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Wang J, Xu J, Mao J, Fu S, Gu H, Wu N, Su G, Lin Z, Zhang K, Lin Y, Zhao Y, Liu G, Zhao H, Zhao Q. A novel hybrid machine learning model for auxiliary diagnosing myocardial ischemia. Front Cardiovasc Med 2024; 11:1327912. [PMID: 38450372 PMCID: PMC10914931 DOI: 10.3389/fcvm.2024.1327912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/22/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Accurate identification of the myocardial texture features of fat around the coronary artery on coronary computed tomography angiography (CCTA) images are crucial to improve clinical diagnostic efficiency of myocardial ischemia (MI). However, current coronary CT examination is difficult to recognize and segment the MI characteristics accurately during earlier period of inflammation. Materials and methods We proposed a random forest model to automatically segment myocardium and extract peripheral fat features. This hybrid machine learning (HML) model is integrated by CCTA images and clinical data. A total of 1,316 radiomics features were extracted from CCTA images. To further obtain the features that contribute the most to the diagnostic model, dimensionality reduction was applied to filter features to three: LNS, GFE, and WLGM. Moreover, statistical hypothesis tests were applied to improve the ability of discriminating and screening clinical features between the ischemic and non-ischemic groups. Results By comparing the accuracy, recall, specificity and AUC of the three models, it can be found that HML had the best performance, with the value of 0.848, 0.762, 0.704 and 0.729. Conclusion In sum, this study demonstrates that ML-based radiomics model showed good predictive value in MI, and offer an enhanced tool for predicting prognosis with greater accuracy.
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Affiliation(s)
- Jing Wang
- Department of Imaging, School of Medicine, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Jing Xu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, Institute of Artificial Intelligence, School of Public Health, Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen University, Xiamen, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, Xiamen University, Xiamen, China
| | - Jingsong Mao
- Department of Vascular Intervention, Affiliated Hospital, Guilin Medical University, Guilin, China
| | - Suzhong Fu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, Institute of Artificial Intelligence, School of Public Health, Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen University, Xiamen, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, Xiamen University, Xiamen, China
| | - Haowei Gu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, Institute of Artificial Intelligence, School of Public Health, Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen University, Xiamen, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, Xiamen University, Xiamen, China
| | - Naiming Wu
- Department of Imaging, School of Medicine, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Guoqing Su
- Department of Radiology, Xiang’an Hospital of Xiamen University, Xiamen, China
| | - Zhiping Lin
- Department of Pharmaceutical Diagnosis, GE Healthcare, Guangzhou, China
| | - Kaiyue Zhang
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, Institute of Artificial Intelligence, School of Public Health, Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen University, Xiamen, China
| | - Yuetong Lin
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, Institute of Artificial Intelligence, School of Public Health, Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen University, Xiamen, China
| | - Yang Zhao
- Department of Mechanical and Electrical Engineering, Xiamen University, Xiamen, China
| | - Gang Liu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, Institute of Artificial Intelligence, School of Public Health, Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen University, Xiamen, China
| | - Hengyu Zhao
- Department of Imaging, School of Medicine, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Qingliang Zhao
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, Institute of Artificial Intelligence, School of Public Health, Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen University, Xiamen, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, Xiamen University, Xiamen, China
- Shenzhen Research Institute of Xiamen University, Shenzhen, China
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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3
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101181. [PMID: 39131968 PMCID: PMC11307799 DOI: 10.1016/j.jscai.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Alnoor M, Qureshi SA. Pediatric Cardiac Interventional Standards-Better Late Than Never! JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101251. [PMID: 39131989 PMCID: PMC11307597 DOI: 10.1016/j.jscai.2023.101251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 08/13/2024]
Affiliation(s)
- Mohammad Alnoor
- UC Davis Pediatric Heart Center, Division of Pediatric Cardiology, UC Davis Health, Sacramento, California
| | - Shakeel A. Qureshi
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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Madrigal VN, Feltman DM, Leuthner SR, Kirsch R, Hamilton R, Dokken D, Needle J, Boss R, Lelkes E, Carter B, Macias E, Bhombal S. Bioethics for Neonatal Cardiac Care. Pediatrics 2022; 150:189885. [PMID: 36317974 DOI: 10.1542/peds.2022-056415n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Clinicians caring for neonates with congenital heart disease encounter challenges with ethical implications in daily practice and must have some basic fluency in ethical principles and practical applications. METHODS Good ethical practice begins with a thorough understanding of the details and narrative of each individual case, examination via classic principles of bioethics, and further framing of that translation into practice. RESULTS We explore some of these issues and expand awareness through the lens of a case presentation beginning with fetal considerations through end-of-life discussions. CONCLUSIONS We include specific sections that bring attention to shared decision-making, research ethics, and outcomes reporting. We review empirical evidence and highlight recommendations.
