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Turk Kardiyoloji Dernegi Arsivi : Turk... Mar 2012Although aortic stiffness (AS) is a strong predictor of cardiovascular events, its value is unknown in patients who have coronary stenosis and undergo percutaneous...
OBJECTIVES
Although aortic stiffness (AS) is a strong predictor of cardiovascular events, its value is unknown in patients who have coronary stenosis and undergo percutaneous coronary intervention (PCI). Our hypothesis was that AS might provide additional information about coronary hemodynamic status. In this context, we investigated the effects of coronary stenosis and PCI on AS.
STUDY DESIGN
The study included 107 patients undergoing coronary angiography. The patients were divided into three groups based on the angiographic results: 39 patients with significant lesions (≥50%) formed the 'critical group' and 38 patients with nonsignificant lesions (<50%) formed the 'noncritical group'. The control group (30 patients) had normal angiograms. Aortic stiffness was determined using the carotid-femoral aortic pulse wave velocity (PWV) method. All patients in the critical group underwent successful PCI and repeat PWV measurements.
RESULTS
All baseline characteristics were similar in the three groups except for the mean PWV, which was significantly higher (9.4±2.2 m/sec) in the critical group compared to the control group (5.7±1.1 m/sec) and the noncritical group (5.8±1.1 m/sec) (p<0.0001). The latter two groups had similar PWV values (p=0.6). After PCI, the mean PWV decreased significantly by 24.4% to 7.1±2.0 m/sec (p=0.002); however, it was still significantly higher than that of the control group (p<0.0001). In correlation analysis, PWV showed significant correlations with age (r=0.412, p=0.01), systolic blood pressure (r=0.342, p<0.01), and hemoglobin (r=-0.370, p=0.02). Multiple logistic regression analysis showed that PWV was a predictor for significant stenosis [Exp(B) 3.960, 95% CI 2.014-7.786].
CONCLUSION
Our findings suggest that significant coronary stenosis is associated with significantly increased AS and successful PCI improves AS to some extent.
Topics: Aged; Case-Control Studies; Coronary Angiography; Coronary Stenosis; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Pulse Wave Analysis; Vascular Stiffness
PubMed: 22710602
DOI: 10.5543/tkda.2012.01714 -
EuroIntervention : Journal of EuroPCR... 2015Coronary angiography is unable to visualise the atherosclerotic involvement of the arterial wall. Bifurcation lesions are particularly difficult to assess by angiography... (Review)
Review
Coronary angiography is unable to visualise the atherosclerotic involvement of the arterial wall. Bifurcation lesions are particularly difficult to assess by angiography because overlapping mother and daughter vessels often obscure the lesion and carina. On the contrary, IVUS imaging allows for precise, real-time, cross-sectional assessment of all bifurcation lesion segments, enabling measurements of luminal and vessel areas. Moreover, IVUS evaluation of stent expansion, apposition and edge problems is also superior to angiographic assessment. In spite of the lack of adequately powered randomised trials, there is growing evidence from large registries and meta-analyses showing better acute and long-term outcomes of DES implantation guided by IVUS, in comparison to angiography-guided procedures. In this review, we summarise current scientific evidence, the European Society of Cardiology recommendations and the European Bifurcation Club consensus for the use of IVUS in bifurcation stenting.
Topics: Coronary Stenosis; Drug-Eluting Stents; Humans; Percutaneous Coronary Intervention; Surgery, Computer-Assisted; Treatment Outcome; Ultrasonography, Interventional
PubMed: 25983172
DOI: 10.4244/EIJV11SVA12 -
Medicine Sep 2016The instantaneous wave-free ratio (iFR) is a new vasodilator-free index of coronary stenosis severity. The aim of this meta-analysis is to assess the diagnostic... (Meta-Analysis)
Meta-Analysis Review
Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve: A PRISMA-compliant meta-analysis of randomized studies.
BACKGROUND
The instantaneous wave-free ratio (iFR) is a new vasodilator-free index of coronary stenosis severity. The aim of this meta-analysis is to assess the diagnostic performance of iFR for the evaluation of coronary stenosis severity with fractional flow reserve as standard reference.
