MD, PhD, FESC
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Publications citing this author (3792)
[Show abstract] [Hide abstract] ABSTRACT: There is a relationship between patients with chronic kidney disease and coronary artery disease. These two entities share both common etiologies and risk factors. Management of different patients with coronary artery disease in the aspect of renal insufficiency and certain medications such as contrast media is thus of high importance. Treatment nihilism is a major problem though and healthcare providers must make efforts to maintain a stable kidney function in all coronary artery disease patients. Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/5430077/Activity.aspx
- Although, there is not enough data in the literature for patients with severe kidney failure, current ESC guidelines do not preclude class effectiveness of b-blocking drugs in MI or HF settings[15,17,28]. Nebivolol and bisoprolol have mostly renal metabolism in contrary to carvedilol and metoprolol that are mostly metabolized by the liver and so preference of the later should be considered in CKD settings.
- Recently a loading dose of 600 mg clopidogrel [before percutaneous coronary interventions (PCI)] was found to acutely prolong CADP-CT 2–3-fold within 24 h . Similarly, a prolongation of CT values could be seen only after a loading dose of 300 mg clopidogrel, but not with the maintenance dose of 75 mg in such patients during the first 5 days of treatment . Our data now extend these observations for the 75-mg dose to a stroke population with a longer duration of observation.
[Show abstract] [Hide abstract] ABSTRACT: In 2007, the Society for Cardiovascular Angiography and Interventions (SCAI) published an Expert Consensus Document titled “The Current Status and Future Direction of Percutaneous Coronary Intervention without On-Site Surgical Backup.”1 This document summarized the available data on the performance of percutaneous coronary intervention (PCI) without on-site surgery in the United States (US), reviewed the existing literature, examined the recommendations for the performance of PCI in this setting from several professional organizations abroad and from experienced programs in the US, defined the best practices for facilities engaged in PCI without on-site surgery and made recommendations for the future role of PCI without on-site surgery. Since publication of that document, new studies, meta-analyses, and randomized trials have been published comparing PCI with and without on-site surgery. In addition, the total number of PCIs performed annually has decreased, reports about the overuse of PCI have emerged, and appropriate use criteria for coronary revascularization have been published. A noteworthy change occurred in the 2011 PCI guideline in which elective PCI was upgraded to Class IIb and primary PCI was upgraded to Class IIa at facilities without on-site surgery.2 Several tables on the structure and operation of programs without on-site surgery from the 2007 SCAI Expert Consensus Document were used in the 2011 PCI guideline recommendations. Finally, new updates of the ACCF/SCAI Expert Consensus Document on Cardiac Catheterization Laboratory Standards and the ACCF/AHA/SCAI Clinical Competence in Coronary Artery Interventional Procedures have been published.3,4 Although many of the concerns about the safety of PCI without on-site surgery have been resolved, there are new issues to consider as the delivery of PCI continues to evolve in the US. Accordingly, the SCAI, ACCF, and AHA have engaged in this effort to reevaluate the current status of PCI without on-site surgery in the US. …
- ID: jwweb3b2server Time: 23:30 I Path: D:/JW/Support/Printer_Autopdf/3D_IN/JW-CCD#140015 PCI Without On-Site Surgery(CSANZ), the Spanish Society of Cardiology, the Brazilian Society of Hemodynamics and Interventional Cardiology (Sociedade Brasileira de Hemodinamica e Cardiologia Intervencionista) and from several other countries313233343536373839. Since 2007, only the guidelines from CSANZ have been updated, most recently in 2011 .