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Affiliation(s)
- Vanessa N Madrigal
- Department of Pediatrics, Division of Critical Care Medicine and Pediatric Ethics Program, Children's National Hospital, George Washington University, Washington, District of Columbia
| | - Dalia M Feltman
- NorthShore University HealthSystem Evanston Hospital, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Steven R Leuthner
- Departments of Pediatrics and Bioethics, Division of Neonatology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Roxanne Kirsch
- Department of Critical Care, Division Cardiac Critical Care Medicine; Department of Bioethics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rekha Hamilton
- Mednax Inc. Cook Children's Medical Center, Fort Worth, Texas
| | - Deborah Dokken
- Family Leader and Staff Member, Institute for Patient and Family-Centered Care, Bethesda, Maryland
| | - Jennifer Needle
- Department of Pediatrics and the Center for Bioethics, University of Minnesota, Minneapolis, Minnesota
| | - Renee Boss
- Department of Pediatrics, Johns Hopkins School of Medicine and Berman Institute of Bioethics, Baltimore, Maryland
| | - Efrat Lelkes
- Department of Pediatrics, Divisions of Critical Care Medicine and Palliative Medicine, Bioethics, University of California San Francisco, San Francisco, California
| | - Brian Carter
- Departments of Humanities and Pediatrics, Division of Neonatology and Bioethics Center, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Eduardo Macias
- Department of Pediatrics, Division of Pediatric Cardiology. University Hospital, University of Texas, San Antonio, Texas
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital. Stanford, Palo Alto, California
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6
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Kinik M, Çamci S, Ari S, Ari H, Melek M, Bozat T. The effect of whole blood viscosity on contrast-induced nephropathy development in patients undergoing percutaneous coronary intervention. Postgrad Med 2021; 134:78-84. [PMID: 34670475 DOI: 10.1080/00325481.2021.1997007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In our study, we aimed to investigate how whole blood viscosity (WBV) affects the development of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). METHODS In our study, 500 patients who applied to the cardiology clinic and underwent PCI for elective procedure, ST segment elevation myocardial infarction (STEMI), and non-STEMI were prospectively included. Before the procedure, we calculated WBV using the formula [(0.12× hematocrit) + (0.17×(total protein - 2.07)]. We defined CIN as the absolute (≥0.5 mg/dl) or relative increase (≥25%) in serum creatinine 48-72 h after exposure to a contrast agent compared with baseline serum creatinine values. RESULTS CIN was developed in 69 (13.6%) of the 500 patients in the study. PCI was performed in 206 patients (41.2%) electively, 175 (35%) due to non-STEMI, and 119 (23%) due to STEMI. CIN was observed in 20.2% of the STEMI group, 13.7% of the non-STEMI group, and 10.2% of the elective PCI group. Multivariate logistic regression analysis results show that the independent predictors of CIN are low ejection fraction [OR:0.95 (95% CI:0.92-0.97); p < 0.001], low glomerular filtration rate [OR:0.96 (95% CI:0.95-0.98); p < 0.001], and increased amount of contrast agent [OR:1.008 (95% CI:1.004-1.01); p < 0.001]. When all patients were examined, no significant relationship was found between WBV and CIN. However, in the subgroup evaluation, it was concluded that low WBV was an independent predictor in elective PCI patients [OR:0.60 (95% CI:0.36-0.99); p = 0.04] for CIN. CONCLUSION We found that low WBV was an independent predictor of CIN in patients undergoing elective PCI(NCT04703049).
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Affiliation(s)
- Mustafa Kinik
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Sencer Çamci
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Selma Ari
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Hasan Ari
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Mehmet Melek
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Tahsin Bozat
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
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7
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O'Byrne ML, Huang J, Asztalos I, Smith CL, Dori Y, Gillespie MJ, Rome JJ, Glatz AC. Pediatric/Congenital Cardiac Catheterization Quality: An Analysis of Existing Metrics. JACC Cardiovasc Interv 2021; 13:2853-2864. [PMID: 33357522 DOI: 10.1016/j.jcin.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to enumerate and categorize quality metrics relevant to the pediatric/congenital cardiac catheterization laboratory (PCCL). BACKGROUND Diagnostic and interventional catheterization procedures are an increasingly important part of the care of young patients with cardiac disease. Measurement of the performance of PCCL programs in a stringent and consistent fashion is a crucial step toward improving outcomes. To the best of our knowledge, a systematic evaluation of current quality metrics in PCCL has not been performed previously. METHODS Potential metrics were evaluated by: 1) a systematic review of peer-reviewed research; 2) a review of metrics from organizations interested in quality improvement, patient safety, and/or PCCL programs; and 3) a survey of U.S. PCCL cardiologists. Collected metrics were grouped on 2 dimensions: 1) Institute of Medicine domains; and 2) the Donabedian structure/process/outcome framework. Survey responses were dichotomized between favorable and unfavorable responses and then compared within and between categories. RESULTS In the systematic review, 6 metrics were identified (from 9 publications), all focused on safety either as an outcome (adverse events [AEs], mortality, and failure to rescue along with radiation exposure) or as a structure (procedure volume or operator experience). Four organizations measure quality metrics of PCCL programs, of which only 1 publicly reports data. For the survey, 229 cardiologists from 118 hospital programs responded (66% of individuals and 72% of hospital programs). The highest favorable ratings were for safety metrics (p < 0.001), of which major AEs, failure to rescue, and procedure-specific AEs had the highest ratings. Of respondents, 67% stated that current risk adjustment were not effective. Favorability ratings for hospital characteristics, PCCL characteristics, and quality improvement processes were significantly lower than for safety and less consistent within categories. CONCLUSIONS There is a limited number of PCCL quality metrics, primarily focused on safety. Confidence in current risk adjustment methodology is low. The knowledge gaps identified should guide future research in the development of new quality metrics.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Jing Huang
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania, USA; Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ivor Asztalos
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher L Smith
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yoav Dori
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan J Rome
