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ABSTRACT: AimsEndothelial dysfunction is considered to play a key role in the development of atherosclerosis. However, only a limited number of human imaging studies have been available to demonstrate this hypothesis. The present study used near-infrared spectroscopy (NIRS) to investigate whether coronary endothelial dysfunction is associated with the lipid core plaque (LCP) in patients with early coronary artery disease.Methods and resultsA total of 32 patients with chest pain who had diameter stenosis <30% were enrolled. All patients underwent coronary endothelial function assessment using intracoronary acetylcholine infusion and NIRS of the proximal left anterior descending artery. The lipid core burden index (LCBI), LCBI/L (LCBI divided by the length of scanned artery), maxLCBI4 mm (maximum value of LCBI for any of the 4-mm segment) and block chemogram (yellow: probability of LCP presence >0.98, tan: 0.84 ≤ P ≤ 0.98, orange: 0.57 ≤ P ≤ 0.84, red: P < 0.57) were measured. The mean percentage of yellow, tan, and orange colour blocks in patients with epicardial endothelial dysfunction was significantly higher than in those with normal epicardial endothelial function (9.5 ± 11.4 vs. 3.1 ± 6.5%, P = 0.042). There was a significant correlation between LCBI (r = -0.460, P = 0.008), LCBI/L (r = -0.453, P = 0.009), and maxLCBI4 mm (r = -0.431, P = 0.014) and the degree of epicardial endothelial function. However, there was no significant correlation between LCBI (r = -0.101, P = 0.58), LCBI/L (r = -0.099, P = 0.59), and maxLCBI4 mm (r = -0.063, P = 0.73) and the degree of microvascular endothelial function.Conclusion
Patients with early coronary artery disease and endothelial dysfunction had a higher lipid content in the vascular wall than patients with normal endothelial function. The result of the present study supports the hypothesis that endothelial dysfunction is associated with pathogenesis of early atherosclerosis.
European Heart Journal 04/2013; · 10.48 Impact Factor
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Circulation Cardiovascular Interventions 02/2013; 6(1):e8. · 6.06 Impact Factor
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ABSTRACT: AIM: The purpose of the current study was to determine if long term treatment with an endothelin-A (ET(A)) receptor antagonist attenuates the progression of coronary plaques in patients with coronary endothelial dysfunction. METHODS: Thirty-five patients with non-obstructive coronary disease and coronary endothelial dysfunction were randomized in a double blind manner to treatment with placebo or ET(A) receptor antagonist Atrasentan (10 mg) for six months. Endothelial function was assessed by the change in coronary blood flow and coronary artery diameter in response to intracoronary acetylcholine. Normalized mean total atheroma volume (TAV(MEAN)), percent atheroma volume (PAV) and changes of atheroma volume were assessed by intravascular ultrasound (IVUS) at baseline and 6-month follow-up. RESULTS: In segments with coronary endothelial dysfunction, there was a significant decrease in normalized TAV(MEAN) and PAV at six months from baseline in the Atrasentan group compared to the placebo group median (IQR) -2.00mm(3) (-7.28, 2.53.) vs 9.11mm(3) (1.23, 14.05), p=0.0024 and 0.955% (-3.43, 1.70) vs 3.85% (-0.39, 14.59) p=0.010. There was no change in normalized TAV or PAV in the segments with normal endothelial function. CONCLUSION: This study demonstrates that 6-month treatment with Atrasentan attenuates progression of coronary plaque in segments with endothelial dysfunction.