[Show abstract] [Hide abstract] ABSTRACT: Background/objectives: Citrus and its peels have been used in Asian folk medicine due to abundant flavonoids and usage of citrus peels, which are byproducts from juice and/or jam processing, may be a good strategy. Therefore, the aim of this study was to examine antioxidant and anti-inflammatory effects of bioconversion of Jeju Hallabong tangor (Citrus kiyomi × ponkan; CKP) peels with cytolase (CKP-C) in RAW 264.7 cells. Materials/methods: Glycosides of CKP were converted into aglycosides with cytolase treatment. RAW 264.7 cells were pre-treated with 0, 100, or 200 µg/ml of citrus peel extracts for 4 h, followed by stimulation with 1 µg/ml lipopolysaccharide (LPS) for 8 h. Cell viability, DPPH radical scavenging activity, nitric oxide (NO), and prostagladin E2 (PGE2) production were examined. Real time-PCR and western immunoblotting assay were performed for detection of mRNA and/or protein expression of pro-inflammatory mediators and cytokines, respectively. Results: HPLC analysis showed that treatment of CKP with cytolase resulted in decreased flavanone rutinoside forms (narirutin and hesperidin) and increased flavanone aglycoside forms (naringenin and hesperetin). DPPH scavenging activities were observed in a dose-dependent manner for all of the citrus peel extracts and CKP-C was more potent than intact CKP. All of the citrus peel extracts decreased NO production by inducible nitric oxide synthase (iNOS) activity and PGE2 production by COX-2. Higher dose of CKP and all CKP-C groups significantly decreased mRNA and protein expression of LPS-stimulated iNOS. Only 200 µg/ml of CKP-C markedly decreased mRNA and protein expression of cyclooxygenase-2 in LPS-stimulated RAW 264.7 cells. Both 100 and 200 µg/ml of CKP-C notably inhibited mRNA levels of interleukin-1β (IL-1β) and IL-6, whereas 200 µg/ml CKP-C significantly inhibited mRNA levels of TNF-α. Conclusions: This result suggests that bioconversion of citrus peels with cytolase may enrich aglycoside flavanones of citrus peels and provide more potent functional food materials for prevention of chronic diseases attributable to oxidation and inflammation by increasing radical scavenging activity and suppressing pro-inflammatory mediators and cytokines.
- Therefore, these results suggest that bioconversion of CKP with cytolase may contribute to a more potent anti-inflammatory agent by more suppression of NO by iNOS rather than PGE2 by COX-2, which are associated with anti-inflammatory regulation in LPS-stimulated RAW 264.7 cells. Activated macrophages and lymphocytes secrete pro-inflammatory cytokines and control the inflammatory responses to inflammatory diseases [1,2,26]. Because iNOS and COX-2 are induced by pro-inflammatory cytokines, we examined mRNA levels of IL-1β, IL-6, and TNF-α in LPS-stimulated RAW 264.7 cells.
[Show abstract] [Hide abstract] ABSTRACT: The arginine metabolite asymmetric dimethylarginine (ADMA) is a competitive inhibitor and uncoupler of endothelial nitric oxide synthase (eNOS), an enzyme that acts in multifarious ways to promote cardiovascular health. This phenomenon likely explains, at least in part, why elevated ADMA has been established as an independent risk factor for cardiovascular events, ventricular hypertrophy, and cardiovascular mortality. Fortunately, the suppressive impact of ADMA on eNOS activity can be offset by increasing intracellular arginine levels with supplemental citrulline. Although the long-term impact of supplemental citrulline on cardiovascular health in patients with elevated ADMA has not yet been studied, shorter-term clinical studies of citrulline administration demonstrate effects suggestive of increased NO synthesis, such as reductions in blood pressure and arterial stiffness, improved endothelium-dependent vasodilation, increased erection hardness, and increased ejection fractions in patients with heart failure. Supplemental citrulline could be a practical option for primary or secondary prevention of cardiovascular events and mortality, as it is inexpensive, has a mild flavor, and is well tolerated in doses (3-6 g daily) that can influence eNOS activity. Large and long-term clinical trials, targeting patients at high risk for cardiovascular events in whom ADMA is elevated, are needed to evaluate citrulline's potential for aiding cardiovascular health.
- Secondly, folate dose-dependently boosts endothelial expression of dihydrofolate reductase, which not only functions in folate metabolism, but also efficiently re-reduces BH2 to BH4, boosting the ratio of BH4 to BH2 and hence promoting recoupling of eNOS . Recoupling of eNOS with high-dose folate has been demonstrated in both clinical and rodent studies [74,. Intriguingly, several decades ago, cardiologist Kurt Oster reported that folate supplementation at 40–80 mg daily provided marked benefit in angina and intermittent claudication, without side effects; unfortunately, he did not attempt controlled trials, and his claims were largely ignored .
- Ticagrelor is a novel, potent, direct P2Y12 antagonist with rapid onset of action and intense, consistent platelet reactivity inhibition . In patients with ACS ticagrelor was superior to clopidogrel in decreasing major adverse cardiac events . Therefore, ticagrelor (together with another P2Y12 inhibitor prasugrel) is preferred over clopidogrel , and is widely used in the setting of ACS.