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Qureshi AI, Jahngir MU, Akinci Y, Gao X, Akhtar IN, Kraus J, Singh B, Lobanova I, Uzun G, Balasetti VKS, Liaqat J, French BR, Siddiq F, Gomez CR. Intraprocedural Back Pain Associated with Awake Neuroendovascular Procedures. J Neuroimaging 2020; 31:209-214. [PMID: 33176020 DOI: 10.1111/jon.12801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/25/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND PURPOSE The prevalence and characteristics of intraprocedural back pain is not well studied in awake patients undergoing neuroendovascular procedures. METHODS We performed a prospective study as part of quality improvement initiative in which all patients who underwent neuroendovascular procedures in awake state were inquired regarding presence, severity (using a numeric rating scale score ranging from 0 [no pain] to 10 [worst pain possible]), and location (using anatomical chart) of back pain immediately after the procedure. The primary endpoint was the proportion of patients with moderate to severe pain (score of ≥3). RESULTS A total of 100 (41.3%) of 242 patients reported intraprocedural back pain with a median severity of 5/10 (range 1-10). The mean age was 58.7 ± 16.2 years. The mean duration of the procedure was 82.3 minutes (range 15-410 minutes). The pain was classified as moderate to severe in 86 of 100 patients. The locations of pain were identified in lumbar (n = 77), thoracic (n = 6), cervical (n = 7), cervical and lumbar (n = 8), and cervical with thoracolumbar (n = 2) regions. There was a significant relationship between patients' history of the previous neck and/or back surgery and frequency of moderate to severe back pain (P = .02). No significant relationship was observed between frequency of none to mild and moderate to severe back pain among the strata by patients' age, body mass index, or duration of procedures. CONCLUSIONS The relatively high prevalence of intraprocedural back pain in patients undergoing neuroendovascular procedures in awake state must be recognized, and strategies to reduce the occurrence need to be identified.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, Columbia, MO.,Department of Neurology, University of Missouri, Columbia, MO
| | | | - Yasemin Akinci
- Zeenat Qureshi Stroke Institute, Columbia, MO.,Department of Neurology, University of Missouri, Columbia, MO
| | - Xiaoyu Gao
- Zeenat Qureshi Stroke Institute, Columbia, MO.,Department of Neurology, University of Missouri, Columbia, MO
| | - Iqra Naveed Akhtar
- Zeenat Qureshi Stroke Institute, Columbia, MO.,Department of Neurology, University of Missouri, Columbia, MO
| | | | - Baljinder Singh
- Zeenat Qureshi Stroke Institute, Columbia, MO.,Department of Neurology, University of Missouri, Columbia, MO
| | - Iryna Lobanova
- Department of Neurology, University of Missouri, Columbia, MO
| | - Guven Uzun
- Zeenat Qureshi Stroke Institute, Columbia, MO.,Department of Neurology, University of Missouri, Columbia, MO
| | | | - Jahanzeb Liaqat
- Zeenat Qureshi Stroke Institute, Columbia, MO.,Department of Neurology, University of Missouri, Columbia, MO
| | - Brandi R French
- Department of Neurology, University of Missouri, Columbia, MO
| | - Farhan Siddiq
- Division of Neurological Surgery, University of Missouri, Columbia, MO
| | - Camilo R Gomez
- Department of Neurology, University of Missouri, Columbia, MO
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9
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Kogure T, Qureshi SA. The Future of Paediatric Heart Interventions: Where Will We Be in 2030? Curr Cardiol Rep 2020; 22:158. [PMID: 33037461 PMCID: PMC7546978 DOI: 10.1007/s11886-020-01404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
Purpose of Review Cardiac catheterization therapies to treat or palliate infants, children and adults with congenital heart disease have developed rapidly worldwide in both technical innovation and device development in the previous three decades. By reviewing of current status of novel or development of devices and techniques, we will discuss what is likely to happen in paediatric heart intervention in the next decade. Recent Findings Recently, biodegradable stents and devices, transcatheter pulmonary valve implantation for the native right ventricle outflow tract and MRI-guided interventions have been progressing rapidly with good immediate to early results. These are expected to be introduced and spread in the next decade although there are still challenges to overcome. Summary The future of paediatric heart intervention is very promising with rapid development of technological progress.
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Affiliation(s)
- Tomohito Kogure
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.,Department of Cardiology, Tokyo Women's Medical University, Tokyo, 162-0054, Japan
| | - Shakeel A Qureshi
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
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Mall A. Management of Patients With Femoral Arterial Sheaths Following Percutaneous Coronary Intervention. Crit Care Nurse 2020; 39:75-77. [PMID: 31961944 DOI: 10.4037/ccn2019587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Anna Mall
- Anna Mall is Clinical Lead, Adult Cardiac Catheterization Laboratory, Duke University Hospital, Durham, North Carolina
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11
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Abstract
PURPOSE OF REVIEW The number of complex procedures performed in the cardiac catheterization laboratory (CCL) is rapidly increasing. Because of their complexity, they frequently require the assistance of an anesthesiologist. The CCL is primarily designed to facilitate a percutaneous cardiac intervention; therefore, it might be a challenging workplace for an anesthesiologist. The aim of this review is to briefly present tasks and challenges of providing anesthesia in the CCL and to provide a concise description of common cardiac procedures performed there. RECENT FINDINGS Recent literature indicates that many complicated cardiac procedures can be performed in CCL under monitored anesthesia care. At the same time several of them (e.g. transcatheter aortic valve replacement) are quickly becoming a viable alternative for surgical valve replacement. The most recent expansion of CCL procedures is related to rapidly growing population of grown-ups with congenital heart disease. All aforementioned developments present new challenges to an anesthesiologist. SUMMARY New and fast development of percutaneous cardiac interventions has created a new working place for the anesthesiologist - the CCL. Our expertise in complex cardiac pathophysiology allows conduct of complicated procedures outside of the operating theater. For the same reasons, there is ongoing discussion whether anesthesia support in CCL should be provided by a general or cardiac anesthesiologist.
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Guenego A, Mosimann PJ, Wintermark M, Heit JJ, Zuber K, Dobrocky T, Lotterie JA, Nicholson P, Marcellus DG, Olivot JM, Gonzalez N, Blanc R, Pereira VM, Gralla J, Kaesmacher J, Fahed R, Piotin M, Cognard C. Safety and Effectiveness of Neuro-thrombectomy on Single compared to Biplane Angiography Systems. Sci Rep 2020; 10:4470. [PMID: 32161286 PMCID: PMC7066129 DOI: 10.1038/s41598-020-60851-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/14/2020] [Indexed: 12/11/2022] Open
Abstract
An increasing number of centers not necessarily equipped with biplane (BP) angiosuites are performing mechanical thrombectomy (MT) in acute ischemic stroke patients. We assessed whether MT performed on single-plane (SP) is equivalent in terms of safety, effectiveness, radiation and contrast agent exposure. Consecutive patients treated by MT in four high volume centers between January 2014 and May 2017 were included. Demographic and MT characteristics were assessed and compared between SP and BP. Of 906 patients treated by MT, 576 (64%) were handled on a BP system. After multivariate analysis, contrast load and fluoroscopy duration were significantly lower in the BP group [100vs200mL, relative effect 0.85 (CI: 0.79-0.92), p = 0.0002; 22 vs 27 min, relative effect 0.84 (CI: 0.76-0.93), p = 0.0008, respectively]. There was no difference in recanalization (modified Thrombolysis-In-Cerebral-Infarction 2b-3), good clinical outcome (modified Rankin Scale 0-2), complications rates, procedure duration or radiation exposure. A three-vessel diagnostic angiogram performed prior to MT led to a significant increase in procedure duration (15% increase, p = 0.05), radiation exposure (33% increase, p < 0.0001) and contrast load (125% increase, p < 0.0001). Mechanical neuro-thrombectomy seems equally safe and effective on a single or biplane angiography system despite increased contrast load and fluoroscopy duration on the former.
