Publications

Simulation and behaviour of single-span portal frames, Part II: Parametric analysis and practical implications

Anion-channel blockade with alinidine: A specific bradycardic drug for coronary heart disease without negative inotropic activity?

In 14 patients undergoing cardiac catheterization for suspected coronary artery disease, alinidine, 0.6 mg/kg, was administered intravenously to determine its effects on left ventricular (LV) function, coronary blood flow and myocardial oxygen consumption. To assess effects independent of changes in heart rate (HR), measurements were made at spontaneous and matched pacing HRs. At spontaneous HR, alinidine decreased HR from 70 ± 2 to 61 ± 3 beats/min (p < 10−6). Peak rate of LV pressure decreased from 1,652 ± 92 to 1,371 ± 80 mm Hg/s (p < 10−5) and Vmax decreased from 47 ± 3 to 41 ± 2 s−1 (p < 10−4). Coronary sinus blood flow decreased from 109 ± 9 to 89 ± 7 ml/min (p < 0.01) and myocardial oxygen consumption from 10.9 ± 1.0 to 9.0 ± 0.8 ml O2/min (p < 0.05). At a matched pacing HR of 98 ± 3 beats/min before and after alinidine administration, peak rate of LV pressure decreased from 1,984 ± 124 to 1,793 ± 106 mm Hg/s (p < 10−4) and Vmax from 60 ± 5 to 56 ± 4 s−1 (p < 0.02). Coronary sinus blood flow and myocardial oxygen consumption were not significantly changed at matched pacing HRs. The time constant of the first 40 ms of LV isovolumic relaxation was prolonged by alinidine only during spontaneous HR. Thus, alinidine results in a bradycardia-dependent decrease in myocardial oxygen consumption. It has negative inotropic properties independent of changes in HR and so is not a pure bradycardia-specific agent.

Widening clinical applications of the SYNTAX Score

The SYNTAX Score (http://www.syntaxscore.com) has established itself as an anatomical based tool for objectively determining the complexity of coronary artery disease and guiding decision-making between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Since the landmark SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) Trial comparing CABG with PCI in patients with complex coronary artery disease (unprotected left main or de novo three vessel disease), numerous validation studies have confirmed the clinical validity of the SYNTAX Score for identifying higher-risk subjects and aiding decision-making between CABG and PCI in a broad range of patient types. The SYNTAX Score is now advocated in both the European and US revascularisation guidelines for decision-making between CABG and PCI as part of a SYNTAX-pioneered heart team approach. Since establishment of the SYNTAX Score, widening clinical applications of this clinical tool have emerged. The purpose of this review is to systematically examine the widening applications of tools based on the SYNTAX Score: (1) by improving the diagnostic accuracy of the SYNTAX Score by adding a functional assessment of lesions; (2) through amalgamation of the anatomical SYNTAX Score with clinical variables to enhance decision-making between CABG and PCI, culminating in the development and validation of the SYNTAX Score II, in which objective and tailored decisions can be made for the individual patient; (3) through assessment of completeness of revascularisation using the residual and post-CABG SYNTAX Scores for PCI and CABG patients, respectively. Finally, the future direction of the SYNTAX Score is covered through discussion of the ongoing development of a non-invasive, functional SYNTAX Score and review of current and planned clinical trials.

Effect of Montelukast on Exhaled Leukotrienes and Quality of Life in Asthmatic Patients

Physical Conditions in Massive-Cluster-Forming Molecular Clumps

In-plane structural response and design of duplex and ferritic stainless steel welded I-section beam–columns

Summary and outlook

OCT imaging has the potential to elucidate structural and functional aspects of the pathogenesis and the dynamics of cardiovascular events. These unique capabilities might help the development of preventive strategies for the leading cause of morbidity and mortality in Western countries. We hope this book will stimulate interest in this fascinating optical imaging technology and encourage further research.

GOLD 2017

Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement

Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR &amp;gt; 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.

TCT-632 Diabetes and Atherosclerosis Do Not Affect Early Degradation of Bioresorbable Vascular Scaffolds

No abstract is provided for this article.

European perspective in the recanalisation of Chronic Total Occlusions (CTO): consensus document from the EuroCTO Club.

PVO 3602 Intravascular ultrasound (IVUS) blood flowmetry and velocity imaging: Preliminary experience in vivo

No abstract is provided for this article.