International journal of cardiology 01/2013; · 7.08 Impact Factor
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European heart journal cardiovascular Imaging. 12/2012;
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ABSTRACT: Background: Vascular dysfunction is a surrogate marker of early-stage atherosclerosis. Serum leukocyte count is a non-traditional risk factor of cardiovascular (CV) disease and has predictive value for CV outcome. The aim of this study was to investigate the relationship between leukocyte count and peripheral vascular dysfunction. Methods and Results: In this cross-sectional study, 357 individuals without known CV disease and with low Framingham risk (10-year hard coronary heart disease risk <10%) were identified. Vascular function was measured by assessing reactive hyperemia-induced vasodilation (reactive hyperemia index, RHI). In 105 individuals with vascular dysfunction (29.4%), the median leukocyte count was significantly higher than in those with normal RHI (6.4×10(9)/L vs. 6.0×10(9)/L; P=0.04). The neutrophil count was the strongest predictor of impaired vascular function among leukocyte subtypes (odds ratio [OR], 2.70; 95% confidence interval [CI]: 1.58-4.60, P<0.001). In a multivariate logistic regression model, the highest quintile of neutrophil count (OR, 2.36; 95% CI: 1.35-4.12; P=0.003), body mass index (OR, 1.05; 95% CI: 1.01-1.09; P=0.009) and systolic blood pressure (OR, 0.97; 95% CI: 0.97-0.99; P<0.001) were independently predictive for vascular dysfunction. Conclusions: The highest quintile of leukocyte count is independently associated with vascular dysfunction in individuals with low CV risk. This suggests that subclinical inflammation affects vascular function. Leukocyte count may be useful for personalized risk stratification.
Circulation Journal 12/2012; · 3.77 Impact Factor
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Joerg Herrmann,
Ryan J Lennon,
Gregory W Barsness,
Gurpreet S Sandhu, Rajiv Gulati,
Patricia J M Best,
Paul Sorajja,
John F Bresnahan,
Verghese Mathew,
Malcolm R Bell,
Abhiram Prasad
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ABSTRACT: BACKGROUND: HIGH SENSITIVITY C-REACTIVE PROTEIN (HSCRP) HAS BEEN IDENTIFIED AS A PREDICTOR OF ADVERSE CARDIOVASCULAR OUTCOMES. WHETHER HSCRP IS A USEFUL BIOMARKER FOR RISK STRATIFICATION IN CONTEMPORARY PERCUTANEOUS CORONARY INTERVENTION REMAINS UNKNOWN.METHODS AND RESULTS: WE CONDUCTED A PROSPECTIVE STUDY AMONG 513 PATIENTS UNDERGOING NON-EMERGENCY PERCUTANEOUS CORONARY INTERVENTION AND EXAMINED THE RELATIONSHIP BETWEEN PRE- AND POSTPROCEDURAL HSCRP LEVELS AND OUTCOMES. THE PATIENTS WERE DIVIDED ACCORDING TO THE MEDIAN PREPROCEDURAL HSCRP LEVEL (0.3 MG/DL). PATIENTS WITH HIGH HSCRP HAD SIGNIFICANTLY MORE ADVERSE CLINICAL CHARACTERISTICS. PREPROCEDURAL HSCRP LEVEL WAS AN INDEPENDENT PREDICTOR OF PERIPROCEDURAL MYOCARDIAL INFARCTION (ODDS RATIO PER DOUBLING OF HSCRP 1.15 [95% CONFIDENCE INTERVAL, 1.011.31]; P=0.038). UNADJUSTED MORTALITY (29.7% VERSUS 9.9%; P0.001) AND THE COMBINED END POINT OF DEATH OR MYOCARDIAL INFARCTION (36.5% VERSUS 16.0%, P0.001) DURING A FOLLOW-UP OF 5 YEARS WERE MARKEDLY GREATER IN PATIENTS WITH HIGH PREPROCEDURAL HSCRP. SIMILAR RELATIONSHIPS EXISTED FOR POSTPROCEDURAL HSCRP. HOWEVER, AFTER MULTIVARIABLE ADJUSTMENT, NEITHER PREPROCEDURAL HSCRP LEVELS (HAZARD RATIO PER DOUBLING 0.96 [0.92, 1.00]; P=0.066) NOR POSTPROCEDURAL HSCRP LEVELS (HAZARD RATIO 0.98 [0.94, 1.02]; P=0.27) WERE SIGNIFICANTLY ASSOCIATED WITH MORTALITY.CONCLUSIONS: High hsCRP is associated with a greater independent risk of periprocedural myocardial infarction, as defined by the universal definition, but is not an independent determinant of mortality after percutaneous coronary intervention. Our findings suggest that routine measurement of hsCRP in patients undergoing percutaneous coronary intervention in contemporary practice is unlikely to be beneficial.
