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1.
Medicine (Baltimore) ; 98(33): e16905, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415437

RESUMO

BACKGROUND: The prognosis of patients with coronary artery disease is mainly related to the extent of myocardium at risk. Proximal coronary arteries, especially the proximal left anterior descending coronary artery (LAD), supply a large part of the myocardium. In this analysis, we aimed to systematically compare the post percutaneous coronary interventional (PCI) outcomes observed with proximal vs non-proximal lesions of the left and right coronary arteries. METHODS: MEDLARS Online, Excerpta Medica database, www.ClinicalTrials.gov, and the Cochrane databases were searched for relevant studies comparing the post PCI outcomes reported on proximal vs non-proximal lesions of the coronary arteries. RevMan software version 5.3 was used to analyze the data to generate respective results. Odds ratios (OR) and 95% confidence intervals (CI) were derived to represent the results appropriately. RESULTS: Six studies with a total number of 11,109 participants who were enrolled between 1990 and 2015 were included in this analysis. The current results showed major adverse cardiac events (MACEs) (OR: 1.28, 95% CI: 1.14-1.45; P = .0001) and mortality (OR: 1.70, 95% CI: 1.43-2.03; P = .00001) to be significantly higher with proximal compared to non-proximal coronary lesions irrespective of the follow-up time periods. However, re-infarction (OR: 1.05, 95% CI: 0.80-1.38; P = .71), repeated revascularization (OR: 1.08, 95% CI: 0.92-1.27; P = .35) and stent thrombosis (OR: 0.59, 95% CI: 0.27-1.31; P = .20) were not significantly different.When patients specifically with LAD lesions were compared with associated non-proximal lesions, mortality was still significantly higher with proximal lesions (OR: 2.26, 95% CI: 1.52-3.36; P = .0001). However, when patients with right proximal coronary artery lesions were compared with the corresponding non-proximal lesions, no significant difference was observed in mortality. CONCLUSION: In-hospital and long-term MACEs and mortality were significantly higher in patients with proximal compared to non-proximal coronary lesions following PCI. In addition, mortality was significantly higher in patients with proximal LAD lesions whereas no significant difference was observed in patients with right proximal coronary artery lesions. Larger trials should further confirm these hypotheses.


Assuntos
Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Vasos Coronários/patologia , Intervenção Coronária Percutânea/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Resultado do Tratamento
2.
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
3.
J Immunol Res ; 2019: 4730507, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31093510

RESUMO

Background: Kawasaki disease (KD) is a systemic form of self-limited vasculitis in children less than five years old, and the main complication is coronary artery injury. However, the etiology of KD remains unclear. The IL-1B polymorphisms rs16944 GG and rs1143627 AA and their diplotype GA/GA have been associated with significantly increased risk of intravenous immunoglobulin (IVIG) resistance in a Taiwanese population, but the relationship between rs16944 A/G and rs1143627 G/A and coronary artery lesions (CALs) in patients with KD has not been investigated. The present study is aimed at investigating whether the rs16944 A/G and rs1143627 G/A polymorphisms in IL-1B were associated with KD susceptibility and CALs in a southern Chinese population. Methods and Results: We recruited 719 patients with KD and 1401 healthy children. Multiplex PCR was used to assess the genotypes of single nucleotide polymorphisms (SNPs), including two SNPs of IL-1B, rs16944 A/G and rs1143627 G/A. According to the results, no significant association was observed between the IL-1B (rs16944 and rs1143627) polymorphisms and KD risk in the patients compared with the healthy controls in our southern Chinese population. However, in further stratified analysis, we found that children younger than 12 months with the rs16944 GG and rs1143627 AA genotypes of IL-1B had a higher risk of CALs than those with the AA/AG genotypes of rs16944 and GG/AG genotypes of rs1143627 (OR = 2.28, 95% CI = 1.32-3.95, P = 0.0032, adjusted OR = 2.33, 95% CI = 1.34-4.04, P = 0.0027). Conclusions: Our results indicated that there was no association between the rs16944 A/G and rs1143627 G/A gene polymorphisms and KD susceptibility. However, the rs16944 GG and rs1143627 AA genotypes of IL-1B may significantly impact the risk of CAL formation in children younger than 12 months, which may contribute to the pathogenesis of KD. These findings need further validation in multicenter studies with larger sample sizes.


