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1.
Comput Methods Biomech Biomed Engin ; 23(1): 33-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31805773

RESUMO

This study numerically investigated the hemodynamics of a patient-specific coronary artery fistula (CAF) before and after the fistula closure. The results indicated that the dilated fistula result in inadequate perfusion to other healthy aortas. Disturbed blood flow, aberrant WSSs, local negative pressure gradients and sharp pressure changes are shown in both untreated and occluded fistula. Furthermore, extreme high WSS appeared at the fistula bending after the terminal closure. It was concluded that the fistula closure may effectively improve the phenomenon of stealing blood but worsen the unfavorable hemodyanmics predisposing the thrombosis formation due to its geometrical torturosity.


Assuntos
Vasos Coronários/fisiopatologia , Fístula/fisiopatologia , Hidrodinâmica , Adulto , Doença da Artéria Coronariana/fisiopatologia , Diástole/fisiologia , Hemorreologia , Humanos , Imagem Tridimensional , Masculino , Modelos Cardiovasculares , Pressão , Estresse Mecânico , Sístole/fisiologia
2.
Orv Hetil ; 160(45): 1791-1797, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31680539

RESUMO

Introduction: There are conflicting data on the prevalence and prognosis of AMI patients with non-obstructive coronary artery disease (MINOCA). Aim: We studied the prevalence and prognosis of MINOCA patients. Method: In the Hungarian Myocardial Infarction Registry (HUMIR) 45,223 patients (pts) with acute myocardial infarction (AMI) were found who were treated between Jan 1, 2014, and June 30, 2018, and coronary arteriography was performed. ST-elevation myocardial infarction was diagnosed in 22,469 pts (49.7%). Patients without obstructive coronary artery disease who had no previous myocardial infarction, heart failure, PCI and CABG procedure were selected to the MINOCA group (n = 2003). Patients with obstructive coronary artery disease belonged to the MICAD group (n = 43,220). We investigated clinical characteristics of the patients, overall survival and reinfarction. Survival curves were estimated with the Kaplan-Meier method and were modeled with the Cox proportional hazards model. Results: The proportion of MINOCA pts among all myocardial infarction was by 4.4% higher in the STEMI pts compared to the NSTEMI group (2.0% vs. 6.8%). The MINOCA pts were younger (age 64.0 ± 14.4 vs. 65.5 ± 12.2 years), and the proportion of women was higher (55.7% vs. 36.5%). Hypertension, diabetes mellitus and peripheral artery disease were more common in the MICAD group (79.1% vs. 73.7%, 33.0% vs. 21.2%, and 12% vs. 8%). The mortality was higher among the MICAD pts. In the MINOCA group, the mortality of men did not differ between STEMI and NSTEMI, as opposed to women: women with STEMI had higher mortality than women with NSTEMI. The risk of reinfarction was higher in the MICAD group, especially in NSTEMI, the risk in the MINOCA group was lower, and there was no substantial difference between types. Conclusion: In this real word, retrospective, observational study, we found a significant difference in the prevalence of MINOCA pts according to different types of myocardial infarction. In the MINOCA group, the mortality of women with STEMI was substantially higher. Orv Hetil. 2019; 160(45): 1791-1797.


Assuntos
Vasos Coronários/fisiopatologia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Idoso , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Hungria/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Prevalência , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo
3.
Vasc Health Risk Manag ; 15: 375-384, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695398

RESUMO

Background: Survivors of myocardial infarction (MI) are at high risk of new major adverse cardiovascular events (MACE). Coronary flow reserve (CFR) is a strong and independent predictor of MACE. Understanding the prevalence of impaired CFR in this patient group and identifying risk markers for impaired CFR are important steps in the development of personalized and targeted treatment for high-risk individuals with prior MI. Methods: PROFLOW is a prospective, exploratory, cross-sectional open study. We used information from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) to identify high-risk patients with a history of type-1 MI. We measured CFR non-invasively in a left anterior descending artery (LAD) using transthoracic Doppler echocardiography. Coronary flow velocity was measured at rest and at maximal flow after induction of hyperemia by intravenous infusion of adenosine (140 µg/kg/min). Independent predictors of CFR were assessed with multiple linear regression. Results: We included 619 patients. The median age was 69 (IQR 65-73), and 114 (18.4%) were women. Almost one-half of the patients, 285 (46.0%) had the multi-vessel disease, and 147 (23.7%) were incompletely revascularized. The majority were on optimal standard treatment eg ASA (93.1%), statins (90.0%), ACEI/ARB (82.6%) and beta-blockers (80.8%). The majority, 547 (88.4%) had no angina pectoris, and 572 (92.2%) were in NYHA class I. Evaluation of CFR was possible in 611 (98.7%) patients. Mean CFR was 2.74 (±0.79 (mean ± SD)). A substantial number of patients (39.7%) had CFR ≤2.5. In a multiple linear regression model age, dyslipidemia, smoking, hypertension, body mass index, incomplete revascularization, and treatment with angiotensin receptor blockers were independent predictors of CFR. Conclusion: In this high-risk group of patients with prior MI, the prevalence of impaired CFR was high. Further risk stratification with CFR in addition to traditional cardiovascular risk factors may improve predictive accuracy for future MACE in this patient population.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler , Reserva Fracionada de Fluxo Miocárdico , Infarto do Miocárdio/diagnóstico por imagem , Adenosina/administração & dosagem , Idoso , Velocidade do Fluxo Sanguíneo , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Vasos Coronários/fisiopatologia , Estudos Transversais , Feminino , Humanos , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Prevenção Secundária , Suécia/epidemiologia , Vasodilatadores/administração & dosagem
4.
Niger J Clin Pract ; 22(9): 1201-1207, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489854