Circulation Cardiovascular Interventions 12/2012; · 6.06 Impact Factor
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Catheterization and Cardiovascular Interventions 11/2012; 80(6):1023-4. · 2.29 Impact Factor
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Jing Li,
Andreas J Flammer,
Ryan J Lennon,
Rebecca E Nelson, Rajiv Gulati,
Paul A Friedman,
Randal J Thomas,
Nicole P Sandhu,
Qi Hua,
Lilach O Lerman,
Amir Lerman
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ABSTRACT: To assess the effect of the metabolic syndrome (MetS) on endothelial function and compare these findings to those in individuals with a similar burden of traditional cardiovascular (CV) risk factors (≥3) without MetS.
Both MetS and multiple CV risk factors were identified from 1103 individuals who underwent the evaluation of endothelial function at the Mayo Clinic, in Rochester, Minnesota, from July 1, 2000, through July 31, 2011. Endothelial function was measured using digital arterial tonometry by assessing reactive hyperemia-induced vasodilation in one arm and adjusting for changes in the contralateral arm (reactive hyperemia index [RHI]).
A total of 316 individuals with MetS and 210 with multiple risk factors were assessed. Endothelial dysfunction was more pronounced in the MetS group compared with the multiple risk factor group (mean ± SD natural logarithmic RHI, 0.61±0.25 and 0.68±0.28, respectively; P=.006). Leukocyte count (7.00±1.89 × 10(9)/L vs 6.41±1.76 × 10(9)/L, respectively; P=.001) and high-sensitivity C-reactive protein level (1.78±1.53 mg/L vs 1.48±1.42 mg/L, respectively; P=.01) were higher in the MetS group compared with the multiple risk factor group. After adjustment for covariates and 6 traditional CV risk factors in a multivariate regression model, MetS had a significant and independent influence on natural logarithmic RHI (β=-.11; P=.01).
The current study found that individuals with MetS have a higher degree of endothelial dysfunction and inflammation compared with individuals with multiple CV risk factors and may therefore have an increased CV risk beyond the contributions of multiple traditional risk factors.
Mayo Clinic Proceedings 09/2012; 87(10):968-75. · 5.70 Impact Factor
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Catheterization and Cardiovascular Interventions 08/2012; 80(2):281-2. · 2.29 Impact Factor
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ABSTRACT: Background: The absence of coronary artery calcium (CAC) is a marker of very low cardiovascular risk. Endothelial cells may have an effect on the initiation and propagation of arterial calcification. We aimed to identify the relationship between the absence of CAC and endothelial function in individuals without cardiovascular disease and diabetes. Methods and Results: CAC was assessed using electron-beam computed tomography and the calcium score was then computed. Endothelial function was measured by assessing reactive hyperemia-induced vasodilation and expressed by the reactive hyperemia index (RHI). Of 82 patients, 39 had non-detectable calcium (CAC score=0) and 43 had a CAC score >0. In the CAC score=0 group, the prevalence of normal endothelial function was 84.6%, compared to 48.8% in the CAC score >0 group, P=0.001. The absence of CAC was highly correlated with normal endothelial function (γ=0.704, P<0.001). On average, endothelial function was significantly better in the CAC score=0 group than in the CAC score >0 group (RHI 2.2±0.6 vs. 1.8±0.5, P=0.002). In a multivariate logistic regression model, only normal endothelial function (odds ratio [OR] 5.03, 95% confidence interval [CI] 1.55-16.27, P=0.007) and age (years) (OR 0.91, 95% CI 0.86-0.96, P=0.002) were independently associated with the absence of CAC. Conclusions: Normal functional status of the vasculature may be important for the prevention of coronary calcification and may partly account for the low cardiovascular risk of absent CAC. (Circ J 2012; 76: 2705-2710).
Circulation Journal 07/2012; 76(11):2705-10. · 3.77 Impact Factor
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ABSTRACT: Coronary stents, drug-eluting stents in particular, have been linked to coronary epicardial endothelial dysfunction after implantation. However, less is known about their impact on coronary microvascular function and their long-term effects on the vasculature.
