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Myocardial ischemia management

Thomas R Porter
In a study, published in this issue of Echo Research and Practice, Ntoskas et al. retrospectively analyzed the safety of a cardiac physiologist performing, and interpreting, Dobutamine stress echocardiography (DSE) in of 300 patients undergoing DSE for the detection of inducible reversible ischemia, myocardial viability and valvular heart disease. While safety during the tests themselves did not appear to be compromised with this unsupervised approach, the interpretation of these DSEs causes concerns regarding broad patient safety relative to misread results...
September 1, 2018: Echo Research and Practice
Cecil A Rambarat, Islam Y Elgendy, Eileen M Handberg, C Noel Bairey Merz, Janet Wei, Margo B Minissian, Michael D Nelson, Louise E J Thomson, Daniel S Berman, Leslee J Shaw, Galen Cook-Wiens, Carl J Pepine
BACKGROUND: In a prior trial of late sodium channel inhibition (ranolazine) among symptomatic subjects without obstructive coronary artery disease (CAD) and limited myocardial perfusion reserve index (MPRI), we observed no improvement in angina or MPRI, overall. Here we describe the clinical characteristics and myocardial perfusion responses of a pre-defined subgroup who had coronary flow reserve (CFR) assessed invasively. METHODS: Symptomatic patients without obstructive CAD and limited MPRI in a randomized, double-blind, crossover trial of ranolazine vs...
September 26, 2018: International Journal of Cardiology
Noriko Oyama-Manabe, Satoshi Yabusaki, Osamu Manabe, Fumi Kato, Hiromi Kanno-Okada, Kohsuke Kudo
Immunoglobulin G4 (IgG4)-related disease can affect the cardiovascular system, including the coronary arteries and pericardium and especially the walls of large and medium-sized vessels. The presence of coronary involvement is critical, as this condition can cause myocardial ischemia or sudden cardiac death. Although histopathologic examination remains the reference standard for detecting organ involvement and diagnosing IgG4-related disease, obtaining biopsy or surgical specimens from the vessel wall is still challenging...
October 5, 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Thomas Godet, Romain Grobost, Emmanuel Futier
PURPOSE OF REVIEW: This review aims to discuss recent findings on the relationship between intraoperative arterial hypotension and organ dysfunction in surgical patients and examines the available evidence for personalizing blood pressure (BP) management as a strategy to improve patient outcome. RECENT FINDINGS: Hypotension contributes to oxygen supply-demand mismatch and may cause an ischemia-reperfusion injury which may manifest as organ dysfunction. Evidence is accumulating suggesting that hypotension is associated with acute postoperative myocardial and kidney injury, and increased risk of mortality in surgical patients...
September 18, 2018: Current Opinion in Critical Care
Guihua Tian, Yang Sun, Shuo Liu, Chengyu Li, Shiqi Chen, Ruijin Qiu, Xiaoyu Zhang, Youping Li, Min Li, Hongcai Shang
Cardiovascular diseases (CVDs) are the major public health problem and a leading cause of morbidity and mortality on a global basis. Wenxin Keli (WXKL), a formally classical Chinese patent medicine with obvious efficacy and favorable safety, plays a great role in the management of patients with CVDs. Accumulating evidence from various animal and cell studies has showed that WXKL could protect myocardium and anti-arrhythmia against CVDs. WXKL exhibited its cardioprotective roles by inhibiting inflammatory reaction, decreasing oxidative stress, regulating vasomotor disorders, lowering cell apoptosis, and protection against endothelial injure, myocardial ischemia, cardiac fibrosis, and cardiac hypertrophy...
2018: Frontiers in Pharmacology
Jenn Rachelle U Santos, Alessandra Brofferio, Bruna Viana, Karel Pacak
Pheochromocytomas and paragangliomas (PHEOs) are rare neuroendocrine tumors. Clinical manifestations include different cardiovascular signs and symptoms, which are related to excessive secretion of catecholamines. Catecholamine-induced cardiomyopathy in PHEO (CICMPP) is a rare but dreaded complication of PHEO. Once patient is diagnosed with this condition, the prognosis is worse and a surgical risk is much higher than expected. This article focuses on how catecholamines affect the heart and the pathophysiologic mechanism of CICMPP...