RESUMO

Background: The presence of vitamin D, and parathyroid hormone receptors has been demonstrated in the vascular endothelium. Variations in vitamin D, and parathyroid hormone levels may affect coronary flow and cause the coronary slow-flow phenomenon (CSF). Methods: We enrolled 93 patients who had undergone coronary angiography and had near-normal coronary arteries. Blood samples were taken to determine the calcium, phosphorus, 25-hydroxy vitamin D, and parathyroid hormone levels. Vitamin D deficiency was defined as a serum 25-hydroxy vitamin D level of less than 20 ng/mL. We divided the study population into two groups according to thrombolysis in myocardial infarction frame count (TFC) levels. Results: Patients with TFC ≤27 were in the control group (n = 39), and those with TFC >27 were in the CSF group (n = 54). 25-Hydroxy vitamin D levels were similar in both groups: 17.5 [3.3-36.1] ng/ml in the CSF group and 15.2 [5.3-34] ng/ml in the control group (P = 0.129). When we analyzed TFC for each of the coronary arteries, we found a weak negative correlation between vitamin D level and TFC of the right coronary artery in the CSF group (r = -0.314, P = 0.021). Parathyroid hormone levels were similar in both groups: 48 [16-140] pg/ml in the CSF group and 52 [25-125] pg/ml in the control group (P = 0.297). Conclusion: The study failed to demonstrate a relationship between serum parathyroid hormone level and CSF. However, a weak negative correlation was found between vitamin D level and TFC of the right coronary artery.


Assuntos
Circulação Coronária/fisiologia , Vasos Coronários/diagnóstico por imagem , Fenômeno de não Refluxo , Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/diagnóstico , Vitamina D/análogos & derivados , Idoso , Calcifediol/sangue , Cálcio/sangue , Angiografia Coronária , Vasos Coronários/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Fósforo/sangue , Vitamina D/sangue , Deficiência de Vitamina D/sangue
5.
BMC Surg ; 19(1): 118, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443701

RESUMO

BACKGROUND: Multiple coronary artery dissection is rare after cardiac surgery. It is difficult to recognize and is easily misdiagnosed as low output syndrome as a result of cardiopulmonary bypass (CPB). CASE PRESENTATION: A 43-year-old woman who had undergone cardiac surgery presented with unstable hemodynamics, and progressively increasing lactate, B-type natriuretic peptide, and cardiac enzyme levels, along with electrocardiogram (ECG) changes. Angiography indicated the presence of severe multiple coronary artery dissection, and 3 stents were implanted, which improved the patient's hemodynamic status and cardiac function. CONCLUSIONS: In the present report, we describe our experience with identifying and treating delayed severe multiple coronary artery dissection caused by cardiac surgery. Timely angiography is vital in patients suspected with coronary artery dissection, and percutaneous coronary intervention (PCI) should be considered as a treatment strategy for cases with severe multiple coronary artery dissection and unstable hemodynamics after cardiac surgery.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Vasos Coronários/lesões , Intervenção Coronária Percutânea , Adulto , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Vasos Coronários/cirurgia , Diagnóstico Tardio , Feminino , Hemodinâmica , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Stents
6.
Mol Cell Biochem ; 461(1-2): 57-64, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31352610

