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Work 1-8 of 8

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Article

Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment

by Sayan Sen; Yousif Ahmad; Hakim-Moulay Dehbi; James P. Howard; Juan F. Iglesias; Rasha Al-Lamee; Ricardo Petraco; Sukhjinder Nijjer; Ravinay Bhindi; Sam Lehman; Darren Walters; James Sapontis; Luc Janssens; Christiaan J. Vrints; Ahmed Khashaba; Mika Laine; Eric Van Belle; Florian Krackhardt; Waldemar Bojara; Olaf Going; Tobias Haerle; Ciro Indolfi; Giampaolo Niccoli; Flavio Ribichini; Nobuhiro Tanaka; Hiroyoshi Yokoi; Hiroaki Takashima; Yuetsu Kikuta; Andrejs Erglis; Hugo Vinhas; Pedro Canas Silva; Sergio B. Baptista; Ali Alghamdi; Farrel Hellig; Bon-Kwon Koo; Chang-Wook Nam; Eun-Seok Shin; Joon-Hyung Doh; Salvatore Brugaletta; Eduardo Alegria-Barrero; Martijin Meuwissen; Jan J. Piek; Niels van Royen; Murat Sezer; Carlo Di Mario; Robert T. Gerber; Iqbal S. Malik; Andrew S.P. Sharp; Suneel Talwar; Kare Tang; Habib Samady; John Altman; Arnold H. Seto; Jasvindar Singh; Allen Jeremias; Hitoshi Matsuo; Rajesh K. Kharbanda; Manesh R. Patel; Patrick Serruys; Javier Escaned; Justin E. Davies

2019

Subjects
  • Health Sciences, Medicine and Surgery
  • File Download
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Abstract:Close

Background: Physicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because of the perception that there is a high risk of major adverse cardiac events (MACE). The authors describe, using the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) trial, MACE rates when LAD lesions are deferred, guided by physiological assessment using fractional flow reserve (FFR) or the instantaneous wave-free ratio (iFR). Objectives: The purpose of this study was to establish the safety of deferring treatment in the LAD using FFR or iFR within the DEFINE-FLAIR trial. Methods: MACE rates at 1 year were compared between groups (iFR and FFR) in patients whose physiological assessment led to LAD lesions being deferred. MACE was defined as a composite of cardiovascular death, myocardial infarction (MI), and unplanned revascularization at 1 year. Patients, and staff performing follow-up, were blinded to whether the decision was made with FFR or iFR. Outcomes were adjusted for age and sex. Results: A total of 872 patients had lesions deferred in the LAD (421 guided by FFR, 451 guided by iFR). The event rate with iFR was significantly lower than with FFR (2.44% vs. 5.26%; adjusted HR: 0.46; 95% confidence interval [CI]: 0.22 to 0.95; p = 0.04). This was driven by significantly lower unplanned revascularization with iFR and numerically lower MI (unplanned revascularization: 2.22% iFR vs. 4.99% FFR; adjusted HR: 0.44; 95% CI: 0.21 to 0.93; p = 0.03; MI: 0.44% iFR vs. 2.14% FFR; adjusted HR: 0.23; 95% CI: 0.05 to 1.07; p = 0.06). Conclusions: iFR-guided deferral appears to be safe for patients with LAD lesions. Patients in whom iFR-guided deferral was performed had statistically significantly lower event rates than those with FFR-guided deferral.

Article

American-Style Football and Cardiovascular Health

by Jonathan Ho-Youn Kim; Ross Zafonte; Alvaro Pascuale-Leon; Lee M. Nadler; Marc Weisskopf; Frank E. Speizer; Herman A. Taylor; Aaron L. Baggish

2018

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, Oncology
  • Health Sciences, Rehabilitation and Therapy
  • File Download

Article

Killing Me Unsoftly Causes and Mechanisms of Arterial Stiffness

by Alicia N. Lyle; Uwe Raaz

2017

Subjects
  • Health Sciences, Medicine and Surgery
  • Health Sciences, Pathology
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Abstract:Close

The aorta is a blood vessel that provides a low-resistance path for blood flow directed from the heart to peripheral organs and tissues. However, the aorta has another central hemodynamic function, whereby the elastic nature of the aortic wall provides a significant biomechanical buffering capacity complementing the pulsatile cardiac blood flow, and this is often referred to as Windkessel function. Stiffening of the arterial wall leads to fundamental alterations in central hemodynamics, with widespread detrimental implications for organ function. In this Recent Highlights article, we describe recent contributions in ATVB that have highlighted the novel mechanisms and consequences of arterial stiffness and the clinical conditions in which arterial stiffness occurs, with a focus on advancements in the field.