Assuntos
Vasos Coronários/patologia , Predisposição Genética para Doença/etnologia , Interleucina-1beta/genética , Síndrome de Linfonodos Mucocutâneos/genética , Adolescente , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Criança , Pré-Escolar , China/epidemiologia , Feminino , Genótipo , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/etnologia , Polimorfismo de Nucleotídeo Único , Fatores de Risco
4.
Medicine (Baltimore) ; 98(22): e15797, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145306

RESUMO

OBJECTIVE: This study evaluated the clinical value of drug-coated balloons for patients with small-vessel coronary artery disease (SVD). METHODS: A computerized literature search was performed using the databases to conduct a meta-analysis and evaluate the clinical value of drug-coated balloons among patients with SVD. RESULTS: This review enrolling 1545 patients receiving drug-coated balloons and 1010 patients receiving stents (including drug-eluting stents and bare-metal stents). The meta-analysis results showed that the incidence of major adverse cardiovascular events among patients with SVD did not significantly differ between the drug-coated balloon group and the stent group within 1 postoperative year (odds ratio = 0.81, P = .5). A subgroup analysis showed that the incidence of myocardial infarction among the drug-coated balloon group was significantly lower than that among the stent group (odds ratio = 0.58, P = .04). Nevertheless, the late lumen loss of the drug-coated balloon group was significantly lower than that of the stent group (mean difference = 0.31, P = .01). CONCLUSIONS: Drug-coated balloons can be used to effectively reduce the incidence of myocardial infarction in patients with SVD within 1 year and decrease the extent of late lumen loss without increasing the incidence of major adverse cardiovascular events.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fármacos Cardiovasculares/administração & dosagem , Estudos de Casos e Controles , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Feminino , Humanos , Incidência , Masculino , Infarto do Miocárdio/etiologia , Razão de Chances , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents Metálicos Autoexpansíveis/efeitos adversos , Resultado do Tratamento
5.
Int Heart J ; 60(3): 715-727, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105143

RESUMO

Occlusion of a major coronary artery induces myocardial infarction (MI), leading to left ventricle (LV) remodeling due to progressive microvasculature dysfunction. Irreversible impairment in microvascular function has been suggested to extend from the infarcted region into the infarct-border or remote regions, depending on the time to revascularization. Our aim was to determine whether the occlusion of a major coronary artery induces microvascular dysfunction in the adjacent area perfused by intact coronary arteries using a porcine model for chronic total occlusion of the left anterior descending artery (LAD). MI was induced via an ameroid constrictor ring around the LAD in adult Göttingen pigs (Sus scrofa domesticus, n = 5). Age-matched normal pigs were treated as controls (n = 3). Cardiac magnetic resonance showed reduced systolic regional wall motion in the left circumflex (LCx) and right coronary artery (RCA) territories, with a progressively worsening motion in the infarction-adjacent area over an eight-week period. On 13N-ammonia positron emission tomography (PET), myocardial blood flow (MBF) during hyperemia was significantly greater in the LCx and RCA territories (particularly in the infarction-adjacent area) compared to that in the LAD territory at four weeks after infarct induction. Subsequently, the flow significantly decreased, approaching that in the LAD territory at eight weeks after infarct induction. Fluoroscopy-guided pressure-wire studies showed significantly higher microvascular resistance in the LCx area at eight weeks compared to that in controls. Electron microscopy showed endothelium swelling and microvasculature disruption in areas adjacent to the LCx and RCA territories. Anterior MI caused coronary microvascular dysfunction in the adjacent area, associated with a reduced MBF and regional wall motion.


