Abstract 18256: Impact of Chronic Kidney Disease Staging on Coronary Atherosclerotic Plaque Change of Non-culprit Lesions after Culprit Percutaneous Coronary Intervention

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kuninobu Kashiyama ◽  
Shinjo Sonoda ◽  
Hirohito Takami ◽  
Reo Anai ◽  
Yoshitaka Muraoka ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Coronary Intervention ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Plaque Volume ◽  
Standard Medical Therapy ◽  
Percutaneous Coronary ◽  
Coronary Atherosclerotic Plaque ◽  
Coronary Events

Introduction: Renal dysfunction is associated with increased coronary plaque burden, which may cause future coronary events. However, little is known about the impact of chronic kidney disease (CKD) staging on coronary atherosclerotic plaque change of non-culprit lesions (NCL) under standard medical therapy after culprit percutaneous coronary intervention (PCI). We investigated serial coronary plaque change of NCL in patients with different stages of CKD using integrated backscatter intravascular ultrasound (IB-IVUS). Methods: We investigated 113 NCL in 113 patients undergoing both IVUS-guided PCI and follow-up IVUS examination. Patients were divided into 4 groups according to baseline CKD stage: CKD-1, n=18; CKD-2, n=43; CKD-3, n=29; and CKD 4-5, n=24. Volumetric IVUS analyses were performed at proximal NCL in de novo target vessels post PCI and at 8-month follow-up. We compared serial changes of plaque burden and composition among groups under standard medical therapy including statins. Results: Baseline patient characteristics showed age was significantly older, diabetic patients were more in CKD-3 than the other groups, but otherwise there was no significant difference among groups. Plaque volume at baseline was greater in CKD 4-5 than the other groups. (p =0.009). At follow-up, plaque volume increased in CKD-3 (+ 4.6 mm3, p <0.001) and CKD 4-5 (+ 9.8 mm3, p <0.001), but decreased in CKD-1 (- 5.4 mm3, p =0.002) and CKD-2 (- 3.2 mm3, p=0.001). Serial plaque volume change was correlated with eGFR. (Y= - 0.2X +11.4, p<0.0001). IB-IVUS analysis showed that lipid plaque increased in CKD-3 (+ 4.6 mm3, p <0.001) and CKD 4-5 (+ 5.4 mm3, p <0.001), but significantly decreased in CKD-2 (- 2.7 mm3, p <0.05) at follow-up. Fibrotic plaque also increased in CKD 4-5 (+ 3.4 mm3, p <0.001), whereas it decreased in CKD-1 (- 3.3 mm3, p <0.05). Multivariate models revealed CKD staging is an independent predictor of plaque progression. Conclusions: Despite standard medical therapy after culprit PCI, late stages of CKD were associated with coronary plaque progression characterized by greater lipid and fibrotic plaque volumes in NCL. Strict risk management should be required to prevent subsequent coronary events in those patients.

scholarly journals Variability of the Plasma Lipidome and Subclinical Coronary Atherosclerosis

2021 ◽  
Author(s):  
Sock Hwee Tan ◽  
Hiromi W.L. Koh ◽  
Jing Yi Chua ◽  
Bo Burla ◽  
Ching Ching Ong ◽  
...  
Keyword(s):  
Risk Score ◽  
Coronary Atherosclerosis ◽  
Framingham Risk Score ◽  
Coronary Plaque ◽  
High Variability ◽  
Plaque Burden ◽  
Plaque Volume ◽  
Framingham Risk ◽  
Coronary Events ◽  
Noncalcified Plaque

