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1.
Trials ; 20(1): 520, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429810

RESUMO

BACKGROUND: Coronary artery disease (CAD) is one of the most common types of the cardiovascular disease. Previous pilot trials have suggested that Traditional Chinese Medicine (TCM) has brought clinical benefits for patients with CAD. We will conduct this trial to determine the efficacy and safety of Shenzhu Guanxin Recipe Granules (SGR) for the treatment of patients with CAD. METHODS: This randomized controlled trial recruited 190 patients who were diagnosed with CAD by clinical manifestation and examination and in which coronary computed tomography angiography (CCTA) showed 50-70% stenosis, with soft or mixed plaque types. The included participants were randomly assigned to the case group and control group using a 1:1 allocation ratio; patients in the case group received SGR and usual care, and those in the control group received placebo (6 g/day for 6 months) and usual care. The endpoint of the study included Calcium Coverage Score (CCS), C-reactive protein (CRP) level, and the levels of blood lipids, tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and ATP-binding membrane cassette transporter A1 (ABCA1) were calculated before recruiting and at the sixth month. The indicators were Seattle Angina Questionnaire (SAQ) and TCM Syndrome Questionnaire scores at 0, 3, and 6 months. DISCUSSION: This clinical trial may provide reliable evidence regarding the clinical effectiveness and safety of SGR therapy for patients with CAD diagnosed by clinical manifestation and examination, in which CCTA showed 50-70% stenosis, with soft or mixed plaque types. TRIAL REGISTRATION: ClinicalTrials.gov, ID: ChiCTR1900020501 . The trial was registered on 25 December 2018.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Estenose Coronária/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Adolescente , Adulto , Idoso , Fármacos Cardiovasculares/efeitos adversos , China , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Método Duplo-Cego , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Placa Aterosclerótica , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
2.
Molecules ; 24(15)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31344782

RESUMO

In arterial thrombosis, von Willebrand factor (VWF) bridges platelets to sites of vascular injury. The adhesive properties of VWF are controlled by its different domains, which may be engineered into ligands for targeting nanoparticles to vascular injuries. Here, we functionalized 200 nm polystyrene nanoparticles with the VWF-A1 domain and studied their spatial adhesion to collagen or collagen-VWF coated, real-sized coronary stenosis models under physiological flow. When VWF-A1 nano-particles (A1-NPs) were perfused through a 75% stenosis model coated with collagen-VWF, the particles preferentially adhered at the post stenotic region relative to the pre-stenosis region while much less adhesion was detected at the stenosis neck (~ 65-fold less). When infused through collagen-coated models or when the A1 coating density of nanoparticles was reduced by 100-fold, the enhanced adhesion at the post-stenotic site was abolished. In a 60% stenosis model, the adhesion of A1-NPs to collagen-VWF-coated models depended on the location examined within the stenosis. Altogether, our results indicate that VWF-A1 NPs exhibit a flow-structure dependent adhesion to VWF and illustrate the important role of studying cardiovascular nano-medicines in settings that closely model the size, geometry, and hemodynamics of pathological environments.


Assuntos
Plaquetas/metabolismo , Estenose Coronária/metabolismo , Nanopartículas , Adesividade Plaquetária , Fator de von Willebrand/metabolismo , Animais , Estenose Coronária/tratamento farmacológico , Estenose Coronária/etiologia , Estenose Coronária/patologia , Modelos Animais de Doenças , Hemodinâmica , Humanos , Nanopartículas/química , Ligação Proteica , Proteínas Recombinantes , Fator de von Willebrand/química , Fator de von Willebrand/isolamento & purificação
3.
BMC Cardiovasc Disord ; 19(1): 79, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940076

