The role of coronary physiology in contemporary percutaneous coronary interventions.

2021 ◽  
Vol 17 ◽  
Author(s):  
Federico Marin ◽  
Roberto Scarsini ◽  
Dimitrios Terentes-Printzios ◽  
Rafail A. Kotronias ◽  
Flavio Ribichini ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Myocardial Revascularization ◽  
Coronary Microcirculation ◽  
Coronary Physiology ◽  
Catheterization Laboratory ◽  
Procedural Time ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Epicardial Stenosis

: Invasive assessment of coronary physiology has radically changed the paradigm of myocardial revascularization in patients with coronary artery disease. Despite the prognostic improvement associated with ischemia-driven revascularization strategy, functional assessment of angiographic intermediate epicardial stenosis remains largely underused in clinical practice. Multiple tools have been developed or are under development in order to reduce the invasiveness, cost, and extra procedural time associated with the invasive assessment of coronary physiology. Besides epicardial stenosis, a growing body of evidence highlights the role of coronary microcirculation in regulating coronary flow with consequent pathophysiological and clinical and prognostic implications. Adequate assessment of coronary microcirculation function and integrity has then become another component of the decision-making algorithm for optimal diagnosis and treatment of coronary syndromes. This review aims at providing a comprehensive description of tools and techniques currently available in the catheterization laboratory to obtain a thorough and complete functional assessment of the entire coronary tree (both for the epicardial and microvascular compartments).

scholarly journals Simplified Assessment of the Index of Microvascular Resistance

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Monika Kodeboina ◽  
Sakura Nagumo ◽  
Daniel Munhoz ◽  
Jeroen Sonck ◽  
Niya Mileva ◽  
...  
Keyword(s):  
Primary Objective ◽  
Catheterization Laboratory ◽  
Measurement Results ◽  
Index Of Microvascular Resistance ◽  
Invasive Method ◽  
Procedural Time ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Time Required ◽  
Microvascular Resistance

Background. To validate a simplified invasive method for the calculation of the index of microvascular resistance (IMR). Methods. This is a prospective, single-center study of patients with chronic coronary syndromes presenting with nonobstructive coronary artery disease. IMR was obtained using both intravenous (IV) adenosine and intracoronary (IC) papaverine. Each IMR measurement was obtained in duplicate. The primary objective was the agreement between IMR acquired using adenosine and papaverine. Secondary objectives include reproducibility of IMR and time required for the IMR measurement. Results. One hundred and sixteen IMR measurements were performed in 29 patients. The mean age was 68.8 ± 7.24 years, and 27.6% was diabetics. IMR values were similar between papaverine and adenosine (17.7 ± 7.26 and 20.1 ± 8.6, p = 0.25 ; Passing-Bablok coefficient A 0.58, 95% CI −2.42 to 3.53; coefficient B 0.90, 95% CI −0.74 to 1.07). The reproducibility of IMR was excellent with both adenosine and papaverine (ICC 0.78, 95% CI 0.63 to 0.88 and ICC 0.93, 95% CI 0.87 to 0.97). The time needed for microvascular assessment was significantly shortened by the use of IC papaverine (3.23 (2.84, 3.78) mins vs. 5.48 (4.94, 7.09) mins, p < 0.0001 ). Conclusion. IMR can be reliably measured using IC papaverine with similar results compared to intravenous infusion of adenosine with increased reproducibility and reduced procedural time. This approach simplifies the invasive assessment of the coronary microcirculation in the catheterization laboratory.

Abstract 275: Interleukins 17th and 22th in Stable Coronary Artery Disease

2013 ◽  
Vol 113 (suppl_1) ◽  
Author(s):  
Dinaldo Oliveira ◽  
Maira R Pitta ◽  
Ivan R Pitta ◽  
Elayne Heide ◽  
Viviane R Gomes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Analytical Study ◽  
Stable Coronary Artery Disease ◽  
Myocardial Revascularization ◽  
Myocardial Scintigraphy ◽  
Cross Sectional ◽  
Artery Disease ◽  
Stable Cad

