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Myocardial ischemia management

Sandro Ninni, Claire Seunes, Staniel Ortmans, Stéphanie Mouton, Thomas Modine, Mohamed Koussa, Bruno Jegou, Jean-Louis Edme, Bart Staels, David Montaigne, Augustin Coisne
BACKGROUND: A relevant morning-afternoon variation in ischemia-reperfusion (IR) insult after cardiac surgery has been demonstrated. We speculated that the biorhythm might also impact systemic reactions involved in acute kidney injury (AKI) following cardiac surgery. We aimed at investigating incidence, determinants and prognostic impact of AKI in a large cohort of patients referred for surgical aortic valve replacement (SAVR) according to surgery time-of-day. METHODS: Between 2009 and 2015, we explored consecutive patients referred to our Heart Valve Center (CHU Lille) for first SAVR...
July 19, 2018: International Journal of Cardiology
Giuliano Tocci, Ilaria Figliuzzi, Vivianne Presta, Francesca Miceli, Barbara Citoni, Roberta Coluccia, Maria Beatrice Musumeci, Andrea Ferrucci, Massimo Volpe
Uncontrolled hypertension is one of the most common determinant for the persistently high burden of cardiovascular (CV) disease, mostly including coronary artery disease (CAD) and hospital admissions due to acute coronary events. Markedly high blood pressure (BP) levels are also frequently observed during the acute phase of coronary syndromes (both ST-segment and non-ST-segment elevation myocardial infarction and unstable angina). In particular, a sustained raise of BP levels above 180/110 mmHg associated with acute cardiac organ damage, i...
July 31, 2018: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
Dandan Wang, Xiaoyue Hu, Seung Hee Lee, Feng Chen, Kai Jiang, Zizhuo Tu, Zejian Liu, Jing Du, Li Wang, Chaoying Yin, Yu Liao, Hongcai Shang, Kathleen A Martin, Raimund I Herzog, Lawrence H Young, Li Qian, John Hwa, Yaozu Xiang
Management for patients with diabetes experiencing myocardial infarction remains a challenge. Here the authors show that hyperglycemia- and hyperinsulinemia-induced microRNA-24 (miR-24) reduction and O-GlcNAcylation in the diabetic heart contribute to poor survival and increased infarct size in diabetic myocardial ischemia/reperfusion (I/R). In a mouse model of myocardial I/R, pharmacological or genetic overexpression of miR-24 in hearts significantly reduced myocardial infarct size. Experimental validation revealed that miR-24 targets multiple key proteins, including O-GlcNac transferase, ATG4A, and BIM, to coordinately protect the myocardium from I/R injury...
June 2018: JACC. Basic to Translational Science
Dennis H VanLoozen, Kenneth A Murdison, Anastasios C Polimenakos
Right ventricle dependent coronary circulation (RVDCC) in pulmonary atresia with intact ventricular septum (PA/IVS) is associated with significant mortality risk in the immediate post-operative period following the initial stage of surgical palliation. Prognosis remains guarded during the interstage period towards conversion to the superior cavopulmonary shunt physiology. Current literature is scarce regarding this specific patient population. Cardiac troponin-I is widely used as a marker of coronary ischemia in adults, but its use for routine monitoring of neonatal myocardial tissue injury due to supply/demand perfusion mismatch is, yet to be determined...
July 28, 2018: Pediatric Cardiology
Zhi-Yuan Wu, Zuo-Guan Chen, Yong-Peng Diao, Rui Sun, Chang-Wei Liu, Yue-Xin Chen, Yue-Hong Zheng, Bao Liu, Yong-Jun Li
AIM: This study aimed to evaluate the safety and efficiency of the sandwich technique in endovascular repair of complex aortoiliac aneurysm. METHODS: Sixteen patients (mean 69.6 years old, ranging from 58 to 78 years old) with complex aortoiliac aneurysm were studied retrospectively from October 2013 to September 2017 in two vascular centers of teaching hospitals. Computed tomography angiography (CTA) was performed to make individual therapy. They were all performed endovascular repair with sandwich technique, including one with the sandwich, chimney and fenestrated technique during the same procedure...
July 24, 2018: Annals of Vascular Surgery
Valérie E Stegehuis, Gilbert W Wijntjens, Jan J Piek, Tim P van de Hoef
PURPOSE OF REVIEW: Accumulating evidence exists for the value of coronary physiology for clinical decision-making in ischemic heart disease (IHD). The most frequently used pressure-derived index to assess stenosis severity, the fractional flow reserve (FFR), has long been considered the gold standard for this purpose, despite the fact that the FFR assesses solely epicardial stenosis severity and aims to estimate coronary flow impairment in the coronary circulation. The coronary flow reserve (CFR) directly assesses coronary blood flow in the coronary circulation, including both the epicardial coronary artery and the coronary microvasculature, but is nowadays less established than FFR...