RESUMO

Metabolic syndrome (MetS) is associated with alterations in coronary vascular smooth muscle and endothelial function. The current study examined the contractile response of the isolated coronary arterioles to serotonin in pigs with and without MetS and investigated the signaling pathways responsible for serotonin-induced vasomotor tone. The MetS pigs (8-weeks old) were fed with a hyper-caloric, fat/cholesterol diet and the control animals (lean) were fed with a regular diet for 12 weeks (n = 6/group). The coronary arterioles (90-180 µm in diameter) were dissected from the harvested pig myocardial tissues and the in vitro coronary arteriolar response to serotonin was measured in the presence of pharmacological inhibitors. The protein expressions of phospholipase A2 (PLA2), TXA2 synthase, and the thromboxane-prostanoid (TP) receptor in the pigs' left ventricular tissue samples were measured using Western blotting. Serotonin (10-9-10-5 M) induced dose-dependent contractions of coronary-resistant arterioles in both non-MetS control (lean) and MetS pigs. This effect was more pronounced in the MetS vessels compared with those of non-MetS controls (lean, P < 0.05]. Serotonin-induced contraction of the MetS vessels was significantly inhibited in the presence of the selective PLA2 inhibitor quinacrine (10-6 M), the COX inhibitor indomethacin (10-5 M), and the TP receptor antagonist SQ29548 (10-6 M), respectively (P < 0.05). MetS exhibited significant increases in tissue levels of TXA2 synthase and TP receptors (P < 0.05 vs. lean), respectively. MetS is associated with increased contractile response of porcine coronary arterioles to serotonin, which is in part via upregulation/activation of PLA2, COX, and subsequent TXA2, suggesting that alteration of vasomotor function may occur at an early stage of MetS and juvenile obesity.


Assuntos
Arteríolas/fisiopatologia , Vasos Coronários/fisiopatologia , Síndrome Metabólica/fisiopatologia , Serotonina/farmacologia , Vasoconstrição/efeitos dos fármacos , Ácido 15-Hidroxi-11 alfa,9 alfa-(epoximetano)prosta-5,13-dienoico/farmacologia , Animais , Arteríolas/efeitos dos fármacos , Compostos Bicíclicos Heterocíclicos com Pontes/farmacologia , Vasos Coronários/efeitos dos fármacos , Modelos Animais de Doenças , Ácidos Graxos Insaturados/farmacologia , Hidrazinas/farmacologia , Indometacina/farmacologia , Masculino , Fosfolipases A2/metabolismo , Prostaglandina-Endoperóxido Sintases/metabolismo , Quinacrina/farmacologia , Receptores de Tromboxanos/metabolismo , Suínos , Tromboxano A2/metabolismo
7.
Nat Commun ; 10(1): 3276, 2019 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-31332177

RESUMO

The survival of ischaemic cardiomyocytes after myocardial infarction (MI) depends on the formation of new blood vessels. However, endogenous neovascularization is inefficient and the regulatory pathways directing coronary vessel growth are not well understood. Here we describe three independent regulatory pathways active in coronary vessels during development through analysis of the expression patterns of differentially regulated endothelial enhancers in the heart. The angiogenic VEGFA-MEF2 regulatory pathway is predominantly active in endocardial-derived vessels, whilst SOXF/RBPJ and BMP-SMAD pathways are seen in sinus venosus-derived arterial and venous coronaries, respectively. Although all developmental pathways contribute to post-MI vessel growth in the neonate, none are active during neovascularization after MI in adult hearts. This was particularly notable for the angiogenic VEGFA-MEF2 pathway, otherwise active in adult hearts and during neoangiogenesis in other adult settings. Our results therefore demonstrate a fundamental divergence between the regulation of coronary vessel growth in healthy and ischemic adult hearts.


Assuntos
Vasos Coronários/metabolismo , Coração/fisiopatologia , Infarto do Miocárdio/metabolismo , Isquemia Miocárdica/fisiopatologia , Transdução de Sinais , Animais , Animais Recém-Nascidos , Vasos Coronários/fisiopatologia , Humanos , Fatores de Transcrição MEF2/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos CBA , Camundongos Knockout , Camundongos Transgênicos , Infarto do Miocárdio/fisiopatologia , Isquemia Miocárdica/metabolismo , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Fator A de Crescimento do Endotélio Vascular/metabolismo
8.
Int J Cardiovasc Imaging ; 35(11): 2103-2112, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31273632