Assuntos
Oclusão Coronária/patologia , Vasos Coronários/patologia , Microvasos/fisiopatologia , Remodelação Ventricular/fisiologia , Adulto , Animais , Angiografia Coronária/métodos , Angiografia Coronária/tendências , Oclusão Coronária/complicações , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Microcirculação/fisiologia , Microvasos/ultraestrutura , Modelos Animais , Infarto do Miocárdio/etiologia , Miocárdio/patologia , Suínos
6.
Medicine (Baltimore) ; 98(21): e15622, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124941

RESUMO

BACKGROUND: Drug-coated balloon as a novel therapeutic strategy has been used to treat restenosis in cases of bare metal and drug-eluting stents. However, evidence of its safety and efficacy is scarce in de novo small coronary artery vessel disease. This meta-analysis aimed to compare the safety and efficacy of the drug-coated balloon and the drug-eluting stent. METHODS: The PubMed, EMBASE, Web of Science, and Cochrane library databases were searched for studies published up to October 17, 2018. Studies comparing the drug-coated balloon with the drug-eluting stent strategy in patients with de novo small coronary artery vessel disease (reference diameter, <3 mm) were identified. The clinical outcomes were nonfatal myocardial infarction, cardiac death, all-cause death, target lesion revascularization, and target-vessel revascularization. Data were analyzed using the statistical software RevMan (version 5.3). Fixed effects models were performed to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Sensitivity analyses were used to detect potential sources of heterogeneity, while subgroup analyses were implemented to assess the differential effects. RESULTS: Three randomized controlled trials and 3 nonrandomized controlled studies were identified. Six studies including a total of 1800 patients compared the differences between the drug-coated balloon and the drug-eluting stent strategies in patients with de novo small coronary artery vessel disease. The results indicated that the drug-coated balloon strategy was associated with a significant reduction in nonfatal myocardial infarction (OR 0.53, 95% CI 0.31-0.90, P = .02) compared with the drug-eluting stent strategy, while insignificant inter-strategy differences were observed in cardiac death (OR 1.56, 95% CI 0.73-3.33, P = .25), all-cause death (OR 0.56, 95% CI 0.25-1.23, P = .15), target lesion revascularization (OR 1.24, 95% CI 0.73-2.1, P = .43), and target-vessel revascularization (OR 0.95, 95% CI 0.59-1.52, P = .84). CONCLUSIONS: This meta-analysis suggests that the drug-coated balloon strategy is noninferior to the drug-eluting stent strategy, delivering a good outcome in nonfatal myocardial infarction, and can be recommended as an optimal treatment strategy in patients with de novo small coronary artery vessel disease. Larger randomized controlled studies with longer follow-up periods are needed to further confirm the benefits of the drug-coated balloon strategy.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Razão de Chances , Complicações Pós-Operatórias/mortalidade , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Nat Commun ; 10(1): 2247, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113953

RESUMO

Complement promotes vascular inflammation in transplant organ rejection and connective tissue diseases. Here we identify ZFYVE21 as a complement-induced Rab5 effector that induces non-canonical NF-κB in endothelial cells (EC). In response to membrane attack complexes (MAC), ZFYVE21 is post-translationally stabilized on MAC+Rab5+ endosomes in a Rab5- and PI(3)P-dependent manner. ZFYVE21 promotes SMURF2-mediated polyubiquitinylation and proteasome-dependent degradation of endosome-associated PTEN to induce vesicular enrichment of PI(3,4,5)P3 and sequential recruitment of activated Akt and NF-κB-inducing kinase (NIK). Pharmacologic alteration of cellular phosphoinositide content with miltefosine reduces ZFYVE21 induction, EC activation, and allograft vasculopathy in a humanized mouse model. ZFYVE21 induction distinctly occurs in response to MAC and is detected in human renal and synovial tissues. Our data identifies ZFYVE21 as a Rab5 effector, defines a Rab5-ZFYVE21-SMURF2-pAkt axis by which it mediates EC activation, and demonstrates a role for this pathway in complement-mediated conditions.