METHODS
We searched PubMed, EMBASE, CENTRAL, ProQuest, Web of Science, and International Clinical Trials Registry Platform (ICTRP) for publications concerning the diagnostic value of iFR. We used a random-effects covariate to synthesize the available data of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). Overall test performance was summarized by the summary receiver operating characteristic curve (sROC) and the area under the curve (AUC).
RESULTS
Eight studies with 1611 subjects were included in the meta-analysis. The pooled sensitivity, specificity, LR+, LR-, and DOR for iFR were respectively 73.3% (70.1-76.2%), 86.4% (84.3-88.3%), 5.71 (4.43-7.37), 0.29 (0.22-0.38), and 20.54 (16.11-26.20). The area under the summary receiver operating characteristic curves for iFR was 0.8786. No publication bias was identified.
CONCLUSION
The available evidence suggests that iFR may be a new, simple, and promising technology for coronary stenosis physiological assessment.
Topics: Area Under Curve; Coronary Stenosis; Diastole; Fractional Flow Reserve, Myocardial; Humans; ROC Curve; Randomized Controlled Trials as Topic; Severity of Illness Index
PubMed: 27603377
DOI: 10.1097/MD.0000000000004774 -
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 -
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 -
BMJ Open Mar 2022Recent studies showed cardiac troponin I (cTnI) might be a non-invasive biomarker to estimate the severity of coronary stenosis. However, serum cTnI is also found...
BACKGROUND AND OBJECTIVE
Recent studies showed cardiac troponin I (cTnI) might be a non-invasive biomarker to estimate the severity of coronary stenosis. However, serum cTnI is also found associated with renal function. The study objective is to analyse the association of serum cTnI and severity of coronary stenosis in patients with varied renal functions.
DESIGN
A retrospective cohort study.
SETTING
The First Affiliated Hospital, College of Medicine, Zhejiang University in Hangzhou, China.
POPULATION
A total of 6487 subjects who underwent elective coronary angiography between January 2017 to June 2020 were involved in this study.
PRIMARY OUTCOMES
Severity of coronary stenosis was divided into three degrees based on Gensini score, mild coronary stenosis, moderate coronary stenosis and severe coronary stenosis.
RESULTS
By using ordinal logistic regression, serum cTnI was associated with severity of coronary stenosis (OR=1.14, p<0.05). By construction and comparison of two models for predicting severity of coronary stenosis, the addition of cTnI significantly improved the predictive ability of the model. Differences between areas under the curves were 0.03, 0.03, 0.03, 0.12 (all p<0.05). Net reclassification improvements were 0.08, 0.05, 0.05, 0.35, respectively, in varied renal functions. Compared with the participants with normal renal function and without hypertroponinaemia, groups of participants with hypertroponinaemia showed higher ORs. ORs were 3.52, 4.20, 4.45, 6.00, respectively, as renal function decreased (all p<0.05).
CONCLUSIONS
In this cohort of patients with stable coronary artery disease and varied renal functions, cTnI was intensely associated with severity of coronary stenosis which based on Gensini score. The presentation of hypertroponinaemia in patients with impaired renal function always indicates a higher risk of severe coronary stenosis.
Topics: Biomarkers; Cohort Studies; Coronary Artery Disease; Coronary Stenosis; Humans; Kidney; Retrospective Studies; Troponin I
PubMed: 35351712
DOI: 10.1136/bmjopen-2021-054722 -
JACC. Cardiovascular Interventions Jul 2019Coronary artery obstruction is an uncommon but devastating complication of transcatheter aortic valve replacement (TAVR). Computed tomography appears to be a sensitive... (Review)
Review
Coronary artery obstruction is an uncommon but devastating complication of transcatheter aortic valve replacement (TAVR). Computed tomography appears to be a sensitive but nonspecific predictor of coronary artery obstruction. Transcatheter approaches to prevent and treat coronary artery obstruction, such as "snorkel" stenting, are unsatisfactory because of serious early and late ischemic complications. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) is an early-stage transcatheter procedure to prevent coronary artery obstruction. It works by splitting the native or bioprosthetic leaflets so that they splay after TAVR and preserve coronary artery inflow. Because of the paucity of suitable alternatives, there is interest in the BASILICA technique despite its infancy. This tutorial review summarizes current thinking about how to predict and prevent coronary artery obstruction using BASILICA. First, the authors depict the main pathophysiological mechanisms of TAVR-associated coronary artery obstruction, along with the factors thought to contribute to coronary obstruction. Next, the authors provide a step-by-step guide to analyzing pre-procedural computed tomographic findings to assess obstruction risk and, if desirable, to plan BASILICA. Next, the authors describe the mechanisms underlying transcatheter electrosurgery. Finally, they provide step-by-step guidance on how to perform the procedure, along with a required equipment list.
