[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Small-diameter ICD leads Sprint Fidelis and Riata have been recalled owing to an increased risk of lead failure, thus arousing the suspicion that lead size might be a critical issue. OBJECTIVE: to compare the incidence of failure of small-diameter (≤8Fr) and standard-diameter (>8Fr) ICD leads implanted in a single center. METHODS: From January 2003 to December 2010, 190 Sprint Fidelis, 182 Riata/Riata ST, 99 Optim (Riata Optim/Durata) and 419 standard-diameter leads were implanted in our center. RESULTS: During a median follow-up of 33 months, the overall failure rate was 6.3%. Follow-up duration was similar for Sprint Fidelis, Riata and standard-diameter leads, but shorter for the Optim group. The failure rate was significantly higher in Sprint Fidelis leads compared to both standard-diameter (4.8%/year vs. 0.8%/year, P<0.001) and Riata/Riata ST leads (4.8%/year vs. 2.6%/year, P=0.03). The incidence of lead failure in Riata/Riata ST proved significantly higher than in standard-diameter leads (2.6%/year vs. 0.8%/year, P=0.001). No cases of lead failure were recorded in the Optim group. On multivariable analyses, small diameter (HR 5.03, 2.53-10.01, p<0.001), or Sprint Fidelis (HR 6.3, 3.1-13.3, P<0.001), Riata/Riata ST (HR 4.5, 1.9-10.5, P=0.001), and age<60years (HR 2.3, 1.3-4.3, P=0.005), were found to independently increase the risk of lead failure. CONCLUSIONS: Compared to standard-diameter leads, both Sprint Fidelis and Riata/Riata ST small-diameter ICD leads are at increased risk of failure, although the incidence of events is significantly lower in the Riata than in the Sprint Fidelis group.
Heart rhythm: the official journal of the Heart Rhythm Society 10/2012; 10(2). DOI:10.1016/j.hrthm.2012.10.017 · 5.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: Atherosclerotic plaques progress in a highly individual manner. Plaque eccentricity has been associated with a rupture-prone phenotype and adverse coronary events in humans. Endothelial shear stress (ESS) critically determines plaque growth and low ESS leads to high-risk lesions. However, the factors responsible for rapid disease progression with increasing plaque eccentricity have not been studied. We investigated in vivo the effect of local hemodynamic and plaque characteristics on progressive luminal narrowing with increasing plaque eccentricity in humans.
Methods: Three-dimensional coronary artery reconstruction using angiographic and intravascular ultrasound data was performed in 374 patients at baseline (BL) and 6-10 months later (FU) to assess plaque natural history as part of the PREDICTION Trial. A total of 874 coronary arteries were divided into consecutive 3-mm segments. We identified 408 BL discrete luminal narrowings with a throat in the middle surrounded by gradual narrowing proximal and distal to the throat. Local BL ESS was assessed by computational fluid dynamics. The eccentricity index (EI) at BL and FU was computed as the ratio of max to min plaque thickness at the throat. Mixed-effects logistic regression was used to investigate the effect of BL variables on the combined endpoint of substantial worsening of luminal narrowing (decrease in lumen area >1.8 mm2 or >20%) with an increase in plaque EI.
Results: Lumen worsening with an increase in plaque EI was evident in 73 luminal narrowings (18%). Independent predictors of worsening lumen narrowing with plaque EI increase were low BL ESS (<1 Pa) distal to the throat (odds ratio [OR] =2.2 [95% CI: 1.3-3.7]; p=0.003) and large BL plaque burden (>51%) at the throat (OR=1.7 [95% CI: 1.0-2.8]; p=0.051). The incidence of worsening lumen narrowing with increasing plaque eccentricity was 30% in the presence of both predictors versus 15% in luminal narrowings without this combination of characteristics (OR=2.4 [95% CI: 1.4-4.3]; p=0.002).
Conclusions: Low local ESS independently predicts areas with rapidly progressive luminal narrowing and increasing plaque eccentricity. Coronary regions manifesting an abrupt anatomic change, i.e., at highest risk to cause an adverse event, can be identified early by assessment of ESS and plaque burden.