Assuntos
Proteínas de Transporte/metabolismo , Endossomos/metabolismo , Rejeição de Enxerto/patologia , NF-kappa B/metabolismo , Vasculite/patologia , Aloenxertos/patologia , Animais , Linhagem Celular , Complexo de Ataque à Membrana do Sistema Complemento/metabolismo , Vasos Coronários/patologia , Vasos Coronários/transplante , Modelos Animais de Doenças , Feminino , Células Endoteliais da Veia Umbilical Humana , Humanos , Camundongos , Camundongos SCID , Fosfatos de Fosfatidilinositol/metabolismo , Ubiquitina-Proteína Ligases/metabolismo , Proteínas rab5 de Ligação ao GTP/metabolismo
8.
Biomed Res Int ; 2019: 9602783, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984786

RESUMO

Background: Gamma-glutamyl transferase (GGT) has been detected in coronary plaques. However, the association between serum GGT levels and coronary atherosclerotic plaque vulnerability in patients with coronary artery disease (CAD) as detected by optical coherence tomography (OCT) has not been investigated. Methods: We performed a retrospective study of consecutively enrolled CAD patients undergoing preintervention OCT examination during coronary angiography. Plaque vulnerability was defined as the presence of ruptured plaques or thin-cap fibroatheroma (TCFA) upon OCT. The association between serum GGT levels and coronary plaque vulnerability was evaluated using multivariate logistic regression analysis. Results: A total of 142 patients were included in our analysis. OCT examination detected ruptured plaques in 16 patients, nonruptured plaques with TCFA in 17 patients, and nonruptured plaques and non-TCFA in 109 patients. Univariate analyses showed that gender, diabetes, Apolipoprotein A1 (ApoA1) and high-density lipoprotein cholesterol (HDL-c), and diagnosis of acute coronary syndrome (ACS) were associated with plaque vulnerability (P all < 0.05). Patients grouped according to serum GGT tertiles did not differ statistically in baseline characteristics or OCT findings. Results of multivariate logistic analyses showed that diabetes and diagnosis of ACS were associated with plaque rupture and TCFA (P < 0.05). Conclusions: GGT serum levels were not associated with OCT detected coronary vulnerability in our cohort of CAD patient.


Assuntos
Doença da Artéria Coronariana/sangue , Placa Aterosclerótica/patologia , Tomografia de Coerência Óptica , gama-Glutamiltransferase/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/patologia , Idoso , Apolipoproteína A-I/sangue , HDL-Colesterol/sangue , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Estudos Retrospectivos
9.
Ren Fail ; 41(1): 244-256, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31014155

RESUMO

PURPOSE: To date, the prevalence and prognostic role of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD) have been investigated in several studies, but have yielded conflicting results. The aim of this meta-analysis is to derive a more precise estimation of CAC prevalence in CKD patients and its association with cardiovascular events and mortality. METHODS: The relevant literature was identified and evaluated from inception until July 2018 through multiple search strategies on PubMed, Embase, and Web of Science. Cross-sectional or cohort (baseline data) studies reporting CAC prevalence were included. Data extracted from eligible studies were used to calculate effect estimates (ESs) and 95% confidence intervals (95%CI). We searched databases for observational studies that explored baseline CAC and subsequent cardiovascular or all-cause mortality risk in CKD patients. RESULTS: The meta-analysis included 47 studies; 38 of these were included in the final analysis of CAC prevalence. The pooled prevalence of CAC in random effect model was 60% (95%CI 53-68%). CAC was positively associated with an increased risk of all-cause mortality (hazard ratio [HR] 3.44; 95%CI 2.40-4.94), cardiovascular mortality (HR 3.87; 95%CI 2.06-7.26), and cardiovascular events (HR 2.09; 95%CI 1.19-3.67), when comparing individuals in the top CAC score group to those in the bottom CAC score group. CONCLUSIONS: The pooled prevalence of CAC is highly prevalent. CAC is independently associated with all-cause and cardiovascular mortality risk as well as cardiovascular events among CKD patients. In view of the high heterogeneity, larger clinical trials are still needed.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Insuficiência Renal Crônica/mortalidade , Calcificação Vascular/epidemiologia , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Humanos , Prevalência , Prognóstico , Insuficiência Renal Crônica/complicações , Medição de Risco , Fatores de Risco , Calcificação Vascular/patologia
10.
Nat Commun ; 10(1): 1888, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015404