Article

Arterial Stiffness and risk of Overall Heart Failure, Heart Failure with Preserved Ejection Fraction, and Heart Failure with Reduced Ejection Fraction: The Health ABC Study

by Ambarish Pandey; Hassan Khan; Anne B. Newman; Edward G. Lakatta; Daniel E. Forman; Javed Butler; Jarett D. Berry

2017

Subjects
  • Engineering, Biomedical
  • Health Sciences, Medicine and Surgery
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Abstract:Close

Higher arterial stiffness is associated with increased risk of atherosclerotic events. However, its contribution toward risk of heart failure (HF) and its subtypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), independent of other risk factors is not well established. In this study, we included Health ABC study (Health, Aging, and Body Composition) participants without prevalent HF who had arterial stiffness measured as carotid-femoral pulse wave velocity (cf-PWV) at baseline (n=2290). Adjusted Cox-proportional hazards models were constructed to determine the association between continuous and data-derived categorical measures (tertiles) of cf-PWV and incidence of HF and its subtypes (HFpEF [ejec tion fraction > 45%] and HFrEF [ejection fraction ≤45%] ). We observed 390 HF events (162 HFpEF and 145 HFrEF events) over 11.4 years of follow-up. In adjusted analysis, higher cf-PWV was associated with greater risk of HF after adjustment for age, sex, ethnicity, mean arterial pressure, and heart rate (hazard ratio [95% confidence interval] for cf-PWV tertile 3 versus tertile 1 [ref] =1.35 [1.05-1.73]). However, this association was not significant after additional adjustment for other cardiovascular risk factors (hazard ratio [95% confidence interval] , 1.14 [0.88-1.47]). cf-PWV velocity was also not associated with risk of HFpEF and HFrEF after adjustment for potential confounders (most adjusted hazard ratio [95% confidence interval] for cf-PWV tertile 3 versus tertile 1 [ref]: HFpEF, 1.06 [0.72-1.56] ; HFrEF, 1.28 [0.83-1.97]). In conclusion, arterial stiffness, as measured by cf-PWV, is not independently associated with risk of HF or its subtypes after adjustment for traditional cardiovascular risk factors.

Article

Vascular Stiffness in Children With Chronic Kidney Disease

by Jonathan D. Savant; Aisha Betoko; Keven E.C. Meyers; Mark Mitsnefes; Joseph T. Flynn; Raymond R. Townsend; Laurence Greenbaum; Allison Dart; Bradley Warady; Susan L. Furth

2017

Subjects
  • Health Sciences, General
  • Health Sciences, Medicine and Surgery
  • File Download
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Abstract:Close

Carotid-femoral pulse wave velocity (cfPWV) is a measure of arterial stiffness associated with cardiovascular events in the general population and in adults with chronic kidney disease. However, few data exist regarding cfPWV in children with chronic kidney disease. We compared observed cfPWV assessed via applanation tonometry in children enrolled in the CKiD cohort study (Chronic Kidney Disease in Children) to normative data in healthy children and examined risk factors associated with elevated cfPWV. cfPWV Z score for height/gender and age/gender was calculated from and compared with published pediatric norms. Multivariable linear regression was used to assess the relationship between cfPWV and age, gender, race, body mass index, diagnosis, urine protein-creatinine ratio, mean arterial pressure, heart rate, number of antihypertensive medications, uric acid, and serum low-density lipoprotein. Of the 95 participants with measured cfPWV, 60% were male, 19% were black, 46% had glomerular cause of chronic kidney disease, 22% had urine protein-creatinine ratio 0.5 to 2.0 mg/mg and 9% had > 2.0 mg/mg, mean age was 15.1 years, average mean arterial pressure was 80 mm Hg, and median glomerular filtration rate was 63 mL/min per 1.73 m 2 . Mean cfPWV was 5.0 m/s (SD, 0.8 m/s); mean cfPWV Z score by height/gender norms was -0.1 (SD, 1.1). cfPWV increased significantly with age, mean arterial pressure, and black race in multivariable analysis; no other variables, including glomerular filtration rate, were independently asso ciated with cfPWV. In this pediatric cohort with mild kidney dysfunction, arterial stiffness was comparable to that of normal children. Future research is needed to examine the impact of chronic kidney disease progression on arterial stiffness and associated cardiovascular parameters in children.