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Affiliation(s)
- Adrien Guenego
- Interventional and Diagnostic Neuroradiology Department, Toulouse University Hospital, Toulouse, France.
| | | | - Max Wintermark
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Jeremy J Heit
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Kevin Zuber
- Statistics department, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Tomas Dobrocky
- Interventional and diagnostic Neuroradiology, Bern, Switzerland
| | - Jean Albert Lotterie
- Stereotaxic Neurosurgery Department, Toulouse University Hospital, Toulouse, France
| | - Patrick Nicholson
- Interventional and Diagnostic Neuroradiology, Toronto Hospital, Toronto, Canada
| | - David G Marcellus
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Jean Marc Olivot
- Vascular Neurology, Stroke Department, Toulouse University Hospital, Toulouse, France
| | - Nestor Gonzalez
- Neurosurgery and Interventional Neuroradiology Department, Cedars Sinai Hospital, Los Angeles, USA
| | - Raphaël Blanc
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Jan Gralla
- Interventional and diagnostic Neuroradiology, Bern, Switzerland
| | | | - Robert Fahed
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Christophe Cognard
- Interventional and Diagnostic Neuroradiology Department, Toulouse University Hospital, Toulouse, France
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Abuzaid M, Abdelrazig A, Sulieman A, Alkhorayef M, Babikir E, Alonazi B, Bradley D. Radiation dose to the paediatric undergoing diagnostic coronary angiography and percutaneous intervention procedures. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Lee WJ, Jung KH, Ryu YJ, Kim JM, Lee ST, Chu K, Kim M, Lee SK, Roh JK. Association of Cardiac Hemodynamic Factors With Severity of White Matter Hyperintensities in Chronic Valvular Heart Disease. JAMA Neurol 2019; 75:80-87. [PMID: 29114731 DOI: 10.1001/jamaneurol.2017.2853] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance The cerebral white matter hyperintensity (WMH) is frequently noted in patients with chronic heart disease. Long-term alteration of cardiac hemodynamics might have an influence on the mechanism of cerebral WMH. Objective To investigate the association between chronically altered cardiac hemodynamics and severity of cerebral WMH in patients with chronic valvular heart disease. Design, Setting, and Participants This cross-sectional analysis identified 303 consecutive patients at a tertiary referral center between 2008 and 2016 who were 50 years or older, and diagnosed with severe chronic valvular heart disease and underwent cardiac catherization, echocardiography, and received brain magnetic resonance imaging. Among these patients, 71 with other demonstrated cardiac disease, central nervous system disease, and/or without sufficient catheterization data were excluded, and the remaining 232 patients were included in further analyses. Exposures The site and mechanism of valve diseases, as well as clinical and medication profiles, were reviewed. Cardiac catheterization parameters such as right atrial (RA) mean pressure, right ventricular pressure, and aortic mean pressure were obtained. Comprehensive echocardiographic hemodynamic markers such as left ventricular (LV) ejection fraction, LV mass index, LV end diastolic volume, cardiac index, and E/e' ratio were also obtained. Main Outcomes and Measures White matter hyperintensity volume was quantitatively evaluated using volumetric analysis. Results This study included 232 patients (103 men [44.4%] and 129 women [55.6%]; mean [SD] (range) age, 65.6 [8.8] (51-88) years) in the final analysis. The mean (SD) WMH volume was 5.93 (7.14) mL (median [interquartile range], 4.33 [1.33-8.62] mL), and mean (SD) RA pressure was 10.0 (4.7) mm Hg. From the catheterization data, 147 patients (63.4%) were classified as having a disease involving the mitral valve; 93 (40.1%), aortic valve; 37 (15.9%), tricuspid valve; and 4 (1.7%), pulmonary valve. In multivariate linear regression analysis, adjusting the type and mechanism of valve disease and clinical, echocardiographic, and/or other catheterization parameters, WMH volume was linearly associated with mean RA pressure (B coefficient, 0.702; 95% CI, 0.373-1.031; P = .001), along with age (B coefficient, 0.145; 95% CI, 0.029-0.261; P = .01) and mean aortic pressure (B coefficient, 0.112; 95% CI, 0.034-0.190; P = .005). Conclusions and Relevance Mean RA pressure was independently associated with the WMH volume in chronic valvular heart disease. Chronically altered RA hemodynamics might have a distinct influence on the pathomechanism underlying the development of WMH.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.,Protein Metabolism Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jae-Kyu Roh
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea
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Al-Momani MS, AbuRuz ME. Incidence and predictors of groin complications early after coronary artery intervention: a prospective observational study. BMC Nurs 2019; 18:24. [PMID: 31297032 PMCID: PMC6599377 DOI: 10.1186/s12912-019-0349-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 06/20/2019] [Indexed: 12/12/2022] Open
Abstract
Background Coronary artery disease remains the most common single cause of death worldwide. Percutaneous coronary intervention is an appropriate management for coronary artery disease which is not free from its potential complications. The purpose of this study was to determine the incidence rate and the predictors of groin complications post percutaneous coronary intervention in cardiac catheterization laboratories in Jordan. Methods This was a prospective observational study with a consecutive sample of 300 patients post percutaneous coronary intervention procedure. Data were collected from the cardiac health care center using a pre-structured observational sheet. Any groin complication developed within the first 24 h post procedure was recorded. All correlated variables were analyzed using logistic regression. Results The sample included 237 (79%) men and 63 (21%) women with a mean age of 57.46 ± 10.51 years. A total of 114 patients (38%) developed one or more groin complications. Ecchymosis was the most frequent groin complication; 102 (34%). Females and participants greater than 65 years were nearly two times more likely to develop groin complications (OR = 2.13, P = .024, 95% CI: 1.11-4.01) and (OR = 2.14, P = .023, 95% CI: 1.11-4.13) compared to other groups. Patients with a systolic blood pressure before sheath removal greater than 180 mmHg were about ten times more likely to develop groin complications (OR = 9.82, P = .001, 95% CI: 2.58-37.37). Conclusions Different factors can increase the risk of groin complications post percutaneous coronary intervention. Therefore, identification of high risk groups (i.e. females) might help in the application of different methods to control these complications.
