01 marzo 2014

THE AMERICAN JOURNAL OF CARDIOLOGY. Relation of Albuminuria to Coronary Microvascular Function in Patients With Chronic Kidney Disease

Sari Imamura, MD, Kumiko Hirata, MD, PhD, Makoto Orii, MD, Kunihiro Shimamura, MD, Yasutsugu Shiono, MD, Kohei Ishibashi, MD, PhD, Takashi Tanimoto, MD, PhD, Takashi Yamano, MD, PhD, Yasushi Ino, MD, PhD, Hironori Kitabata, MD, PhD, Tomoyuki Yamaguchi, MD, PhD, Takashi Kubo, MD, PhD, Atsushi Tanaka, MD, PhD, Toshio Imanishi, MD, PhD, Takashi Akasaka, MD, PhD

The relation between albuminuria and coronary microvascular function in patients with chronic kidney disease (CKD) has not been fully investigated. Therefore, we sought to assess whether albuminuria is associated with coronary flow velocity reserve (CFVR) impairment in patients with CKD. Coronary flow study was prospectively performed in 175 patients with CKD. CFVR of the left anterior descending artery was measured to evaluate coronary microvascular function using transthoracic echocardiography. We divided the patients into 5 groups according to the stages of CKD and analyzed the effect of albuminuria. CFVR gradually decreased with an increase in CKD stages. CFVR in patients with albuminuria was lower than those without albuminuria. In groups with CKD stages 2 and 3, the patients with albuminuria showed lower CFVR than those without albuminuria. Multiple logistic regression analysis revealed that albuminuria, age, and gender were independently associated with CFVR impairment. Of these factors, albuminuria was the most powerful predictor with the risk ratio of 12.4 for CFVR impairment. In conclusion, the more the CKD stages progressed, the more severe CFVR was impaired. Albuminuria was associated with CFVR impairment in patients with CKD; even in mild-to-moderate CKD, patients with albuminuria showed further reduced coronary vasodilator capacity.

15 marzo 2014

THE AMERICAN JOURNAL OF CARDIOLOGY. Risk Factors for Progression of Functional Tricuspid Regurgitation

Avinoam Shiran, MD, Riham Najjar, BSc, Salim Adawi, MD, Doron Aronson, MD

The aim of this study was to determine the risk factors for tricuspid regurgitation (TR) progression in a contemporary population of patients referred for echocardiography. In a case-control study, we compared 100 consecutive patients with TR progression on serial echocardiograms (trivial or mild TR on the first echocardiogram and moderate or severe functional TR on a follow-up echocardiogram) with 100 patients matched for age and gender, having mild TR at baseline and no TR progression. Mean age was 72 ± 10 years, 55% were males, and time to TR progression was 5.3 ± 2.9 years. Less than 10% had rheumatic heart disease. Left ventricular ejection fraction was preserved (≥50%) in 85% of the TR progression group and in 74% of the control group (p = 0.06). Pulmonary artery systolic pressure increased from 41 ± 16 to 56 ± 18 mm Hg in the TR progression group and decreased from 44 ± 13 to 41 ± 11 mm Hg in the control group (p <0.0001). Independent risk factors for TR progression were pulmonary artery systolic pressure change during follow-up (odds ratio per 1 mm Hg 1.14, 95% confidence interval 1.06 to 1.23, p <0.0001), permanent atrial fibrillation (odds ratio 14.3, 95% confidence interval 4.6 to 44.2, p <0.0001), and coronary artery disease (odds ratio 5.7, 95% confidence interval 1.4 to 22.8, p = 0.015). All-cause mortality at 3 years was 20% for patients without TR progression, 42% for moderate TR, and 63% for severe TR, p <0.0001. Progression-to-severe TR independently predicted subsequent mortality. In conclusion, in patients with low prevalence of rheumatic heart disease and preserved left ventricular ejection fraction, pulmonary artery systolic pressure increase and permanent atrial fibrillation were the most powerful risk factors for TR progression. Progression-to-severe TR was an independent predictor of subsequent mortality.