RESUMO

The use of nonsteroidal anti-inflammatory drugs that inhibit cyclooxygenase (COX)-1 and COX-2, increases heart failure risk. It is unknown whether microsomal (m) prostaglandin (PG) E synthase (S)-1, a target downstream of COX, regulates myocardial (M) ischemia/reperfusion (I/R) injury, a key determinant of heart failure. Here we report that COX-1 and mPGES-1 mediate production of substantial amounts of PGE2 and confer cardiac protection in MI/R. Deletion of mPges-1 impairs cardiac microvascular perfusion and increases inflammatory cell infiltration in mouse MI/R. Consistently, mPges-1 deletion depresses the arteriolar dilatory response to I/R in vivo and to acetylcholine ex vivo, and enhances leukocyte-endothelial cell interaction, which is mediated via PGE receptor-4 (EP4). Furthermore, endothelium-restricted Ep4 deletion impairs microcirculation, and exacerbates MI/R injury, irrespective of EP4 agonism. Treatment with misoprostol, a clinically available PGE analogue, improves microcirculation and reduces MI/R injury. Thus, mPGES-1, a key microcirculation protector, constrains MI/R injury and this beneficial effect is partially mediated via endothelial EP4.


Assuntos
Vasos Coronários/patologia , Ciclo-Oxigenase 1/metabolismo , Proteínas de Membrana/metabolismo , Traumatismo por Reperfusão Miocárdica/patologia , Prostaglandina-E Sintases/metabolismo , Receptores de Prostaglandina E Subtipo EP4/metabolismo , Animais , Ciclo-Oxigenase 1/genética , Dinoprostona/metabolismo , Modelos Animais de Doenças , Endotélio/patologia , Humanos , Masculino , Proteínas de Membrana/genética , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Microcirculação/efeitos dos fármacos , Misoprostol/farmacologia , Misoprostol/uso terapêutico , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Traumatismo por Reperfusão Miocárdica/etiologia , Miocárdio/patologia , Prostaglandina-E Sintases/genética , Receptores de Prostaglandina E Subtipo EP4/genética , Transdução de Sinais
11.
Int Heart J ; 60(3): 778-783, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019166

RESUMO

Echocardiographic detection of abnormalities occurring medially and distally in coronary arteries is uncommon and is not well recognized. Herein, we describe an 87-year-old woman with two distinct aneurysms involving a branch of the left anterior descending coronary artery (LAD), one of which communicated with the pulmonary artery (PA). Initially determined via transthoracic echocardiography (TTE), these findings were subsequently validated by coronary computed tomography angiography (CTA). We also present a review of the published studies of multiple coronary artery aneurysms (CAAs) exceeding 20 mm in diameter, focusing on the location, etiology, symptoms, and common ultrasonic characteristics of 30 cases. Echocardiography is a valuable, noninvasive technique for initial detection, monitoring, and follow-up of CAAs, serving to direct further diagnostics.


Assuntos
Aneurisma Coronário/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia/métodos , Assistência ao Convalescente , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada/métodos , Aneurisma Coronário/patologia , Angiografia Coronária/métodos , Vasos Coronários/patologia , Feminino , Humanos
14.
Medicine (Baltimore) ; 98(14): e14865, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946314