RESUMO

BACKGROUND: Takayasu arteritis is a rare systemic vasculitis, which affects the aorta and its major branches, especially in young females. Diagnosis and treatment for Takayasu arteritis with coronary stenosis are important to prevent fatal complications. Immunosuppressive treatment such as corticosteroid is a common treatment for this condition. However, the effects of immunosuppressive treatment on inflammatory coronary stenosis caused by Takayasu arteritis remains unknown. CASE PRESENTATION: An 18-year-old female had chest oppression on effort and was referred to our hospital due to ST-segment depression in I, aVL, and V2-4 on electrocardiogram. Coronary angiography showed severe stenosis in the ostium of both the left main trunk and the right coronary artery. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography showed isolated inflammation of the aortic root. She was diagnosed with Takayasu arteritis and treated with combined immunosuppressive treatment with corticosteroid and tocilizumab, which decreased the FDG uptake in the aortic root. Four months after initiation of the immunosuppressive treatment, coronary angiography showed regression of the coronary ostial stenosis. Coronary artery bypass surgery was considered, but the patient rejected invasive revascularization for coronary artery disease. She did not have chest oppression or ST-segment depression after the immunosuppressive treatment. She had no cardiac events for 6 months after discharge. CONCLUSIONS: We described regressed coronary ostial stenosis in a young female patient with Takayasu arteritis. Immunosuppressive treatment might have a favorable effect on coronary ostial stenosis in Takayasu arteritis.


Assuntos
Corticosteroides/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Estenose Coronária/tratamento farmacológico , Imunossupressores/uso terapêutico , Prednisolona/uso terapêutico , Arterite de Takayasu/tratamento farmacológico , Adolescente , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/etiologia , Quimioterapia Combinada , Feminino , Humanos , Indução de Remissão , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(14): e15106, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946377

RESUMO

INTRODUCTION: Coronary bifurcations are encountered in about 15% to 20% of percutaneous coronary interventions (PCIs). They are considered technically challenging and associated with worse clinical outcomes than nonbifurcation lesions. The BiOSS LIM C is a dedicated bifurcation balloon expandable stent made of cobalt-chromium alloy (strut thickness 70 µm) releasing sirolimus (1.4 µg/mm) from the surface of a biodegradable coating comprised of a copolymer of lactic and glycolic acids. CONCLUSION: The aim of the randomized, multicenter, open-label, controlled POLBOS III trial is to compare BiOSS LIM C with limus second-generation drug-eluting stents (DES) in the treatment of non-left main stem coronary bifurcations (ClinicalTrials.gov NCT03548272).


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Estenose Coronária/tratamento farmacológico , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents Metálicos Autoexpansíveis , Síndrome Coronariana Aguda/terapia , Cromo , Cobalto , Estenose Coronária/terapia , Humanos , Estudos Multicêntricos como Assunto , Projetos de Pesquisa , Sirolimo/administração & dosagem , Resultado do Tratamento
5.
J Cardiovasc Med (Hagerstown) ; 20(5): 306-312, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30865138

RESUMO

: Acetylsalicylic acid (ASA) represents one of the most widely used pharmacological treatments for the prevention of atherothrombotic events. However, its use in low-risk patients is still debated, due to the complex balance between benefits and bleeding complications, therefore requiring new tools for the assessment of cardiovascular risk. Immature platelet count (IPC) has been suggested as a marker of platelet reactivity and turnover, thus potentially reflecting the progression of the chronic atherothrombotic vascular damage, which could be prevented by ASA. However, no study has evaluated, so far, the impact of long-term therapy with ASA on the IPC among patients undergoing coronary angiography, which was the aim of the present study. We included patients from a single centre. Significant coronary artery disease (CAD) was defined as at least one-vessel stenosis more than 50%. Immature platelet fraction (IPF) levels were measured by routine blood cells count (a Sysmex XE-2100) in patients naive or chronically treated with ASA at admission. Among 1475 patients, 464 (31.5%) were ASA-naive. Patients on long-term antiplatelet therapy were more often men (P < 0.001), with a higher prevalence of cardiovascular risk factors and CAD. The mean levels of IPC did not differ between ASA-naive and treated patents (8 ±â€Š5.3 vs. 7.8 ±â€Š4.9, P = 0.48). Similar results were obtained when considering IPC distribution across tertiles, as ASA therapy did not result as an independent predictor of IPC levels above the third tertile (≥8.6 × 10/ml) [adjusted odds ratio (95% confidence interval) = 0.96 (0.63-1.48), P = 0.87]. Results were confirmed in major higher risk subgroups of patients. The present study shows that among high-risk patients undergoing coronary angiography, the long-term therapy with ASA does not affect the levels of IPC.