Neural and Humoral Control of the Airways

Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention

Objectives This study sought to explore the association between biomarker elevation, with creatine kinase–myocardial band (CK-MB) or cardiac troponin (cTn), following percutaneous coronary intervention (PCI) and mortality in patients undergoing PCI for stable angina with normal baseline values. Background Several studies have shown a strong association between post-PCI CK-MB elevation and subsequent mortality. However, the prognostic significance of troponin elevation following coronary intervention is still debated. Methods Patient-level data from 5 contemporary coronary stent trials and 1 large registry were pooled. Mortality of patients with stable angina, with normal baseline biomarkers, was compared between patients with and those without different cutoff values of cTn and CK-MB. Results A total of 13,452 patients were included in this pooled analysis. The overall percentage of patients with elevated biomarkers following PCI was 23.9% for CK-MB and 68.4% for cTn. In the patient cohort for whom both assays were available (n = 8,859), 2.4% had both CK-MB ≥5 × the upper limit of normal (ULN) and cTn ≥35 × ULN, while 92% had both CK-MB <5 × ULN and cTn <35 × ULN. Among patients with CK-MB ≥5 × ULN (n = 315), 212 (67.3%) also had cTn ≥35 × ULN. Conversely, 390 of patients (64.8%) who had cTn ≥35 × ULN did not have CK-MB ≥5 × ULN. A total of 259 patients (1.9%) died at 1 year; 20 (7.7%) had CK-MB ≥5 × ULN, and 23 (8.8%) had cTn ≥35 × ULN. In the Cox multivariate analysis, in which the CK-MB and cTn ratios post-procedure were forced into the model, age, prior myocardial infarction, lesion complexity, hyperlipidemia, and CK-MB ratio (≥10) post-procedure were associated with increased 1-year mortality. Conclusions Following elective PCI in patients in stable condition treated with second-generation drug-eluting stent, CK-MB and cTn elevations remain common. After multivariate adjustment, there was an increased mortality rate with elevation of CK-MB after PCI, whereas cTn elevation was not independently associated with mortality at 1 year.

EuroIntervention: at the crossroads of open access

No abstract is provided for this article.

EVEN AFTER PERCUTANEOUS CORONARY INTERVENTION OF ANGIOGRAPHICALLY SIGNIFICANT LESIONS, IVUS-DEFINED HIGH-GRADE STENOSES ARE COMMON. A BASELINE IVUS ANALYSIS FROM THE PROSPECT TRIAL

No abstract is provided for this article.

AESTHETICS, ECONOMICS AND DESIGN OF STAINLESS STEEL STRUCTURES

The use of stainless steel in structural and architectural applications is growing due, in part, to the material's attractive appearance, corrosion resistance, ease of maintenance, low life cycle costs and fire resistance, alongside improved and more widespread design guidance and enhanced product availability.This paper explores the aesthetics, economics and design of stainless steel structures, highlighting recent applications in practice and recent advances in research.Increasingly, the construction industry, in common with most other industries, is expected to consider the longer term economic and environmental implications of material specification.Whilst structural carbon steel generally offers the most economic solution based on initial material costs, alternative metallic materials such as aluminium and stainless steel offer long-term benefits and associated cost savings.Life-cycle cost analyses of carbon steel and stainless steel employed in a range of structural applications are summarized herein.Although a number of similarities between stainless steel and ordinary carbon steel exist, there is sufficient diversity in their physical properties to require separate treatment in structural design.In addition to the straightforward differences in basic material properties (such as Young's modulus and yield strength), further fundamental differences exist, such as the nature of the stress-strain curve and the material's response to cold-work and elevated temperatures; these have implications at ultimate, serviceability and fire limit states.Current design rules for stainless steel structures and deficiencies thereof are described in this paper.

Glucocorticosteroids increase beta 2-adrenergic receptor transcription in human lung

beta 2-Adrenergic receptors (beta 2R) are widely distributed and mediate a wide range of cellular responses in lung. Because glucocorticosteroids increase expression of beta 2R in cell lines, we have investigated the effects of glucocorticoids on the beta 2R mRNA level and the number of beta 2R in human peripheral lung in vitro. Incubation of lung tissues with dexamethasone (Dex) elevated both beta 2R mRNA level (as measured by Northern blot analysis) and beta 2R number (as measured by [125I]iodocyanopindolol binding). The increased accumulation of beta 2R mRNA could be detected at 15 min (1.27 +/- 0.1-fold) and the maximal accumulation occurred at 2 h (2.73 +/- 0.5-fold). The Dex-induced increase in beta 2R mRNA returned to the control level by 17 h. The increase in beta 2R number (1.58 +/- 0.2-fold) was slower, reaching a maximum between 17 and 24 h. Dex increased beta 2R mRNA in a time- and concentration-dependent manner that was abolished by the steroid receptor antagonist mifepristone (RU-38486 or RU-486). The stability of beta 2R mRNA was unchanged by Dex, and a nuclear run-on assay revealed that Dex approximately doubled the transcriptional rate of the beta 2R gene. These observations suggest that glucocorticoids act on steroid receptors to increase beta 2R expression by increasing the rate of beta 2R gene transcription.