Topics: Aortic Valve; Bioprosthesis; Coronary Circulation; Coronary Stenosis; Electrosurgery; Heart Valve Prosthesis; Humans; Iatrogenic Disease; Predictive Value of Tests; Prosthesis Design; Risk Assessment; Risk Factors; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement; Treatment Outcome; Vascular Patency
PubMed: 31272666
DOI: 10.1016/j.jcin.2019.04.052 -
International Heart Journal Nov 2019Recent clinical studies revealed that anatomical information assessed by coronary computed tomography angiography (CTA) may be used effectively to diagnose coronary...
Recent clinical studies revealed that anatomical information assessed by coronary computed tomography angiography (CTA) may be used effectively to diagnose coronary artery disease (CAD). However, a physiological assessment, demonstrating myocardial ischemia, is required to justify a therapeutic strategy for CAD. This study aimed to investigate whether using CTA to assess myocardial supply area can improve the prediction of myocardial ischemia.We analyzed 201 vessels with moderate (luminal narrowing ≥ 50%, < 70%) and severe (luminal narrowing ≥ 70%, < 99%) stenosis on CTA from 174 patients, who were suspected of having stable angina and underwent measurement of fractional flow reserve (FFR). The myocardial area supplied by the coronary artery, distal to the stenosis, was evaluated with CTA, as reported previously (modified Alberta Provincial Project for Outcome Assessment in Coronary Heart score) and was classified into 3 groups (large, medium, and small).Both percentage area stenosis and myocardial supply area were significantly correlated with FFR (r = -0.46, P < 0.01, and r = -0.45, P < 0.01). Among patients who had coronary plaques, with moderate stenosis and a small myocardial supply area, only 3 of 42 lesions (7%) were identified as ischemic; deviation from the ischemic threshold (FFR = 0.80) was P < 0.01. The combined assessment of lesion stenosis and myocardial supply area, using CTA, improved the prediction of myocardial ischemia significantly compared to lesion stenosis alone (77% versus 59%, P < 0.01).Adding the assessment of myocardial supply area to standard CTA might help predict myocardial ischemia in patients with stable angina pectoris.
Topics: Aged; Computed Tomography Angiography; Coronary Circulation; Coronary Stenosis; Female; Fractional Flow Reserve, Myocardial; Humans; Male; Middle Aged; Myocardial Ischemia; Predictive Value of Tests; Retrospective Studies
PubMed: 31735779
DOI: 10.1536/ihj.19-141 -
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 -
Indian Heart Journal Sep 2016Prediction of left main coronary artery (LMCA) or equivalent disease is important with regard to selecting the appropriate treatment strategy. The classical... (Review)
Review
Prediction of left main coronary artery (LMCA) or equivalent disease is important with regard to selecting the appropriate treatment strategy. The classical electrocardiographic pattern of LMCA disease includes ST elevation (STE) in lead aVR in the presence of extensive ST depression (most prominent in leads I, II, and V4-6) with the STE in aVR≥V1. Patients with these findings may potentially require early coronary angiography and coronary bypass surgery; therefore selected patients with these findings on exercise testing might benefit from more urgent or expedited angiography.
Topics: Coronary Angiography; Coronary Stenosis; Coronary Vessels; Electrocardiography; Exercise Test; Humans
PubMed: 27751297
DOI: 10.1016/j.ihj.2016.03.025