15 abril 2014

THE AMERICAN JOURNAL OF CARDIOLOGY. Preventable Coronary Heart Disease Events from Control of Cardiovascular Risk Factors in US Adults With Diabetes (Projections from Utilizing the UKPDS Risk Engine)

Nathan D. Wong, PhD, MPH, Christopher Patao, BS, Shaista Malik, MD, PhD, Uchenna Iloeje, MD, MPH

Type 2 diabetes mellitus (T2DM) carries significant risks for coronary heart disease (CHD). We examined the potential US population impact of single and composite risk factor control. Among US adults with diagnosed T2DM aged ≥30 years in the National Health and Nutrition Examination Survey 2007 to 2012, we assessed CHD events preventable using the United Kingdom Prospective Diabetes Study CHD risk engine. We examined in all those not at goal the impact of statistical control of smoking, glycated hemoglobin, systolic blood pressure, and total and high-density lipoprotein cholesterol, according to the predefined criteria setting risk factors at different levels of control representing (1) “All to Goal,” (2) at “Nominal Control,” or (3) at “Aggressive Control.” Preventable CHD events represented the difference between the number of events estimated from the control of these risk factors versus current levels of the risk factors. Of 606 men (representing 6.2 million) and 603 women (6.3 million) with DM and no previous CHD, 1.3 million men and 0.7 million women would develop a CHD event within 10 years if left uncontrolled. Controlling all risk factors to goal was projected to prevent 35% and 45% of CHD events in men and women, respectively. Nominal risk factor control was projected to prevent 36% and 38% and aggressive control 51% and 61% of CHD events, respectively. In conclusion, a significant proportion of CHD events in adults with T2DM could be prevented from composite control of risk factors often not at goal.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. A Systematic Review and Meta-Analysis on Primary Percutaneous Coronary Intervention of an Unprotected Left Main Coronary Artery Culprit Lesion in the Setting of Acute Myocardial Infarction

Marije M. Vis, MD; Marcel A. Beijk, MD, PhD; Maik J. Grundeken, MD; Jan Baan, MD, PhD; Karel T. Koch, MD, PhD; Joanna J. Wykrzykowska, MD, PhD; E. Karin Arkenbout, MD, PhD; Jan G.P. Tijssen, PhD; Robbert J. de Winter, MD, PhD; Jan J. Piek, MD, PhD; José P.S. Henriques, MD, PhD

Objectives: This study sought to evaluate 30-day all-cause mortality of patients treated with primary percutaneous coronary intervention (PCI) presenting with an acute myocardial infarction (AMI) due to an unprotected left main coronary artery (ULMCA) culprit lesion. In addition, an average estimated mortality rate was extrapolated from the available data.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. The “Final” 5-Year Follow-Up From the ENDEAVOR IV Trial Comparing a Zotarolimus-Eluting Stent With a Paclitaxel-Eluting Stent

Ajay J. Kirtane, MD, SM⁎; Martin B. Leon, MD⁎; Michael W. Ball, MD†; Harpaul S. Bajwa, MD‡; Michael H. Sketch, MD§; Patrick S. Coleman, MD∥; Robert C. Stoler, MD¶; Stylianos Papadakos, MD#; Donald E. Cutlip, MD⁎⁎; Laura Mauri, MD, MSc††; David E. Kandzari, MD‡‡

Objectives: This study sought to report the final 5-year outcomes of the ENDEAVOR IV (A Randomized, Controlled Trial of the Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus the Taxus Paclitaxel-Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions) trial comparing the Endeavor zotarolimus-eluting stent (E-ZES) (Medtronic, Santa Rosa, California) with the Taxus paclitaxel-eluting stent (PES) (Boston Scientific, Natick, Massachusetts) in patients with single de novo coronary lesions.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. The REMEDEE Trial. A Randomized Comparison of a Combination Sirolimus-Eluting Endothelial Progenitor Cell Capture Stent With a Paclitaxel-Eluting Stent