Objective: While the risk of acute coronary events has been associated with biological variability of circulating cholesterol, the association with variability of other atherogenic lipids remains less understood. We evaluated the longitudinal variability of 284 lipids and investigated their association with asymptomatic coronary atherosclerosis. Approach and Results: Circulating lipids were extracted from fasting blood samples of 83 community-sampled symptom-free participants (age 41–75 years), collected longitudinally over 6 months. Three types of coronary plaque volume (calcified, lipid-rich, and fibrotic) were quantified using computed tomography coronary angiogram. We first deconvoluted between-subject (CV g ) and within-subject (CV w ) lipid variabilities. We then tested whether the mean lipid abundance was different across groups categorized by Framingham risk score and plaques phenotypes (lipid-rich, fibrotic, and calcified). Last, we investigated whether visit-to-visit variability of each lipid was associated with plaque burden. Most lipids (72.5%) exhibited higher CV g than CV w . Among the lipids (N=145) with 1.2-fold higher CV g than CV w , 26 species including glycerides and ceramides were significantly associated with Framingham risk score and the 3 plaque phenotypes (false discovery rate <0.05). In an exploratory analysis of person-specific visit-to-visit variability without multiple-comparisons testing, high variability of 3 lysophospholipids (lysophosphatidylcholines 16:0, 18:0, and O-18:1) were associated with lipid-rich and fibrotic (noncalcified) plaque volume while high variability of diacylglycerol 18:1_20:0, triacylglycerols 52:2, 52:3, and 52:4, ceramide d18:0/20:0, dihexosylceramide d18:1/16:0, and sphingomyelin 36:3 were associated with calcified plaque volume. Conclusions: High person-specific longitudinal variation of specific nonsterol lipids are associated with the burden of subclinical coronary atherosclerosis. Larger studies are needed to confirm these exploratory findings.

scholarly journals Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial

Heart ◽  
2020 ◽  
Vol 106 (10) ◽  
pp. 758-764 ◽  
Author(s):  
Barry Hennigan ◽  
Colin Berry ◽  
Damien Collison ◽  
David Corcoran ◽  
Hany Eteiba ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Medical Therapy ◽  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Stress Perfusion ◽  
Grey Zone ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary

IntroductionThere is conflicting evidence regarding the benefits of percutaneous coronary intervention (PCI) in patients with grey zone fractional flow reserve (GZFFR artery) values (0.75–0.80). The prevalence of ischaemia is unknown. We wished to define the prevalence of ischaemia in GZFFR artery and assess whether PCI is superior to optimal medical therapy (OMT) for angina control.MethodsWe enrolled 104 patients with angina with 1:1 randomisation to PCI or OMT. The artery was interrogated with a Doppler flow/pressure wire. Patients underwent Magnetic Resonance Imaging (MRI) with follow-up at 3 and 12 months. The primary outcome was angina status at 3 months using the Seattle Angina Questionnaire (SAQ).Results104 patients (age 60±9 years), 79 (76%) males and 79 (76%) Left Anterior Descending (LAD) stenoses were randomised. Coronary physiology and SAQ were similar. Of 98 patients with stress perfusion MRI data, 17 (17%) had abnormal perfusion (≥2 segments with ≥25% ischaemia or ≥1 segment with ≥50% ischaemia) in the target GZFFR artery. Of 89 patients with invasive physiology data, 26 (28%) had coronary flow velocity reserve <2.0 in the target GZFFR artery. After 3 months of follow-up, compared with patients treated with OMT only, patients treated by PCI and OMT had greater improvements in SAQ angina frequency (21 (28) vs 10 (23); p=0.026) and quality of life (24 (26) vs 11 (24); p=0.008) though these differences were no longer significant at 12 months.ConclusionsNon-invasive evidence of major ischaemia is uncommon in patients with GZFFR artery. Compared with OMT alone, patients randomised to undergo PCI reported improved symptoms after 3 months but these differences were no longer significant after 12 months.Trial registration numberNCT02425969.

Abstract 907: Plaque Burden at Left Main Coronary Artery of Patients Undergoing Percutaneous Coronary Intervention with Metabolic Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Motohiro Miyagi ◽  
Hideki Ishii ◽  
Tetsuya Amano ◽  
Tadayuki Uetani ◽  
Satoshi Isobe ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Plaque Burden ◽  
Plaque Volume ◽  
Left Main ◽  
Plaque Area ◽  
Percutaneous Coronary ◽  
The Relationship

