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1.
J Thorac Cardiovasc Surg ; 161(3): 1010-1018.e1, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33431208

RESUMO

OBJECTIVES: This study was conducted to evaluate graft patency rates during the 5 years after coronary artery bypass grafting according to the functional significance of the coronary artery stenosis, as determined by myocardial single-photon-emission computed tomography. METHODS: Two hundred ninety-five patients who underwent coronary artery bypass grafting using Y-composite grafts based on the in situ left internal thoracic artery, and in whom preoperative stress/rest myocardial single-photon-emission computed tomography and 1-year angiographies were available were enrolled. Seven hundred sixty-nine and 262 distal anastomoses were constructed to ischemic and nonischemic areas, respectively. One-year and 5-year angiographic occlusion rates were evaluated in all and 80.3% of study patients, respectively. Factors associated with graft occlusion were evaluated using generalized linear mixed-effects models. RESULTS: Overall 1- and 5-year graft occlusion rates were 4.3% (44 of 1031 distal anastomoses) and 5.5% (45 out of 820), respectively. The occlusion rates of grafts bypassed to vessels with functionally significant and insignificant stenosis were 2.7% (21 out of 769) and 8.8% (23 out of 262) at 1 year and were 4.0% (25 out of 618) and 9.9% (20 out of 202) at 5 years, respectively. Graft occlusion during the 5 years after coronary artery bypass grafting was associated with the functional significance of coronary artery stenosis (odds ratio, 0.50; 95% confidence interval, 0.28-0.92). The odds ratio of the graft occlusion according to functional ischemia was lower and significant in grafts to arteries with intermediate stenosis (stenosis ≥70% but <90%; odds ratio, 0.34; 95% confidence interval, 0.13-0.93) whereas it was higher and insignificant in grafts to arteries with severe stenosis (≥90% stenosis; odds ratio, 0.76; 95% confidence interval, 0.33-1.72). CONCLUSIONS: Graft occlusion during the 5 years after coronary artery bypass grafting was associated with the functional significance of coronary artery stenosis, particularly when the stenosis degree was not severe.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/cirurgia , Oclusão de Enxerto Vascular/etiologia , Idoso , Angiografia Coronária , Circulação Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Grau de Desobstrução Vascular
2.
Gene ; 765: 145131, 2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-32898608

RESUMO

The inflammatory events related to prostaglandins may play an important role in the progression of vessel stenosis. The aim of this study was to investigate the monocyte PTGES and 15-PGDH gene expression levels and the serum 13,14-dihyro-15-keto-PGF2α value involved in PGE2 metabolism in patients with coronary artery stenosis and restenosis. Moreover, the effects of miR-520, miR-1297 and miR-34 were studied on the gene expression levels. A total of sixty subjects referred for coronary angiography including healthy controls (stenosis <5%), subjects with stent no restenosis) SNR, stenosis <5%) and subjects in stent restenosis (ISR, restenosis >70%) were participated in the study. The gene expression levels and the serum 13,14-dihyro-15-keto- PGF2α value were measured by RT-qPCR and ELISA techniques, respectively. Moreover, the effects of miRNAs on the gene expression levels were investigated by the monocyte transfection of miR/PEI complexes. The PTGES and 15-PGDH gene expression levels and serum 13,14-dihyro-15-keto- PGF2α value increased significantly (P <0.05). Based on the miR-520 and miR-34 expression levels, the miR/PEI transfection studies were confirmed significantly the gene expression changes. The monocyte PGE2 synthesis pathway is actively considered in the SNR and ISR patients and might be related to miR-34 and miR-520 functions.


Assuntos
Reestenose Coronária/metabolismo , Estenose Coronária/metabolismo , Dinoprostona/metabolismo , Adulto , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Reestenose Coronária/fisiopatologia , Estenose Coronária/fisiopatologia , Dinoprosta/análogos & derivados , Dinoprosta/análise , Dinoprosta/sangue , Dinoprostona/genética , Feminino , Expressão Gênica/genética , Regulação da Expressão Gênica/genética , Humanos , Hidroxiprostaglandina Desidrogenases/análise , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Stents
3.
Angiology ; 72(1): 62-69, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32815383