We evaluated 71 patients (mean age, 53.0±10.1 years) with chest pain and angiographically nonsignificant coronary artery disease 17.1±17.1 months after left anterior descending coronary artery stenting. Seventy-one age- and sex-matched patients (mean age, 53.0±10.3 years) with chest pain but no prior coronary intervention served as controls. Coronary blood flow in response to the endothelium-dependent vasodilator acetylcholine as well as the microvascular (endothelium-independent) coronary flow reserve in response to intracoronary adenosine were evaluated. Quantitative coronary angiography was used to study epicardial diameter changes to acetylcholine. Microcirculatory function was not significantly different between the stenting and control groups (median [interquartile range] coronary flow reserve, 2.9 [2.5-3.4] versus 3.0 [2.4-3.4] mL/min, P=0.24; change of coronary blood flow, 34.9% [-34.4% to 90.0%] versus 54.7% [-5.6% to 104.6%], P=0.18). Both groups exhibited epicardial endothelial dysfunction (-23.0% [-47.4% to -7.6%] versus -20.0% [-40.0% to 0.0%], P=0.4). Results did not differ between patients with drug-eluting stents (n=46) and patients with bare-metal stents (n=24).
This study demonstrates that in patients with coronary arteries in which a stent has been placed, coronary microcirculatory and epicardial vascular function are not significantly different from that of an age- and sex-matched population with similar symptoms but nonsignificant coronary artery disease.
Circulation Cardiovascular Interventions 07/2012; 5(4):523-9. · 6.06 Impact Factor
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Marysia S Tweet,
Sharonne N Hayes,
Sridevi R Pitta,
Robert D Simari,
Amir Lerman,
Ryan J Lennon,
Bernard J Gersh,
Sherezade Khambatta,
Patricia J M Best,
Charanjit S Rihal, Rajiv Gulati
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ABSTRACT: Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain origin. Clinical features and prognosis remain insufficiently characterized.
A retrospective single-center cohort study identified 87 patients with angiographically confirmed SCAD. Incidence, clinical characteristics, treatment modalities, in-hospital outcomes, and long-term risk of SCAD recurrence or major adverse cardiac events were evaluated. Mean age was 42.6 years; 82% were female. Extreme exertion at SCAD onset was more frequent in men (7 of 16 versus 2 of 71; P<0.001), and postpartum status was observed in 13 of 71 women (18%). Presentation was ST-elevation myocardial infarction in 49%. Multivessel SCAD was found in 23%. Initial conservative management (31 of 87) and coronary artery bypass grafting (7 of 87) were associated with an uncomplicated in-hospital course, whereas percutaneous coronary intervention was complicated by technical failure in 15 of 43 patients (35%) and 1 death. During a median follow-up of 47 months (interquartile range, 18-106 months), SCAD recurred in 15 patients, all female. Estimated 10-year rate of major adverse cardiac events (death, heart failure, myocardial infarction, and SCAD recurrence) was 47%. Fibromuscular dysplasia of the iliac artery was identified incidentally in 8 of 16 femoral angiograms (50%) undertaken before closure device placement and in the carotid arteries of 2 others with carotid dissection.
SCAD affects a young, predominantly female population, frequently presenting as ST-elevation myocardial infarction. Although in-hospital mortality is low regardless of initial treatment, percutaneous coronary intervention is associated with high rates of complication. Risks of SCAD recurrence and major adverse cardiac events in the long term emphasize the need for close follow-up. Fibromuscular dysplasia is a novel association and potentially causative factor.
Circulation 07/2012; 126(5):579-88. · 14.74 Impact Factor
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ABSTRACT: Aortic valve replacement in the setting of critical aortic valve stenosis with cardiogenic shock is associated with high mortality, yet surgery is the only definitive treatment. We present the case of a patient with critical aortic valve stenosis and cardiogenic shock who received a short period of percutaneous mechanical support and balloon aortic valvuloplasty that resulted in rapid clinical improvement. The patient then underwent uneventful aortic valve replacement. We believe that temporary mechanical circulatory support coupled with balloon aortic valvuloplasty helped to restore hemodynamic stability before surgery, leading to a better outcome.