July 26, 2018: Current Cardiology Reports
Ivan Jurić, Emir Fazlibegović, Danijel Pravdić, Boris Starčević, Ante Punda, Dražen Huić, Mustafa Hadžiomerović, Damir Rozić, Marko Martinac, Darko Markota, Mirjana Vasilj, Ivan Vasilj, Anshul Saxena
Background: Patients with stable coronary artery disease (CAD) can be evaluated for myocardial viability by examining reverse redistribution of Thallium-201 (201 TI) through cardiac scintigraphy. There is limited knowledge about association of a reverse redistribution with favorable cardiac outcomes. In this study, we hypothesized that higher left ventricular ejection fraction (LVEF), lower myocardial necrosis, fewer ischemic events, and less angina will be associated with reverse redistribution of 201 TI imaging...
2018: Clinical Medicine Insights. Cardiology
Tetsuya Ogawa, Kosaku Nitta
Vascular calcification is common in patients with end-stage renal disease (ESRD). In addition to traditional cardiovascular risk factors, ESRD patients also have a number of nontraditional cardiovascular risk factors that may play an important role in the pathogenesis of vascular calcification. The transformation of vascular smooth muscle cells into osteoblast-like cells may be a key element in the pathogenesis of vascular calcification in the presence of calcium and phosphate deposition due to abnormal bone metabolism and impaired renal excretion...
2018: Contributions to Nephrology
Dominik Berliner, Lars S Maier, Ulrike Wollenberg, Roger Limberg, Jan D Schmitto, Dirk Westermann, Johann Bauersachs
Background: Chronic ischemic heart disease is frequent and represents the most common cause of death in western countries. Angina pectoris, the clinical symptom of myocardial ischemia, is associated with increased morbidity and mortality also in patients without obstructive coronary artery disease. The aim of this study was to investigate the current care of patients with recurrent myocardial ischemia after ruling out significant coronary stenosis in the setting of outpatient care. Methods: Data were obtained by a detailed and structured survey...
June 2018: Journal of Thoracic Disease
Sidra Khalid, Aariez Khalid, Praful Maroo
Takotsubo cardiomyopathy is characterized by transient left ventricular apical ballooning, which results in temporary left ventricular dysfunction. We present a case of a 62-year-old female who presented with chest pain and shortness of breath. Her electrocardiogram was suggestive of myocardial ischemia and her troponin levels were elevated. Cardiac catheterization showed mild coronary artery disease and left ventriculography revealed severe apical hypokinesia. A diagnosis of Takotsubo cardiomyopathy was made...
May 14, 2018: Curēus
Bharathi D Jagadeesan, Kenneth K Liao, Ganesh Raveendran
Complex Coronary artery to Pulmonary artery fistulas (CPFs) can be difficult to manage with embolization or ligation. An 88-year-old woman with exertional angina was found to have a complex precordial CPF, severe Mitral regurgitation, and Pulmonary Hypertension. CPF treatment was recommended prior to minimally invasive mitral valve replacement (to avoid postoperative myocardial ischemia from worsened steal). The CPF was supplied by multiple branches from the LAD and RCA, and formed a complex common varicosity with multiple drainage channels to the pulmonary artery...
July 18, 2018: Catheterization and Cardiovascular Interventions
Alberto Pérez-Castellanos, Manuel Martínez-Sellés, Aitor Uribarri, Carolina Devesa-Cordero, José Carlos Sánchez-Salado, Albert Ariza-Solé, Iago Sousa, Miriam Juárez, Francisco Fernández-Avilés
INTRODUCTION AND OBJECTIVES: Despite therapeutic hypothermia, unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Our objective was to assess the usefulness of the variables obtained in the early moments after resuscitation in the prediction of 6-month prognosis. METHODS: A multicenter study was performed in 3 intensive cardiac care units. The analysis was done in 153 consecutive survivors of out-of-hospital cardiac arrest who underwent targeted temperature management between January 2007 and July 2015...
July 9, 2018: Revista Española de Cardiología
Dominik Buckert, Simon Witzel, Jürgen M Steinacker, Wolfgang Rottbauer, Peter Bernhardt
OBJECTIVES: The purpose of this study was the prospective and randomized evaluation of cardiovascular endpoints and quality of life in patients with stable coronary artery disease comparing a cardiac magnetic resonance (CMR)-based management strategy with a coronary angiography-based approach. BACKGROUND: Evidence from trials prospectively evaluating the role of CMR in clinical pathways and decision processes is limited. METHODS: Patients with symptomatic CAD were randomized to diagnostic coronary angiography (group 1) or adenosine stress CMR (group 2)...