Michael Haude, MD, PhD⁎; Stephen W.L. Lee, MD†; Stephen G. Worthley, MBBS, PhD‡; Sigmund Silber, MD, PhD§; Stefan Verheye, MD, PhD∥; Sandra Erbs, MD¶; Mohd Ali Rosli, MD#; Roberto Botelho, MD, PhD⁎⁎; Ian Meredith, MBBS, PhD††; Kui Hian Sim, MBBS‡‡; Pieter R. Stella, MD, PhD§§; Huay-Cheem Tan, MBBS∥∥; Robert Whitbourn, MBBS¶¶; Sukumaran Thambar, MBBS##; Alexandre Abizaid, MD, PhD⁎⁎⁎; Tian Hai Koh, MBBS†††; Peter Den Heijer, MD, PhD‡‡‡; Helen Parise, ScD§§§; Ecaterina Cristea, MD§§§; Akiko Maehara, MD§§§; Roxana Mehran, MD§§§

Objectives: This study sought to compare the efficacy and safety results after coronary implantation of a combined sirolimus-eluting CD34 antibody coated Combo stent (OrbusNeich Medical, Ft. Lauderdale, Florida) with the paclitaxel-eluting Taxus Liberté stent (PES) (Boston Scientific, Natick, Massachusetts). This report summarizes the first-in-man randomized, controlled multicenter REMEDEE trial (Randomized study to Evaluate the safety and effectiveness of an abluMinal sirolimus coatED bio-Engineered StEnt) angiographic, intravascular ultrasound, and clinical results up to 12 months.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Analysis of Stroke Occurring in the SYNTAX Trial Comparing Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention in the Treatment of Complex Coronary Artery Disease

Michael J. Mack, MD⁎; Stuart J. Head, MSc†; David R. Holmes, MD‡; Elisabeth Ståhle, MD§; Ted E. Feldman, MD∥; Antonio Colombo, MD¶; Marie-Claude Morice, MD#; Felix Unger, MD⁎⁎; Andrejs Erglis, MD††; Robert Stoler, MD‡‡; Keith D. Dawkins, MD§§; Patrick W. Serruys, MD, PhD†; Friedrich W. Mohr, MD, PhD∥∥; A. Pieter Kappetein, MD, PhD†

Objectives This study sought to analyze stroke rates in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial´s randomized and registry cohorts of patients being treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) for treatment of complex coronary artery disease.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Clinical Outcome of Patients With and Without Diabetes Mellitus After Percutaneous Coronary Intervention With the Resolute Zotarolimus-Eluting Stent. 2-Year Results From the Prospectively Pooled Analysis of the International Global RESOLUTE Program

Sigmund Silber, MD, PhD⁎; Patrick W. Serruys, MD, PhD†; Martin B. Leon, MD‡; Ian T. Meredith, MBBS, PhD§; Stephan Windecker, MD∥; Franz-Josef Neumann, MD, PhD¶; Jorge Belardi, MD#; Petr Widimsky, MD, DRSc⁎⁎; Joe Massaro, PhD††; Victor Novack, MD, PhD‡‡; Alan C. Yeung, MD§§; Shigeru Saito, MD∥∥; Laura Mauri, MD, MSc¶¶

Objectives: The aim of this study was to describe the process to obtain Food and Drug Administration (FDA) approval for the expanded indication for treatment with the Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Inc., Santa Rosa, California) in patients with coronary artery disease and diabetes.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Randomized Comparison of Clinical Outcomes Between Intravascular Ultrasound and Angiography-Guided Drug-Eluting Stent Implantation for Long Coronary Artery Stenoses

Jung-Sun Kim, MD⁎; Tae-Soo Kang, MD†; Gary S. Mintz, MD‡; Byoung-Eun Park, MD†; Dong-Ho Shin, MD, MPH⁎; Byeong-Keuk Kim, MD⁎; Young-Guk Ko, MD⁎; Donghoon Choi, MD⁎; Yangsoo Jang, MD⁎; Myeong-Ki Hong, MD

Objectives: This study sought to assess the impact of intravascular ultrasound (IVUS) guidance on clinical outcomes following drug-eluting stent implantation when treating long lesions.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Relationship of Thrombus Characteristics to the Incidence of Angiographically Visible Distal Embolization in Patients With ST-Segment Elevation Myocardial Infarction Treated With Thrombus Aspiration