Article

TIMI Frame Count and Adverse Events in Women with No Obstructive Coronary Disease: A Pilot Study from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE)

by John W. Petersen; B. Della Johnson; Kevin E. Kip; R. David Anderson; Eileen M. Handberg; Barry Sharaf; Puja Kiran Mehta; Sheryl F. Kelsey; C. Noel Bairey Merz; Carl J, Pepine

2014

Subjects
  • Health Sciences, General
  • Health Sciences, Public Health
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Background: TIMI frame count (TFC) predicts outcomes in patients with obstructive coronary artery disease (CAD); it remains unclear whether TFC predicts outcomes in patients without obstructive CAD. Methods: TFC was determined in a sample of women with no obstructive CAD enrolled in the Women's Ischemia Syndrome Evaluation (WISE) study. Because TFC is known to be higher in the left anterior descending artery (LAD), TFC determined in the LAD was divided by 1.7 to provide a corrected TFC (cTFC). Results: A total of 298 women, with angiograms suitable for TFC analysis and long-term (6-10 year) follow up data, were included in this sub-study. Their age was 55±11 years, most were white (86%), half had a history of smoking, and half had a history of hypertension. Higher resting cTFC was associated with a higher rate of hospitalization for angina (34% in women with a cTFC > 35, 15% in women with a cTFC ≤35, P < 0.001). cTFC provided independent prediction of hospitalization for angina after adjusting for many baseline characteristics. In this cohort, resting cTFC was not predictive of major events (myocardial infarction, heart failure, stroke, or all-cause death), cardiovascular events, all-cause mortality, or cardiovascular mortality. Conclusions: In women with signs and symptoms of ischemia but no obstructive CAD, resting cTFC provides independent prediction of hospitalization for angina. Larger studies are required to determine if resting TFC is predictive of major events in patients without obstructive coronary artery disease.

Article

Sickle Mice Are Sensitive to Hypoxia/Ischemia-Induced Stroke but Respond to Tissue-Type Plasminogen Activator Treatment

by Yu-Yo Sun; Jolly Lee; Henry Huang; Mary Wagner; Clinton Joiner; David Archer; Chia-Yi Kuan

2017

Subjects
  • Biology, Neuroscience
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Background and Purpose-The effects of lytic stroke therapy in patients with sickle cell anemia are unknown, although a recent study suggested that coexistent sickle cell anemia does not increase the risk of cerebral hemorrhage. This finding calls for systemic analysis of the effects of thrombolytic stroke therapy, first in humanized sickle mice, and then in patients. There is also a need for additional predictive markers of sickle cell anemia-associated vasculopathy. Methods-We used Doppler ultrasound to examine the carotid artery of Townes sickle mice tested their responses to repetitive mild hypoxia-ischemia- and transient hypoxia-ischemia-induced stroke at 3 or 6 months of age, respectively. We also examined the effects of tPA (tissue-type plasminogen activator) treatment in transient hypoxia-ischemia-injured sickle mice. Results-Three-month-old sickle cell (SS) mice showed elevated resistive index in the carotid artery and higher sensitivity to repetitive mild hypoxia-ischemia-induced cerebral infarct. Six-month-old SS mice showed greater resistive index and increased flow velocity without obstructive vasculopathy in the carotid artery. Instead, the cerebral vascular wall in SS mice showed ectopic expression of PAI-1 (plasminogen activator inhibitor-1) and P-selectin, suggesting a proadhesive and prothrombotic propensity. Indeed, SS mice showed enhanced leukocyte and platelet adherence to the cerebral vascular wall, broader fibrin deposition, and higher mortality after transient hypoxia-ischemia. Yet, post-transient hypoxia- ischemia treatment with tPA reduced thrombosis and mortality in SS mice. Conclusions-Sickle mice are sensitive to hypoxia/ischemia-induced cerebral infarct but benefit from thrombolytic treatment. An increased resistive index in carotid arteries may be an early marker of sickle cell vasculopathy. Visual Overview-An online visual overview is available for this article.

Article

Myocardial Bridging Contemporary Understanding of Pathophysiology With Implications for Diagnostic and Therapeutic Strategies

by Michel T. Corban; Olivia Y. Hung; Parham Eshtehardi; Emad Rasoul-Arzrumly; Michael McDaniel; Girum Mekonnen; Lucas Timmins; Jerre Lutz; Robert Guyton; Habib Samady

2014

Subjects
  • Health Sciences, Medicine and Surgery
  • Engineering, Biomedical
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Abstract:Close

Patients with myocardial bridging are often asymptomatic, but this anomaly may be associated with exertional angina, acute coronary syndromes, cardiac arrhythmias, syncope, or even sudden cardiac death. This review presents our understanding of the pathophysiology of myocardial bridging and describes prevailing diagnostic modalities and therapeutic options for this challenging clinical entity.
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