RESUMO

The optimal strategy for assessing the ischemic significance of intermediate coronary stenoses with adenosine-induced fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) is still debated. Few studies have previously assessed the impact of age on FFR and iFR, which was the aim of our study. Patients undergoing FFR and iFR evaluation for intermediate (40%-70%) coronary lesions were included and divided according to age. Fractional flow reserve was performed by intracoronary boluses of adenosine (60-1440 µg). Instantaneous wave-free ratio was automatically calculated. Among 148 patients undergoing FFR measurement of 166 lesions, 45.3% were ≥70 years. Elderly patients had higher minimal lumen diameter (P = .03). We also observed a linear relationship between iFR and FFR independently of age. Fractional flow reserve values were higher in the elderly patients, whereas iFR was not related to age. A total of 33 lesions had a positive iFR with no difference for age (17.3% vs 22%, P = .56), while FFR <0.80 was more infrequent in the elderly patients (17.1% vs 34.8%, P = .02). In intermediate coronary stenoses, iFR and FFR correlation is unaffected by age. Fractional flow reserve is higher in the elderly patients, whereas iFR is less affected by age. Future large-scale studies are needed to define whether iFR should be the preferred choice in elderly patients.


Assuntos
Envelhecimento/fisiologia , Estenose Coronária/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Adenosina/administração & dosagem , Idoso , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Vasodilatadores/administração & dosagem
4.
JAMA Netw Open ; 3(12): e2028312, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315111

RESUMO

Importance: Both noninvasive anatomic and functional testing strategies are now routinely used as initial workup in patients with low-risk stable chest pain (SCP). Objective: To determine whether anatomic approaches (ie, coronary computed tomography angiography [CTA] and coronary CTA supplemented with noninvasive fractional flow reserve [FFRCT], performed in patients with 30% to 69% stenosis) are cost-effective compared with functional testing for the assessment of low-risk SCP. Design, Setting, and Participants: This cost-effectiveness analysis used an individual-based Markov microsimulation model for low-risk SCP. The model was developed using patient data from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. The model was validated by comparing model outcomes with outcomes observed in the PROMISE trial for anatomic (coronary CTA) and functional (stress testing) strategies, including diagnostic test results, referral to invasive coronary angiography (ICA), coronary revascularization, incident major adverse cardiovascular event (MACE), and costs during 60 days and 2 years. The validated model was used to determine whether anatomic approaches are cost-effective over a lifetime compared with functional testing. Exposure: Choice of index test for evaluation of low-risk SCP. Main Outcomes and Measures: Downstream ICA and coronary revascularization, MACE (death, nonfatal myocardial infarction), cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of competing strategies. Results: The model cohort included 10 003 individual patients (median [interquartile range] age, 60.0 [54.4-65.9] years; 5270 [52.7%] women; 7693 [77.4%] White individuals), who entered the model 100 times. The Markov model accurately estimated the test assignment, results of anatomic and functional index testing, referral to ICA, revascularization, MACE, and costs at 60 days and 2 years compared with observed data in PROMISE (eg, coronary CTA: ICA, 12.2% [95% CI, 10.9%-13.5%] vs 12.3% [95% CI, 12.2%-12.4%]; revascularization, 6.2% [95% CI, 5.5%-6.9%] vs 6.4% [95% CI, 6.3%-6.5%]; functional strategy: ICA, 8.1% [95% CI, 7.4%-8.9%] vs 8.2% [95% CI, 8.1%-8.3%]; revascularization, 3.2% [95% CI, 2.7%-3.7%] vs 3.3% [95% CI, 3.2%-3.4%]; 2-year MACE rates: coronary CTA, 2.1% [95% CI, 1.7%-2.5%] vs 2.3% [95% CI, 2.2%-2.4%]; functional strategy, 2.2% [95% CI, 1.8%-2.6%] vs 2.4% [95% CI, 2.3%-2.4%]). Anatomic approaches led to higher ICA and revascularization rates at 60 days, 2 years, and 5 years compared with functional testing but were more effective in patient selection for ICA (eg, 60-day revascularization-to-ICA ratio, CTA: 53.7% [95% CI, 53.3%-54.0%]; CTA with FFRCT: 59.5% [95% CI, 59.2%-59.8%]; functional testing: 40.7% [95% CI, 40.4%-50.0%]). Over a lifetime, anatomic approaches gained an additional 6 months in perfect health compared with functional testing (CTA, 25.16 [95% CI, 25.14-25.19] QALYs; CTA with FFRCT, 25.14 [95% CI, 25.12-25.17] QALYs; functional testing, 24.68 [95% CI, 24.66-24.70] QALYs). Anatomic strategies were less costly and more effective; thus, CTA with FFRCT dominated and CTA alone was cost-effective (ICERs ranged from $1912/QALY for women and $3,559/QALY for men) compared with functional testing. In probabilistic sensitivity analyses, anatomic approaches were cost-effective in more than 65% of scenarios, assuming a willingness-to-pay threshold of $100 000/QALY. Conclusions and Relevance: The results of this study suggest that anatomic strategies may present a more favorable initial diagnostic option in the evaluation of low-risk SCP compared with functional testing.