RESUMO

Computed tomography derived fractional flow reserve (FFRCT) and computed tomography stress myocardial perfusion imaging (CTP) are techniques to assess haemodynamic significance of coronary stenosis. To compare the diagnostic performance of FFRCT and static rest/stress CTP in detecting fractional flow reserve (FFR) defined haemodynamically-significant stenosis (FFR ≤ 0.8). Fifty-one patients (96 vessels) with suspected coronary artery disease from a single institution planned for elective invasive-angiography prospectively underwent research indicated 320-detector-CT-coronary-angiography (CTA) and adenosine-stress CTP and invasive FFR. Analyses were performed in separate core-laboratories for FFRCT and CTP blinded to FFR results. Myocardial perfusion was assessed visually and semi-quantitatively by transmural perfusion ratio (TPR). Invasive FFR ≤ 0.8 was present in 33% of vessels and 49% of patients. FFRCT, visual CTP and TPR analysis was feasible in 96%, 92% and 92% of patients respectively. Overall per-vessel sensitivity, specificity and diagnostic accuracy for FFRCT were 81%, 85%, 84%, for visual CTP were 50%, 89%, 75% and for TPR were 69%, 48%, 56% respectively. Receiver-operating-characteristics curve analysis demonstrated larger per vessel area-under-curve (AUC) for FFRCT (0.89) compared with visual CTP (0.70; p < 0.001), TPR (0.58; p < 0.001) and CTA (0.70; p = 0.0007); AUC for CTA + FFRCT (0.91) was higher than CTA + visual CTP (0.77, p = 0.008) and CTA + TPR (0.74, p < 0.001). Per-patient AUC for FFRCT (0.90) was higher than visual CTP (0.69; p = 0.0016), TPR (0.56; p < 0.0001) and CTA (0.68; p = 0.001). Based on this selected cohort of patients FFRCT is superior to visually and semi-quantitatively assessed static rest/stress CTP in detecting haemodynamically-significant coronary stenosis as determined on invasive FFR.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Hemodinâmica , Tomografia Computadorizada Multidetectores , Imagem de Perfusão do Miocárdio/métodos , Adenosina/administração & dosagem , Idoso , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Vasodilatadores/administração & dosagem
9.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289167

RESUMO

We present the case of a 45-year-old healthy man who successfully completed three stages of the Bruce protocol but developed inferolateral ST segment elevation in the recovery phase. The ECG change was associated with a marked drop in blood pressure. He underwent emergency coronary angiography which revealed normal coronary arteries. It is likely that post-exercise hypotension triggered coronary spasm which caused the ST segment elevation. Alternatively, coronary spasm may have been the primary event, inducing sufficient myocardial ischaemia to cause a marked drop in blood pressure. Exercise tolerance testing is often a reliable test to rule out reversible myocardial ischaemia. While the physician is focused on ischaemic changes or rhythm abnormalities developing during the exercise phase, the recovery period is just as important and requires as much vigilance. Coronary vasospasm can result in significant ST changes and haemodynamic compromise at any point during the test, and the ECG traces can be indistinguishable from a classic ST elevation myocardial infarction, as in the present case.


Assuntos
Vasos Coronários/diagnóstico por imagem , Teste de Esforço/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Espasmo/tratamento farmacológico , Fármacos Cardiovasculares/administração & dosagem , Fármacos Cardiovasculares/uso terapêutico , Angiografia Coronária/métodos , Vasos Coronários/anatomia & histologia , Vasos Coronários/fisiopatologia , Diagnóstico Diferencial , Diltiazem/administração & dosagem , Diltiazem/uso terapêutico , Ecocardiografia , Eletrocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Hipotensão Pós-Exercício/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Espasmo/complicações , Espasmo/fisiopatologia , Resultado do Tratamento
10.
Biomed Res Int ; 2019: 6374582, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31355272

RESUMO

Dronedarone is recommended for the treatment of atrial fibrillation. However, we do not know its effect on vascular remodeling. This study was designed to assess whether dronedarone has the potential to improve the intramyocardial artery remodeling induced by chronic hypertension. Ten-month-old male spontaneously hypertensive rats (SHR) were randomly assigned to receive dronedarone (100 mg/kg) or vehicle. Age-matched male Wistar-Kyoto rats served as controls. After 14 days of treatment, we studied the structure (geometry and fibrosis) of the intramyocardial artery using histological analysis. Nitric oxide (NO) in plasma was analyzed. In the untreated SHR, we observed a significant increase in external diameter, lumen diameter, wall width, cross-sectional area, and collagen volume density, as was expected in the experimental model. Dronedarone induced a significant decrease in wall width, cross-sectional area, and collagen volume density in SHR-D in comparison with untreated SHR. The values obtained in SHR-D were similar in the WKY control group. We found significantly higher NO levels in plasma in SHR-D than in untreated SHR. Dronedarone improves the intramyocardial artery remodeling induced by chronic hypertension in SHR through increased nitric oxide bioavailability.