Heart Surgery Forum 06/2012; 15(3):E177-9. · 0.63 Impact Factor
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Yoshiki Matsuo,
Takuro Takumi,
Verghese Mathew,
Woo-Young Chung,
Gregory W Barsness,
Charanjit S Rihal, Rajiv Gulati,
Eric T McCue,
David R Holmes,
Eric Eeckhout,
Ryan J Lennon,
Lilach O Lerman,
Amir Lerman
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ABSTRACT: Few studies have examined plaque characteristics among multiple arterial beds in vivo. The purpose of this study was to compare the plaque morphology and arterial remodeling between coronary and peripheral arteries using gray-scale and radiofrequency intravascular ultrasound (IVUS) at clinical presentation.
IVUS imaging was performed in 68 patients with coronary and 93 with peripheral artery lesions (29 carotid, 50 renal, and 14 iliac arteries). Plaques were classified as fibroatheroma (VH-FA) (further subclassified as thin-capped [VH-TCFA] and thick-capped [VH-ThCFA]), fibrocalcific plaque (VH-FC) and pathological intimal thickening (VH-PIT). Plaque rupture (13% of coronary, 7% of carotid, 6% of renal, and 7% of iliac arteries; P = NS) and VH-TCFA (37% of coronary, 24% of carotid, 16% of renal, and 7% of iliac arteries; P = 0.02) were observed in all arteries. Compared with coronary arteries, VH-FA was less frequently observed in renal (P < 0.001) and iliac arteries (P < 0.006). Lesions with positive remodeling demonstrated more characteristics of VH-FA in coronary (84% vs. 25%, P < 0.001), carotid (72% vs. 20%, P = 0.001), and renal arteries (42% vs. 4%, P = 0.001) compared with those with intermediate/negative remodeling. There was positive relationship between remodeling index and percent necrotic area in all four arteries.
Atherosclerotic plaque phenotypes were heterogeneous among four different arteries; renal and iliac arteries had more stable phenotypes compared with coronary artery. In contrast, the associations of remodeling pattern with plaque phenotype and composition were similar among the various arterial beds.
Atherosclerosis 05/2012; 223(2):365-71. · 3.79 Impact Factor
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ABSTRACT: Clinical outcomes after stent placement in patients with a history of metal allergy remain incompletely understood. We performed a single-center retrospective study to evaluate such outcomes.
Twenty-nine allergic patients who underwent coronary stent implantation were compared with a nonallergic group (n=250) matched for demographics and a propensity score for allergy to metal. Hypersensitivity to nickel was reported in 26 of 29 and chromium in 9 of 29. Patch testing performed in 11 of 29 patients was positive in all. Comparing allergy versus control subjects, there were no differences in number of segments treated (1.4±0.7 versus 1.5±0.7), stents placed (1.7±1.1 versus 1.6±0.9), and frequency of drug-eluting stent usage (52% versus 60%). In-hospital death (0% versus 0%), myocardial infarction (MI, 4% versus 3%, P=0.27), and 30-day death (3% versus 0%, P=0.53) and MI (3% versus 4%, P=0.71) were statistically similar. There were no differences in 4-year death (12% versus 13%), target lesion revascularization (TLR, 13 versus 17%, P=0.54), or death/MI/TLR (24% versus 34%, P=0.20). Clinically driven repeat angiography in 12 of 29 allergy patients revealed binary restenosis rates of 27% in bare metal stents and 0% in drug-eluting stents, with mean diameter in-stent restenosis of 36% and 8%, respectively. There was no change in circulating eosinophil and lymphocyte counts after stenting in the allergy group (0.19-0.20, P=0.67, and 1.90-1.79, P=0.59, respectively).
A history of metal allergy was not associated with adverse early or late outcomes in this single-center study.
Circulation Cardiovascular Interventions 03/2012; 5(2):220-6. · 6.06 Impact Factor
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ABSTRACT: This study sought to determine whether procedural factors during percutaneous coronary intervention (PCI) are associated with the occurrence of ischemic stroke or transient ischemic attack (PCI-stroke).