Assuntos
Dor no Peito/diagnóstico , Angiografia por Tomografia Computadorizada , Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Teste de Esforço , Reserva Fracionada de Fluxo Miocárdico , Revascularização Miocárdica , Angiografia por Tomografia Computadorizada/economia , Angiografia por Tomografia Computadorizada/métodos , Estenose Coronária/fisiopatologia , Análise Custo-Benefício/métodos , Teste de Esforço/economia , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Teóricos , Revascularização Miocárdica/métodos , Revascularização Miocárdica/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Medição de Risco/economia , Medição de Risco/métodos
5.
Medicine (Baltimore) ; 99(46): e23148, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181686

RESUMO

To evaluate the perfusion of coronary circulation and its related factors and the difference in the peak filling times in aortic sinus and coronary sinus by coronary computed tomography angiography (CCTA).From January 1 to August 1, 2018, 61 outpatients with angina pectoris were recruited, completed a questionnaire about risk factors and underwent CCTA, which was also used to assess the stenosis of different coronary artery segments.The duration of circulation was 9.50 ±â€Š2.43 seconds in patients with flat T wave, which was shorter than the duration in normal subjects (P = .021). However, other cardiovascular risk factors showed no effect on the duration of circulation. In addition, the duration of circulation was closely related to the peak filling time of coronary sinus [r(s) = 0.681]. We further divided the circulation time difference (delta) values into 3 levels (<6, 6-12, and ≥12 seconds).It showed that the circulation duration (Y) was associated with:Therefore, the cardiac circulation duration was negatively related to the degree of stenosis in the 1 diagonal and proximal LCA.It compensates for the inability of CCTA to assess circulation at rest simply by determining the peak filling time in the aortic sinus and the coronary sinus. Moderate cardiac microcirculation duration was related to a low incidence of clinical symptoms and electrocardiogram disorders, which was determined mainly by the diagonal and left circumflex branch 1 of LCA.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença das Coronárias , Vasos Coronários , Circulação Coronária/fisiologia , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Doença das Coronárias/fisiopatologia , Estenose Coronária/patologia , Estenose Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
6.
PLoS One ; 15(8): e0237275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760123

RESUMO

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% ± 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.


Assuntos
Estenose Coronária/diagnóstico , Idoso , Angiografia Coronária , Estenose Coronária/fisiopatologia , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico
7.
Methodist Debakey Cardiovasc J ; 16(2): 77-85, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670467

RESUMO

Cardiac computed tomography angiography (CCTA) has evolved into a versatile imaging modality that can depict atherosclerosis burden, determine functional significance of a stenotic lesion, and guide the management and treatment of stable coronary artery disease.1 With newer-generation scanners, diagnostic CCTA can be obtained in the majority of patients with a very acceptable radiation dose. We discuss the ability of CCTA to provide comprehensive assessment of a patient with suspected CAD, including functional techniques of stress-rest myocardial perfusion assessment using a vasodilator and a purely post-processing approach that assesses fractional flow reserve derived by CCTA. In addition, recent data validated the role of CCTA in managing stable patients with chest pain and suspected CAD, serving as a gatekeeper for invasive coronary angiogram as well as optimizing the preprocedural planning of percutaneous coronary revascularization and coronary artery bypass surgery.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Imagem de Perfusão do Miocárdio , Tomada de Decisão Clínica , Ponte de Artéria Coronária , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Humanos , Intervenção Coronária Percutânea , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
8.
J Interv Cardiol ; 2020: 4094121, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32508540