July 2018: JACC. Cardiovascular Imaging
Theodoros Ntoskas, Farhanda Ahmad, Paul Woodmansey
BACKGROUND: Dobutamine stress echocardiography (DSE) services have traditionally been medically led. In some UK institutions DSE lists are led by physiologists with medical support. In our tertiary cardiac centre at New Cross Hospital (NCH), the DSE service was established by a consultant echocardiographer. Following intensive training and assessment, the Trust approved drug administration by named senior cardiac physiologists. We believe this is the first report of a cardiac physiologist-managed DSE service, including physiologist drug administration...
July 4, 2018: Echo Research and Practice
Nigel S Tan, Paul Dorian
Patients resuscitated from out-of-hospital cardiac arrest (OHCA) frequently have underlying coronary artery disease (CAD), but the relationship between the arrest and myocardial ischemia or infarction due to CAD can be difficult to discern in clinical practice. Patients often present with clinical profiles that guideline recommendations for appropriate implantable cardioverter-defibrillator use do not address. In cases of incomplete revascularization or mild but sustained impairment of ventricular function, it is not clear if the cause of the cardiac arrest is completely "reversible...
August 2018: Canadian Journal of Cardiology
Evgeny Shkolnik, Greta Burneikaite, Gabrielius Jakutis, Mikhail Scherbak, Gitana Zuoziene, Birute Petrauskiene, Ekaterina Trush, Yury Vasyuk, Aleksandras Laucevicius, Jelena Celutkiene
BACKGROUND: Despite major advances in managing coronary artery disease and continuous research on alternative techniques to enhance myocardial perfusion and reduce symptoms, coronary artery disease is still one of the leading causes of adult disability worldwide. Cardiac shock-wave therapy (CSWT) has shown promising results in the amelioration of myocardial ischemia in experimental studies; however, clinical results are limited to single-center, mostly uncontrolled and underpowered trials...
June 16, 2018: Coronary Artery Disease
Niels Peter Rønnow Sand, Karsten Tange Veien, Søren Steen Nielsen, Bjarne Linde Nørgaard, Pia Larsen, Allan Johansen, Søren Hess, Lone Deibjerg, Majed Husain, Anders Junker, Kristian Korsgaard Thomsen, Allan Rohold, Lisette Okkels Jensen
OBJECTIVES: This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT ) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA. BACKGROUND: No previous study has prospectively compared the diagnostic performance of FFRCT and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD)...
June 9, 2018: JACC. Cardiovascular Imaging
Arif Albulushi, Andreas Giannopoulos, Nikolaos Kafkas, Stylianos Dragasis, Gregory Pavlides, Yiannis S Chatzizisis
Acute right ventricular myocardial infarction (RVMI) is observed in 30-50% of patients presenting with inferior wall myocardial infarction (MI) and, occasionally, with anterior wall MI. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. Areas covered: The pathophysiological mechanisms, diagnostic steps, and novel therapeutic approaches of acute RVMI are described. Expert commentary: Diagnosis of acute RVMI is based on physical examination, cardiac biomarkers, electrocardiography, and coronary angiography, whereas noninvasive imaging modalities (echocardiography, cardiac magnetic resonance imaging) play a complementary role...
July 2018: Expert Review of Cardiovascular Therapy
Yaling Han, Jiyan Chen, Miaohan Qiu, Yi Li, Jing Li, Yingqing Feng, Jian Qiu, Liang Meng, Yihong Sun, Guizhou Tao, Zhaohui Wu, Chunyu Yang, Jincheng Guo, Kui Pu, Shaoliang Chen, Xiaozeng Wang
BACKGROUND: The prognosis of patients with coronary artery disease (CAD) at hospital discharge was constantly varying, and postdischarge risk of ischemic events remain a concern. However, risk prediction tools to identify risk of ischemia for these patients has not yet been reported. AIMS: We sought to develop a scoring system for predicting long-term ischemic events in CAD patients receiving antiplatelet therapy that would be beneficial in appropriate personalized decision-making for these patients...
June 5, 2018: Cardiovascular Therapeutics
Christian H Simpson, William H Richardson, Greg S Swartzentruber, Vincent J Lloyd
Cardiac ischemia or myocardial infarction after pit viper envenomation is rare. Few case reports have been published, none describing cases reported after crotaline snake envenomation in the United States. We report a case of ST-segment elevation myocardial infarction (STEMI) occurring in a 73-year-old man after an envenomation by a juvenile canebrake rattlesnake (Crotalus horridus). The man was bitten on the left index finger and subsequently developed localized edema followed by hypotension, chest pain, and altered mental status...
May 30, 2018: Wilderness & Environmental Medicine
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