Stroke is a devastating complication of PCI. Demographic predictors are nonmodifiable. Whether PCI-stroke is associated with procedural factors, which may be modifiable, is unknown.
We performed a single-center retrospective study of 21,497 PCI hospitalizations between 1994 and 2008. We compared procedural factors from patients who suffered an ischemic stroke or transient ischemic attack related to PCI (n=79) and a control group (n=158), and matched them 2:1 based on a predicted probability of stroke developed from a logistic regression model.
PCI-stroke procedures involved the use of more catheters (median: 3 [quarter (Q) 1, Q3: 3, 4] vs. 3 [Q1, Q3: 2, 3], p<0.001), greater contrast volumes (250 ml vs. 218 ml, p=0.006), and larger guide caliber (median: 7-F [Q1, Q3: 6, 8] vs. 6-F [Q1, Q3: 6, 8], p<0.001). The number of lesions attempted (1.7±0.8 vs. 1.5±0.8, p=0.14) and stents placed (1.4±1.2 vs. 1.2±1.1, p=0.35) were similar between groups, but PCI-stroke patients were more likely to have undergone rotational atherectomy (10% vs. 3%, p=0.029). Overall procedural success was lower in the PCI-stroke group compared with controls (71% vs. 85%, p=0.017). Evaluation of the entire PCI population revealed no difference in the rate of PCI-stroke between radial and femoral approaches (0.4% vs. 0.4%, p=0.78).
Ischemic stroke related to PCI is associated with potentially modifiable technical parameters. Careful procedural planning is warranted, particularly in patients at increased risk.
02/2012; 5(2):200-6. · 1.07 Impact Factor
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Peter J Psaltis,
Adriana Harbuzariu,
Sinny Delacroix,
Tyra A Witt,
Eric W Holroyd,
Daniel B Spoon,
Scott J Hoffman,
Shuchong Pan,
Laurel S Kleppe,
Cheryl S Mueske, Rajiv Gulati,
Gurpreet S Sandhu,
Robert D Simari
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ABSTRACT: Hematopoiesis originates from the dorsal aorta during embryogenesis. Although adult blood vessels harbor progenitor populations for endothelial and smooth muscle cells, it is not known if they contain hematopoietic progenitor or stem cells. Here, we hypothesized that the arterial wall is a source of hematopoietic progenitor and stem cells in postnatal life.
Single-cell aortic disaggregates were prepared from adult chow-fed C57BL/6 and apolipoprotein E-null (ApoE(-/-)) mice. In short- and long-term methylcellulose-based culture, aortic cells generated a broad spectrum of multipotent and lineage-specific hematopoietic colony-forming units, with a preponderance of macrophage colony-forming units. This clonogenicity was higher in lesion-free ApoE(-/-) mice and localized primarily to stem cell antigen-1-positive cells in the adventitia. Expression of stem cell antigen-1 in the aorta colocalized with canonical hematopoietic stem cell markers, as well as CD45 and mature leukocyte antigens. Adoptive transfer of labeled aortic cells from green fluorescent protein transgenic donors to irradiated C57BL/6 recipients confirmed the content of rare hematopoietic stem cells (1 per 4 000 000 cells) capable of self-renewal and durable, low-level reconstitution of leukocytes. Moreover, the predominance of long-term macrophage precursors was evident by late recovery of green fluorescent protein-positive colonies from recipient bone marrow and spleen that were exclusively macrophage colony-forming units. Although trafficking from bone marrow was shown to replenish some of the hematopoietic potential of the aorta after irradiation, the majority of macrophage precursors appeared to arise locally, suggesting long-term residence in the vessel wall.
The postnatal murine aorta contains rare multipotent hematopoietic progenitor/stem cells and is selectively enriched with stem cell antigen-1-positive monocyte/macrophage precursors. These populations may represent novel, local vascular sources of inflammatory cells.