RESUMO

While coronary revascularization strategies guided by instantaneous wave-free ratio (iFR) are, in general, noninferior to those guided by fractional flow reserve (FFR) with respect to the rate of major adverse cardiac events at one-year follow-up in patients with stable angina or an acute coronary syndrome, the overall accuracy of diagnosis with iFR in large patient cohorts is about 80% compared with the diagnosis with FFR. So far, it remains incompletely understood what factors contribute to the discordant diagnosis between iFR and FFR. In this study, a computational method was used to systemically investigate the respective effects of various cardiovascular factors on FFR and iFR. The results showed that deterioration in aortic valve disease (e.g., regurgitation or stenosis) led to a marked decrease in iFR and a mild increase in FFR given fixed severity of coronary artery stenosis and that increasing coronary microvascular resistance caused a considerable increase in both iFR and FFR, but the degree of increase in iFR was lower than that in FFR. These findings suggest that there is a high probability of discordant diagnosis between iFR and FFR in patients with severe aortic valve disease or coronary microcirculation dysfunction.


Assuntos
Síndrome Coronariana Aguda , Angina Estável , Valva Aórtica , Angiografia Coronária/métodos , Estenose Coronária , Vasos Coronários , Reserva Fracionada de Fluxo Miocárdico , Revascularização Miocárdica/métodos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Angina Estável/diagnóstico , Angina Estável/etiologia , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Simulação por Computador , Circulação Coronária , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Humanos , Seleção de Pacientes , Índice de Gravidade de Doença , Resistência Vascular
9.
Int J Cardiovasc Imaging ; 36(10): 2039-2050, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32488454

RESUMO

To explore the superiority of radiomics analysis in the diagnostic performance of coronary computed tomography angiography (CCTA) for identifying myocardial ischaemia and predicting major adverse cardiovascular events (MACE). A total of 105 lesions from 88 patients who underwent CCTA and invasive fractional flow reserve measurement were collected as the training set, and another 31 patients with CCTA and clinical outcome information were used as the validation set. Conventional CCTA features included the stenosis diameter, length, Agatston score and high-risk plaque characteristics. After extracting and selecting radiomics features, the robustness of the radiomics features was examined, and then conventional and radiomics models were established using logistic regressions. The area under the receiver operating characteristic (ROC) curve (AUC) and Net Reclassification Index (NRI) were analysed to compare the discrimination and classification abilities between the two models in both the training and validation sets. A total of 1409 radiomics features were extracted, and three wavelet features were finally screened out. The robustness test showed good stability for the refined radiomics features. Compared with the conventional model, the radiomics model displayed a significantly improved diagnostic performance in the training set (AUC 0.762 vs. 0.631, 95% confidence interval [CI] 0.671-0.853 vs. 0.519-0.742, P = 0.058) but a slightly improved diagnostic performance in the validation set (AUC 0.671 vs. 0.592, 95% CI 0.466-0.875 vs. 0.519-0.742, P = 0.448). The NRI of the radiomics model was increased in both the training and validation sets (NRI 0.198 and 0.238, respectively). Quantitative radiomics analysis was feasible and might help to improve the diagnostic performance of CCTA but is still controversial for predicting MACE.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Interpretação de Imagem Radiográfica Assistida por Computador , Idoso , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Ondaletas
10.
Comput Methods Biomech Biomed Engin ; 23(12): 894-905, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32519914

RESUMO

Stenosis in the bifurcated coronary artery has attracted wide attention among the researchers. Many investigations have been carried out by means of Computational Fluid Dynamics (CFD) to better understand the physical mechanism inside the stenotic bifurcated artery. However, the main focus of the existing publications is limited to the variation of hemodynamic parameters affected by the stenosis and bifurcation structure. The present study aims to make further evaluations of stenosis development and diagnostic lesion assessments based on the critical values of hemodynamic and practical diagnostic parameters. The bifurcated coronary artery with initial stenosis source has been studied in 2 D unsteady model. Different locations of initial stenosis source have been found to greatly affect the orientation of the further stenosis development. In addition, different stenosis severities (diameter stenosis: 30%, 50% and 70%), different stenosis lengths (3 mm, 6 mm and 9 mm) and different pulse rates (75 bpm, 100 bpm and 120 bpm) as controlling parameters have been investigated.