Assuntos
Aspirina/administração & dosagem , Plaquetas/efeitos dos fármacos , Doença da Artéria Coronariana/tratamento farmacológico , Estenose Coronária/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Idoso , Aspirina/efeitos adversos , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/sangue , Estenose Coronária/diagnóstico por imagem , Estudos Transversais , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Contagem de Plaquetas , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
6.
Int J Rheum Dis ; 22(1): 152-157, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25545064

RESUMO

A 55-year-old woman with newly diagnosed Takayasu arteritis was followed for 7 years, during which time she underwent bare metal stenting, drug eluting stenting and coronary bypass grafting for critical coronary and renal artery stenoses. Interventions were initially successful but restenosis occurred within 24 months for all modalities. In contrast, native vessel disease was largely stable after the introduction of immunosuppressive therapy. We advocate a conservative revascularization approach in Takayasu arteritis in the absence of critical end organ ischemia and early optimization of medical therapy.


Assuntos
Ponte de Artéria Coronária , Estenose Coronária/cirurgia , Procedimentos Endovasculares , Obstrução da Artéria Renal/cirurgia , Arterite de Takayasu/cirurgia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/tratamento farmacológico , Stents Farmacológicos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Imunossupressores/uso terapêutico , Metais , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/tratamento farmacológico , Stents , Arterite de Takayasu/diagnóstico por imagem , Arterite de Takayasu/tratamento farmacológico , Resultado do Tratamento
7.
Expert Rev Cardiovasc Ther ; 16(10): 765-770, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30122073

RESUMO

BACKGROUND: Fractional flow reserve (FFR) has become a useful tool in the assessment of physiological significance of coronary artery stenosis (CAS), and Adenosine (ADE) is associated with a high incidence of transient side effects. Sodium nitroprusside (NPS) has been proposed as an alternative vasodilator agent. A meta-analysis of studies comparing ADE and NPS for FFR assessment in the same coronary lesions was performed. METHODS: Authors searched for articles comparing NPS and ADE for FFR assessment in intermediate coronary lesions published through January 2018. The following keywords were used: 'fractional flow reserve' AND 'nitroprusside'. Data were summarized using weighted mean differences for paired data. RESULTS: Seven studies were identified comprising 342 patients and 401 lesions. Four studies evaluated intravenous ADE and 3 studies intracoronary ADE administration. Weighted means FFR values obtained with ADE and NPS were 0.8411 and 0.8445, respectively (weighted mean difference: 0.00, 95% confidence interval (CI) -0.01 to 0.01, p = 0,548). Adverse events were significantly reduced with IC NPS (RR = 0.08, 95%CI 0.02-0.30, P < 0.0001). CONCLUSIONS: NPS produces similar FFR measurements compared to ADE with a significant reduction in adverse effects. These results may support its use as a suitable alternative to ADE for FFR assessment.


Assuntos
Adenosina/uso terapêutico , Estenose Coronária/tratamento farmacológico , Estenose Coronária/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Nitroprussiato/uso terapêutico , Vasodilatadores/uso terapêutico , Humanos
8.
Biomed Pharmacother ; 106: 776-784, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29990871

RESUMO

Coronary microembolization (CME) is a common complication during the treatment of acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Nicorandil can be used to prevent myocardial injury after PCI to reduce the incidence of coronary no-reflow and slow flow, and play a role in myocardial protection, suggesting that its mechanism may be related to the inhibition of CME-induced inflammation of cardiomyocytes. However, the specific mechanism remains unclear. This study investigated the myocardial protective effects of nicorandil pretreatment on CME-induced myocardial injury and the specific mechanism of its inhibition of myocardial inflammation. An CME rat model exhibited CME-induced myocardial inflammation and the elevation of serum tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-1ß based on echocardiography, myocardial enzyme detection, hematoxylin and eosin (HE) and hematoxylin-basic fuchsin-picric acid (HBFP) stainings, ELISA, quantitative real-time PCR, and western blotting. Nicorandil treatment seven days before CME induction effectively inhibited myocardial inflammation, ameliorated myocardial injury, and improved cardiac function, mainly by inhibiting Toll-like receptor 4 (TLR4)-mediated myeloid differentiation primary response protein 88 (MyD88)-dependent nuclear factor-kappa B (NF-κB) signaling. Rat neonatal cardiomyocyte experiments further confirmed that nicorandil ameliorated lipopolysaccharide (LPS)-induced myocardial inflammation and improved cardiomyocyte survival. The specific mechanisms mainly involved the inhibition of TLR4/MyD88/NF-κB signaling and the reduction of the inflammatory cytokines TNF-α and IL-1ß released from cardiomyocytes. In summary, nicorandil significantly protected cardiomyocytes from CME-induced myocardial injury mainly by inhibiting TLR4/MyD88/NF-κB signaling, thereby reducing the onset of CME-induced myocardial inflammation. This could be one of the important mechanisms for reducing postoperative myocardial injury via PCI-preoperative prophylactic treatment with nicorandil.