Assuntos
Vasos Coronários , Dronedarona/farmacologia , Hipertensão , Óxido Nítrico/sangue , Remodelação Vascular/efeitos dos fármacos , Animais , Doença Crônica , Vasos Coronários/metabolismo , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Hipertensão/patologia , Hipertensão/fisiopatologia , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY
11.
Int J Cardiovasc Imaging ; 35(11): 1963-1969, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31243612

RESUMO

Quantitative flow ratio (QFR) is an image-based fractional flow reserve (FFR) computed by three-dimensional quantitative coronary angiography and estimated flow velocity. Several studies have reported that QFR was rapidly computed within approximately 5 min and had a good diagnostic performance as compared with FFR. However, studies comparing QFR with instantaneous wave-free ratio (iFR) as an index with a prognostic value comparable to that of FFR are limited. Thus, we investigated the applicability of QFR with respect to iFR, both being easy-to-measure indices not requiring pharmacological hyperaemic induction. We computed QFR in prospectively enrolled 150 coronary lesions (including 50 lesions for onsite QFR analysis) in consecutive patients with intermediate stenosis evaluated by iFR. The correlation and diagnostic performance of QFR were compared using iFR as a reference. The mean QFR and iFR were 0.81 ± 0.12 and 0.89 ± 0.11, respectively. QFR and iFR exhibited a good correlation in all subjects (R = 0.70, p < 0.0001) and the onsite-analysed vessels (R = 0.74, p < 0.0001). In the receiver-operating characteristics analysis, the area under the curve of QFR predicting iFR ≤ 0.89 was 0.91. Applying the cut-off value of QFR ≤ 0.80 and iFR ≤ 0.89, the sensitivity, specificity, positive and negative predictive values were 85%, 83%, 72%, and 91%, respectively, in all subjects, and 82%, 82%, 78%, and 85%, respectively, in the onsite-analysed vessels. QFR including onsite analysis demonstrated a good correlation with iFR and a diagnostic performance comparable to that of iFR in consecutive patients with intermediate coronary stenosis, suggesting its potential as a rapidly derived index for evaluating myocardial ischaemia in clinical settings.


Assuntos
Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fluxo de Trabalho
12.
BMC Res Notes ; 12(1): 336, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196144

RESUMO

OBJECTIVE: The study was dedicated to investigation of some hemostasis and endothelial dysfunction factors association with probability of presence of vulnerable atherosclerotic plaques in coronary arteries in men with atherosclerosis. RESULTS: The blood levels of factor VII, factor XII and MCP-1 were higher, and concentration of sVCAM-1 lower in men with vulnerable atherosclerotic plaques in the coronary arteries, compared to men who had stable plaques. Have been revealed correlation links between the blood levels of factor II, factor XII, MCP-1 and the presence of vulnerable atherosclerotic plaques in the coronary arteries. Results of logistic regression analysis showed that the relative risk of present of vulnerable atherosclerotic plaques in the coronary arteries is associated with an elevated blood level of factor XII and MCP-1.


Assuntos
Aterosclerose/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Endotélio Vascular/fisiopatologia , Hemostasia , Placa Aterosclerótica/fisiopatologia , Idoso , Aterosclerose/sangue , Quimiocina CCL2/sangue , Doença da Artéria Coronariana/sangue , Vasos Coronários/metabolismo , Vasos Coronários/fisiopatologia , Endotélio Vascular/metabolismo , Fator XII/metabolismo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/sangue , Probabilidade , Protrombina/metabolismo , Molécula 1 de Adesão de Célula Vascular/sangue
13.
Int J Cardiovasc Imaging ; 35(11): 1945-1954, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31214851

RESUMO

Lesion characteristics determined by angiography after balloon angioplasty such as residual dimeter stenosis (DS) or dissection type has been used to determine the treatment method of drug-coated balloon (DCB) or metal stent for de novo coronary lesions. The aim of this study is to identify angiographic and functional mismatch using residual DS, dissection type and fractional flow reserve (FFR). Baseline and post-balloon parameters were obtained from 151 patients with 167 lesions. Angiographically significant parameters after balloon angioplasty are residual DS > 30% or dissection type C or more. Post-balloon FFR cutoff value of 0.75 was used to define functionally significant lesions. The weak correlation was found between residual DS and post-balloon FFR (r =  - 0.317, p < 0.001). There were 68.7% of mismatch population (residual DS > 30% and post-balloon FFR ≥ 0.75) and 7.1% of reverse mismatch population (residual DS ≤ 30% and post-balloon FFR < 0.75). All reverse mismatch lesions were found in left anterior descending artery. There was no correlation between dissection severity and post-balloon FFR (p = 0.654). In high post-balloon FFR group, long-term clinical outcomes showed no difference between DCB and stent groups with (p = 0.788) or without (p = 0.426) the adjustment of lesion characteristics. There were high frequencies of mismatch between angiographic lesion characteristics and FFR values after balloon angioplasty. Post-balloon FFR measurements may be safe and effective compared to angiography-guided treatment if DCB only treatment is considered.


