Publications

Prognostic Impact of Race in Patients Undergoing PCI

Objectives The aim of this study was to assess race-based differences in patients undergoing percutaneous coronary intervention from a large pooled database of randomized controlled trials. Background Data on race-based outcomes after percutaneous coronary intervention are limited, deriving mainly from registries and single-center studies. Methods Baseline characteristics and outcomes at 30 days, 1 year, and 5 years were assessed across different races, from an individual patient data pooled analysis from 10 randomized trials. Endpoints of interest included death, myocardial infarction, and major adverse cardiac events (defined as cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization). Multivariate Cox proportional hazards regression was performed to assess associations between race and outcomes, controlling for differences in 12 baseline covariates. Results Among 22,638 patients, 20,585 (90.9%) were white, 918 (4.1%) were black, 404 (1.8%) were Asian, and 473 (2.1%) were Hispanic. Baseline and angiographic characteristics differed among groups. Five-year major adverse cardiac event rates were 18.8% in white patients (reference group), compared with 23.9% in black patients (p = 0.0009), 11.2% in Asian patients (p = 0.0007), and 21.5% in Hispanic patients (p = 0.07). Multivariate analysis demonstrated an independent association between black race and 5-year risk for major adverse cardiac events (hazard ratio: 1.28; 95% confidence interval: 1.05 to 1.57; p = 0.01). Conclusions In the present large-scale individual patient data pooled analysis, comorbidities were significantly more frequent in minority-group patients than in white patients enrolled in coronary stent randomized controlled trials. After accounting for these differences, black race was an independent predictor of worse outcomes, whereas Hispanic ethnicity and Asian race were not. Further research examining race-based outcomes after percutaneous coronary intervention is warranted to understand these differences.

700.41 Comparison Of Hemodynamic Performance Between Myval and Sapien 3 Ultra Resilia - Insights From Published Data

No abstract is provided for this article.

Chronic lung diseases: prospects for regeneration and repair

COPD and idiopathic pulmonary fibrosis (IPF) together represent a considerable unmet medical need, and advances in their treatment lag well behind those of other chronic conditions. Both diseases involve maladaptive repair mechanisms leading to progressive and irreversible damage. However, our understanding of the complex underlying disease mechanisms is incomplete; with current diagnostic approaches, COPD and IPF are often discovered at an advanced stage and existing definitions of COPD and IPF can be misleading. To halt or reverse disease progression and achieve lung regeneration, there is a need for earlier identification and treatment of these diseases. A precision medicine approach to treatment is also important, involving the recognition of disease subtypes, or endotypes, according to underlying disease mechanisms, rather than the current “one-size-fits-all” approach. This review is based on discussions at a meeting involving 38 leading global experts in chronic lung disease mechanisms, and describes advances in the understanding of the pathology and molecular mechanisms of COPD and IPF to identify potential targets for reversing disease degeneration and promoting tissue repair and lung regeneration. We also discuss limitations of existing disease measures, technical advances in understanding disease pathology, and novel methods for targeted drug delivery.

Changes in mitral regurgitation after transcatheter aortic valve implantation

To assess the acute and intermediate changes in mitral regurgitation (MR) severity after transcatheter aortic valve implantation (TAVI) with the CoreValve Revalving SystemTM (CRS).Following surgical aortic valve replacement, improvement in MR is reported in 27-82% of the patients. The changes in MR severity following CRS implantation are unknown.Transthoracic echocardiography was performed in 79 consecutive patients before and after treatment, and at the first outpatient visit. Left ventricular dimensions and ejection fraction (LVEF), left atrial (LA) size, and aortic gradient were measured. MR was assessed by color flow mapping and was graded as none, mild, moderate, or severe. It was defined as organic or functional. The depth of CRS implantation was measured by angiography.Post-treatment, the mean gradient decreased from 48 +/- 16 mm Hg to 9 +/- 5 mm Hg (P < 0.0001). There was no significant change in the left ventricular dimensions, LA size, and LVEF. MR pretreatment was mild, moderate, or severe in 57%, 18%, and 1% of the patients, respectively. It was defined as organic in 27 patients (36%) and functional in 27 patients (36%). The degree of MR remained unchanged in 61% of the patients, improved in 17%, and worsened in 22%. MR improvement was associated with a lower baseline LVEF (P = 0.02). There was no association between the changes in MR severity and the depth of CRS implantation.Most patients who underwent TAVI had some degree of MR. Overall there was no change in the degree of MR post-treatment. Patients in whom MR improved had a lower LVEF at baseline.