Background: The left main coronary artery (LMCA) is an important target of atherosclerotic plaque accumulation. The purpose of this study is to investigate the relationship between metabolic syndrome and plaque characteristics at LMCA. Methods: We enrolled 63 consecutive patients with stable angina who underwent percutaneous coronary intervention (PCI). Using intravascular ultrasound (IVUS), cross-sectional area (CSA), lumen area and plaque area were checked at LMCA undergoing PCI for the left anterior descending coronary artery or left circumflex coronary artery but not LMCA. Total plaque volume at LMCA was also checked by IVUS. The tissue characteristics of coronary plaque at LMCA was analyzed and quantified using integrated backscatter (IB) IVUS. The patients were devided into the two groups who had metabolic syndrome (n = 34) or not (n = 39). We evaluated the relationship between plaque burden at LMCA and metabolic syndrome. Results: Patients with metabolic syndrome had significantly larger plaque area and CSA at minimum lumen area (MLA) of LMCA than patients without metabolic syndrome (10.8 ± 3.7mm2 vs 8.2 ± 4.4 mm2, p = 0.01, 25.8 ± 5.0mm2 vs 23.1 ± 5.4 mm2, p = 0.04, respectively). About total plaque volume at LMCA, patients with metabolic syndrome had also significantly larger volume than patients without metabolic syndrome (53.8 ± 24.7mm3 vs 39.8 ± 21.2 mm3, p = 0.021, respectively). Furthermore, the lipid component of plaque volume at LMCA using IB-IVUS was significantly larger in patients with metabolic syndrome than without metabolic syndrome (25.7 ± 12.1mm3 vs 19.3 ± 11.6 mm3, p = 0.038, respectively). Conclusion: These findings suggest that patients with metabolic syndrome have not only larger plaque but also lipid-rich plaque at LMCA than without metabolic syndrome. IVUS and IB-IVUS Parameter at LMCA

scholarly journals P278 Does recanalization of chronic total occlusion reflect on myocardial function?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O Petrovic ◽  
S Juricic ◽  
D Trifunovic-Zamaklar ◽  
I Paunovic ◽  
I Rakocevic ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Medical Therapy ◽  
Chronic Total Occlusion ◽  
Myocardial Function ◽  
Coronary Intervention ◽  
P Value ◽  
Total Occlusion ◽  
Mechanical Dispersion ◽  
Percutaneous Coronary

Abstract Background Percutaneous coronary intervention for chronic total occlusion (PCI CTO) is still high risk procedure and it is doubtful will it become standard of care. There is evidence that it can reduce angina but even silent ischemia represent ischemic burden that ultimately lead to left ventricle remodeling and electrical instability. Purpose Our aim was to access effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) on myocardial function. Methods We compared two groups of pts. First patients with percutaneous coronary intervention of chronic total occlusion with optimal medical therapy and second group - patients with only optimal medical therapy (control group). Echocardiographic exam was performed before randomization and after 6 months of follow-up. Doppler intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured. MPI (Myocardial performance index) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral wave (E) was divided by average peak early diastolic annular velocity (e"). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time intervals from 17 segments, reflecting myocardial contraction heterogeneity. Results A total of 94 age matched CTO patients (48 in PCI + OMT group and 46 in OMT) were analyzed. Changes in ejection fraction (EF), diastolic function represented by E/e", global cardiac function represented by MPI, global longitudinal strain (GLS) and myocardial dispersion changes were compared between groups. At follow up between groups in there was no significant change in ejection fraction (EF), diastolic function, GLS and mechanical dispersion, but there was improvement in MPI. Conclusion Myocardial performance index is sensitive marker which can detect subtle improvement in global myocardial function after recanalization of chronic total occlusion.. Variable PCI + OMT (n = 46) OMT (n = 48) ΔOMT vs. ΔPCI + OMT p value baseline At 6month follow up P value baseline At 6month follow up P value EF (%) 55.69 ± 8.56 54.83 ± 8.44 0.10 50.22 ± 11.71 51.42 ± 10.45 0.06 0.71 MPI 0.676 ± 0.99 0.632 ± 0.96 &lt;0.01* 0.593 ± 0.14 0.604 ± 0.12 0.22 &lt;0.01* E/e" 13.10 ± 6.90 12.05 ± 5,08 &lt;0.05* 14,12 ± 5.70 13.02 ± 5.62 &lt;0.05* 0.23 GLS (%) -14,38 ± 3,38 -15,22 ± 3,68 &lt;0.05* -13.33 ± 3.43 -13.29 ± 3.42 0.87 0.07 Mechanical dispersion (ms) 63.89 ± 26.22 57.35 ± 27.33 &lt;0.01* 53.30 ± 21.68 50.00 ± 22.40 0.05 0.06 Δ- percentage changes between baseline and at 6 month follow up

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

2016 ◽  
Vol 11 (1) ◽  
pp. 33
Author(s):  
Yohei Sotomi ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Rotational Atherectomy ◽  
Percutaneous Coronary ◽  
Orbital Atherectomy ◽  
Long Term Follow Up ◽  
Coronary Lesions ◽  
Calcified Coronary Lesions

Despite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging. Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy.

scholarly journals Clinical outcomes and survival analysis in patients with psycho-cardiological disease: a retrospective analysis of 132 cases

