Abstract P189: Factors Associated With Stenosis on Invasive Coronary Angiography for Persons Living With Human Immunodeficiency Virus (PLWH): The HIV Electronic Comprehensive Cohort of CVD Complications (HIVE-4CVD)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Andrew Furman ◽  
Robert Riestenberg ◽  
Anna Pawlowski ◽  
Daniel Schneider ◽  
Donald M Lloyd-Jones ◽  
...  
Keyword(s):  
Viral Load ◽  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Clinical Care ◽  
Invasive Coronary Angiography ◽  
Hiv Viral Load ◽  
Cvd Risk ◽  
Significant Difference ◽  
Stenosis Severity ◽  
Significant Coronary Stenosis

Background: Persons living with HIV (PLWH) have greater risks for atherosclerotic cardiovascular disease (ASCVD) than uninfected persons. However, data are sparse regarding HIV-specific factors associated with coronary atherosclerosis. Methods: HIVE-4CVD is an electronic data repository of demographic and clinical data collected during the routine clinical care of 5041 PLWH and 10082 uninfected controls frequency matched on age, sex, race, zip code, and clinic location receiving care at Northwestern Medicine from 1/1/2000 to 5/17/2017. Using validated natural language extraction algorithms, we analyzed data on coronary stenosis severity for the 286 PLWH and 266 uninfected controls in HIVE-4CVD who underwent coronary angiography. Stenosis severity was recorded as the highest percentage of stenosis noted for each patient in each artery (LAD, LCx, RCA). Multivariable logistic regression models adjusted for demographics and CVD risk factors were used to evaluate odds of significant (≥50%) coronary stenosis (1) for PLWH versus uninfected controls and (2) across different levels of HIV viremia and immune suppression among PLWH. Results: Of the 286 PLWH and 266 uninfected controls undergoing coronary angiography, 205 (55.4%) PLWH vs. 165 (44.6%) uninfected controls had diagnoses of myocardial infarction (p=0.02). The location and severity of coronary stenoses did not differ significantly for PLWH vs. uninfected controls; mean maximal overall stenosis and mean maximal LAD, RCA, and LCx stenoses were 52.3% vs. 50.2% (p=0.52), 44.5% vs. 42.3% (p=0.48), 37.0% vs. 36.1% (p=0.78) and 31.4% vs. 31.6% (p=0.95) respectively. There was no significant difference in odds of having significant coronary stenosis for PLWH vs. uninfected controls (multivariable-adjusted OR 1.15, 95% CI 0.79-1.70). Among PLWH, peak HIV viral load was associated with borderline significantly greater odds of ≥50% coronary stenosis after adjustment for demographics, CVD risk factors, and HIV therapies (OR 1.07 per 10-fold greater peak HIV viral load, 95% CI 1.00-1.14, p=0.04), but lower Nadir CD4+ T cell count (<200 vs. ≥200 cells/mm 3 ) was not (OR 1.05, 95% CI 0.74-1.48, p=0.79). Conclusions: There was no consistent or significant difference in severity of coronary artery stenosis among PLWH and uninfected controls undergoing invasive coronary angiography in the course of routine clinical care. Higher peak HIV viral load is associated with borderline significantly greater odds of having significant coronary stenosis among PLWH undergoing invasive coronary angiography.

Abstract 16116: Chronic Kidney Disease in HIV Population and Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bertrand Ebner ◽  
Jelani Grant ◽  
Louis Vincent ◽  
Quentin Loyd ◽  
Catherine Boulanger ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Viral Load ◽  
Kidney Disease ◽  
Clinical Laboratory ◽  
South Florida ◽  
Cvd Risk ◽  
Comparable Rate ◽  
Persons Living With Hiv ◽  
Significant Difference

