Abstract: The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardialperfusionimaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted.
Transradial approach (TRA) is the default access site for diagnostic angiography and intervention in many centers. Repeat ipsilateral radial artery access late after index procedure has been associated with failures. It is unknown whether early (≤30 days) and very early (<24 hours) repeat radial access is technically feasible and safe. Study population consisted of consecutive patients undergoing repeat (≥2) procedures within 30 days in a high-volume TRA center. Transradial access failure and resulting femoral approach was categorized as primary (no repeat attempt) or secondary (crossover). Timing of repeat access and reasons for failure were recorded. From November 2012 to December 2014, repeat catheterization by TRA was performed twice in 573 of 626 patients (92%) (median delay 4 [2 to 9] days), 3 times in 29 of 38 (76%) patients (median delay 15 [5 to 26] days), and 4 times in 1 patient within 21 days. When repeat catheterization occurred during the first 24 hours following the index procedure, 53% and 75% of patients had second and third procedures using the same ipsilateral radial artery, respectively. Primary radial failure occurred in 5.8% for second attempt and 13% for a third attempt, whereas crossovers were noted in 2.7% and 2.6%, respectively. Main reasons for failed re-access of ipsilateral radial artery were related either to operator's reluctance to repeat attempt (primary failure) or to issues with puncture site (crossover). In a high-volume TRA center, patients who required repeat catheterization within 24 hours and within the first 30 days had the same radial artery re-accessed in the majority of cases.
Abstract: Transradial access for coronaryangiography and intervention is preferred over the femoral approach but can ... years, 64% male) in whom transradial access was attempted for coronaryangiography or intervention to identify predictors of transradial access failure... age, and smaller height independently predict transradial access failure in coronaryangiography and intervention.
Patients with continuous-flow left ventricular assist devices (LVADs) are at elevated risk of developing ventricular arrhythmias (VA), which can result in right ventricular dysfunction and abnormal LVAD function. Predictors of postoperative VA after LVAD placement are unclear. We hypothesized that global left ventricular circumferential strain (LVCS), a marker of transmural impairment in myocardial function, would independently predict postoperative VA in patients who underwent LVAD implantation. We studied 98 consecutive patients (57 ± 11 years, 83% men) who underwent HeartMate II axial flow LVAD placement. Speckle tracking-derived global circumferential strain was assessed from mid-left ventricular short-axis images. The primary composite end point was defined as any ventricular tachycardia that required intervention (anti-arrhythmic medication, cardioversion, implantable cardioverter defibrillator placement, implantable cardioverter defibrillator shock) or any ventricular fibrillation. A total of 33 patients (34%) experienced the primary end point (median follow-up: 7 months). Reduced LVCS was statistically significantly related to the primary end point (hazard ratio 1.77, 95% confidence interval 1.09 to 2.87 per 1 standard deviation reduction in LVCS, p = 0.02). LVCS above a cut-off value of -9.7% was associated with significantly reduced arrhythmia-free survival (log-rank p = 0.001). In conclusion, global LVCS is an independent predictor of ventricular arrhythmias after LVAD placement.
Cardiac Arrhythmia (4), Tachycardia (1), Ventricular Fibrillation (1), more mentions
AbstractText: To assess the agreement between transpulmonary thermodilution (TPT) and critical care echocardiography (CCE) in ventilated septic shock patients AbstractText: Ventilated patients in sinus rhythm requiring advanced hemodynamic assessment for septic shock were included in this prospective multicenter descriptive study... Keyword: echocardiography. Keyword: hemodynamic. Keyword: thermodilution.
... occlusion alone but with a higher threshold, which might be more compatible with the precision of echocardiography AbstractText: Diagnostic study AbstractText: Medical ICU AbstractText: Thirty mechanically ventilated patients in whom fluid administration was ... This threshold is more compatible with the precision of echocardiography than that obtained by end-expiratory occlusion alone.
CitationSubset: AIM. CitationSubset: IM. DescriptorName: Cardiology Service, Hospital. DescriptorName: Cardiovascular Diseases. DescriptorName: Echocardiography. DescriptorName: Female. DescriptorName: Follow-Up Studies. DescriptorName: Guideline Adherence. DescriptorName: Humans. DescriptorName: Male. DescriptorName: Practice Patterns, Physicians'. DescriptorName: Prospective Studies. DescriptorName: Single-Blind Method. AbstractText: Appropriate use criteria (AUC) have defined transthoracic echocardiogram (TTE) indications for which there is a clear lack of benefit as rarely appropriate ...
Cardiovascular Diseases (1) Cardiovascular Diseases (1), more mentions
Invasive coronaryangiography (ICA) with measurement of fractional flow reserve (FFR) by means of ... However, the solely anatomic assessment provided with both coronaryCT angiography and ICA has poor discriminatory power for ischemia-inducing lesions ... FFR derived from standard coronaryCT angiography (FFRCT) data sets by using any of several advanced computational ...
BACKGROUND: Coronary computed tomography angiography (CTA) and functional testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety.
METHODS: We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and functional testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other functional tests if randomized to the functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose.
RESULTS: Of 9470 patients, none had major and <1% had minor complications (CTA: 0.8% [37/4633] vs. functional: 0.6% [27/4837]). CTA identified more incidental findings (11.6% [539/4633] vs. 0.7% [34/4837], p < 0.001), most commonly pulmonary nodules (9.4%, 437/4633). CTA had similar 90-day cumulative radiation dose to functional testing. However, in the subgroup whose physicians intended nuclear stress (CTA 3147; nuclear 3203), CTA had lower median index test (8.8 vs. 12.6 mSv, p < 0.001) and 90-day cumulative (11.6 vs. 13.1 mSv, p < 0.001) dose, independent of patient characteristics. The lowest nuclear doses employed 1-day Tc-99m protocols (12.2 mSv). The lowest CTA doses were at sites performing ≥500 CTAs/year (6.9 mSv) and with advanced (latest available) CT scanners (5.5 mSv).
CONCLUSION: Complications were negligibly rare for both CTA and functional testing. CTA detects more incidental findings. Compared to nuclear stress testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550).
... patients with acute coronary syndromes to percutaneous coronary interventions (PCIs) or coronary artery bypass grafting (CABG) and, furthermore, to study gender differences in complications and mortality AbstractText: All consecutive coronaryangiographies (CAs) and PCIs performed in Sweden and Iceland are prospectively registered in the Swedish CoronaryAngiography and Angioplasty Registry.
Pathologic Constriction (1), Coronary Artery Disease (1), more mentions
AbstractText: To evaluate the diagnostic and prognostic benefits of CTcoronaryangiography (CTCA) using the 2016 National Institute for Health and Care ... invasive angiography (p=0.481) but markedly reduced rates of normal coronaryangiography (HR 0.32 (0.19 to 0.52), p <0.001... 1.13 to 2.92), p=0.014) without reducing rates of normal coronaryangiography (HR 0.78 (0.30 to 2.05), p=0.622.
AbstractText: Transvenous lead extraction (TLE) carries a significant risk of intraprocedural complications. Phased-array intracardiac echocardiography (ICE) is widely used during cardiac procedures; however, its utility during TLE has not been well described AbstractText: We sought to define the utility of ICE imaging during TLE AbstractText: Fifty patients referred for TLE were included... Keyword: Intracardiac echocardiography. Keyword: Lead binding sites.