Publications

Reprinted with permission from: Eur Heart J. 2018; 19: 959-961.

No abstract is provided for this article.

Quality of life (QoL) assessment is an integral part of disease management and prognosis for all chronic illnesses, including COPD. Non-smoking (NS) COPD accounts for 25-45% of all COPD cases globally, and is relatively more common in India. There is little information on QoL of NS-COPD patients and how it compares with smoking (S)-COPD. We studied the QoL of NS-COPD using SGRQ and CAT and compared it with S-COPD. Methods: 80 smoking & 77 non-smoking physician-confirmed COPD patients with a post-bronchodilator FEV1/FVC 0.05). There was a strong correlation between SGRQ and CAT scores for both NS-COPD (r2= 0.54, p=0.0001) and S-COPD (r2= 0.67, p=0.0001). Interestingly, the SGRQ scores are higher in Indian patients than in Western patients for equivalent FEV1 values. Conclusion: Impairment of QoL of NS-COPD is similar to S-COPD in an Indian cohort.

The cyclic nucleotide phosphodiesterase (PDE) of guinea‐pig eosinophils was partially characterized and the effects of selective inhibitors of PDE isoenzymes upon opsonized zymosan (OZ)‐stimulated respiratory burst were studied. PDE activity in eosinophil lysates appeared to be membrane‐associated, displayed substrate specificity for adenosine 3′: 5′ cyclic monophosphate (cyclic AMP) versus guanosine 3′: 5′ cyclic monophosphate (cyclic GMP) and was insensitive to cyclic GMP or Ca 2+ and calmodulin. The non‐selective PDE inhibitor, 3‐isobutyl‐1‐methylxanthine caused a concentration‐dependent inhibition of both OZ‐stimulated hydrogen peroxide (H 2 O 2 ) generation and cyclic AMP hydrolysis. The type IV‐selective PDE inhibitors, rolipram and denbufylline, also inhibited H 2 O 2 generation and cyclic AMP hydrolysis in a concentration‐dependent manner whilst SK&F 94120 and Org 9935 (type III‐selective) and zaprinast (type Ia or V‐selective) were ineffective. Dibutyryl cyclic AMP, a cell‐permeable, non‐hydrolysable analogue of cyclic AMP, caused a concentration‐dependent inhibition of H 2 O 2 generation stimulated by OZ. Dibutyryl cyclic GMP was ineffective. It is concluded that eosinophil respiratory burst activity induced by OZ can be regulated by intracellular cyclic AMP and that the levels of cyclic AMP are controlled exclusively by a rolipram‐ and denbufylline‐sensitive PDE isoenzyme that resembles a type IV species.

Background: The side branch (SB) compromise after main vessel (MV) stenting remains a significant problem in coronary bifurcation treatment. Currently the two major hypotheses for the mechanism of SB compromise are carina shift from MV into the SB and plaque shift into the ostium of side vessel. It is proposed herein, SB ostial deformation leading to reshaping of the ostium from circle to ellipse is a third possible mechanism. In the current study, the theoretical effects and correlation of ostial deformation with fractional flow reserve (FFR) is explored. Methods: Based on angiographic measurements and theoretical analysis formulas, three different SB ostial areas using circular ostial shape assumption and elliptical ostial shape assumption were calculated. Three different types of ostial areas with FFR values after MV stenting in 49 patients from the FIESTA registry were compared and analyzed. Results: It was found that there is significant overestimation of stenosis severity when estimated by the circle formula, than with the ellipse formula — ASc vs. ASds with 25% ± 13%, p < 0.001, ASc vs. ASmld with 9% ± 10%, p < 0.001. The elliptical shape assumptions provide more accurate ostial area stenosis, which correlates better with FFR. This finding is more significant in less severe stenosis (< 70% area stenosis) than in a more severe one. Conclusions: A third possible mechanism of SB compromise after MV stenting of coronary bifurcation stenosis is elliptical ostial deformation at the ostium of SBs. The ostial area, calculated based on elliptical assumption correlates better with FFR, than area stenosis calculated with the traditional circular formula.

OBJECTIVES: The authors sought to determine the incidence and causes of geographical miss (GM) and evaluate its impact on edge restenosis after ‘primary’, centered, intracoronary β‐radiation therapy. BACKGROUND: Edge restenosis is a limitation of intracoronary β‐radiation therapy. GM occurs when the radiation source does not fully cover the injured segment and may account for this phenomenon. METHODS: One hundred and eighty‐one patients enrolled in the Dose‐Finding study were retrospectively analyzed. The patients were randomized to receive 9, 12, 15 or 18 Gy at 1 mm tissue depth. Using quantitative coronary angiography the effective irradiated segment (EIRS) and both edges were studied prior to and after intervention, and at six‐month follow‐up. GM was defined as a situation where the effective radiation source length (24 mm) did not fully cover the injured segment. The edges of the EIRS that were injured during the procedure constituted the GM edges. A greater than 50% diameter stenosis at follow‐up was considered significant. GM was determined by the simultaneous, electrocardiographically matched, side‐by‐side projection of the source and balloons in place, in identical projections surrounded by contrast. RESULTS: In 16% of patients GM was noninterpretable owing to inadequate filming. GM constituted 21.1% of the interpretable edges and 40.1% of the interpretable vessels analyzed. The occurrence of restenosis in the EIRS and the analyzed vessel segment (VS) was similar between procedures with and without GM. In vessels with GM, restenosis was significantly increased from the EIRS to the VS (from 8.77% to 21%, p = 0.05) as opposed to non‐GM vessels (from 11.9% to 19%, p = 0.6). GM tended to be associated with a greater incidence of significant stenosis at the edges of the EIRS (8.3% versus 4.0%, p = 0.15) compared with individuals with >50 % stenosis but no GM. This effect was more prominent at the distal edge. The relation of GM and edge restenosis was independent of dosage. CONCLUSIONS: Since GM does not affect the incidence of restenosis in the EIRS, restenosis in this segment should be considered a treatment failure, probably due to inadequate dosage. GM is related to significant increase in restenosis from the EIRS to the VS. GM tends to be associated with restenosis at the edges of the EIRS. This is a local phenomenon, which is independent of dosage and which has a specific pathophysiology (combination of injury and low‐dose radiation). If GM can be eliminated, the results of vascular brachytherapy will be improved. (Int J Cardiovasc Intervent 2003; 5: 181–189)

No abstract is provided for this article.

ObjectivesThe aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI)clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection.

No abstract is provided for this article.