RESUMO

BACKGROUND: In patients with complex true coronary bifurcation lesions (CBLs), Crush or Culotte stenting has been the commonest approaches of percutaneous coronary intervention (PCI). However, the optimal one remains in debate. METHODS: A systematic review and meta-analysis of cohort studies searched from PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese National Knowledge Infrastructure (CNKI), VIP information database, and WangFang Data Information Site, to compare the long-term safety and efficacy of PCI with Crush versus Culotte in patients with CBLs. The primary end point was target lesion revascularization (TLR) and secondary end points were a composite of major adverse cardiac events (MACE) including cardiac death (CD), myocardial infarction (MI), stent thrombosis (ST), and target vessel revascularization (TVR) by PCI or bypass surgery, and each individual component at long-term follow-up. Furthermore, omitting each study in turn was used to sensitivity analysis for high heterogeneity of studies. RESULTS: A total of 7 studies were included to perform a meta-analysis, 3 randomized trials and 4 observational studies with 2211 patients, 1281 treated with Crush and 930 with Culotte. There was no significant difference in TLR and MACE between Crush and Culotte [RR 0.76, 95% CI (0.48-1.23), I = 57%; RR 0.78, 95% CI (0.47-1.29), I = 83%, respectively]. ST tended to be lower in patients treated with Crush [RR 0.61, 95% CI (0.37-1.01), I = 23%]. CD and MI were comparable between the 2 groups [RR 0.80, 95% CI (0.43-1.49), I = 0%; RR 0.74, 95% CI (0.49-1.13), I = 32%, respectively]. TVR was also associated with the similar risk [RR 0.76, 95% CI (0.49-1.16), I = 60%]. However, high heterogeneity was detected for TLR, MACE, and TVR, and the source of heterogeneity was DKCRUSH-III study by Chen, SL. CONCLUSIONS: In the treatment of coronary bifurcation lesions, TLR and MACE were not significant difference between the Crush and Culotte groups, but TLR and MACE were also regarded as high heterogeneity mainly due to better outcomes achieved by DK Crush and there was a trend toward lower ST in the Crush group. Crush, particularly DK Crush, may be superior to conventional Culotte for treatment of CBLs. PROSPERO REGISTRATION NUMBER: CRD42018111868.


Assuntos
Vasos Coronários/patologia , Intervenção Coronária Percutânea/métodos , Stents/tendências , Idoso , Idoso de 80 Anos ou mais , Reestenose Coronária/complicações , Vasos Coronários/anatomia & histologia , Vasos Coronários/cirurgia , Morte , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Estudos Observacionais como Assunto , Intervenção Coronária Percutânea/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Stents/efeitos adversos , Resultado do Tratamento
15.
Int J Cardiovasc Imaging ; 35(6): 973-980, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30874980

RESUMO

The purpose of this study was to evaluate the vessel healing status 3 months after stent implantation of bioresorbable-polymer drug-eluting stents (BP-DESs) in comparison with durable-polymer DESs (DP-DESs) by angioscopy. Study design was a single-center all-comer prospective cohort study: the RESTORE registry (UMIN000033009). All patients who received successful angioscopic examination at planned 3-month follow-up after the DES implantation in the native coronary artery were enrolled. We evaluated main, maximum, minimum strut coverage grades and coverage heterogeneity score defined as a difference between maximum and minimum coverage grades. All lesions were divided into three segments: proximal, mid, and distal segments. A total of 108 patients (66.6 ± 10 years) with 124 lesions were analyzed (BP-DES 57 patients 61 lesions 226 segments vs. DP-DES 57 patients 63 lesions 203 segments; six patients had both BP-DES and DP-DES). Patient and lesion demographics, procedural characteristics were well balanced. Main coverage grade (mean ± standard error; 1.08 ± 0.02 vs. 1.05 ± 0.03, p = 0.354) and minimum coverage grade (1.00 ± 0.00 vs. 1.00 ± 0.00, p > 0.999) were not significantly different between BP-DES and DP-DES groups. Maximum coverage grade was significantly higher in the BP-DES than in the DP-DES (1.45 ± 0.04 vs. 1.35 ± 0.04, p = 0.049). Coverage heterogeneity score did not differ between BP-DES and DP-DES groups (1.05 ± 0.07 vs. 0.90 ± 0.07, p = 0.162). At 3-month follow-up, the current BP-DES had higher maximum stent coverage than the contemporary DP-DES, while main and minimum coverage grades and heterogeneity of the neointimal coverage were comparable. Further prospective randomized trials should be conducted to evaluate the clinical significance of the present imaging results.