Assuntos
Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Análise Numérica Assistida por Computador , Velocidade do Fluxo Sanguíneo , Simulação por Computador , Hemodinâmica , Humanos , Hidrodinâmica , Modelos Cardiovasculares , Estresse Mecânico
11.
Nat Rev Cardiol ; 17(10): 629-640, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32409779

RESUMO

Evidence supporting the use of coronary physiology as an adjunct to coronary angiography to guide percutaneous coronary interventions has accumulated over the past 25 years. The fractional flow reserve has dominated this evolving physiological guidance of coronary intervention and its use is supported by large clinical outcome trials. However, despite clinical practice guidelines advocating its use in most patients with coronary stenosis who are eligible for coronary intervention, the uptake of a physiology-guided approach remains limited. The use of non-hyperaemic coronary pressure measurements to guide coronary interventions was introduced in an attempt to simplify the routine application of coronary physiology-guided intervention in daily practice. Over the past decade, a large scientific effort has focused on the development of several non-hyperaemic pressure ratios. In this Review, we detail the basic principles of coronary physiology in non-hyperaemic conditions, the rationale for the use of non-hyperaemic coronary pressure measurements for stenosis evaluation, the current evidence base for the available non-hyperaemic coronary pressure ratios, the basis for the discordance between non-hyperaemic coronary pressure ratios and fractional flow reserve, and the potential advantages of these new parameters over fractional flow reserve.


Assuntos
Pressão Arterial , Volume Sanguíneo , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Vasos Coronários/fisiopatologia , Intervenção Coronária Percutânea/métodos , Hemodinâmica , Humanos
12.
Int J Cardiovasc Imaging ; 36(7): 1249-1260, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32405734

RESUMO

This study aimed to clarify the diagnostic and prognostic potential of strain rate in patients with suspected stable angina pectoris (SAP). Strain rate by 2-dimensional speckle tracking echocardiography (2DSTE) has been suggested to be able to diagnose coronary artery disease (CAD) and predict cardiovascular events in various patient groups. Prospectively enrolled patients (n = 296) with suspected SAP, no previous cardiac disease, and normal left ventricular ejection fraction were examined by 2DSTE, exercise ECG, and coronary angiography. Obstructive CAD was defined as stenosis ≥ 70% in ≥ 1 coronary artery on coronary angiography (n = 107). Major adverse cardiac events (MACE) included myocardial infarction, heart failure, atrial fibrillation, and stroke. In multivariable analysis adjusted for baseline data, conventional echocardiography, and Duke score, early diastolic strain rate (SRe) was independently associated with significant CAD with a 1.35 increased risk of having CAD per 0.1 decrease in SRe (OR = 1.35, 95% CI 1.03-1.76, P = 0.027). Peak velocity of early diastolic filling (E)/SRe was not associated with significant CAD (OR = 1.14, 95% CI 0.81-1.62, P = 0.445). MACE occurred in 34 patients (12%) during follow-up (median 3.5 years) and both SRe (HR 1.26, 95% CI (1.07-1.49), P = 0.006) and E/SRe (HR 1.24, 95% CI (1.04-1.47), P = 0.017) were independent predictors after multivariable adjustment. In patients with suspected SAP, SRe by 2DSTE was independently associated with presence of CAD. In addition, SRe and E/SRe provided independent and incremental prognostic value for predicting future MACE.


Assuntos
Angina Estável/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Ecocardiografia , Função Ventricular Esquerda , Idoso , Angina Estável/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Diástole , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
13.
BMC Cardiovasc Disord ; 20(1): 226, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414371