Kei Yunoki, MD, PhD⁎; Takahiko Naruko, MD, PhD⁎; Takeshi Inoue, MD, PhD†; Kenichi Sugioka, MD, PhD‡; Mayumi Inaba, MD, PhD§; Yoko Iwasa, MD, PhD§; Ryushi Komatsu, MD, PhD⁎; Akira Itoh, MD, PhD⁎; Kazuo Haze, MD, PhD⁎; Minoru Yoshiyama, MD, PhD‡; Anton E. Becker, MD, PhD∥; Makiko Ueda, MD, PhD§

Objectives: This study sought to investigate the association between pathological characteristics of aspirated intracoronary thrombi and the incidence of angiographically visible distal embolization (AVDE) during primary percutaneous coronary intervention (p-PCI) in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombus aspiration.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of Automated Contrast Injector Systems on Contrast Use and Contrast-Associated Complications in Patients Undergoing Percutaneous Coronary Interventions

Hitinder S. Gurm, MD⁎; Dean Smith, PhD, MPH⁎; David Share, MD†; David Wohns, MD‡; John Collins, MD§; Mohan Madala, MD∥; Srinivas Koneru, MD¶; Dan Menees, MD⁎; Stanley Chetcuti, MD

Objectives: The purpose of this study was to assess the impact of manual versus automated contrast injection on renal complications in patients undergoing percutaneous coronary intervention (PCI).

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Short-Term Mechanical Unloading With Left Ventricular Assist Devices After Acute Myocardial Infarction Conserves Calcium Cycling and Improves Heart Function

Xufeng Wei, MD, PhD⁎; Tieluo Li, MD⁎; Brian Hagen, PhD‡; Pei Zhang, PhD⁎; Pablo G. Sanchez, MD, PhD⁎; Katrina Williams, BS⁎; Shuying Li, MD§; Giacomo Bianchi, MD∥; Ho Sung Son, MD, PhD¶; Changfu Wu, PhD⁎; Christopher DeFilippi, MD§; Kai Xu, PhD⁎; William J. Lederer, MD‡; Zhongjun J. Wu, PhD⁎; Bartley P. Griffith, MD⁎

Objectives: This study sought to demonstrate that short-term cardiac unloading with a left ventricular (LV) assist device (LVAD) after acute myocardial infarction (MI) can conserve calcium cycling and improve heart function.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Aortic Arch Rupture. An Uncommon but Fatal Complication During Transcatheter Aortic Valve Implantation

Ziad Dahdouh, MD; Vincent Roule, MD; Thérèse Lognoné, MD; Rémi Sabatier, MD; Gilles Grollier, MD

Nowadays, TAVI has become a popular technique for the management of aortic stenosis. Its indication is limited to symptomatic individuals who are at high surgical risk (1). With the expansion of TAVI worldwide, some life-threatening procedural complications have occurred (2). Severe aortic calcification, which is common in elderly patients, can increase the risk of aortic rupture during TAVI, representing mostly a fatal complication. We thought that the rupture occurred at the time of advancing the delivery system around the aortic arch, because there was some resistance at this level, with clinical manifestation appearing after the device was deployed. Therefore, careful evaluation and selection of the access site should seriously consider the benefit–risk ratio of TAVI and must be discussed on a case-by-case basis.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Closure of Ascending Aorta Pseudoaneurysm to Right Atrium Fistula

Salwa M. Gendi, MD; Damien Kenny, MD; John Hibbeln, MD; Ziyad M. Hijazi, MD, MPH

A 75-year-old man presented with worsening right heart failure on the background of previous supracoronary ascending aortic replacement and bioprosthetic aortic valve replacement for bicuspid aortopathy.

01 abril 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Percutaneous Closure of a Giant Saphenous Vein Graft Aneurysm With an Amplatzer Vascular Plug

Matthew J. Brooks, MBBS⁎; Leeanne Grigg, MBBS⁎; Peter Mitchell, MBBS†; Ravi Iyer, MBBS⁎; Dominica Zentner, MBBS⁎; Ai Vee Ng, MBBS⁎; Ronen Gurvitch, MBBS⁎

A 67-year-old man with scleroderma was diagnosed with a giant (12.1 × 8.2 × 7.9 cm) saphenous vein graft (SVG) aneurysm while undergoing evaluation for dyspnea 15 years post-coronary artery bypass surgery. Computed tomography demonstrated the aneurysm to arise from the SVG supplying the second obtuse marginal just distal to its aortic anastomosis