[Show abstract][Hide abstract] ABSTRACT: Aim Conflicting evidence exists as to whether the mitral E/E' ratio can be a reliable predictor of the left ventricular end-diastolic pressure (LVEDP). Our aim was to assess the value of the mitral E/E' ratio for the estimation of left ventricular diastolic pressures (LVDP) in patients without heart failure (HF). METHODS AND RESULTS: Echo-Doppler examination and left heart catheterization were carried out in 100 consecutive patients to assess the correlation between echo-Doppler parameters and the LVDP. The E/A ratio showed the best correlation with the pre-a LVDP and the LVEDP, whereas septal and mean E/E' ratios were significantly correlated with pre-a LVDP but not with the LVEDP. No difference in the echo-Doppler parameters was found between patients with normal and elevated LVEDP. Mitral E/E' ratio was significantly higher in patients with an ejection fraction (EF) <50% compared with those with the EF ≥ 50% and in patients with a dilated left ventricular (LV) compared with those with a normal LV. No significant difference in mean LVEDP was found among the three groups with E/E' ratios of <8, 8-15, and >15. The best cut-off values identified by receiver operating characteristic curve analysis for septal, lateral, and mean E/E' had sensitivities of 53, 68, and 54% and specificities of 66, 51, and 69% for identifying a >15 mmHg LVEDP. CONCLUSION: In patients without HF mitral E/E' ratio is influenced by EF and LV volumes and is better correlated with the pre-a LVDP than with the LVEDP. The suboptimal sensitivity and specificity of E/E' for predicting increased LVDP suggest that the mitral E/E' ratio is of limited clinical value in patients without HF.
[Show abstract][Hide abstract] ABSTRACT: We assessed the clinical profile of patients with acute coronary syndrome (ACS) and nonobstructive coronary artery disease (CAD) in a real world setting, focusing on pattern of care and on prognosis.
Each nonobstructive CAD (<50% stenosis in any epicardial coronary artery) patient was matched with an obstructive CAD patient; adjusted estimates of prescription of guideline-recommended drugs at discharge and of long-term prognosis were evaluated.
Among 2995 consecutive ACS patients who underwent coronary angiography, 125 (4.2%) had nonobstructive CAD. Nonobstructive CAD patients had significantly lower odds of receiving aspirin [odds ratio (OR) 0.31, 95% confidence interval (CI): 0.14-0.68], thienopyridines (OR 0.01, 95% CI: 0.00-0.07), statins (OR 0.31, 95% CI: 0.17-0.58), beta-blockers (OR 0.32, 95% CI: 0.17-0.63) and angiotensin converting enzyme-inhibitors /angiotensin receptor blockers (OR 0.36, 95% CI: 0.17-0.91) compared with matched patients. During a 3-year follow-up, nonobstructive CAD patients had significantly fewer cardiovascular deaths and myocardial infarctions but numerically more episodes of unstable angina.
The prevalence of nonobstructive CAD appears lower (4.2%) compared with published data. After extensive adjustment, patients with nonobstructive CAD were significantly less likely to be treated with guideline-recommended therapy, including aspirin and statins. Multicenter prospective studies targeting this specific population and the potential benefit of guideline-recommended therapies appear warranted.
Journal of Cardiovascular Medicine 07/2011; 12(10):700-8. DOI:10.2459/JCM.0b013e328348e575 · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the correlation between non invasive echo-Doppler parameters of diastolic function and invasively measured end-diastolic left ventricular (LV) filling pressures in patients with normal or depressed LV function.
The patient population was composed of 44 subjects, (34 men and 10 women) 52% with normal ventricular function, who underwent echo-Doppler and hemodynamic evaluation within 24 hours between the two exams.
LV end-diastolic pressure was statistically different (P=0.022) in the 4 subgroups divided on the basis of the mitral flow pattern in the overall population and in the patients with depressed LV function, but not in those with normal LV function. In the overall population LV end-diastolic pressure was significantly correlated with: 1) E/A ratio of mitral flow (r=0.45, P=0.002); 2) mitral E wave peak velocity (r=0.39, P=0.017); 3) isovolumic relaxation time (r=-0.34, P=0.01); 4) left atrial diameter (r=0.33, P=0.037); 5) duration of retrograde A wave of pulmonary venous flow (r=0.33, P=0.03); 6) Pulmonary vein D wave peak velocity (r=0.29, P=0,05). Multivariate analysis showed that the correlation between the echo-Doppler variables and LV end-diastolic pressure was statistically significant only in patients with depressed LV function, but not in those with normal function.
Among the echo-Doppler variables examined, those derived from transmitral flow and pulmonary vein flow show the best correlation with left ventricular end-diastolic pressure; however, the correlation is statistically significant only in patients with depressed LV function. Thus, the echo-Doppler evaluation of LV diastolic function should take into account this limitation and should be based on a multiparametric approach.