Assuntos
Angioplastia Coronária com Balão , Cateterismo Cardíaco , Angiografia Coronária , Doença da Artéria Coronariana/terapia , Estenose Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Cateteres Cardíacos , Materiais Revestidos Biocompatíveis , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Stents , Resultado do Tratamento
14.
J Card Surg ; 34(8): 663-669, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31212371

RESUMO

BACKGROUND: In patients with end-stage renal disease requiring hemodialysis (HD patients), myocardial ischemia after coronary artery disease is a major cause of mortality. Coronary pathophysiology, namely myocardial microvascular dysfunction, appears to differ from patients not requiring HD (non-HD patients). OBJECTIVES: We compared functional improvement of myocardial ischemia after coronary artery bypass surgery (CABG) between HD and non-HD patients by transthoracic coronary flow velocity reserve (CFVR). METHODS: We retrospectively reviewed isolated CABG patients from between 2008 and 2017. Finally, 161 patients were enrolled; each underwent pre- and postoperative CFVR assessment, and left anterior descending (LAD) artery revascularization with "in-situ" internal mammary artery (IMA). Graft patency was confirmed, and after successful CABG, postoperative CFVR improvement between the two groups was compared. RESULTS: Preoperative CFVR value in group H was 1.81 ± 0.52, group N was 1.93 ± 0.66. There was no significant difference between the groups. IMA to LAD grafts were patent in postoperative evaluation in all patients. Postoperative CFVR in group H was 2.48 ± 0.72 and group N was 2.83 ± 0.73 (P = .042). Significant difference was observed. CONCLUSION: In both groups, CFVR values improved after successful CABG, but postoperative CFVR values were significant different. In younger populations CFVR values are generally higher. Our HD group was significantly younger than the non-HD group, but CFVR values were postoperatively significantly lower. CFVR values are reportedly affected by both epicardial and microcoronary circulation. In this study population, as all grafts to the LAD were patent, the lower CFVR value in the HD group was considered to have resulted in microvascular disorders.


Assuntos
Velocidade do Fluxo Sanguíneo , Ponte de Artéria Coronária , Vasos Coronários/fisiopatologia , Falência Renal Crônica/terapia , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Diálise Renal , Idoso , Circulação Coronária , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Estudos Retrospectivos , Resultado do Tratamento
15.
Int J Cardiovasc Imaging ; 35(11): 1971-1978, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31218524

RESUMO

Normalized optical density (NOD) measured by optical coherence tomography represents neointimal maturity after coronary stent implantation and is correlated with morphologic information provided by both light and electron microscopy. We aimed to test the hypothesis that even second generation drug-eluting stents (DESs) are problematic in terms of neointimal maturity. We implanted bare-metal stents (BMS: n = 14), everolimus-eluting stents (EESs: n = 15) or zotarolimus-eluting stents (ZESs: n = 12) at 41 sites in 32 patients with stable coronary artery disease. OCT was performed at up to 12 months of follow-up, and the average optical density of neointima covering struts was evaluated. NOD was calculated as the optical density of stent-strut covering tissue divided by the optical density of the struts. We also measured circulating CD34+ /CD133+ /CD45low cells, and serum levels of stromal cell-derived factor (SDF)-1, interleukin (IL)-8 and matrix metalloproteinase (MMP)-9 at baseline and follow-up. NOD was lower in the EES (0.70 ± 0.06) group than in the BMS (0.76 ± 0.07, P < 0.05) and ZES (0.76 ± 0.06, P < 0.05) groups. The mean neointimal area (R = 0.33, P < 0.05) and mean neointimal thickness (R = 0.37, P < 0.05) were correlated with NOD. Although NOD was not correlated with percent changes in circulating endothelial progenitor cells, and the levels of SDF-1 and IL-8, it was negatively correlated with the change in MMP-9 level (R = - 0.51, P < 0.01). Neointimal maturity might be lower at EES sites than BMS or ZES sites. This might lead to impaired neointimal tissue growth and matrix degradation. These results suggest a specific pathophysiology after DES implantation.


Assuntos
Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Stents Farmacológicos , Neointima , Intervenção Coronária Percutânea/instrumentação , Tomografia de Coerência Óptica , Idoso , Idoso de 80 Anos ou mais , Fármacos Cardiovasculares/administração & dosagem , Quimiocina CXCL12/sangue , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/metabolismo , Vasos Coronários/fisiopatologia , Células Progenitoras Endoteliais/metabolismo , Células Progenitoras Endoteliais/patologia , Everolimo/administração & dosagem , Feminino , Humanos , Interleucina-8/sangue , Masculino , Metaloproteinase 9 da Matriz/sangue , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Desenho de Prótese , Sirolimo/administração & dosagem , Sirolimo/análogos & derivados , Fatores de Tempo , Resultado do Tratamento , Remodelação Vascular
16.
Tex Heart Inst J ; 46(2): 139-142, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236082

