress on elucidating mechanisms leading to acute coronary syndrome and sudden cardiac death. Pathology and imaging studies have identified features of coronary atherosclerosis that precede acute coronary events. However, many factors influence the risk of adverse events from coronary atherosclerotic disease and available data support our transition from focusing on individual "vulnerable plaque," coronary arterial stenosis, and inducible myocardial ischemia to understanding coronary heart disease as multifactorial, chronic disease. The concept of the vulnerable patient has evolved, with the atheroma burden, its metabolic activity, and the disposition to vascular thrombosis building a platform for assessing central aspects of coronary heart disease. In turn, this model has directed us to a focus on controlling the activity of atherosclerotic disease and on modifying the susceptibility of vascular thrombosis which has led to reduced morbidity and mortality from coronary heart disease.
Topics: Coronary Artery Disease; Coronary Stenosis; Humans; Myocardial Ischemia; Plaque, Atherosclerotic
PubMed: 31537269
DOI: 10.1016/j.jacc.2019.07.062 -
Journal of the American Heart... Apr 2022
Topics: Coronary Artery Disease; Coronary Stenosis; Humans; Percutaneous Coronary Intervention; Treatment Outcome
PubMed: 35352567
DOI: 10.1161/JAHA.122.025748