Assuntos
Implantes Absorvíveis , Angioscopia , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Polímeros/química , Cicatrização , Idoso , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neointima , Intervenção Coronária Percutânea/efeitos adversos , Placa Aterosclerótica , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento
16.
J Cardiovasc Comput Tomogr ; 13(3): 34-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30837117

RESUMO

BACKGROUND: While exercise has been associated with favorable coronary artery disease (CAD) outcomes, the relationship between endurance exercise levels and CAD findings has not been well explored. PURPOSE: To evaluate the relationship of endurance exercise to CAD findings by coronary computed tomographic angiography (CCTA). METHODS: We evaluated consecutive patients referred to CCTA who filled out a survey instrument between 2015 and 2017, and who graded their level of weekly endurance exercise as: none, low (1-2 times per week), moderate (3-5 times per week) or high (5-7 times per week); along with the number of hours per week engaged in exercise as: low (<30 min), moderate (1 h) or high (>1-3 h). CCTA: analysis included measurement of maximum per-patient, per-vessel and per-segment stenosis severity, which was judged as minimal (<25%), mild (<50%), moderate (50-70%), and severe (>70%). CAD extent and severity was also summated CADRADS score, plaque burden by segment involvement score (SIS), and non-calcified plaque score (G-score). High-risk plaque (HRP), as defined by the presence of low attenuation plaque, positive arterial remodelling, spotty calcifications and napkin ring signs, was assessed. Finally, coronary artery calcium scores (CCS), as determined by Agatston units, were quantified. RESULTS: The study cohort comprised 252 patients (55.3y ±10.1, 39.7% females) with 97 inactives, 87 with low and 68 with moderate-to-high recreational endurance exercise levels (>=3x/week ≥ 1 h) included. Prevalence of subclinical CAD was 57.4%. Prevalence of >50% stenosis was with 13.2% lower at moderate-to-high exercise levels as compared to inactives (p = 0.04). Stenosis severity score (p = 0.04), total (p = 0.036) non-calcified plaque burden were lower (p = 0.026) in athletes, and in the absence of confounding risk factors, the effect strenghtened (SIS and G-score, p = 0.012 and 0.008). There was no difference in the CCS. High-risk plaque prevalence was higher in controls as compared to athletes with moderate-to-high exercise levels (13.4% vs 0%, p = 0.002), and HDL was lower (p < 0.001), respectively. MACE rate was 0%, and ICA rate of >50% stenosis 3.5% at 1 year follow-up. CONCLUSION: Regular moderate-to-high endurance exercise results in lower total and non-calcified plaque burden and less high-risk plaque.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Resistência Física , Aptidão Física , Placa Aterosclerótica , Adulto , Idoso , Áustria/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/prevenção & controle , Estenose Coronária/epidemiologia , Estenose Coronária/patologia , Estenose Coronária/prevenção & controle , Vasos Coronários/patologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Comportamento Sedentário , Índice de Gravidade de Doença
17.
N Z Med J ; 132(1491): 93-95, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30845133

RESUMO

Percutaneous coronary intervention (PCI) of heavily calcified stenoses remains a significant challenge to interventional cardiologists. Over the last years, high-pressure balloons, cutting balloons as well as atherectomy devices have been used to tackle such lesions. Lithoplasty is a method of lesion modification using intravascular lithotripsy (IVL, shockwave) to treat particularly calcified coronary lesions. A 55-year-old male without previous cardiac history reported chest pain and was found to have ECG changes anterolaterally and significantly elevated troponins. Coronary angiogram showed heavily calcified severe proximal left anterior descending (LAD) stenosis. The attempts to predilate the lesion with semi-compliant and non-compliant balloons at high pressures were unsuccessful so the decision was made to use a shockwave balloon. Subsequently a drug-eluting stent was successfully implanted and post-dilated at high pressure. Final angiography showed an excellent result, also confirmed in optical coherence tomography (OCT).