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Affiliation(s)
| | - Mohannad Eid AbuRuz
- 2Applied Science Private University, Po box 142 Shafa Badran, Amman, 11934 Jordan
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Abstract
Objective: The use of fluoroscopy in pediatric catheter ablation has decreased because of mapping systems. In this study, we present the efficiency and reliability of the electroanatomic mapping system in nonfluoroscopic pediatric catheter ablation. Methods: The medical records of patients aged <18 years who underwent ablation between November 2016 and April 2018 were evaluated. Fluoroscopy was not used in cases involving ablation of right sided-arrhythmia foci. Fluoroscopy was used only for trans-septal puncture or retroaortic approach/coronary angiography. Results: A total of 76 patients underwent catheter ablation for 78 supraventricular and ventricular tachyarrhythmia substrates under the guidance of EnSite Velocity system. Fluoroscopy was used in only 14 (18.4%) of these substrates. The mean fluoroscopy duration in these 14 procedures was 5.4±3.15 min. No complications were noted, except a temporary right bundle branch block in one patient and pericardial effusion in another following cryoablation. The acute success rate in achieving complete elimination of arrhythmia substrates was 97.4% (76/78). The recurrence rate was 5.1% (4/78) at follow-up. Conclusion: Fluoroscopy can be completely eliminated in most pediatric catheter ablation procedures with the use of mapping systems by achieving high acute success rates and acceptable low complication rates.
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Koca S, Akdeniz C, Tuzcu V. Transseptal Puncture for Catheter Ablation in Children. Pediatr Cardiol 2019; 40:799-804. [PMID: 30729261 DOI: 10.1007/s00246-019-02069-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/31/2019] [Indexed: 11/25/2022]
Abstract
Transseptal puncture (TP) is used in pediatric patients to access the left atrium in left-sided arrhythmia catheter ablation. Performing this procedure can be difficult and risky, especially in small children. In this study, we aimed to evaluate the safety and feasibility of TPs in children ≤ 30 kg. Between April 2012 and April 2018, a retrospective evaluation was conducted of the clinical features, procedural outcomes, and follow-ups of ≤ 30 kg pediatric patients who required TPs for left-sided ablations at a pediatric electrophysiology center in which a three-dimensional mapping system was routinely used. A total of 45 pediatric patients who were ≤ 30 kg, underwent TPs: 10 patients ≤ 20 kg (Group 1) and 35 patients > 20 kg and ≤ 30 kg (Group 2). The TP success rate was 97.8%. The median procedure and fluoroscopy times were 120 min and 5.43 min, respectively. One patient developed self-limited pericardial effusion during the procedure; however, there were no incidences of cardiac tamponade. There was no significant difference between the two groups in terms of the procedure time and fluoroscopy time, and pericardial effusion was only observed in Group 2. TPs are safe and feasible in small children. These procedures can be performed with low complication rates in children weighing ≤ 30 kg.
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Affiliation(s)
- Serhat Koca
- Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey.
- Yuksek Ihtisas Hospital, Kizilay St. Nu 4 Sihhiye, Ankara, Turkey.
| | - Celal Akdeniz
- Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Volkan Tuzcu
- Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
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Catheter ablation for supraventricular tachycardia in children ≤ 20 kg using an electroanatomical system. J Interv Card Electrophysiol 2019; 55:99-104. [PMID: 30603855 DOI: 10.1007/s10840-018-0499-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/17/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Catheter ablation is the only choice of treatment in some small children with medically refractory supraventricular tachycardia (SVT). Electroanatomical mapping systems (EMS) are more commonly utilized in electrophysiological procedures in recent years, which resulted in a significant decrease in fluoroscopy exposure. The potential benefit of EMS in small children has not been studied. Therefore, we investigated the outcomes of children undergoing catheter ablation weighing ≤ 20 kg using an electroanatomical mapping system. METHODS This study evaluated the outcomes, characteristics, and follow-ups of children ≤ 20 kg who underwent SVT ablations between April 2012 and April 2018 in a pediatric electrophysiology center where EMS were routinely used. RESULTS In a 6-year period, 1129 children underwent SVT catheter ablation under EMS guidance at our institution. A total of 84 of them were weighing ≤ 20 kg. The acute success rate was 97.6% in 85 tachycardia substrates. No fluoroscopy was used in 58 of the patients, while a median of 5 (4-14) min of fluoroscopy was used in the remaining 26 patients. Recurrences were seen in 4 patients (4.8%) at a mean follow-up of 3.89 ± 2.08 years. Five patients developed non-vital complications (2 right bundle block and 3 temporary complete block that spontaneously resolved during the procedure). CONCLUSIONS The outcome of catheter ablation with the guidance of EMS for the treatment of SVT in small children is favorable. Fluoroscopy exposure can be decreased and even eliminated in most patients.
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Abstract
Purpose of the Review The purpose of this review is to illustrate specific challenges and opportunities in the building of an adult congenital heart disease (ACHD) program and to highlight critical components and important allies. Recent Findings With more than 1.4 million adults with congenital heart disease in the USA alone, access to specialized, compassionate, high-quality comprehensive care requires a shift toward more aggressive expansion of ACHD care, especially in the context of sparse ACHD provider representation in the vast majority of adult medical centers. Summary The effective build of an ACHD program requires measured escalation in management of ACHD complexity matched with cultivation of key resources and clinical services ranging from congenital cardiac surgery and interventional cardiology to acquired heart disease as well as partnerships with non-cardiac specialists. By reframing ACHD care as a shared goal between patients, providers, hospitals, pharmaceutical and device industry, and payers, a potent business model can be built around the developing ACHD program to facilitate acquisition of these key resources.