RESUMO

BACKGROUND: We aimed to investigate the association of lesion-specific epicardial adipose tissue (EAT) volume and density with the presence of myocardial ischemia. METHODS: We enrolled 45 patients (55 lesions) with known or suspected coronary artery disease who underwent coronary computed tomography angiography (CTA) followed by invasive fractional flow reserve (FFR) assessment within 30 days. EAT volume (index) and density in patient-, vessel- and lesion-level were measured on CTA images. Lesion-specific ischemia was defined as a lesion with stenosis diameter > 90% or FFR ≤0.80. Multivariate analysis determined the independent association of EAT parameters with lesion-specific ischemia. RESULTS: Mean age of the patients was 60 years, and 75% were male. Overall, 55.6% of patients had ischemic lesions and a mean FFR baseline value of 0.82 ± 0.10. Total EAT volume index was significantly higher in patients with functionally or anatomically significant stenosis. Specifically, peri-lesion EAT volume index, not the density, was positively correlated with lesion-specific ischemia independent of luminal stenosis and plaque characteristics (hazard ratio 1.56, 95% confidence interval 1.04-2.33, P = 0.032; per 0.1 ml/m2 increase). Moreover, peri-lesion EAT volume was negatively correlated with lesion FFR values, whereas total EAT volume was positively correlated with fat accumulation and glucose metabolism. In addition, there was no association of EAT volume or density with myocardial ischemia in vessel-level analysis. CONCLUSIONS: Lesion-specific EAT volume index, but not density, seems positively and independently associated with myocardial ischemia, while its incremental diagnostic value of lesion-specific ischemia should be further investigated.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Adiposidade , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Hemodinâmica , Tecido Adiposo/fisiopatologia , Idoso , Cateterismo Cardíaco , Estenose Coronária/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio , Valor Preditivo dos Testes , Prognóstico , Estudo de Prova de Conceito , Estudos Retrospectivos
14.
Int J Cardiovasc Imaging ; 36(8): 1407-1416, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32367188

RESUMO

Contrast-flow quantitative flow ratio (cQFR) is a new technology for quantitative evaluation of coronary stenosis using computational fluid dynamics based on angiograms. The aim of this study was to assess the sensitivity and specificity of cQFR to detect myocardial ischemia using stress magnetic resonance imaging (MRI) as a reference standard. Patients who received stress MRI and coronary angiography were selected from the hospital database. Relevant ischemia on stress MRI was defined as a perfusion deficit in ≥ 2 of 16 segments. cQFR was quantitated based on 3-dimensional quantitative coronary angiography using QAngio XA3D1.1 software by two blinded and independent investigators. A cQFR of ≤ 0.80 was considered abnormal. Among 87 patients 230 vessels met the criteria for full analysis by cQFR (88%). In vascular territories with a significant perfusion deficit, cQFR was significantly lower compared to areas with normal perfusion (0.72 (0.62-0.78) vs. 0.96 (0.89-0.99); p < 0.001). The sensitivity of cQFR in detecting significant epicardial stenoses of coronary vessels with documented ischemia in stress MRI was 81% (68-90%), the specificity was 88% (82-92%). Diameter stenoses (DS) and area stenoses (AS) in vessels with positive stress MRI were significantly higher than in vessels without ischemia (DS 59.1% (49.4-68.4%) vs. 34.8% (27.1-46.1%) p < 0.001; AS 75.6% (63.0-85.2%) vs. 45.0% (30.8-63.6%), p < 0.001). The analysis reveals a high correlation between coronary stenosis measured by cQFR and ischemic areas detected by stress MRI. The data set the stage to plan randomized studies assessing cQFR measurements with regard to clinical outcomes.


Assuntos
Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Idoso , Velocidade do Fluxo Sanguíneo , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Função Ventricular Esquerda
15.
J Interv Cardiol ; 2020: 5787439, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32327943

RESUMO

Background: The saline-induced distal coronary pressure/aortic pressure ratio predicted fractional flow reserve (FFR). The resting full-cycle ratio (RFR) represents the maximal relative pressure difference in a cardiac cycle. Therefore, the present study aimed to compare the results of saline-induced RFR (sRFR) with FFR. Methods: Seventy consecutive lesions with only moderate stenosis were included. The FFR, RFR, and sRFR values were compared. The sRFR was assessed using an intracoronary bolus infusion of saline (2 mL/s) for five heartbeats. The FFR was obtained after an intravenous injection of papaverine. Results: Overall, the FFR, sRFR, and RFR values were 0.78 ± 0.12, 0.79 ± 0.13, and 0.83 ± 0.14, respectively. With regard to anatomical morphology were 40, 18, and 12 cases of focal, diffuse, and tandem lesion. There was a significant correlation between the sRFR and FFR (R = 0.96, p < 0.01). There were also significant correlations between the sRFR and FFR in the left coronary and right coronary artery (R = 0.95, p < 0.01 and R = 0.98, p < 0.01). Furthermore, significant correlations between sRFR and FFR were observed in not only focal but also in nonfocal lesion including tandem and diffuse lesions (R = 0.93, p < 0.01 and R = 0.97, p < 0.01). A close agreement on FFR and sRFR was shown using the Bland-Altman analysis (95% CI of agreement: -0.08-0.07). In the receiver operating characteristic curve analysis, the cutoff value of sRFR to predict an FFR of 0.80 was 0.81 (area under curve, 0.97; sensitivity 90.6%; and specificity 98.2%). Conclusion: The sRFR can accurately and safely predict the FFR and might be effective for diagnosing ischemia.