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199098
Author(s):  
Minhua Lai ◽  
Teimei Shen ◽  
Hong Cui ◽  
Lixia Lin ◽  
Peng Ran ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Total Cholesterol ◽  
Clinical Outcomes ◽  
Detection Rate ◽  
Troponin T ◽  
Coronary Intervention ◽  
Cumulative Survival ◽  
Percutaneous Coronary ◽  
Clinical Detection

Objectives The deleterious effects of psychological problems on coronary heart disease (CHD) are not satisfactorily explained. We explored influential factors associated with mortality in psycho-cardiological disease in a Chinese sample. Methods Of 7460 cardiac patients, we selected 132 patients with CHD and mental illness. Follow-up was conducted via telephone. We analyzed clinical characteristics, clinical outcomes, and survival. Results The clinical detection rate of psycho-cardiological disease in the overall patient population was 1.8%. Of these, 113 patients completed follow-up; 18 died owing to cardiovascular diseases during follow-up. Kaplan–Meier analysis showed dysphagia, limb function, self-care ability, percutaneous coronary intervention, low-density lipoprotein, total cholesterol, pro-brain natriuretic peptide and high-sensitivity (hs) troponin T had significant associations with cumulative survival. Cox regression analysis showed total cholesterol (hazard ratio [HR]: 2.765, 95% confidence interval [CI]: 1.001–7.641), hs troponin T (HR: 4.668, 95% CI: 1.293–16.854), and percutaneous coronary intervention (HR: 3.619, 95% CI: 1.383–9.474) were independently associated with cumulative survival. Conclusions The clinical detection rate of psycho-cardiological disease was far lower than expected. Normal total cholesterol and hs troponin T were associated with reduced cardiovascular disease mortality over 2 years. Percutaneous coronary intervention is a prognostic risk factor in patients with psycho-cardiological disease.

Combined impact of residual inflammatory risk and chronic kidney disease on long-term clinical outcomes in patients undergoing percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Takahashi ◽  
T Dohi ◽  
T Funamizu ◽  
H Endo ◽  
H Wada ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Hs Crp ◽  
Stable Cad ◽  
Combined Impact ◽  
Group 1

Abstract Background Inflammatory status pre-percutaneous coronary intervention (PCI) and post-PCI has been reported not only associated with poor prognosis, but also to impair renal function. Statins reduce cardiovascular events by lowering lipids and have anti-inflammatory impacts, but residual inflammatory risk (RIR) exists. It remains unclear that the synergistic effect of RIR and chronic kidney disease (CKD) on long-term clinical outcome in stable coronary artery disease (CAD) patients undergoing PCI in statin era. Aim The aim of this study was to investigate the long-term combined impact of RIR evaluating hs-CRP at follow-up and CKD among stable CAD patients undergoing PCI in statin era. Methods This is a single-center, observational, retrospective cohort study assessing consecutive 2,984 stable CAD patients who underwent first PCI from 2000 to 2016. We analyzed 2,087 patients for whom hs-CRP at follow-up (6–9 months later) was available. High residual inflammatory risk was defined as hs-CRP &gt;0.6 mg/L according to the median value at follow up. Patients were assigned to four groups as Group1 (high RIR and CKD), Group2 (low RIR and CKD), Group3 (high RIR and non-CKD) or Group4 (low RIR and non-CKD). We evaluated all-cause death and major adverse cardiac events (MACE), defined as a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and non-fatal stroke. Results Of patients (83% men; mean age 67 years), there were 299 (14.3%) patients in group 1, 201 (9.6%) patients in group 2, 754 (36.1%) patients in group 3, and 833 (39.9%) patients in group 4. The median follow-up period was 5.2 years (IQR, 1.9–9.9 years). In total, 189 (frequency, 16.1%) cases of all-cause death and 128 (11.2%) MACE were identified during follow-up, including 53 (4.6%) CV deaths, 27 (2.4%) MIs and 52 (4.8%) strokes. The rate of all-cause death and MACE in group 1 was significantly higher than other groups (p&lt;0.001, respectively). There was a stepwise increase in the incidence rates of all-cause death and MACE. After adjustment for important covariates, the presence of high RIR and/or CKD were independently associated with higher incidence of MACE and higher all-cause mortality. (shown on figure). Conclusion The presence of both high RIR and CKD conferred a synergistic adverse effect on the risk for long-term adverse cardiac events in patients undergoing PCI. Kaplan-Meier curve Funding Acknowledgement Type of funding source: None

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