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Abstract
Diagnostic and interventional cardiac catheterization is routinely used in the diagnosis and treatment of congenital heart disease. There are well-established concerns regarding the risk of radiation exposure to patients and staff, particularly in children given the cumulative effects of repeat exposure. Magnetic resonance imaging (MRI) offers the advantage of being able to provide better soft tissue visualization, tissue characterization, and quantification of ventricular volumes and vascular flow. Initial work using MRI catheterization employed fusion of x-ray and MRI techniques, with x-ray fluoroscopy to guide catheter placement and subsequent MRI assessment for anatomical and hemodynamic assessment. Image overlay of 3D previously acquired MRI datasets with live fluoroscopic imaging has also been used to guide catheter procedures.Hybrid x-ray and MRI-guided catheterization paved the way for clinical application and validation of this technique in the assessment of pulmonary vascular resistance and pharmacological stress studies. Purely MRI-guided catheterization also proved possible with passive catheter tracking. First-in-man MRI-guided cardiac catheter interventions were possible due to the development of MRI-compatible guidewires, but halted due to guidewire limitations.More recent developments in passive and active catheter tracking have led to improved visualization of catheters for MRI-guided catheterization. Improvements in hardware and software have also increased image quality and scanning times with better interactive tools for the operator in the MRI catheter suite to navigate through the anatomy as required in real time. This has expanded to MRI-guided electrophysiology studies and radiofrequency ablation in humans. Animal studies show promise for the utility of MRI-guided interventional catheterization. Ongoing investment and development of MRI-compatible guidewires will pave the way for MRI-guided diagnostic and interventional catheterization coming into the mainstream.
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Stellenwert der diagnostischen Koronarangiographie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-018-0266-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Fernández Lozano I, Pozo Osinalde E, García Bolao I, Ojeda Pineda S, Rodríguez Padial L, Íñiguez Romo A. Criteria for the Management of Technological Assets in Cardiovascular Imaging. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:643-655. [PMID: 29941313 DOI: 10.1016/j.rec.2018.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
Adequate, updated and functional technology is essential in cardiology. In Spain, the economic scenario has strongly impacted technology renewal programs and obsolescence is a growing problem. The current report attempts to describe the current situation and the conditions that must concur to update, replace or adopt new technologies in the field of cardiology.
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Affiliation(s)
| | - Eduardo Pozo Osinalde
- Unidad de Imagen Cardiovascular, Servicio de Cardiología, Hospital Clínico San Carlos, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Ignacio García Bolao
- Servicio de Cardiología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
| | | | | | - Andrés Íñiguez Romo
- Servicio de Cardiología, Complejo Hospitalario de Vigo, Vigo, Pontevedra, Spain
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Quan C, Lee SS. Pattern and degree of radiation exposure during endovascular surgery performed using a mobile C-arm or in a hybrid room. Ann Surg Treat Res 2018; 96:131-137. [PMID: 30838185 PMCID: PMC6393411 DOI: 10.4174/astr.2019.96.3.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/16/2018] [Accepted: 06/29/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose A prospective study was conducted to compare radiation exposure to different parts of an endovascular surgeon's body when using a mobile C-arm with that in a hybrid room. Methods Exposure during individual procedures performed on 39 patients with a mobile C-arm and 42 patients in a hybrid room, from July 2016 to December 2016, was evaluated. Results The procedures performed, fluoroscopy time, and dose-area product were not significantly different between groups. The dose-area product per second in the hybrid room group appeared greater than in the C-arm group (4.5 µGym2/sec vs. 3.1 µGym2/sec). In the C-arm group, the peak skin dose on the right neck (1.77 mSv) and shoulder (1.48 mSv) appeared higher than those on their left side (0.32 mSv, 0.53 mSv, respectively) and the counterparts of the hybrid room group (0.88 mSv, 0.20 mSv, respectively). Conclusion The peak skin dose in the hybrid room appeared highest for the lower part of the protective apron. The dose-area product per second seemed to be greater in the hybrid room than when using the C-arm. Thus, attention should be focused on protecting the surgeon's upper body when using the C-arm and the lower body when using the hybrid room.
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Affiliation(s)
- Cheng Quan
- Department of Vascular Surgery, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Sang Su Lee
- Research Institute for Convergence of Biomedical Science and Technology, Division of Vascular and Endovascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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Outcome of Liver Transplant Recipients With Revascularized Coronary Artery Disease: A Comparative Analysis With and Without Cardiovascular Risk Factors. Transplantation 2017; 101:793-803. [PMID: 28099403 DOI: 10.1097/tp.0000000000001647] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is a significant problem during evaluation for liver transplantation (LT). We aim to assess survival in LT recipients based on presence, severity, extent of CAD, and cardiac events within 90 days of LT. METHODS Eighty-seven LT recipients with history of pre-LT angiogram (December 2005 to December 2012) were compared with 2 control groups without prior angiogram, 72 LT recipients matched for cardiovascular risk factors (control group I), and 119 consecutive LT recipients without any CV risk factors (control group II). CAD was assessed by (1) vessel score (≥50% reduction in luminal diameter), and (2) Extent score (Reardon scoring system). RESULTS Of the 87 LT recipients (study group), 58 (66.7%) had none or less than 50% stenosis, 29 (33.3%) had obstructive CAD (≥50% stenosis), 7 (8%) with single-vessel disease, and 22 (25.3%) with multivessel disease. In the study group, irrespective of prerevascularization severity of CAD (P = 0.357), number of segments involved (0, 1-2, > 2 segments, P = 0.304) and extent of CAD based on Reardon score (0, 1-9, >10, P = 0.224), comparable posttransplant survival was noted. Overall, patient survival in the revascularized CAD group was comparable to angiogram group without obstructive CAD, and both control group I and control group II (P = 0.184, Log Rank). Postoperative cardiac events within 90 days of LT predicted poor survival in study group as well as control groups. CONCLUSIONS Severity or extent of CAD does not impact post-LT survival, if appropriately revascularized. Early postoperative cardiac events are associated with inferior survival in LT recipients, irrespective of underlying CAD.