September 18, 2018: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
John J Wang, Olle Pahlm, James W Warren, John L Sapp, B Milan Horáček
BACKGROUND: Criteria for electrocardiographic detection of acute myocardial ischemia recommended by the Consensus Document of ESC/ACCF/AHA/WHF consist of two parts: The ST elevation myocardial infarction (STEMI) criteria based on ST elevation (ST↑) in 10 pairs of contiguous leads and the other on ST depression (ST↓) in the same 10 contiguous pairs. Our aim was to assess sensitivity (SE) and specificity (SP) of these criteria-and to seek their possible improvements-in three databases of 12‑lead ECGs...
August 13, 2018: Journal of Electrocardiology
Sripal Bangalore, David J Maron, Jerome L Fleg, Sean M O'Brien, Charles A Herzog, Gregg W Stone, Daniel B Mark, John A Spertus, Karen P Alexander, Mandeep S Sidhu, Glenn M Chertow, William E Boden, Judith S Hochman
BACKGROUND: Patients with chronic kidney disease (CKD) and stable ischemic heart disease are at markedly increased risk of cardiovascular events. Prior trials comparing a strategy of optimal medical therapy (OMT) with or without revascularization have largely excluded patients with advanced CKD. Whether a routine invasive approach when compared with a conservative strategy is beneficial in such patients is unknown. METHODS: ISCHEMIA-CKD is a National Heart, Lung, and Blood Institute-funded randomized trial designed to determine the comparative effectiveness of an initial invasive strategy (cardiac catheterization and optimal revascularization [percutaneous coronary intervention or coronary artery bypass graft surgery, if suitable] plus OMT) versus a conservative strategy (OMT alone, with cardiac catheterization and revascularization [percutaneous coronary intervention or coronary artery bypass graft surgery, if suitable] reserved for failure of OMT) on long-term clinical outcomes in 777 patients with advanced CKD (defined as those with estimated glomerular filtration rate <30 mL/min/1...
August 1, 2018: American Heart Journal
Jessica K Zègre-Hemsey, Larisa A Burke, Holli A DeVon
Early diagnosis is critical in the management of patients with acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), because effective therapies are time-dependent. Aims of this secondary analysis were to determine: (i) the prognostic value of symptoms for an ACS diagnosis in conjunction with electrocardiographic (ECG) and troponin results; and (ii) if any of 13 symptoms were associated with prehospital delay in those presenting to the emergency department (ED) with potential ACS...
October 2018: Research in Nursing & Health
Jae Kwan Song
Coronary artery vasospasm (CVS) is an important mechanism of myocardial ischemia and produces any of the manifestations of coronary artery disease from silent myocardial ischemia, to effort-induced angina and variant angina, to acute coronary syndrome including myocardial infarction or sudden cardiac death. The pathogenesis, characteristic clinical features, diagnosis, and treatment of CVS are summarized. Emphasis is placed on correct diagnosis of CVS using pharmacological spasm provocation test, either during coronary angiography or with echocardiographic monitoring of ventricular wall motion...
September 2018: Korean Circulation Journal
Kevin L Chow, Philip J Alexander, James P Sur, Ellen C Omi
INTRODUCTION: Blunt cardiac trauma covers a spectrum of injuries from clinically insignificant myocardial contusions to lethal ruptures of cardiac valves and chambers. Traumatic coronary artery-cameral fistulas (TCAF) are a rare sequelae of blunt chest trauma. CASE PRESENTATION: A 53-year-old male developed a TCAF after a motor vehicle collision. He was found on admission to be in cardiogenic shock with an elevated troponin and intermittent bifascicular block. An echocardiogram revealed hypokinesis of the mid-anteroseptal myocardium with an ejection fraction of 50%...
August 13, 2018: International Journal of Surgery Case Reports
Lynn Ang, Nathan Cowdin, Kara Mizokami-Stout, Rodica Pop-Busui
IN BRIEF Distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are prevalent diabetes complications with high morbidity, mortality, and amputation risks. The diagnosis of DSPN is principally a clinical one based on the presence of typical symptoms combined with symmetrical, distal-to-proximal stocking-glove sensory loss. CAN is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, major cardiovascular events, and myocardial dysfunction...
August 2018: Diabetes Spectrum: a Publication of the American Diabetes Association
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...
December 1, 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...
October 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
BACKGROUND: This study aimed to evaluate the safety and efficiency of the sandwich technique in endovascular repair of complex aortoiliac aneurysm. METHODS: Sixteen patients (mean age 69.6 years, ranging from 58 to 78 years) 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 techniques during the same procedure...
July 25, 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
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