Background: Chronic kidney disease (CKD) is well known to increase the risk of cardiovascular disease (CVD). However, there is limited knowledge about the association between CKD in persons living with HIV (PLWH) and CVD. We sought to investigate the prevalence and characteristics of CVD in PLWH with and without CKD at a large single center in South Florida. Methods: A retrospective chart review of 985 of PLWH from a Special Immunology clinic at a large center in South Florida between 2017-2019 was performed. Data on demographics, clinical, laboratory and diagnostic studies were obtained from electronic health records. Results: The prevalence of CKD in PLWH in our cohort was 11%. The group of CKD was older (58 vs. 51 years p<0.05), with significantly more men (66% vs. 53% p=0.012). The CKD cohort had increased rates of hypertension, coronary artery disease (CAD), heart failure, diabetes mellitus, and cerebrovascular disease (<0.05 for all). PLWH with CKD had a significantly higher HbA1C level, systolic and diastolic blood pressure, statin use, and lower LDL-C (p<0.05 for all). Subjects with HIV and CKD had a higher rate of cardiac catheterization (7.2%), with an increased rate of obstructive CAD (6.3%), when compared to PLWH without CKD (1.3% and 0.7%, respectively, p<0.05 for both). The rate of diastolic dysfunction was significantly higher in PLWH with CKD than those without CKD (p=0.004), although, no difference in ejection fraction (p=0.079) was noted. We found a significantly lower average CD4 count in individuals with HIV and CKD compared to those without CKD (483 ± 297 cells/mm 3 vs. 570 ± 342 cells/mm 3 , p=0.006). No significant difference was noted between groups in mean viral load, proportion with undetectable viral load, and use of antiretroviral medications. Prevalence of chronic hepatitis infection (B and/or C) was also higher in the CKD cohort (p<0.05). Conclusion: In this study, we found a comparable rate of CKD compared to age-matched patients from the general population. We found higher rates of traditional CVD risk factors and disease in the CKD cohort, without significant difference in HIV-related factors. This supports the importance of CVD risk factor optimization in this population.

scholarly journals Trans-coronary Pacing via Rota Wire Prevents Bradycardia During Rotational Atherectomy: A Case Report

2022 ◽  
Author(s):  
Hirofumi Kusumoto ◽  
Kasumi Ishibuchi ◽  
Katsuyuki Hasegawa ◽  
Satoru Otsuji
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Calcified Lesion ◽  
Temporary Pacemaker ◽  
Coronary Lesions ◽  
Pacemaker Insertion ◽  
Calcified Coronary Lesions ◽  
Significant Coronary Stenosis ◽  
Severe Calcification

Abstract Back ground Rotational atherectomy (RA) is used for plaque modification in patients with heavily calcified coronary lesions. RA can induce significant bradycardia or atrioventricular block requiring for temporary pacemaker insertion. In this report, we present a case of trans-coronary pacing via a Rota wire to prevent bradycardia during RA in the proximal right coronary artery (RCA). Case summary A 72-year-old woman with a one month history of worsening effort angina was admitted to our hospital. Computed tomography coronary angiography disclosed significant coronary stenosis with severe calcification in proximal RCA. Coronary angiography revealed significant coronary stenosis with severe calcification in the proximal RCA. Subsequently, percutaneous coronary artery intervention was performed under the guidance of intravascular ultrasound(IVUS). The pull-back IVUS showed a circumferential calcified lesion in the proximal RCA, that was treated using RA, which induced significant bradycardia requiring temporary pacemaker insertion. Immediately, trans-coronary pacing was provided via a Rota wire placed in the far distal RCA; this was used for back-up pacing during RA. RA was completed by safely modifying the calcified lesion. After successful debulking of the calcified lesion, we dilated with a balloon, and a drug-eluting stent was implanted at the proximal RCA. Final IVUS and angiography showed good stent apposition and expansion. we did not observe any serious intraprocedural complications. Discussion RA is used for plaque modification in patients with heavily calcified coronary lesions. RA can induce significant bradycardia or atrioventricular block requiring for temporary pacemaker insertion via the transvenous route. This method could be an effective method to prevent bradycardia during RA.

Revascularization decisions in patients with stable angina and intermediate lesions: results of the second International Survey on Interventional Strategy (ISIS-2)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Toth ◽  
W Wijns ◽  
S Fournier ◽  
B Toth ◽  
N Johnson ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Diagnostic Method ◽  
Quantitative Coronary Angiography ◽  
Diagnostic Tools ◽  
Funding Source ◽  
Private Company ◽  
Web Based ◽  
Stenosis Severity ◽  
Coronary Syndromes