Introduction: The role of the immune and inflammatory pathways in coronary artery disease (CAD) is important but not complete understood. The aim of this study was to evaluate expressions of the interleukins 17th and 22th in patients with stable coronary artery disease. Hypothesis: Interleukins 17th and 22th are not increased in stable CAD. Methods: This is a cross-sectional, prospective, analytical study, conducted from August to December 2012. We included 40 patients (P) with stable CAD, CCS III or IV, ischemic myocardial scintigraphy, who had not been subjected to any kind of myocardial revascularization and with coronary stenosis equal or major than 50% according to current coronary angiography. There were 20 healthy volunteers (C), to take up comparison of expression of interleukins (IL). We evaluated the levels of IL 17th and 22th of the patients and controls. Interleukins were evaluated in serum of patients and after 48 hours of cells in culture with and without stimulus. IL concentrations were expressed in pg / ml. Statistical analysis was performed using the Mann-Whitney or Student t test. P ≤ 0,05 was considered statistically significant. Results: There were 26 men and 14 women in the group of the patients and 12 men and 8 women in the controls. The age was similar between the groups (63.2 ± 8.9 years vs 57.9 ± 9.4, p = ns). The comparison between the groups showed: Interleukin 17th: Serum: P = 3.9 (972.2 -- 2.93) vs C = 3.90 (28.8 -- 1.74), p = 0.5; culture 48 hours without stimulus: P = 3.90 (3.90 -- 3.90) vs C = 6.37 (3.90 - 11), p = 0.8; culture 48 hours with stimulus: P = 302.42 (2200 -- 3.90) vs C = 815 (1353 -- 3.90), p = 0.06. Interleukin 22th: Serum: P = 15.62 (64.72 -- 15.62) vs C = 15.62 (121 -- 15.62), p = 0.2; Culture 48 hours without stimulus: P = 11 (128.93 -- 7.81) vs C = 7.81 (7.81 -- 7.81), P = 0.8; Culture 48 hours with stimulus: P = 135 (2486.7 -- 7, 81) vs C = 322.86 (1319.11 -- 7.81), p = 0.4. Conclusions: There were no differences in concentrations of interleukins, but the trend of higher expression of the IL 17th in the controls after cell culture with stimulus. In conclusion, in patients with stable CAD the interleukins 17th and 22th did not exhibit increased concentrations.

scholarly journals Review. Automatic Segmentation Techniques of the Coronary Artery Using CT Images in Acute Coronary Syndromes

2017 ◽  
Vol 3 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Sándor Miklós Szilágyi ◽  
Monica Marton Popovici ◽  
László Szilágyi
Keyword(s):  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Vascular System ◽  
Imaging Techniques ◽  
Automatic Segmentation ◽  
Patients At Risk ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Coronary Artery Tree

AbstractCoronary artery disease represents one of the leading reasons of death worldwide, and acute coronary syndromes are their most devastating consequences. It is extremely important to identify the patients at risk for developing an acute myocardial infarction, and this goal can be achieved using noninvasive imaging techniques. Coronary computed tomography angiography (CCTA) is currently one of the most reliable methods used for assessing the coronary arteries; however, its use in emergency settings is sometimes limited due to time constraints. This paper presents the main characteristics of plaque vulnerability, the role of CCTA in the assessment of vulnerable plaques, and automatic segmentation techniques of the coronary artery tree based on CT angiography images. A detailed inventory of existing methods is given, representing the state-of-the-art of computational methods applied in vascular system segmentation, focusing on the current applications in acute coronary syndromes.

scholarly journals Bivalirudin in the Treatment of Coronary Artery Disease

2014 ◽  
Vol 5 (2) ◽  
pp. 67-80
Author(s):  
Rohan Jayasinghe ◽  
Ryan Maxwell ◽  
Vaishnavi Sridhar
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Myocardial Infarctions ◽  
Percutaneous Coronary ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Artery Disease

Periprocedural anticoagulation continues to be a vital aspect in the management of coronary artery disease. Bivalirudin is a relatively new drug that has caught much attention in the last decade, especially in the context of percutaneous coronary intervention for acute coronary syndromes. Multiple clinical trials have shown the efficacy, safety profile and limitations of bivalirudin in contrast to previously used heparin and glycoprotein IIb/IIIa inhibitors. These trials have included patients with moderate to high-risk stable angina, unstable angina, non-ST-elevation and ST-elevation myocardial infarctions requiring PCI. The growing body of evidence on bivalirudin has also improved the understanding of its applicability and efficacy over other hirudin-based anticoagulants, however continual review of more recent evidence is important in order to integrate bivalirudin more widely across the various guidelines. This article aims to study the cross-section of the evidence base to date on the clinical use, efficacy and risks related to the use of bivalirudin and attempts to provide the clinician with a practical overview of the role of bivalirudin in the most recent guidelines.