Inhibition of allergen-induced lung eosinophilia by type-III and combined type III- and IV-selective phosphodiesterase inhibitors in Brown-Norway rats

Millimetre-wave and near-infrared signposts of massive molecular clump evolution and star cluster formation

We report new near-infrared and mm-wave observational data on a selection of massive Galactic molecular clumps (part of the CHaMP sample) and their associated young star clusters. The clumps show, for the first time in a "dense gas tracer", a significant correlation between HCO+ line emission from cold molecular gas and Br{\gamma} line emission of associated nebulae. This correlation arises in the HCO+ line's brightness, not its linewidth. In contrast, the correlation between the N2H+ line emission and Br{\gamma} is weak or absent. The HCO+/N2H+ line ratio also varies widely from clump to clump: bright HCO+ emission tends to be more closely associated with Br{\gamma} nebulosity, while bright N2H+ emission tends to avoid areas that are bright in Br{\gamma}. Both molecular species show correlations of weak significance with infrared H2 v=1-0 and v=2-1 line emission, in or near the clumps. The H2 emission line ratio is consistent with fluorescent excitation in most of the clumps, although thermal excitation is seen in a few clumps. We interpret these trends as evidence for evolution in the gas conditions due to the effects of ongoing star formation in the clumps, in particular, the importance of UV radiation from massive YSOs as the driving agent that heats the molecular gas and alters its chemistry. This suggests that some traditional dense gas tracers of molecular clouds do not sample a homogeneous population of clumps, i.e., that the HCO+ brightness in particular is directly related to the heating and disruption of cold gas by massive young stars, whereas the N2H+ better samples gas not yet affected by this process. We therefore suggest that the HCO+-N2H+-Br{\gamma} relationship is a useful diagnostic of a molecular clump's progress in forming massive stars.

Drug-coated balloon angioplasty and stenting for coronary artery lesions – Authors' reply

Vascular Remodeling in Coronary Artery Disease

Summary Traditionally, the diagnosis of significant coronary atherosclerotic disease has relied on angiographic techniques. Both histologic analyses and, more recently, intravascular ultrasonography techniques have revealed that a significant atherosclerotic plaque load may be present in epicardial coronary arteries without significant luminal narrowing, consistent with compensatory vessel enlargement or remodeling. In patients with coronary atherosclerosis, more limited structural changes are present in the smaller resistance arterioles, whereas a decrease in luminal area with an increase in wall thickness and perivascular fibrosis are the characteristic structural changes observed in resistance arteries in the presence of systemic hypertension. Further, functional changes, such as impairment of endothelium-mediated vasodilation, are present in epicardial and resistance vessels of patients with coronary atherosclerosis and may influence the progression of this disease and development of ischemic syndromes. The introduction of two-dimensional intravascular and Doppler ultrasonography enables us to study in vivo these morphologic and functional changes. In this article, the knowledge acquired in humans on the mechanisms and clinical relevance of vascular remodeling with the use of these two ultrasonography-based techniques is reviewed. The possibility of using pharmacologic interventions to improve or normalize the vascular response to endothelium-dependent and independent vascular interventions is discussed, with special attention to the efficacy of the inhibition of the angiotensin-converting enzyme.

STAGED PERCUTANEOUS CORONARY INTERVENTION IN THE SYNTAX STUDY: THREE-YEAR OUTCOMES

No abstract is provided for this article.

Characterization of beta adrenoceptor subtypes in canine airway smooth muscle by radioligand binding and physiological responses.

Beta adrenoceptor subtypes in canine tracheal smooth muscle have been investigated by radioligand binding and by physiological responses to beta agonists and sympathetic nerve stimulation in vitro. Specific binding of [3H]dihydroalprenolol to tracheal smooth muscle membranes was of high affinity (Kd = 1.0 +/- 0.08 nM), as in peripheral lung membranes from the same animals, but the concentration of binding sites (95.6 +/- 4.7 fmol/mg of protein) was much lower than in lung (532 +/- 48 fmol/mg of protein). Binding was stereoselective and agonists competed with the rank order of potency isoproterenol greater than epinephrine greater than norepinephrine, signifying a preponderance of beta-2 receptors. Using selective beta antagonists, we determined the ratio of beta-1/beta-2 receptors in tracheal smooth muscle membranes to be 1:4. The relaxation response of tracheal smooth muscle strips to exogenous beta agonists was mediated by beta-2 receptors, with a very small contribution from beta-1 receptors. However, the relaxation response to electrical field stimulation of sympathetic nerves was mediated predominantly by beta-1 receptors. Our results suggest that most beta receptors in dog tracheal smooth muscle are of the beta-2 subtype and mediate responses to circulating catecholamines, but there is a small concentration of beta-1 receptors which mediate the response to neurally released norepinephrine.

There is no need for complicated equations and mathematical models. Exhaled nitric oxide can be partitioned with two simple exhalations

Background: By measuring eNO at multiple flows and applying mathematical models of eNO exchange dynamics, the signal can be partitioned into its proximal airway [Jno (nl/sec)] and distal airway/alveolar contributions [CA(NO) (ppb)]. This method is time consuming, requires at least 3 exhalations and is affected by a number of limitations such as axial diffusion and turbulent flow. We eveloped a more practical method based on the production of NO (Vno) at two exhalation flow rates. Methods: In a group of 27 normal subjects (38±2 yr; 20 male), 13 steroid naive asthmatic patients (34±3 yr; 6 male, FEV1 70±4% predicted), 14 patients with chronic obstructive pulmonary disease (COPD) (65±2 yr; 10 male, FEV1 58±3%), and 12 patients with cystic fibrosis (21±4 yr; 8 male, FEV1 60±3%) we compared CA(NO) and Jno with the variation of total NO production at 50 and 200 ml/s [Vno50-200 (nl/s)]. Vno was measured by calculating the average area under the curve (NO concentration/time) of two successive exhalations at each flow rate. Results: Vno50-200 was strongly correlated with Jnoin normal subjects (r=0.94, p Conclusions: The flow dependent component of exhaled NO, which is affected by its bronchial production, can be estimated by measuring Vno50-200. This method is simple, does not require sophisticated equipment or equations and is in agreement with Jno calculated mathematically.