[Show abstract] [Hide abstract] ABSTRACT: Background Recently, 1.5-Tesla cardiac magnetic resonance imaging (CMR) was reported to provide a reliable alternative to transthoracic echocardiography (TTE) for the quantification of aortic stenosis (AS) severity. Few data are available using higher magnetic field strength MRI systems in this context. Aims To evaluate the feasibility and reproducibility of the assessment of aortic valve area (AVA) using 3-Tesla CMR in routine clinical practice, and to assess concordance between TTE and CMR for the estimation of AS severity. Methods Ninety-one consecutive patients (60 men; mean age 74 ± 10 years) with known AS documented by TTE were included prospectively in the study. Results All patients underwent comprehensive TTE and CMR examination, including AVA estimation using the TTE continuity equation (0.81 ± 0.18 cm²), direct CMR planimetry (CMRp) (0.90 ± 0.22 cm²) and CMR using Hakki's formula (CMRhk), a simplified Gorlin formula (0.70 ± 0.19 cm²). Although significant agreement with TTE was found for CMRp (r = 0.72) and CMRhk (r = 0.66), CMRp slightly overestimated (bias = 0.11 ± 0.18 cm²) and CMRhk slightly underestimated (bias = –0.11 ± 0.17 cm²) AVA compared with TTE. Inter- and intraobserver reproducibilities of CMR measurements were excellent (r = 0.72 and r = 0.74 for CMRp and r = 0.88 and r = 0.92 for peak aortic velocity, respectively). Conclusion 3-Tesla CMR is a feasible, radiation-free, reproducible imaging modality for the estimation of severity of AS in routine practice, knowing that CMRp tends to overestimate AVA and CMRhk to underestimate AVA compared with TTE.
- Aortic annulus measurement is critical for patient selection and successful percutaneous valve implantation. Recent data showed that CMR could provide accurate assessment of aortic root and annulus [28,29] . In an in vitro model, CMR measurements were the most accurate for assessing the actual dimensions of the aortic ring compared with computed tomography and three-dimensional TTE .
[Show abstract] [Hide abstract] ABSTRACT: Exact quantification of plaque extension during coronary angioplasty (PCI) usually falls on interventional cardiologist (IC). Quantitative coronary stenosis assessment (QCA) may be possibly committed to the radiology technician (RT), who usually supports cath-lab nurse and IC during PCI. We therefore sought to investigate the reliability of QCA performed by RT in comparison with IC. Forty-four consecutive patients with acute coronary syndrome underwent PCI; target coronary vessel size beneath target coronary lesion (S) and target coronary lesion length (L) were assessed by the RT, junior IC (JIC), and senior IC (SIC) and then compared. SIC evaluation, which determined the final stent selection for coronary stenting, was considered as a reference benchmark. RT performance with QCA support in assessing target vessel size and target lesion length was not significantly different from SIC (r = 0.46, p < 0.01; r = 0.64, p < 0.001, respectively) as well as JIC (r = 0.79, r = 0.75, p < 0.001, respectively). JIC performance was significantly better than RT in assessing target vessel size (p < 0.05), while not significant when assessing target lesion length. RT may reliably assess target lesion by using adequate QCA software in the cath-lab in case of PCI; RT performance does not differ from SIC.
- Further improvements were made in third generation systems which took advantage of images from new digital fl at-panel detectors instead of the conventional image intensifi er systems. This latest system is better able to determine smaller diameter vessels  and analyse complex lesion morphology with irregular borders . Despite a widely showed reliability of QCA software, there is discrepancy between visual estimation and computer-assisted measurement of lesion severity .
[Show abstract] [Hide abstract] ABSTRACT: We present a rare case of a 74 year old female with unruptured aneurysm of the left coronary sinus of Valsalva accompanied with patent foramen ovale and atrial fibrillation. This rare combination was detected during diagnostics for a cardiac etiology stroke. The left coronary sinus of Valsalva was reconstructed using an autologous pericardial patch, the left atrial appendage closed, left atrial ablation performed with cooled radiofrequency and the patent foramen ovale sutured directly. The patient was dismissed on the 12th postoperative day after having an uncomplicated postoperative course.
- The preferred surgical approach may be aortotomy, atriototomy or ventriculotomy. The reported postoperative results of SVA surgery have been excellent[1,2].