Assuntos
Pressão Arterial/fisiologia , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco , Angiografia Coronária , Vasos Coronários/fisiopatologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença
16.
Circ Cardiovasc Interv ; 13(5): e007868, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32345039

RESUMO

BACKGROUND: The resting distal-to-aortic coronary pressure ratio (Pd/Pa) is a universally available, hyperemia-free physiological index of coronary stenosis. We investigated clinical outcomes according to resting Pd/Pa versus hyperemic fractional flow reserve (FFR). METHODS: From the IRIS-FFR (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve) registry, 7014 lesions in 4707 patients with valid resting Pd/Pa and FFR were included in this study. The primary outcome was major adverse cardiac events (MACE; a composite of cardiac death, myocardial infarction, and repeat intervention). The MACE rate was compared among resting Pd/Pa ≤0.92 and FFR ≤0.80. A marginal Cox model accounted for correlated data in patients with multiple lesions. RESULTS: During a median follow-up of 2.0 years, 223 MACEs occurred. Resting Pd/Pa was an independent predictor for the occurrence of MACE (adjusted hazard ratio [aHR], 1.89 [95% CI, 1.32-2.71]; P=0.001) over clinical and angiographic variables. When resting Pd/Pa and FFR were added into a multivariable model, MACE was no longer significantly associated with resting Pd/Pa (aHR, 1.35 [95% CI, 0.93-1.97]; P=0.12) but remained to be associated with FFR (aHR, 2.34 [95% CI, 1.56-3.54]; P<0.001). Compared with lesions with normal value of resting Pa/Pa and FFR, lesions with abnormal values of either resting Pd/Pa (aHR, 2.12 [95% CI, 1.17-3.84]; P=0.014) or FFR (aHR, 2.32 [95% CI, 1.52-3.55]; P<0.001) or both (aHR, 2.37 [95% CI, 1.57-3.57]; P<0.001) showed a significantly increased risk of the occurrence of MACE. CONCLUSIONS: Resting Pd/Pa appeared to be a less-robust prognostic index than FFR. Resting Pd/Pa could be used as a prognostic index when hyperemic agents are contraindicated or not easily available. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01366404.


Assuntos
Aorta/fisiopatologia , Pressão Arterial , Cateterismo Cardíaco , Estenose Coronária/diagnóstico , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Idoso , Angiografia Coronária , Estenose Coronária/mortalidade , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sistema de Registros , Reprodutibilidade dos Testes , República da Coreia , Medição de Risco , Fatores de Risco
17.
Int J Cardiovasc Imaging ; 36(7): 1377-1384, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32246388

RESUMO

Transient ischemic dilation (TID), a marker of severe coronary artery disease (CAD), is the post-stress to rest left ventricular (LV) volume ratio quantified using non ECG gated single photon emission computerized tomography (SPECT). Although prone positioning causes physiological reduction of LV volume in normal subjects, we hypothesize this may not occur in TID with underlying severe CAD as cardiac hemodynamics worsen when prone. We aim to evaluate the utility of the non ECG gated supine to prone LV volume ratio (SPLVr) for identifying severe CAD. Retrospective data analysis from 130 patients with TID ratio ≥ 1.21 and both post-stress supine and prone images. SPLVr had a significant negative correlation with summed stress (r = - 0.221, p = 0.011) and rest (r = - 0.292, p = 0.001) scores. Of the 129 cases with follow-up invasive or computed tomography coronary angiography, 52 (40.3%) had severe CAD (left main ≥ 50% stenosis, 3-vessel with ≥ 70% stenosis or 2-vessel with proximal left anterior descending ≥ 70% stenosis). Mean SPLVr was significantly lower in severe CAD cases (1.05 ± 0.14 vs 1.12 ± 0.17, p = 0.012). SPLVr predicted severe CAD on univariate [OR 0.12 (95% CI 0.00-0.35) p = 0.01] but not in multivariate analysis. SPLVr is a novel marker that negatively correlates with extent of perfusion abnormalities and is lower amongst TID patients with severe CAD. Larger studies are needed to assess if SPLVr can reliably identify underlying severe CAD amongst TID cases.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Posicionamento do Paciente , Decúbito Ventral , Volume Sistólico , Decúbito Dorsal , Tomografia Computadorizada de Emissão de Fóton Único , Função Ventricular Esquerda , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
JACC Cardiovasc Interv ; 13(6): 693-705, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32192689