Assuntos
Anti-Inflamatórios/farmacologia , Estenose Coronária/tratamento farmacológico , Embolia/tratamento farmacológico , Fator 88 de Diferenciação Mieloide/metabolismo , Infarto do Miocárdio/prevenção & controle , Miocardite/prevenção & controle , Miócitos Cardíacos/efeitos dos fármacos , NF-kappa B/metabolismo , Nicorandil/farmacologia , Receptor 4 Toll-Like/metabolismo , Disfunção Ventricular Esquerda/prevenção & controle , Animais , Sobrevivência Celular , Estenose Coronária/etiologia , Estenose Coronária/metabolismo , Estenose Coronária/patologia , Citoproteção , Modelos Animais de Doenças , Embolia/etiologia , Embolia/metabolismo , Embolia/patologia , Mediadores da Inflamação/sangue , Interleucina-1beta/sangue , Lipopolissacarídeos/farmacologia , Masculino , Microesferas , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Miocardite/etiologia , Miocardite/metabolismo , Miocardite/patologia , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Ratos Sprague-Dawley , Transdução de Sinais , Volume Sistólico/efeitos dos fármacos , Fator de Necrose Tumoral alfa/sangue , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/metabolismo , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos
10.
BMJ Case Rep ; 20182018 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-29930191

RESUMO

We describe a case of a middle-aged man who presented to the emergency department with typical anginal chest pains and found to have new, deeply inverted T-waves on ECG consistent with Wellens' syndrome. Similar to the description by Wellens et al, a critical 99% stenosis of the proximal left anterior descending artery was indeed confirmed by coronary angiography and successfully treated with drug-eluting stent. It is very important that physicians recognise this ECG finding as a harbinger of a serious cardiovascular condition and the necessity for an early invasive cardiac catheterisation.


Assuntos
Aorta Torácica/fisiopatologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/tratamento farmacológico , Adulto , Angina Pectoris/etiologia , Cateterismo Cardíaco , Dor no Peito/etiologia , Angiografia Coronária , Estenose Coronária/fisiopatologia , Gerenciamento Clínico , Stents Farmacológicos , Eletrocardiografia , Humanos , Masculino
11.
JACC Cardiovasc Imaging ; 11(10): 1475-1484, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29909109

RESUMO

OBJECTIVES: This study sought to describe the impact of statins on individual coronary atherosclerotic plaques. BACKGROUND: Although statins reduce the risk of major adverse cardiovascular events, their long-term effects on coronary atherosclerosis remain unclear. METHODS: We performed a prospective, multinational study consisting of a registry of consecutive patients without history of coronary artery disease who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. Atherosclerotic plaques were quantitatively analyzed for percent diameter stenosis (%DS), percent atheroma volume (PAV), plaque composition, and presence of high-risk plaque (HRP), defined by the presence of ≥2 features of low-attenuation plaque, positive arterial remodeling, or spotty calcifications. RESULTS: Among 1,255 patients (60 ± 9 years of age; 57% men), 1,079 coronary artery lesions were evaluated in statin-naive patients (n = 474), and 2,496 coronary artery lesions were evaluated in statin-taking patients (n = 781). Compared with lesions in statin-naive patients, those in statin-taking patients displayed a slower rate of overall PAV progression (1.76 ± 2.40% per year vs. 2.04 ± 2.37% per year, respectively; p = 0.002) but more rapid progression of calcified PAV (1.27 ± 1.54% per year vs. 0.98 ± 1.27% per year, respectively; p < 0.001). Progression of noncalcified PAV and annual incidence of new HRP features were lower in lesions in statin-taking patients (0.49 ± 2.39% per year vs. 1.06 ± 2.42% per year and 0.9% per year vs. 1.6% per year, respectively; all p < 0.001). The rates of progression to >50% DS were not different (1.0% vs. 1.4%, respectively; p > 0.05). Statins were associated with a 21% reduction in annualized total PAV progression above the median and 35% reduction in HRP development. CONCLUSIONS: Statins were associated with slower progression of overall coronary atherosclerosis volume, with increased plaque calcification and reduction of high-risk plaque features. Statins did not affect the progression of percentage of stenosis severity of coronary artery lesions but induced phenotypic plaque transformation. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Estenose Coronária/tratamento farmacológico , Vasos Coronários/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Placa Aterosclerótica , Idoso , Brasil , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Progressão da Doença , Europa (Continente) , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Masculino , Pessoa de Meia-Idade , América do Norte , Estudos Prospectivos , Sistema de Registros , República da Coreia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
13.
N Engl J Med ; 379(3): 250-259, 2018 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-29785878