[Show abstract] [Hide abstract] ABSTRACT: Abstract OBJECTIVES: There is still little evidence to boldport routine dual antiplatelet therapy (DAPT) with P 2 Y 12 antagonists following coronary artery bypass grafting (CABG). The Arterial Revascularization Trial (ART) was designed to compare 10-year survival after bilateral versus single internal thoracic artery grafting. We aimed to get insights into the effect of DAPT (with clopidogrel) following CABG on 1-year outcomes by performing a post hoc ART analysis. METHODS: Among patients enrolled in the ART ( n = 3102), 609 (21%) and 2308 (79%) were discharged on DAPT or aspirin alone, respectively. The primary end-point was the incidence of major adverse cerebrovascular and cardiac events (MACCE) at 1 year including cardiac death, myocardial infarction, cerebrovascular accident and reintervention; safety end-point was bleeding requiring hospitalization. Propensity score (PS) matching was used to create comparable groups. RESULTS: Among 609 PS-matched pairs, MACCE occurred in 34 (5.6%) and 34 (5.6%) in the DAPT and aspirin alone groups, respectively, with no significant difference between the 2 groups [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.59-1.59; P = 0.90]. Only 188 (31%) subjects completed 1 year of DAPT, and in this subgroup, MACCE rate was 5.8% (HR 1.11, 95% CI 0.53-2.30; P = 0.78). In the overall sample, bleeding rate was higher in DAPT group (2.3% vs 1.1%; P = 0.02), although this difference was no longer significant after matching (2.3% vs 1.8%; P = 0.54). CONCLUSIONS: Based on these findings, when compared with aspirin alone, DAPT with clopidogrel prescribed at discharge was not associated with a significant reduction of adverse cardiac and cerebrovascular events at 1 year following CABG. KEYWORDS: Bleeding; Coronary artery bypass grafting ; Dual antiplatelet therapy PMID: 28387790 DOI: 10.1093/ejcts/ezx075
- Prasugrel and ticagrelor were approved for use in Europe in 2009 and 2010, respectively, and the question whether DAPT with newer P 2 Y 12 antagonists is more effective remains to be determined. Of note, a recent meta-analysisincluding 4 CABG subgroups ACS randomized controlled trials(n = 3901) and 5 post-elective CABG trials(n = 986) concluded that DAPT resumption with higher intensity P 2 Y 12 antagonists (prasugrel or ticagrelor), but not clopidogrel, reduces all-cause mortality in ACS patients who have undergone CABG. In the ART, the vast majority of patients with prior MI within 1 year were discharged on aspirin alone in contrast with current recommendation to continue DAPT for 1 year following ACS regardless of the treatment adopted.
[Show abstract] [Hide abstract] ABSTRACT: Context: The cardiotoxic effect of selective cyclo-oxygenase-2 inhibitors is well known. While rofecoxib and valdecoxib have been withdrawn, celecoxib remains on the market. Folic acid, a naturally occurring vitamin, has been shown to reduce myocardial ischemia and post-reperfusion injury in rats. Objective: This study examined the cardiac effects of celecoxib and folic acid on doxorubicin-induced cardiomyopathy in rats. Materials and methods: Cardiomyopathy was induced in male Wistar rats with six intraperitoneal injections of 2.5 mg/kg doxorubicin over a period of two weeks. The effect of 28 days of celecoxib (100 mg/kg/day) and its combination with folic acid (10 mg/kg/day) was studied on doxorubicin-induced cardiomyopathy according to serum lactate dehydrogenase (LDH), creatine kinase (CK-MB), troponin-T (Tn-T), tumor necrosis factor alpha (TNF-α), cardiac thiobarbituric acid reactive substance (TBARS), and glutathione (GSH) levels as well as systolic blood pressure (SBP), heart rate (HR) and ultrastructural studies. Results: Celecoxib cardiotoxicity was manifested by significant increases in the LDH, Tn-T, TNF-α, CK-MB, SBP, HR (p < 0.001) and TBARS (p < 0.01) levels and a significant decrease in the GSH (p < 0.05) level when used alone or administered with doxorubicin. However, the combination of folic acid with celecoxib caused a significant reversal of these parameters and reduced the cardiotoxicity of celecoxib that was aggravated by doxorubicin. The ultrastructural study also revealed myocardial protection with this combination. Discussion and conclusion: Folic acid protects against the cardiotoxic effects of celecoxib, which are aggravated in the presence of doxorubicin. Folic acid may act as a useful adjunct in patients who are taking celecoxib.