RESUMO

OBJECTIVES: The aim of this study was to assess the incidence of unfavorable coronary access after transcatheter aortic valve replacement (TAVR) using post-implantation computed tomography (CT). BACKGROUND: Real-world data regarding coronary access after TAVR assessed using post-implantation CT are scarce. METHODS: Post-TAVR CT of 66 patients treated with Evolut R or Evolut PRO valves and 345 patients treated with SAPIEN 3 valves were analyzed. The distance from inflow of the transcatheter heart valve (THV) to the coronary ostia and the overlap between THV commissures and the coronary ostia were assessed. Coronary access was defined as unfavorable if the coronary ostium was below the skirt or in front of the THV commissural posts above the skirt in each coronary artery. RESULTS: CT-identified features of unfavorable coronary access were observed in 34.8% (n = 23) for the left coronary artery and 25.8% (n = 17) for the right coronary artery in the Evolut R/Evolut PRO group, while those percentages were 15.7% (n = 54) for the left coronary artery and 8.1% (n = 28) for the right coronary artery in the SAPIEN 3 group. In the Evolut R/Evolut PRO group, 16 coronary engagements were performed after TAVR, while 64 coronary engagements were performed in the SAPIEN 3 group after TAVR. In an engagement-level analysis, the success rates of selective coronary engagement were significantly lower in patients with CT-identified features of unfavorable coronary access compared with those with favorable coronary access in both the Evolut R/Evolut PRO (0.0% vs. 77.8%; p = 0.003) and SAPIEN 3 (33.3% vs. 91.4%; p = 0.003) groups. CONCLUSIONS: Coronary access may be challenging in a significant proportion of patients after TAVR. THVs with low skirt or commissure height and large open cells that are designed to achieve commissure-to-commissure alignment with the native aortic valve may facilitate future coronary access. (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Thrombosis and Its Treatment With Anticoagulation [RESOLVE]; NCT02318342).


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Cateterismo Cardíaco , Estenose Coronária/etiologia , Vasos Coronários , Próteses Valvulares Cardíacas , Intervenção Coronária Percutânea , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
20.
JACC Cardiovasc Interv ; 13(6): 709-722, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32192691

RESUMO

OBJECTIVES: The authors sought to estimate possible interference of the Medtronic Evolut R/Pro transcatheter heart valve (THV) frame with coronary access using multislice computed tomography (MSCT) data. BACKGROUND: Lower-risk patients undergoing transcatheter aortic valve replacement (TAVR) endure a high cumulative risk of coronary events, but coronary access can be challenging. METHODS: In 101 patients who received an Evolut R/Pro THV, post-TAVR MSCT (performed at a median of 30 days after TAVR) was used to assess possible interference of the elements of the THV frame with coronary access. RESULTS: The closest cell of the THV frame vertically aligned with the coronary ostium was located opposite the ostium in 58% and 63%, below the ostium in 22% and 30%, or above the ostium in 20% and 7% of left and right coronary arteries, respectively. The free sinus of Valsalva space between the THV frame and the coronary ostium was 0.45 ± 0.17 cm and 0.44 ± 0.17 cm for the left and right coronary arteries, respectively, and showed a stepwise decrease with decreasing THV size (p < 0.001). Bioprosthetic valve commissures were antianatomic (i.e., not aligned with native commissures) in 45 patients (47%), and the commissural post was overlapping a coronary ostium in 15 patients (16%). Two patients (2.0%) had a possible interference of the paravalvular sealing skirt with coronary access. CONCLUSIONS: Using post-TAVR MSCT data, the main mechanism of potential interference of Evolut R/Pro frame with coronary access was an antianatomic commissural post overlapping the coronary ostium.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Próteses Valvulares Cardíacas , Tomografia Computadorizada Multidetectores , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Estenose Coronária/etiologia , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Desenho de Prótese , Sistema de Registros , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
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