RESUMO

BACKGROUND: We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease. METHODS: Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy and were entered into a registry. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. RESULTS: A total of 888 patients underwent randomization (447 patients in the PCI group and 441 in the medical-therapy group). At 5 years, the rate of the primary end point was lower in the PCI group than in the medical-therapy group (13.9% vs. 27.0%; hazard ratio, 0.46; 95% confidence interval [CI], 0.34 to 0.63; P<0.001). The difference was driven by urgent revascularizations, which occurred in 6.3% of the patients in the PCI group as compared with 21.1% of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to 0.41). There were no significant differences between the PCI group and the medical-therapy group in the rates of death (5.1% and 5.2%, respectively; hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1% and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no significant difference in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced after PCI than after medical therapy. CONCLUSIONS: In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent revascularization at 5 years than medical therapy alone. Patients without hemodynamically significant stenoses had a favorable long-term outcome with medical therapy alone. (Funded by St. Jude Medical and others; FAME 2 ClinicalTrials.gov number, NCT01132495 .).


Assuntos
Estenose Coronária/tratamento farmacológico , Estenose Coronária/terapia , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Idoso , Angina Pectoris/terapia , Anti-Hipertensivos/uso terapêutico , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Estenose Coronária/fisiopatologia , Stents Farmacológicos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Inibidores da Agregação de Plaquetas/uso terapêutico , Retratamento/estatística & dados numéricos
14.
Int J Cardiovasc Imaging ; 34(9): 1339-1347, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29696453

RESUMO

There is limited data on the efficacy of paclitaxel-coated balloon (PCB) compared to stents for de novo coronary lesions. The purpose of this study was to compare the efficacy of PCB treatment with stent implantation for de novo coronary lesions after successful plain old balloon angioplasty (POBA) guided by fractional flow reserve (FFR). In 200 patients scheduled for elective percutaneous coronary intervention (PCI) for de novo lesions, FFR was measured after POBA (POBA-FFR). If POBA-FFR was ≥ 0.75, patients were treated with PCB (PCB group, n = 78) or stent (Stent group, n = 73). If POBA-FFR was < 0.75, stent was implanted as planned (Reference group, n = 42). The primary endpoint was late lumen loss at 9 months and the secondary endpoint was adverse cardiac events (cardiac death, myocardial infarction, target lesion thrombosis, or repeat revascularization) at 12 months follow-up. There was no between-group differences in the POBA-FFR (0.87 ± 0.05 in PCB, 0.89 ± 0.06 in stent, p = 0.101). At 9 months, late lumen loss was significantly lower in the PCB group compared to the Stent group (0.05 ± 0.33 vs. 0.59 ± 0.76 mm, p < 0.001). Adverse cardiac events were not different between the PCB, Stent and Reference groups (2.6, 5.5, and 9.5% respectively; p = 0.430 for PCB vs. Stent group; p = 0.229 for the reference vs. both other groups). PCB treatment guided by POBA-FFR showed excellent 9 months angiographic and functional results, as well as comparable 12 months clinical outcomes, compared with stent implantation for de novo coronary lesions.


Assuntos
Anti-Inflamatórios/administração & dosagem , Estenose Coronária/terapia , Stents Farmacológicos , Paclitaxel/administração & dosagem , Intervenção Coronária Percutânea , Idoso , Angioplastia Coronária com Balão , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento
15.
J Cardiovasc Comput Tomogr ; 12(3): 257-260, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29486988