RESUMO

Reversible cerebral vasoconstriction syndrome is a rare disorder associated with neurologic symptoms secondary to diffuse cerebral vasospasm. Cardiac involvement in this disease is exceedingly rare. A 50-year-old woman was admitted to our hospital for evaluation of chest pain. During a 3-year period, she had been admitted multiple times because of chest pain and elevated serum cardiac enzymes. Transthoracic echocardiograms showed transient wall-motion abnormalities; however, coronary angiograms revealed no coronary artery disease. At the current admission, she had a thunderclap headache, and cerebral angiograms revealed diffuse cerebral vasoconstriction that improved after verapamil infusion, confirming the diagnosis of reversible cerebral vasoconstriction syndrome. The patient was treated successfully with oral diltiazem and had no recurrence of symptoms. We describe what we think is the first reported case of coronary artery spasm in association with reversible cerebral vasoconstriction syndrome. Future research should be focused on identifying treatment options and defining the mechanisms by which the cerebral and coronary vasculature are affected.


Assuntos
Circulação Coronária/fisiologia , Vasoespasmo Coronário/complicações , Vasos Coronários/diagnóstico por imagem , Vasoespasmo Intracraniano/etiologia , Angiografia Cerebral , Angiografia Coronária , Vasoespasmo Coronário/diagnóstico , Vasos Coronários/fisiopatologia , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Vasoespasmo Intracraniano/diagnóstico
17.
J Cardiovasc Comput Tomogr ; 13(3): 11-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040061

RESUMO

AIMS: This study describes the real-world referral pattern of patients to a CT myocardial perfusion service, the technical issues associated with providing the service, the results of the studies, and the subsequent downstream utilization of other investigations, and patient outcomes. METHODS AND RESULTS: 115 consecutive patients underwent CTA, dynamic rest and dipyridamole-stress perfusion scanning. There were 29 (25%) and 14 (12%) patients who had reversible defects and fixed defects respectively, indicating abnormal flow reserve and previous infarction respectively. In the patients with fixed defects, delayed hyperenhancement was noted in all, indicative of prior infarction, scarring and non-viability. With the existing CTA Appropriateness Criteria, the categorization of "Appropriate," "Of Uncertain Appropriateness", and "Inappropriate" would have been applied to 25%, 25% and 50% of the present studies respectively. Up to 72% could have been referred for ischemia evaluation with other modalities of functional imaging after the non-diagnostic CT angiogram. Follow up was complete in 113 subjects (98%) over a period of 14 ±â€¯8 months. In the 29 patients with abnormal flow reserve and CAD, 62% underwent invasive angiography and 94%, angioplasty within a 90-day period. In the patients who underwent angioplasty, all remained free of myocardial infarction or death and 88% remained free of myocardial infarction, death or readmission over a mean of 14 ±â€¯8 months. CONCLUSION: A CT-myocardial perfusion service provided measures of ischemia and infarct detection over that of CTA alone. The information was utilized clinically by doctors to support a strategy of referral to revascularization versus conservative medical management.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Circulação Coronária , Vasos Coronários/diagnóstico por imagem , Hemodinâmica , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Idoso , Tomada de Decisão Clínica , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Valor Preditivo dos Testes , Prognóstico , Encaminhamento e Consulta , Sistema de Registros , Reprodutibilidade dos Testes , Fatores de Tempo
18.
Hypertension ; 74(1): 208-215, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31055952

RESUMO

Early detection of coronary artery dysfunction is of paramount cardiovascular clinical importance, but a noninvasive assessment is lacking. Indeed, the brachial artery flow-mediated dilation test only weakly correlated with acetylcholine-induced coronary artery function ( r=0.36). However, brachial artery flow-mediated dilation methodologies have, over time, substantially improved. This study sought to determine if updates to this technique have improved the relationship with coronary artery function and the noninvasive indication of coronary artery dysfunction. Coronary artery and brachial artery function were assessed in 28 patients referred for cardiac catheterization (61±11 years). Coronary artery function was determined by the change in artery diameter with a 1.82 µg/min intracoronary acetylcholine infusion. Based on the change in vessel diameter, patients were characterized as having dysfunctional coronary arteries (>5% vasoconstriction) or relatively functional coronary arteries (<5% vasoconstriction). Brachial artery function was determined by flow-mediated dilation, adhering to current guidelines. The acetylcholine-induced change in vessel diameter was smaller in patients with dysfunctional compared with relatively functional coronary arteries (-11.8±4.6% versus 5.8±9.8%, P<0.001). Consistent with this, brachial artery flow-mediated dilation was attenuated in patients with dysfunctional compared with relatively functional coronaries (2.9±1.9% versus 6.2±4.2%, P=0.007). Brachial artery flow-mediated dilation was strongly correlated with the acetylcholine-induced change in coronary artery diameter ( r=0.77, P<0.0001) and was a strong indicator of coronary artery dysfunction (receiver operator characteristic=78%). The current data support that updates to the brachial artery flow-mediated dilation technique have strengthened the relationship with coronary artery function, which may now provide a clinically meaningful indication of coronary artery dysfunction.