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Sun Y, Li W, Yin L, Wei L, Wang Y. Diagnostic accuracy of treadmill exercise tests among Chinese women with coronary artery diseases: A systematic review and meta-analysis. Int J Cardiol 2017; 227:894-900. [PMID: 27919426 DOI: 10.1016/j.ijcard.2016.11.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/06/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND The treadmill exercise test (TET) is one of the most common noninvasive diagnosis approaches for ischemic heart diseases, but potential reduction of TET accuracy among Chinese female patients was ignored by most studies, especially in perimenopause women. Hence, we aim to perform a systematic review and meta-analysis evaluating the TET diagnostic accuracy for Chinese women compared with coronary angiography (CAG). METHODS PubMed, MEDLINE, EMBASE, CNKI and WANFANG (1990 to 2015) were performed to identify studies assessing the diagnostic accuracy of TET versus CAG. Random effects modeling strategies were used to produce summary receiver operating characteristic (SROC) curves, including overall estimates for sensitivity and specificity. RESULTS A total of 19 studies involving 2396 Chinese females were included in our systematic review. TET has moderate levels of sensitivity (0.80) and specificity (0.65) to detect coronary artery stenoses in female patients with suspected coronary artery diseases, generating 0.79 of the area under the curve (AUC). In subgroup analyses, the pooled sensitivity of postmenopause and premenopausal/perimenopausal groups were 0.83 and 0.80, respectively. However, the postmenopause group has a higher pooled specificity: 0.68 versus 0.32 compared with premenopausal/perimenopausal women, and a higher corresponding AUC (0.81 versus 0.56). CONCLUSIONS TET may be used as a triage test for women with suspected and subclinical CAD. The positive results of TET should be treated with caution because of its higher false-positive, especially for premenopausal/perimenopausal women, and further confirmatory diagnosis is needed. However, patients with negative TET results could be precluded for further evaluation using CAG, and avoid unnecessary risk and economic burden to patients.
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Affiliation(s)
- Yi Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China.
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China
| | - Limei Wei
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037), China
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Nagpal P, Mullan BF, Sen I, Saboo SS, Khandelwal A. Advances in Imaging and Management Trends of Traumatic Aortic Injuries. Cardiovasc Intervent Radiol 2017; 40:643-654. [DOI: 10.1007/s00270-017-1572-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/02/2017] [Indexed: 01/16/2023]
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Shetti AN, Karigar SL, Mustilwar RG, Singh DR, Nag K. Anesthesiologist in cardiac catheterization laboratory; the roles and goals!! A postgraduate educational review [corrected]. Anesth Essays Res 2017; 11:811-815. [PMID: 29284831 PMCID: PMC5735470 DOI: 10.4103/0259-1162.186866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is not uncommon to see in developing and underdeveloped countries, where the anesthesiologist who is untrained in cardiac specialty takes care of cardiac catheterization centers. The service in cardiac catheterization laboratories (CCL) in developed countries and some of the developing countries is mainly provided by the cardiac anesthesiologists. The scenario is not same in some part of developing countries or in underdeveloped countries which are mainly due to increase in number of CCL (catheterization laboratory) when compared to the number of cardiac anesthesiologists working outside the operation theater. It is also important for training the postgraduate in this field as to make them capable and competitive in managing such cases during emergency situation as it may save the life of a patient. Many a times, CCL is built as per the need of cardiologist ignoring the basic needs of cardiac anesthesiologist. It is important to note that anesthesiologist should be competent enough to provide complete, integrated anesthetic care outside the operation theater with available resources. It is challenging for the anesthesiologist to provide sedation or general anesthesia in such critical area where he/she will be dealing with life-threatening situations. In the modern era, the interventional techniques are advancing and treating complex heart diseases is more often. Days are not far where the CCL procedures may reduce the requirement of major surgeries. A careful and dedicated approach by the anesthesiologist with thorough knowledge and skills decreases morbidity and mortality rate. This article helps both cardiac and noncardiac anesthesiologists to improve their knowledge and to approach the patient systematically.
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Affiliation(s)
- Akshaya N Shetti
- Department of Anaesthesiology and Critical Care, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Shivanand L Karigar
- Department of Anesthesiology, BLDE University and Research Centre, Bijapur, Karnataka, India
| | - Rachita G Mustilwar
- Department of Periodontology and Implantology, Rural Dental College, Loni, Maharashtra, India
| | - D Roshan Singh
- Department of Anesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Kusha Nag
- Department of Anesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Shams T, Zaidat O, Yavagal D, Xavier A, Jovin T, Janardhan V. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions. INTERVENTIONAL NEUROLOGY 2016; 5:1-28. [PMID: 27610118 PMCID: PMC4934489 DOI: 10.1159/000443617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices.
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Affiliation(s)
- Tanzila Shams
- Texas Stroke Institute, HCA North Texas Division, Dallas-Fort Worth, Tex., USA
| | - Osama Zaidat
- Mercy Neuroscience and Stroke Center, Toledo, Ohio, USA
| | - Dileep Yavagal
- Jackson Memorial Hospital, University of Miami Health System, Miami, Fla., USA
| | - Andrew Xavier
- Detroit Medical Center, Wayne State University, Detroit, Mich., USA
| | - Tudor Jovin
- UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburg, Pa., USA
| | - Vallabh Janardhan
- Texas Stroke Institute, HCA North Texas Division, Dallas-Fort Worth, Tex., USA
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Yang FB, Guo WL, Sheng M, Sun L, Ding YY, Xu QQ, Xu MG, Lv HT. Diagnostic accuracy of coronary angiography using 64-slice computed tomography in coronary artery disease. Saudi Med J 2016; 36:1156-62. [PMID: 26446324 PMCID: PMC4621719 DOI: 10.15537/smj.2015.10.12415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: To conduct a meta-analysis and investigate the diagnostic value of 64-slice computed tomography (CT) angiography for diagnosing coronary artery disease (CAD) in patients. Methods: A comprehensive literature search from March 2005 to August 2014 was performed on the following databases: Cochrane Library; Medline; EmBase; PubMed; and BioMed Central database. As a reference standard, studies that assessed 64-slice CT angiography in detecting coronary artery stenosis (CAS) with invasive coronary angiography were included. Coronary artery stenosis was defined as ≥50% diameter stenosis. Diagnostic value was determined by pooling sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR) values at segment-level analysis. Diagnostic accuracy was undertaken using area under the curve (AUC) value and summary receiver operating characteristic (SROC) curves. Publication bias was examined by Deek’s funnel plot asymmetry test. Results: Eight studies were included in the analysis, enrolling a total of 579 patients (7,407 segment coronary vessels). At segment-level, pooled sensitivity value was 90% (95% confidence interval [CI]: 83-95%), specificity was 91% (95% CI: 61-98%), PLR value was 9.7 (95% CI: 1.8-53.3), and NLR value was 0.11 (95% CI: 0.05-0.22) for CAS. Optimal cut-off point of sensitivity was 90%, and specificity under the SROC curve was 91%. The AUC value was 0.94. Conclusion: The 64-slice CT angiography is a reliable tool for detection of CAD when using a cut-off of ≥50% diameter stenosis in elderly population.