Circulation 12/2011; 125(4):592-603. · 14.74 Impact Factor
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Takuro Takumi,
Verghese Mathew,
Gregory W Barsness,
Tetsuro Kataoka,
Ronen Rubinshtein,
Charanjit S Rihal, Rajiv Gulati,
Eric Eeckhout,
Ryan J Lennon,
Lilach O Lerman,
Amir Lerman
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ABSTRACT: To evaluate the effect of plaque composition on renal function after renal artery intervention (RAI).
In 33 consecutive patients with atherosclerotic renal artery stenosis (enrolled between January 1, 2007, and April 30, 2009), renal angiography, pressure gradients across the lesion, and intravascular ultrasonography (IVUS) with virtual histology (VH)-derived plaque characteristics were assessed. In 25 patients who underwent RAI, estimated glomerular filtration rate (eGFR) was evaluated at baseline and at 3 months.
Mean pressure gradients across the lesion were poorly associated with baseline eGFR (r=-0.37; P=.07). In gray scale IVUS data, only remodeling index was significantly correlated with baseline eGFR (r=-0.38; P=.03). Plaque components classified by VH-IVUS had no correlation with baseline eGFR. During follow-up of 25 patients, the improvement in eGFR after RAI was observed in 9 patients, unchanged in 3, and deteriorated in 13. Overall, follow-up eGFR (median, 49.0 mL/min/1.73 m(2); interquartile range [IQR], 40.6-63.9 mL/min/1.73 m(2)) was unchanged compared with baseline eGFR (median, 53.8 mL/min/1.73 m(2); IQR, 41.4-63.4 mL/min/1.73 m(2); P=.38). The percent change in eGFR (median, -0.2%; IQR, -16.0% to 16.0%) after RAI had a significant negative correlation with the mean percentage of necrotic core classified by VH-IVUS (r=-0.47; P=.02), and the mean percentage of necrotic core was significantly larger in patients with deterioration of eGFR than in patients without deterioration of eGFR (median, 12.7%; IQR, 9.5%-19.5%; vs median, 8.3%; IQR, 5.5%-11.6%; P=.04).
In patients with atherosclerotic renal artery stenosis, the change in eGFR after RAI was related to plaque composition classified by VH-IVUS. The evaluation of plaque composition may provide more insights into the change in renal function after RAI.
Mayo Clinic Proceedings 12/2011; 86(12):1165-72. · 5.70 Impact Factor
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ABSTRACT: The Cox Maze III procedure has been simplified with the availability of tissue ablation devices; however, complications related to their use are recognized. We report a case of 45-year-old woman who underwent mitral valve repair and concomitant Cryo-Maze procedure. She had reversible right coronary artery spasm develop after the procedure demonstrated by ST-segment elevation changes and coronary angiography, which was reversed with intracoronary nitroglycerin. The region of spasm suggested it as a consequence of proximity of the right coronary artery to the right atrial ablation lines.
The Annals of thoracic surgery 11/2011; 92(5):1884-7. · 3.74 Impact Factor
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ABSTRACT: Transradial access for coronary intervention is associated with reduced access complications compared with transfemoral. Transradial access for renal artery intervention has been less well studied. Safety compared with transfemoral access is undetermined.
We evaluated the feasibility of transradial renal intervention (n = 11 patients) and compared safety parameters with a matched group of transfemoral controls (n = 44). All transradial interventions were successful with no complications. Femoral crossover was required in one due to insufficient guide length. Compared with transfemoral, there were fewer access complications in the transradial group (0 of 11 vs 3 of 44, P = .06) but no differences in fluoroscopy time or contrast volumes (25.3 ± 14.4 vs 29.0 ± 25.1 minutes, P = .47; 83.0 ± 43.7 vs 82.6 ± 35.2 cc, P = .97). At follow-up (median 6 months), radial patency was 100%. Creatinine and systolic blood pressure had decreased (mean 1.4 ± 0.5 to 1.2 ± 0.5, P = .06; 160 ± 25 to 135 ± 17, P = .009).
Elective transradial renal intervention is feasible and safe. Radial-renal distance is a limitation with available guides.
Vascular and Endovascular Surgery 09/2011; 45(8):738-42. · 0.99 Impact Factor