- However, the dose of FA in the intervention groups, among trials included in this study was low and ranged from 0.5 to 15 mg/day. In the present study, we used a high dose of 10 mg/kg/d FA, which has been shown to prevent myocardial ischaemia and heart failure in Wistar rats in vitro and in vivo (Hagar 2002; Moens et al. 2008 ). This dose corresponds to the human equivalent dose of approximately 113 mg for a 70-kg person (ReaganShaw et al. 2007).
[Show abstract] [Hide abstract] ABSTRACT: Introduction: Primary graft dysfunction is a major cause of mortality after heart transplantation. Objective: To evaluate correlations between donor-related clinical/biochemical markers and the occurrence of primary graft dysfunction/clinical outcomes of recipients within 30 days of transplant. Methods: The prospective study involved 43 donor/recipient pairs. Data collected from donors included demographic and echocardiographic information, noradrenaline administration rates and concentrations of soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data collected from recipients included operating, cardiopulmonary bypass, intensive care unit and hospitalization times, inotrope administration and left/right ventricular function through echocardiography. Results: Recipients who developed moderate/severe left ventricular dysfunction had received organs from significantly older donors (P =0.020). Recipients from donors who required moderate/high doses of noradrenaline (>0.23 µg/kg/min) around harvesting time exhibited lower post-transplant ventricular ejection fractions (P =0.002) and required longer CPB times (P =0.039). Significantly higher concentrations of sTNFR1 (P =0.014) and sTNFR2 (P =0.030) in donors were associated with reduced intensive care unit times (≤5 days) in recipients, while higher donor IL-6 (P =0.029) and IL-10 (P =0.037) levels were correlated with reduced hospitalization times (≤25 days) in recipients. Recipients who required moderate/high levels of noradrenaline for weaning off cardiopulmonary bypass were associated with lower donor concentrations of sTNFR2 (P =0.028) and IL-6 (P =0.001). Conclusion: High levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with enhanced evolution in recipients. Allografts from older donors, or from those treated with noradrenaline doses >0.23 µg/kg/min, were more frequently affected by primary graft dysfunction within 30 days of surgery.
- Moreover, our findings suggest a tendency towards increased frequency of right ventricular dysfunction in transplanted patients who received organ from donors treated with moderate/high noradrenaline doses. Earlier reports have suggested that high levels of the cardiac markers TNF-α, IL-6, cTnT, procalcitonin and BNP are correlated with the administration of high doses of inotropic agents and with some degree of PGD [2,12,20] . However, the results presented herein indicate that higher plasma levels of sTNFR1 and sTNFR2 in donors signal a reduction in ICU time for recipients, while enhanced concentrations of plasma cytokines IL-6 and IL-10 in donors are associated with reduced hospitalization time for particularly during hospital confinement.
- There are not yet major clinical trials confirming this beneficial effect. Recently, our group demonstrated in an in vitro and in an in vivo model the beneficial effect of folic acid on IRinduced endothelial dysfunction, myocardial necrosis, contraction band necrosis, apoptosis and lethal ventricular arrhythmias . Folic acid can directly bind on eNOS, and, via enhancing the bioavailability of BH 4 , it restores the balance between NO and free radicals (eNOSuncoupling effect). Further clinical research is strongly recommended.
[Show abstract] [Hide abstract] ABSTRACT: Corresponding author at: UBC-Heart and Stroke Foundation Professor in Women's Cardiovascular Health, Providence Health Care Research Institute, 1081 Burrard Street, Vancouver, BC V6Z 1Y6.
- Women with ACS and a high TIMI risk score, which includes clinical, ECG criteria, and biochemical markers, have historically had lower rates of angiography and reperfusion and increased rates of refractory angina and rehospitalization for unstable angina, compared to men (Anand et al., 2005). In a more contemporary Belgian cohort of STEMI patients who receive primary PCI, the TIMI risk score was effective in predicting in-hospital mortality for both women and men but performed slightly better in men (Gevaert et al., 2014). Although the GRACE score also does not use sex as a parameter because it was not shown to be a statistically significant predictor of hospital mortality during score development (Granger et al., 2003), it may improve risk discrimination in women with the additional parameters of creatinine and cardiac arrest at admission, which may reflect sex differences (Agrawal et al., 2015).