How should I treat a tortuous calcified right coronary artery?

No abstract is provided for this article.

Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve

Objectives In this retrospective study, we examined the incidence of post-procedural conduction abnormalities and the need for pacing in patients undergoing percutaneous implantation of the aortic valve. Background Safety and feasibility studies have suggested anecdotally the occurrence of conduction abnormalities and requirements for pacing after percutaneous implantation of the aortic valve. Methods We examined the standard 12-lead electrocardiograms (ECGs) of 40 consecutive patients in whom a CoreValve Revalving System (CoreValve, Paris, France) was implanted between November 2005 and March 2008. We examined the 12-lead ECG before treatment, after treatment, and at 1-month follow-up. We documented the requirements for temporary or permanent pacemaking. Results The mean age of patients was 82 ± 7 years. Post-procedural mortality at 72 h was 0%. There was a significant increase in the frequency of left bundle branch block (LBBB) after percutaneous aortic valve replacement (15% before treatment vs. 55% after treatment, p = 0.001). Although the incidence of LBBB had decreased after follow-up of 1 month, it did not reach statistical significance, with the proportion decreasing from 55% to 48% (p = 0.63). The only 2 patients with pre-treatment right bundle branch block became dependent on temporary pacing immediately after valve implantation and subsequently needed permanent pacing. A temporary and permanent pacemaker was required in 20% and 18% of patients, respectively. Conclusions In this study, there was a significant increase in the frequency of LBBB after percutaneous insertion of the aortic valvar prosthesis. Patients with pre-existing right bundle branch block may be at risk for the development of complete heart block and subsequent need for pacing.

Effectiveness of sirolimus-eluting stent implantation for recurrent in-stent restenosis after brachytherapy

No abstract is provided for this article.

Geometrical validation of intravascular ultrasound radiofrequency data analysis (Virtual Histology) acquired with a 30 MHz boston scientific corporation imaging catheter

Recently, the plaque characterization field was explored with the use of the substrate (frequency domain analysis) rather than the envelope (amplitude or gray-scale imaging) of the intravascular ultrasound (IVUS) radiofrequency data. However, there is no data about the agreement of quantitative outcome between the two methods. The aim of this study was to assess the correlation and agreement between quantitative coronary ultrasound and the geometrical measurements provided by the spectral analysis of ultrasound radiofrequency data [IVUS-Virtual Histology (IVUS-VH), Volcano Therapeutics). Twenty-five patients were included in this study. The IVUS catheter used was a commercially available mechanical sector scanner (Ultracross 2.9 Fr 30 MHz catheter, Boston Scientific) covered with an outer sheath. IVUS-VH significantly underestimated lumen [relative difference (RD) = 14.8 ± 5.6; P < 0.001], vessel (RD = 14.1 ± 4.8; P < 0.001), and plaque (RD = 11.5 ± 10.8; P < 0.001) cross-sectional areas (CSAs). Nevertheless, when adjusted for the ultrasound propagation delay caused by the sheath, relative differences of measurements were remarkably low (0.49% ± 6.3%, P = 0.64 for lumen; 2.33% ± 4.6%, P = 0.007 for vessel; and 4.2% ± 10.4%, P = 0.005 for plaque CSA). These data suggest that the volumetric output of the IVUS-VH software underestimates measurements when acquired with a 30 MHz catheter. However, after applying a mathematical adjustment method for the ultrasound propagation delay caused by the outer sheath of the 30 MHz catheter, relative differences of direct measurements were negligible. These results suggest that ultrasound radiofrequency data analysis could provide, aside from precise compositional data, an accurate geometrical output. © 2005 Wiley-Liss, Inc.

Treatment of coronary artery disease in dialysis patients with sirolimus-eluting stents: 1-year clinical follow-up of a consecutive series of cases.

From April 16, 2002 to October 16, 2002, 10 consecutive patients with coronary disease on chronic dialysis were treated with sirolimus-eluting stents. Diabetes was present in 30% and half of the patients had multivessel coronary disease. On average, patients had been on dialysis for 5 years prior to the procedure (range: 2-15 years). Five patients were on hemodialysis and 5 patients were on peritoneal dialysis. Overall, 18 lesions were treated with 1.9 +/- 1.1 sirolimus-eluting stents per patient. At a mean follow-up of 403 days, there were no cases of death, myocardial infarction, or target lesion revascularization.

TCT-838 Prognostic Significance of a Previous Family History of Premature Coronary Artery Disease in Patients with Left Main Disease Undergoing PCI or CABG: Subgroup Analysis from EXCEL Trial

No abstract is provided for this article.