RESUMO

AIM: To assess the association of coronary artery geometry with the severity of coronary artery disease (CAD). METHODS: 73 asymptomatic individuals at increased risk of CAD due to peripheral vascular disease (18 women, mean age 63.5 ±â€¯8.2 years) underwent coronary computed tomography angiography (coronary CTA) using first generation dual-source CT. Curvature and tortuosity of the coronary arteries were quantified using semi-automatically generated centerlines. Measurements were performed for individual segments and for the entire artery. Coronary segments were labeled according to the presence of significant stenosis, defined as >70% luminal narrowing, and the presence of plaque. Comparisons were made by segment and by artery, using linear mixed models. RESULTS: Overall, median curvature and tortuosity were, respectively, 0.094 [0.071; 0.120] and 1.080 [1.040; 1.120] on a per-segment level, and 0.096 [0.078; 0.118] and 1.175 [1.090; 1.420] on a per-artery level. Curvature was associated with significant stenosis at a per-segment (p < 0.001) and per-artery level (p = 0.002). Curvature was 16.7% higher for segments with stenosis, and 13.8% higher for arteries with stenosis. Tortuosity was associated with significant stenosis only at the per-segment level (p = 0.002). Curvature was related to the presence of plaque at the per-segment (p < 0.001) and per-artery level (p < 0.001), tortuosity was only related to plaque at the per-segment level (p < 0.001). CONCLUSION: Coronary artery geometry as derived from coronary CTA is related to the presence of plaque and significant stenosis.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/tratamento farmacológico , Vasos Coronários/diagnóstico por imagem , Idoso , Doença da Artéria Coronariana/patologia , Estenose Coronária/patologia , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Placa Aterosclerótica , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
16.
Cardiovasc Revasc Med ; 19(3 Pt B): 343-347, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28927636

RESUMO

BACKGROUND: Fractional flow reserve (FFR) is used to assess the functional significance of coronary artery stenoses. The optimal anti-thrombotic regimen for FFR has not been studied. PURPOSE: The goal of this study was to determine whether FFR could be safely performed in Type A coronary lesions, using only upstream dual anti-platelet therapy (DAT) with aspirin and clopidogrel, compared with DAT plus anticoagulation in low risk coronary lesions. METHODS/MATERIALS: Two hundred patients undergoing FFR for Type A intermediate coronary lesions were blindly randomized into two groups of 100 patients each. Group 1: Upstream DAT, without intra-procedural anti-coagulation and Group 2: Upstream DAT plus intra-procedural bivalirudin. The primary end-points were any coronary thrombotic complications during the index hospital stay, and a composite end-point of any major adverse cardiovascular events (MACE) at 30-days. Secondary end-points included post-procedure troponin levels and TIMI major and minor bleeding scores. RESULTS: There were no thrombotic complications reported. At 30-days, two MACE occurred in Group 1, and three in Group 2 (p=0.83). No difference was seen in the post-procedure troponin levels (p=0.72), or TIMI bleeding scores study between groups (p=093). CONCLUSIONS: This initial study evaluating a simplified anti-thrombotic regimen for FFR, suggests that FFR can be performed in low risk coronary lesions using DAT without the need for intra-procedural anticoagulation, with similar results as DAT plus anticoagulation with bivalirudin. Further research in this area is needed to determine the optimal and most cost-effective anti-thrombotic regimen for FFR calculation.


Assuntos
Aspirina/administração & dosagem , Clopidogrel/administração & dosagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/tratamento farmacológico , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/tratamento farmacológico , Reserva Fracionada de Fluxo Miocárdico , Inibidores da Agregação de Plaquetas/administração & dosagem , Idoso , Anticoagulantes/administração & dosagem , Aspirina/efeitos adversos , Clopidogrel/efeitos adversos , Angiografia Coronária/efeitos adversos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/sangue , Estenose Coronária/fisiopatologia , Trombose Coronária/etiologia , Trombose Coronária/prevenção & controle , Método Duplo-Cego , Quimioterapia Combinada , Estudos de Viabilidade , Feminino , Hirudinas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Valor Preditivo dos Testes , Proteínas Recombinantes/administração & dosagem , Fatores de Risco
17.
Artigo em Inglês | MEDLINE | ID: mdl-28653394

