Publications

Do Differences in Repeat Revascularization Explain the Antianginal Benefits of Bypass Surgery Versus Percutaneous Coronary Intervention?

Patients with multivessel coronary disease treated with coronary artery bypass graft (CABG) have less angina than those treated with percutaneous coronary intervention (PCI); however, there is uncertainty as to the mechanism of greater angina relief with CABG and whether more frequent repeat revascularization in patients treated with PCI could account for this treatment difference.In the Synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery trial, 1800 patients with 3-vessel or left main coronary artery disease were randomized to CABG or PCI with paclitaxel-eluting stents. Health status was assessed at baseline, 1, 6, and 12 months, using the Seattle Angina Questionnaire and the Medical Outcomes Study Short Form General Health Survey, and the association between repeat revascularization and health status during follow-up was assessed using longitudinal models. In adjusted analyses, patients who underwent repeat revascularization had worse angina frequency scores than patients who did not in both treatment groups, with differences of 8.5 points at 6 months and 3.1 points at 12 months in patients treated with PCI and 19.8 points at 6 months and 11.2 points at 12 months in patients with patients treated with CABG. Among patients who did not require repeat revascularization, the adjusted effect of CABG versus PCI on 12-month angina frequency scores was nearly identical to the overall benefit in the intention-to-treat analysis.Among patients with multivessel coronary artery disease treated with PCI or CABG, the occurrence of repeat revascularization during follow-up did not fully explain the antianginal benefit of CABG in the overall population. The differential association between repeat revascularization and anginal status, according to the type of initial revascularization procedure, suggests that this end point should play a limited role in any direct comparison of the 2 treatment strategies.

Moisture damage related fungal microbiota and new-onset wheezing in children

TCT-313 Incidence and Impact of Major Bleeding Events After PCI or CABG for Left Main Coronary Artery Disease: The EXCEL Trial

No abstract is provided for this article.

Extension of Increased Atherosclerotic Wall Thickness Into High Shear Stress Regions Is Associated With Loss of Compensatory Remodeling

Atherosclerosis preferentially develops at average low shear stress (SS) locations. SS-related signaling maintains lumen dimensions by inducing outward arterial remodeling. Prolonged plaque accumulation at low SS predilection locations explains an inverse relation between wall thickness (WT) and SS. No data exist on WT-SS relations when lumen narrowing and loss of compensatory remodeling commence.In 14 patients, an angiographically normal artery (stenosis <50%) was investigated with ANGiography and ivUS (ANGUS) to provide 3D lumen and wall geometry. Selection of segments >5 mm in length, in between side branches, yielded 25 segments in 12 patients. SS at the wall was calculated by computational fluid dynamics. WT smaller than 0.2*lumen diameter was defined as normal. Largest arc of normal WT defined reference cross sections. Lumen area relative to the reference cross sections defined area stenosis (AS). Average segmental AS smaller or greater than 10% defined preserved or narrowed lumen, respectively. Total vessel area relative to the reference defined vascular remodeling (VR). For the preserved lumens (n=11, AS=1.7+/-5.6%, P=NS), axially averaged WT and SS were inversely related (slope, -0.46+/-0.55 mm/Pa, P<0.05) and VR was positive (7+/-9%, P<0.05). Narrowed segments (n=13, 1 excluded, AS=18+/-6%, P<0.05) showed no relation between WT and SS or vascular remodeling.In patient coronary arteries, the often-reported inverse WT-SS relationship appears restricted to lumen preservation and positive vascular remodeling. Its disappearance with lumen narrowing suggests a growing importance of non-SS-related plaque progression.

Glucocorticoids reduce tachykinin NK2 receptor expression in bovine tracheal smooth muscle

Two Facets of Shear Stress Post Drug Coating Balloon: Angiography Versus Optical Coherence Tomography Fusion Approach

No abstract is provided for this article.

Quantitative assessment of myocardial perfusion by thallium-201 tomography and by X-ray contrast medium appearance techniques

No abstract is provided for this article.

Muscarinic receptors in lung.