scholarly journals Role of territorial speckle tracking echocardiography in identifying the localization of significant coronary artery disease in patients with non-ST-segment elevation acute coronary syndromes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Gherbesi ◽  
G Chiarello ◽  
V L Paiocchi ◽  
L A Leo ◽  
S A Schlossbauer ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Wall Motion ◽  
Speckle Tracking Echocardiography ◽  
St Segment Elevation ◽  
Non Invasive ◽  
St Segment ◽  
Coronary Syndromes ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Abstract Background In non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients, several studies demonstrated that 2D speckle tracking echocardiography (STE) is able to predict the presence of coronary artery disease (CAD). Conversely, the role of STE for the localization of significant CAD is less well established. Purpose To investigate the role of territorial longitudinal (TLS) and circumferential strain (TCS) assessed with STE as a non-invasive predictor of localization of significant CAD in patients with NSTE-ACS. Methods We retrospectively enrolled NSTE-ACS patients with significant stenosis (≥70%) at least in one major epicardial coronary artery and without previous cardiovascular events over two years of time. Echocardiography was recorded before coronary angiography and myocardial strain was evaluated offline by an operator blinded to clinical data. Territorial strain was calculated grouping and averaging the strain values of the segments perfused by the 3 major coronary arteries. Results 150 patients were included (age 66.3±11.8 years, 71% male; 90.7% NSTEMI and 9.3% unstable angina). ROC curve analysis demonstrated the ability of TLS and TCS to identify the presence of coronary stenosis of LAD, LCX or RCA (AUC for TLS-LAD 0.74 [0.66–0.82] p=0.0001; LCX 0.73 [0.65–0.81] p=0.0001; RCA 0.69 [0.60–0.77] p=0.0001-AUC for TCS-LAD 0.80 [0.70–0.90] p=0.0001; LCX 0.76 [0.67–0.85] p=0.0001; RCA 0.65 [0.55–0.75] p=0.0001), superior to territorial wall motion score index (Figure 1). The diagnostic value was confirmed in the subgroup of patients without wall motion abnormalities for TLS and for TCS, except for RCA. Conclusion Territorial strain assessed with STE might be a non-invasive tool to localize coronary artery stenosis in patients with NSTE-ACS, even without wall motion abnormalities. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. ROC curve analyses

scholarly journals Is there a place for a multidisciplinary “Heart Team” approach to the selection of myocardial revascularization method in patients with acute coronary syndromes?

2021 ◽  
Vol 26 (2) ◽  
pp. 4210
Author(s):  
O. L. Barbarash ◽  
V. I. Ganyukov ◽  
R. S. Tarasov ◽  
L. S. Barbarash
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Team Approach ◽  
Heart Team ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Selection Of

Current review article, based on foreign and Russian studies, guidelines of the European and North American cardiological and surgical communities, summarizes the expert positions on the place of multidisciplinary “Heart Team” approach in the selection of management strategy for patients with various types of coronary artery disease. The positions of modern clinical guidelines regarding percutaneous coronary intervention and coronary artery bypass grafting in acute coronary syndrome are given. Prospective positions for optimizing the decisionmaking process by a multidisciplinary team when considering difficult patients are presented.

scholarly journals Role of Invasive Functional Assessment in Surgical Revascularization of Coronary Artery Disease

Circulation ◽  
2018 ◽  
Vol 137 (16) ◽  
pp. 1731-1739 ◽  
Author(s):  
Bipul Baibhav ◽  
Maheedhar Gedela ◽  
Michael Moulton ◽  
Gregory Pavlides ◽  
Vincent Pompili ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Functional Assessment ◽  
Surgical Revascularization ◽  
Artery Disease

Pathophysiology of the coronary circulation

ESC CardioMed ◽  
2018 ◽  
pp. 1320-1324
Author(s):  
Nils P. Johnson ◽  
K. Lance Gould
Keyword(s):  
Pressure Loss ◽  
High Performance ◽  
Building Blocks ◽  
Maximum Pressure ◽  
Control Mechanisms ◽  
Coronary Physiology ◽  
Performance System ◽  
Artery Disease ◽  
Epicardial Stenosis ◽  
Definition Of

All coronary physiology serves a single purpose: the capacity to achieve extraordinary myocardial blood flow and cardiac output for extreme physical demands. Since evolutionary survival requires maximum capacity only intermittently, complex control mechanisms reduce ‘resting’ flow to levels considered ‘normal’ thereby giving the appearance of a ‘high resistance system’ at baseline. From this conceptual definition of coronary physiology as a high-performance system throttled at rest, the inverse idea of coronary pathophysiology arises naturally as the inability to augment flow. Five basic physiological principles exist as building blocks for coronary pathophysiology: diastole dominates perfusion; oxygen extraction has already been maximized at baseline; curvilinear pressure loss versus flow relationships due to coronary artery disease; interaction between the myocardial bed and epicardial stenosis define maximum pressure loss and flow increase; and pathology produces longitudinal and transmural gradients of pressure and flow.

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