RESUMO

BACKGROUND: Experimental evidence suggests that ranolazine decreases susceptibility to ischemia-induced arrhythmias independent of effects on coronary artery blood flow. OBJECTIVE: In symptomatic diabetic patients with non-flow-limiting coronary artery stenosis with diffuse atherosclerosis and/or microvascular dysfunction, we explored whether ranolazine reduces T-wave heterogeneity (TWH), an electrocardiographic (ECG) marker of arrhythmogenic repolarization abnormalities shown to predict sudden cardiac death. METHODS: We studied all 16 patients with analyzable ECG recordings during rest and exercise tolerance testing before and after 4 weeks of ranolazine in the double-blind, crossover, placebo-controlled RAND-CFR trial (NCT01754259). TWH was quantified without knowledge of treatment assignment by second central moment analysis, which assesses the interlead splay of T waves in precordial leads about a mean waveform. Myocardial blood flow (MBF) was measured by positron emission tomography. RESULTS: At baseline, prior to randomization, TWH during rest was 54 ± 7 µV and was not altered following placebo (47 ± 6 µV, p = .47) but was reduced by 28% (to 39 ± 5 µV, p = .002) after ranolazine. Ranolazine did not increase MBF at rest. Exercise increased TWH after placebo by 49% (to 70 ± 8 µV, p = .03). Ranolazine did not reduce TWH during exercise (to 75 ± 16 µV), and there were no differences among the groups (p = .95, ANOVA). TWH was not correlated with MBF at rest before (r2  = .07, p = .36) or after ranolazine (r2  = .23, p = .06). CONCLUSIONS: In symptomatic diabetic patients with non-flow-limiting coronary artery stenosis with diffuse atherosclerosis and/or microvascular dysfunction, ranolazine reduced TWH at rest but not during exercise. Reduction in repolarization abnormalities appears to be independent of alterations in MBF.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Estenose Coronária/complicações , Estenose Coronária/tratamento farmacológico , Diabetes Mellitus/fisiopatologia , Ranolazina/uso terapêutico , Estenose Coronária/fisiopatologia , Estudos Cross-Over , Método Duplo-Cego , Eletrocardiografia/efeitos dos fármacos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
18.
Korean J Intern Med ; 33(3): 522-531, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29050464

RESUMO

BACKGROUND/AIMS: Although epigallocatechin-3-gallate (EGCG), which is found in high contents in the dried leaves of green tea, has been reported to have an anti-platelet effect, synergistic effects of EGCG in addition to current anti-platelet medications remains to be elucidated. METHODS: Blood samples were obtained from 40 participants who took aspirin (ASA, n = 10), clopidogrel (CPD, n = 10), ticagrelor (TCG, n = 10) and no anti-platelet medication (Control, n = 10). Ex vivo platelet aggregation and adhesion under various stimulators were analyzed by multiple electrode aggregometry (MEA) and Impact-R systems. PAC-1 and P-selectin expressions in human platelets were analyzed by flow cytometry. RESULTS: In MEA analysis, adenosine diphosphate (ADP) and thrombin receptor activating peptide (TRAP)-induced platelet aggregations were lower in the CPD and the TCG groups; arachidonic acid (AA)-induced platelet aggregation was lower in the ASA group, whereas collagen (COL)-induced platelet aggregations were comparable among four groups. EGCG significantly reduced ADP- and COL-induced platelet aggregation in dose-dependent manner (ADP, p = 0.04; COL, p < 0.01). There were no additional suppressions of platelet aggregation stimulated by AA in the ASA group, and by ADP in the CPD and TCG groups. Moreover, EGCG suppressed shear stress-induced platelet adhesion on Impact-R, and had no effect on P-selectin and PAC-1 expressions. CONCLUSIONS: Ex vivo treatment of EGCG inhibited platelet adhesion and aggregation without changes in P-selectin and PAC-1 expression. There was no additional suppressions in platelet aggregation stimulated by AA in the ASA group and ADP in the CPD and TCG groups.


Assuntos
Aspirina , Catequina/análogos & derivados , Clopidogrel , Estenose Coronária , Inibidores da Agregação de Plaquetas , Ticagrelor , Adulto , Idoso , Aspirina/uso terapêutico , Plaquetas , Catequina/uso terapêutico , Clopidogrel/uso terapêutico , Estenose Coronária/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , República da Coreia , Ticagrelor/uso terapêutico , Ticlopidina
19.
Kardiol Pol ; 76(2): 464-470, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29192951