Muscarinic receptors are present on several different cells in lung and are predominantly involved in bronchoconstriction and mucus secretion. Muscarinic receptor activation leads to breakdown of phosphoinositides in airway smooth muscle cell membranes, which leads to intracellular calcium release and contraction. Muscarinic receptor subtypes are now recognised, and muscarinic receptors on cholinergic nerves which inhibit acetylcholine release (auto-receptors) may differ from those on airway smooth muscle. There is evidence that muscarinic receptor density is less in peripheral airways, so that cholinergic drugs may be less effective against small airway obstruction. The possibility that muscarinic receptors function abnormally in airway disease has been considered but is unlikely since the airways are hyperresponsive to several different stimuli, in addition to cholinergic agonists.

Vélicités intracoronaires en cours d'angioplastie

Zafirlukastof its Pharmacology and Therapeutic Efficacy in Asthma

Compliance With Guideline-Directed Medical Therapy in Contemporary Coronary Revascularization Trials

Background Despite the well-established benefits of secondary cardiovascular prevention, the importance of concurrent medical therapy in clinical trials of coronary revascularization is often overlooked. Objectives The goal of this study was to assess compliance with guideline-directed medical therapy (GDMT) in clinical trials and its potential impact on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Methods The Cochrane Central Register of Controlled Trials and MEDLINE were searched from 2005 to August 2017. Clinical trial registries and reference lists of relevant studies were also searched. Randomized controlled trials comparing PCI with drug-eluting stents versus CABG and reporting medical therapy after revascularization were included. The study outcome was compliance with GDMT, defined as the following: 1) any antiplatelet agent plus beta-blocker plus statin (GDMT1); and 2) any antiplatelet agent plus beta-blocker plus statin plus angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (GDMT2). Data collection and analysis were performed according to the methodological recommendations of The Cochrane Collaboration. Results From a total of 439 references, 5 trials were included based on our inclusion and exclusion criteria. Overall, compliance with GDMT1 was low and decreased over time from 67% at 1 year to 53% at 5 years. Compliance with GDMT2 was even lower and decreased from 40% at 1 year to 38% at 5 years. Compliance with both GDMT1 and GDMT2 was higher in PCI than in CABG at all time points. Meta-regression suggested an association between lower use of GDMT1 and adverse clinical outcomes in PCI versus CABG at 5 years. Conclusions Compliance with GDMT in contemporary clinical trials remains suboptimal and is significantly lower after CABG than after PCI, which may influence the comparison of clinical trial endpoints between those study groups.

Near-infrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease

Purpose: Intra-coronary near-infrared spectroscopy (NIRS) is capable of identifying lipid core-containing plaques, which can subsequently be quantified as a lipid core burden index (LCBI). Currently, no data are available on the long-term prognostic value of NIRS in patients with coronary artery disease (CAD). Methods: In this prospective, observational study, NIRS imaging was performed in a non-culprit coronary artery in 203 patients referred for angiography due to stable angina pectoris (SAP) or acute coronary syndrome (ACS). Results: The one-year cumulative incidence of the primary endpoint (the composite of all-cause mortality, non-fatal ACS, stroke and unplanned coronary revascularization) was 10.4%. Cumulative one-year rates in patients with an LCBI equal to and above the median (43.0) versus those with LCBI values below the median, were 16.7% versus 4.0% (P=0.003) (adjusted hazard ratio, 4.04; 95% confidence interval, 1.33-12). The relation between LCBI and the primary endpoint was similar in SAP and ACS patients (p-value for heterogeneity=0.14). Similar results were observed for the secondary endpoints of all-cause mortality or non-fatal ACS (8.8% vs. 1.0%, P=0.010), all-cause mortality, non-fatal ACS or stroke (11.8% vs. 1.0%, P=0.002) and all-cause mortality, non-fatal ACS or unplanned coronary revascularization (13.7% vs. 4.0%, P=0.014). KM curves for the primary endpoint Conclusion: CAD patients with a LCBI equal to or above the median of 43.0, as assessed by NIRS in a non-culprit coronary artery, had a four-fold risk of adverse cardiovascular events during one-year follow-up. Apparently, the LCBI as assessed in a non-culprit vessel, reflects vascular vulnerability of the larger coronary tree. Our results should be (externally) validated in a larger sample.

Augustine’s View of History in His City of God

At first glance, Augustine’s view of history might seem an unpromising area of study. That the great African father is regarded as a theological giant is a given, but he is not so regarded with respect to his historical prowess by many modern scholars.

Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus-eluting bioresorbable polylactide scaffold in comparison with the cobalt-chromium metallic stent?

Immediately after stent/scaffold implantation, quantitative coronary angiography (QCA) in comparison to optical coherence tomography (OCT) more severely underestimates the lumen diameter (LD) in Absorb than in XIENCE. This OCT-QCA discrepancy has not been evaluated at long-term follow-up. The present study aimed to assess the accuracy of QCA with reference to OCT in Absorb as compared to XIENCE.We assessed two-year QCA and OCT in the ABSORB Japan randomised trial (Absorb n=87, XIENCE n=44). The accuracy of QCA parameters was assessed with reference to OCT measurements. OCT-QCA luminal dimensions were compared in matched cross-sections at both edges of the scaffolds (n=127) and stents (n=78). OCT-QCA late lumen loss (LLL) was also assessed using the Bland-Altman method. The systematic error of LD on QCA in Absorb was -0.092 mm (relative difference -3.3%) with a random error of 0.473 mm, whereas in XIENCE the systematic error was -0.018 mm (-0.5%) with a random error of 0.477 mm. These OCT-QCA discrepancies did not differ between Absorb and XIENCE (p=0.275) at two-year follow-up. QCA tended to underestimate LLL more in Absorb than in XIENCE (QCA-LLL minus OCT-LLL: -0.180±0.308 mm vs. -0.058±0.322 mm, p=0.058) at two-year follow-up, although this comparison was not statistically powered.The two-year dimensional measurements on QCA had minor and insignificant systematic errors between both devices. A discrepancy between QCA-LLL and OCT-LLL would raise a question as to whether this parameter is appropriate for the comparative assessment of device performance.

Anti-IgE Antibody Therapy for Asthma

Over the past 10 years there have been striking improvements in the treatment of asthma, largely as a result of the earlier and more widespread use of inhaled corticosteroids. The development of new treatments for asthma has proved difficult, although several immunologic approaches are undergoing preclinical and clinical assessment.1 Antileukotrienes are the only new class of drugs to treat asthma that have been introduced in the past 25 years, but their efficacy is somewhat limited and unpredictable, as compared with that of inhaled corticosteroids.Mild asthma can be controlled in most patients by relatively low doses of inhaled corticosteroids, and . . .

A novel target of formoterol, a dual-specificity phosphatase DUSP4 on regulation of corticosteroid budesonide sensitivity

Introduction: We previously reported that formoterol, a long-acting β 2 -adrenoceptor agonist, activated a serine/threonine protein phosphatase PP2A which is involved in the restoration of corticosteroid (CS) sensitivity by formoterol (Kobayashi et al ERJ 2009;34:583s). We explored other phosphatases and identified dual-specificity phosphatase DUSP4 as a possible novel target of formoterol. Aims: To confirm that DUSP4 is activated by formoterol and is involved in regulation of CS sensitivity. Methods: U937 monocytic cells were incubated with IL-2 and IL-4 for 48 h to induce CS insensitivity. CS sensitivity was determined by the CS budesonide ability to inhibit TNFα-induced IL-8 production and to translocate glucocorticoid receptor (GR) from cell cytoplasm to nucleus. Phosphatase activity of immunopurified DUSP4 was measured by fluorescence-based assay. The nuclear/cytoplasmic GR ratio and phosphorylation levels of GR-Ser 226 and JNK1 kinase were analysed by western-blotting. In some experiments DUSP4 was knocked down by siRNA. Results: Formoterol increased DUSP4 activity, which was reduced under IL-2/IL-4 exposure. Knock-down of DUSP4 reduced GR nuclear translocation and CS sensitivity. Knock-down of DUSP4 also abrogated the dephosphorylation of GR-Ser 226 and JNK1 by formoterol - the effects involved in GR nuclear translocation and restoration of CS sensitivity. Conclusions: Formoterol regulates sensitivity to budesonide through activation of DUSP4 which dephosphorylates JNK1 and which in turn leads to dephosphorylation of GR-Ser 226 . This novel mechanism by formoterol may contribute to the clinical efficacy of combination of formoterol and budesonide.

Classification and Current Treatment Options of In-Stent Restenosis

No abstract is provided for this article.

Modulation of acetylcholine release from parasympathetic nerves innervating guinea-pig and human trachea by endomorphin-1 and -2