Abstract Background ISIS-1 survey (conducted in 2012–2013) demonstrated a significant disconnect between guideline recommendations on invasive functional and imaging assessment of coronary stenosis severity and effective intention to adoption in patients with chronic coronary syndromes (CCS). Ever since, more evidences and new indexes/tools have become available, supposedly resulting into a simplified adoption. Therefore, six years later the second survey was repeated (ISIS-2) with the aim to evaluate a possible evolution in the intended adoption of invasive diagnostic tools. Methods ISIS-2 was conducted via a web-based platform from June to December 2019. Here, five complete angiograms were provided, presenting only focal intermediate stenoses. FFR and quantitative coronary angiography (QCA) values were known and kept concealed to the participants. Estimation of stenosis significance was asked for each lesion. In case of uncertainty, the most appropriate adjunctive invasive diagnostic method among QCA, intravascular ultrasound, optical coherence tomography, or invasive functional test (i.e. with FFR or a non-hyperemic index) was to be selected. Primary endpoint of the study was the rate of requested adjunctive functional or imaging assessment, as indicated by guideline recommendations. Secondary endpoint was the rate and accuracy of purely angiography-based decisions. Results A total of 411 participants performed 3749 lesion evaluations in ISIS-2: 2237 (60%) decisions were taken solely on angiogram and expressed no need for further evaluation with adjunctive tools. This rate of angiographic reliance was significantly reduced in ISIS-2 as compared with ISIS-1 (3139 [71%]; p&lt;0.001). Here the decision (significant or non-significant) was discordant with the known functional significance in 870 (39%) cases, markedly less as in ISIS-1 (1459, 46%; p&lt;0.001). In ISIS-2, participants expressed the need for either invasive functional assessment or intravascular imaging in 1110 (29%) and 379 (11%) cases, respectively. These rates were significantly higher as compared with ISIS-1 (928 [21%]; p&lt;0.001 and 354 [8%]; p&lt;0.001, respectively). Conclusions ISIS-2 survey suggests an evolving pattern over 6 years in the intention to integrate coronary angiography with invasive coronary physiology and imaging testing in patients with CCS. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Unrestricted grant from Abbott Medical

scholarly journals SmartFFR, a New Functional Index of Coronary Stenosis: Comparison With Invasive FFR Data

2021 ◽  
Vol 8 ◽  
Author(s):  
Panagiotis K. Siogkas ◽  
Lampros Lakkas ◽  
Antonis I. Sakellarios ◽  
George Rigas ◽  
Savvas Kyriakidis ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Invasive Coronary Angiography ◽  
Rigid Wall ◽  
Site Index ◽  
Computational Time ◽  
Fractional Flow ◽  
Functional Index ◽  
Flow Reserve ◽  
The Mean

Aims: In this study, we evaluate the efficacy of SmartFFR, a new functional index of coronary stenosis severity compared with gold standard invasive measurement of fractional flow reserve (FFR). We also assess the influence of the type of simulation employed on smartFFR (i.e. Fluid Structure Interaction vs. rigid wall assumption).Methods and Results: In a dataset of 167 patients undergoing either computed tomography coronary angiography (CTCA) and invasive coronary angiography or only invasive coronary angiography (ICA), as well as invasive FFR measurement, SmartFFR was computed after the 3D reconstruction of the vessels of interest and the subsequent blood flow simulations. 202 vessels were analyzed with a mean total computational time of seven minutes. SmartFFR was used to process all models reconstructed by either method. The mean FFR value of the examined dataset was 0.846 ± 0.089 with 95% CI for the mean of 0.833–0.858, whereas the mean SmartFFR value was 0.853 ± 0.095 with 95% CI for the mean of 0.84–0.866. SmartFFR was significantly correlated with invasive FFR values (RCCTA = 0.86, pCCTA &lt; 0.0001, RICA = 0.84, pICA &lt; 0.0001, Roverall = 0.833, poverall &lt; 0.0001), showing good agreement as depicted by the Bland-Altman method of analysis. The optimal SmartFFR threshold to diagnose ischemia was ≤0.83 for the overall dataset, ≤0.83 for the CTCA-derived dataset and ≤0.81 for the ICA-derived dataset, as defined by a ROC analysis (AUCoverall = 0.956, p &lt; 0.001, AUCICA = 0.975, p &lt; 0.001, AUCCCTA = 0.952, p &lt; 0.001).Conclusion: SmartFFR is a fast and accurate on-site index of hemodynamic significance of coronary stenosis both at single coronary segment and at two or more branches level simultaneously, which can be applied to all CTCA or ICA sequences of acceptable quality.

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