Assuntos
Estenose Coronária/terapia , Stents Farmacológicos , Litotripsia/métodos , Calcificação Vascular/terapia , Angiografia Coronária/métodos , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/patologia , Vasos Coronários/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
18.
J Cardiothorac Surg ; 14(1): 54, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30871615

RESUMO

BACKGROUND: The incidence of perioperative myocardial infarction is reported to 2-8%. The aim of the study (retrospectively registered) was to evaluate whether control coronary angiography after surgery is useful in case of suspected postoperative myocardial ischemia. METHODS: All patients who demonstrated signs of myocardial ischemia post CABG and underwent coronary angiography from 6/2008 to 06/2015 were retrospectively analyzed. Myocardial ischemia post CABG was defined as an increase of CK/CK-MB, occasionally associated with arrhythmias or low output syndrome. RESULTS: Overall, 108 patients (age 66 ± 9 years) demonstrated signs of myocardial ischemia post CABG and underwent coronary angiography corresponding to an incidence of 2.2%. Of them, 70 patients (65%) demonstrated graft pathologies. A therapeutic consequence was drawn in 62 Patients (57%), which consisted of redo surgery in 10 patients (9%) and PCI with stent placement in 52 patients (48%). Of the remaining 46 patients, 29 patients showed intact bypass grafts (27%), whereas 17 patients had minor pathologies (16%). Demographic data including the extent of the coronary artery disease, urgency of operation, comorbidities, EuroScore, surgical technique, postoperative lab tests and transfusion requirements were comparable among the groups. Redo surgery patients had prior PCI in 33% of patients, which was much higher than in the other groups. Patients with reintervention had a 30d-mortality rate of 13%, conservatively treated patients only 2.2%. Mortality was highest after redo surgery with 25%. CONCLUSIONS: Postoperative coronary angiography is a useful tool with a significant therapeutic value. Pathological findings mandate further revascularization therapy in roughly half of the patients. PCI is a safe choice in the majority of patients, redo surgery is much less indicated.


Assuntos
Angiografia Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Isquemia Miocárdica/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/etiologia , Intervenção Coronária Percutânea , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Pharm Biol ; 57(1): 48-54, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30905241

RESUMO

CONTEXT: Heart failure (HF) is one of the most serious diseases worldwide. Astragaloside IV (ASI) is widely used for the treatment of cardiovascular disease in China. OBJECTIVE: To evaluate the protective effect of ASI on the HF in a Sprague-Dawley rat model of left coronary artery ligation, and investigate the angiogenesis-related mechanisms. MATERIALS AND METHODS: Left coronary artery was ligated to induce a rat model of HF, and the rats were treated with vehicle (saline) or different doses of ASI (0.1, 0.3 and 1 mg/kg/day) by oral gavage for 6 weeks. Cardiac function was evaluated by echocardiography. Infarct size was determined by triphenyltetrazolium chloride staining. Cardiac vascular density was analyzed by microangiography. Real-time PCR, Western blot and chromatin immunoprecipitation were performed to investigate the mechanisms. RESULTS: ASI treatment improved the body weight and survival rate of HF rats, as well as the cardiac function of HF rats, with significantly improved ejection fraction (75.27 ± 5.75% vs. 36.26 ± 4.14%) and fractional shortening (45.39 ± 3.66% vs. 17.88 ± 1.32%). ASI reduced the infarct size of the HF rats by 47%. ASI promoted angiogenesis, with increased vascular density (2.08-fold) and induced mRNA expression of CD31 (1.81-fold) and VEGF (2.70-fold) in the ischemic heart. Furthermore, ASI induced the phosphorylation of JAK (1.89-fold) and STAT3 (2.95-fold), as well as the activity of VEGF promoter which was regulated by STAT3. DISCUSSION AND CONCLUSIONS: ASI alleviated HF by promoting angiogenesis through JAK-STAT3 pathway, providing novel alternative strategies to prevent HF in the future.


Assuntos
Indutores da Angiogênese/farmacologia , Vasos Coronários/efeitos dos fármacos , Insuficiência Cardíaca/tratamento farmacológico , Janus Quinases/metabolismo , Saponinas/farmacologia , Triterpenos/farmacologia , Animais , Vasos Coronários/metabolismo , Vasos Coronários/patologia , Modelos Animais de Doenças , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/patologia , Células Endoteliais da Veia Umbilical Humana , Humanos , Estimativa de Kaplan-Meier , Masculino , Infarto do Miocárdio/tratamento farmacológico , Miocárdio/metabolismo , Miocárdio/patologia , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fator de Transcrição STAT3 , Transdução de Sinais/efeitos dos fármacos , Ganho de Peso/efeitos dos fármacos
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