RESUMO

BACKGROUND: The optimal approach to coronary bifurcation treatment by percutaneous coronary intervention (PCI) is still a subject of debate, and dedicated bifurcation stents are one of the proposed solutions. AIM: The aim of this report was to assess the effectiveness and safety profile of a new dedicated bifurcation stent - sirolimus-eluting BiOSS LIM C® (Balton, Poland) at the first three months of a 12-month registry. METHODS: This is a two-centre registry, which enrolled patients with non-ST elevation acute coronary syndrome (NSTE-ACS) and stable angina. Provisional T-stenting is the obligatory strategy of the treatment. Angiographic control is planned at 12 months. The primary endpoint is the cumulative rate of cardiac death, myocardial infarction (MI), and target lesion revas-cularisation (TLR) at 12 months. RESULTS: A total of 48 patients with lesions in coronary bifurcations were enrolled (mean age 67.9 ± 8.9 years, 14.6% female). There were 20.8% of patients with NSTE-ACS, 93.8% with hypertension, 35.4% with diabetes, 52.1% had previous MI, and 47.9% and 14.6% underwent prior PCI and coronary artery bypass grafting, respectively. The device success rate was 100%. The side branch was treated with an additional classical drug-eluting stent implantation in 18.8% of cases. The periprocedural MI (MI type 4a) was observed in two (4.2%) cases. At three months there was one (2.1%) case of TLR. No death, MI, or stent thrombosis were observed in the follow-up period. CONCLUSIONS: Bifurcation treatment with a single dedicated bifurcation stent (BiOSS LIM C®) is feasible and highly successful (100% implantation success rate). The short-term clinical outcomes are very promising, also in distal left main stenosis. The 12-month observations are pending.


Assuntos
Estenose Coronária/cirurgia , Stents Farmacológicos , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/cirurgia , Idoso , Angina Estável/tratamento farmacológico , Angina Estável/cirurgia , Cromo , Cobalto , Estenose Coronária/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Sistema de Registros , Sirolimo/uso terapêutico , Resultado do Tratamento
20.
Exp Gerontol ; 102: 93-100, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29248560

RESUMO

Vascular endothelial growth factor (VEGF) has been identified as a potential treatment for effectively improving cognitive function in several neuropathological conditions. However, the underlying mechanism and the relevant downstream protective pathways that are activated in neurons by VEGF remain elusive, especially in chronic global cerebral ischemia. In this study, we intended to investigate the signaling mechanisms of VEGF in cognitive protection and anti-apoptosis in a rat model of chronic global cerebral ischemia induced by permanent bilateral common carotid artery occlusion (2-VO). The results showed that intranasal administration of VEGF (72h post-ischemia for 6 successive days) caused a significant improvement in the cognitive deficits induced by 2-VO, accompanied by a reversal of oxidative stress and VEGF depletion in the hippocampus. In addition, VEGF-treatment decreased the expression of Bax and Caspase-3, increased the expression of anti-apoptotic Bcl-xl and the main protein involved in energy homeostasis AMP-activated protein kinase (AMPK), which may account for the anti-apoptotic effects of VEGF. Importantly, VEGF administration upregulated the phosphorylation levels of Akt (pAkt) and PI3K, activated Notch1 pathway in 2-VO hippocampus. These findings suggested that intranasal administration of VEGF alleviated cognitive impairment induced by 2-VO injury, and attenuated oxidative damage and neuronal injury in hippocampus associated with the regulation of PI3K/Akt and Notch1 signaling pathway, which might be the underlying mechanisms of VEGF on global chronic cerebral ischemia.


Assuntos
Comportamento Animal/efeitos dos fármacos , Artéria Carótida Primitiva , Transtornos Cognitivos/prevenção & controle , Cognição/efeitos dos fármacos , Estenose Coronária/tratamento farmacológico , Hipocampo/efeitos dos fármacos , Fármacos Neuroprotetores/administração & dosagem , Fosfatidilinositol 3-Quinase/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Receptor Notch1/metabolismo , Fator A de Crescimento do Endotélio Vascular/administração & dosagem , Administração Intranasal , Animais , Apoptose/efeitos dos fármacos , Proteínas Reguladoras de Apoptose/metabolismo , Artéria Carótida Primitiva/cirurgia , Transtornos Cognitivos/enzimologia , Transtornos Cognitivos/patologia , Transtornos Cognitivos/psicologia , Estenose Coronária/enzimologia , Estenose Coronária/patologia , Estenose Coronária/psicologia , Modelos Animais de Doenças , Hipocampo/enzimologia , Hipocampo/patologia , Hipocampo/fisiopatologia , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Memória/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Neurônios/enzimologia , Neurônios/patologia , Estresse Oxidativo/efeitos dos fármacos , Fosforilação , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos
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