Assuntos
Acetilcolina/administração & dosagem , Artéria Braquial/efeitos dos fármacos , Cateterismo Cardíaco/métodos , Doença da Artéria Coronariana/diagnóstico , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/efeitos dos fármacos , Idoso , Artéria Braquial/fisiopatologia , Estudos de Coortes , Circulação Coronária/fisiologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Infusões Intralesionais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Medição de Risco , Vasoconstrição/efeitos dos fármacos , Vasoconstrição/fisiologia , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologia
19.
Int J Cardiovasc Imaging ; 35(9): 1557-1561, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31044328

RESUMO

Right ventricular systolic dysfunction is prognostic in various cardiovascular diseases. Right ventricular systolic function is not commonly assessed in the catheterization laboratory. Therefore, we developed a novel, reproducible method to measure right ventricular systolic function during selective coronary angiography. We analyzed the angiographic systolic translational motion and maximum speed of the right coronary artery (RCA) in 97 consecutive patients and compared it to the tricuspid annular plane systolic excursion (TAPSE) as measured by echocardiography. All measurements were performed by two independent operators on two occasions. Inter-observer variability and intra-observer variability were excellent for RCA motion distance and for RCA maximum speed. There was a significant correlation of the RCA motion distance and RCA maximum speed with the TAPSE measured by echocardiography (Pearson's correlation for RCA distance: r = 0.59, p < 0.001, r2 = 0.35; for RCA speed: r = 0.40, p < 0.001, r2 = 0.16). The area under the receiver operating curve for the RCA motion distance was 0.88 (95% CI 0.80-0.96) for discrimination of normal and abnormal right ventricular systolic function. A cut-off value less than 22.3 mm systolic RCA motion had a specificity of 93.3% and a sensitivity of 75.6% for identifying an abnormal right ventricular systolic function. Analysis of the RCA motion is a reproducible and reliable method to measure right ventricular systolic function during selective coronary angiography. It is a simple and useful tool to assess right ventricular function in the catheterization laboratory and may serve for risk assessment for right ventricular failure. CLINICAL TRIAL REGISTRATION: Data for this study was collected retrospectively from Swiss Transcatheter Aortic Valve Implantation Registry (NCT01368250). https://clinicaltrials.gov/show/NCT01368250 .


Assuntos
Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Movimentos dos Órgãos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Idoso , Idoso de 80 Anos ou mais , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sístole , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia
20.
Int J Cardiovasc Imaging ; 35(9): 1563-1572, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31053979

RESUMO

The measurement of fractional flow reserve (FFR) and superficial wall stress (SWS) identifies inducible myocardial ischemia and plaque vulnerability, respectively. A simultaneous evaluation of both FFR and SWS is still lacking, while it may have a major impact on therapy. A new computational model of one-way fluid-structure interaction (FSI) was implemented and used to perform a total of 54 analyses in virtual coronary lesion models, based on plaque compositions, arterial remodeling patterns, and stenosis morphologies under physiological conditions. Due to a greater lumen dilation and more induced strain, FFR in the lipid-rich lesions (0.81 ± 0.15) was higher than that in fibrous lesions (0.79 ± 0.16, P = 0.001) and calcified lesions (0.79 ± 0.16, P = 0.001). Four types of lesions were further defined, based on the combination of cutoff values for FFR (0.80) and maximum relative SWS (30 kPa): The level of risk increased from (1) plaques with mild-to-moderate stenosis but negative remodeling for lipid-rich (Type A: non-ischemic, stable) to (2) lipid-rich plaques with mild-to-moderate stenosis and without-to-positive remodeling (Type B: non-ischemic, unstable) or plaques with severe stenosis but negative remodeling for lipid-rich (Type C: ischemic, stable) to (3) lipid-rich plaques with severe stenosis and without-to-positive remodeling (Type D: ischemic, unstable). The analysis of FSI to simultaneously evaluate inducible myocardial ischemia and plaque stability may be useful to identify coronary lesions at a high risk and to ultimately optimize treatment. Further research is warranted to assess whether a more aggressive treatment may improve the prognosis of patients with non-ischemic, intermediate, and unstable lesions.


Assuntos
Cateterismo Cardíaco , Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Hemodinâmica , Modelos Cardiovasculares , Placa Aterosclerótica , Fenômenos Biomecânicos , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/patologia , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Humanos , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Ruptura Espontânea , Índice de Gravidade de Doença
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