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Affiliation(s)
- Fu-Bin Yang
- Radiology Department, Children's Hospital of Soochow University, Suzhou, People's Republic of China. E-mail.
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Chang B, Urman RD. Non-operating Room Anesthesia: The Principles of Patient Assessment and Preparation. Anesthesiol Clin 2016; 34:223-240. [PMID: 26927750 DOI: 10.1016/j.anclin.2015.10.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A significant number of anesthetics are performed outside of the operating room (OR). Despite the increased requirement for anesthesia services, the framework to perform the necessary preprocedural anesthesia assessments to optimize patients has not been uniformly developed. Performing anesthesia in non-OR locations poses significant and distinct challenges compared with the procedures in the OR. Anesthesiologists are faced with patients with increasingly complicated comorbidities undergoing novel, complex interventional procedures. With unique training in preoperative triaging, and an expertise in intraoperative and postoperative management of complex patients, anesthesiologists can contribute to greater efficiency and patient safety in the non-OR setting.
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Affiliation(s)
- Beverly Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Hospital and Clinics, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Zhai H, Li L, Yin Y, Zhang J, Chen H, Liu R, Xia YF. The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency. Ren Fail 2016; 38:437-41. [PMID: 26853771 DOI: 10.3109/0886022x.2016.1138818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1 g 3/day × 3 days and slow intravenous input sodium chloride 1000 ∼1500 mL 3-12 h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4 h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251 umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.
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Affiliation(s)
- Hongxia Zhai
- a Department of Cadres , First Hospital Affiliated to General Hospital of People's Liberation Army , Beijing , China
| | - Liang Li
- a Department of Cadres , First Hospital Affiliated to General Hospital of People's Liberation Army , Beijing , China
| | - Yaxin Yin
- a Department of Cadres , First Hospital Affiliated to General Hospital of People's Liberation Army , Beijing , China
| | - Jinjin Zhang
- a Department of Cadres , First Hospital Affiliated to General Hospital of People's Liberation Army , Beijing , China
| | - Haiwei Chen
- a Department of Cadres , First Hospital Affiliated to General Hospital of People's Liberation Army , Beijing , China
| | - Runmei Liu
- a Department of Cadres , First Hospital Affiliated to General Hospital of People's Liberation Army , Beijing , China
| | - Yun-feng Xia
- a Department of Cadres , First Hospital Affiliated to General Hospital of People's Liberation Army , Beijing , China
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Andreini D, Martuscelli E, Guaricci AI, Carrabba N, Magnoni M, Tedeschi C, Pelliccia A, Pontone G. Clinical recommendations on Cardiac-CT in 2015. J Cardiovasc Med (Hagerstown) 2016; 17:73-84. [DOI: 10.2459/jcm.0000000000000318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bin Abdulrahman KA, Tawfik B. Strategic directions for university hospitals in Saudi Arabia. MEDICAL TEACHER 2016; 38 Suppl 1:S1-S4. [PMID: 26984027 DOI: 10.3109/0142159x.2016.1142518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The kingdom of Saudi Arabia is currently witnessing a massive support for its healthcare services. This year's fiscal budget for health care is by far the largest in the history of the kingdom. While pursuing the conventional goals of healthcare delivery systems, such as equity, affordability and availability of services, the ministry of education (MOE), formerly called ministry of higher education (MOHE), is also seeking to achieve certain excellence standards, which are expected to set the bar for other countries in the region to follow suit. Almost all, under construction, university hospitals were adopting a paradigm shift in the standard of health care and training provided. This report summarizes these standards.
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Rasalingam R, Holland MR, Cooper DH, Novak E, Rich MW, Miller JG, Pérez JE. Patients with Diabetes and Significant Epicardial Coronary Artery Disease Have Increased Systolic Left Ventricular Apical Rotation and Rotation Rate at Rest. Echocardiography 2015; 33:537-45. [PMID: 26593856 DOI: 10.1111/echo.13124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether resting myocardial deformation and rotation may be altered in diabetic patients with significant epicardial coronary artery disease (CAD) with normal left ventricular ejection fraction. DESIGN A prospective observational study. SETTING Diagnosis of epicardial CAD in patients with diabetes. PATIENTS AND METHODS Eighty-four patients with diabetes suspected of epicardial CAD scheduled for cardiac catheterization had a resting echocardiogram performed prior to their procedure. Echocardiographic measurements were compared between patients with and without significant epicardial CAD as determined by cardiac catheterization. MAIN OUTCOME MEASURES Measurement of longitudinal strain, strain rate, apical rotation, and rotation rate, using speckle tracking echocardiography. RESULTS Eighty-four patients were studied, 39 (46.4%) of whom had significant epicardial CAD. Global peak systolic apical rotation was significantly increased (14.9 ± 5.1 vs. 11.0 ± 4.8 degrees, P < 0.001) in patients with epicardial CAD along with faster peak systolic apical rotation rate (90.4 ± 29 vs. 68.1 ± 22.2 degrees/sec, P < 0.001). These findings were further confirmed through multivariate logistic regression analysis (global peak systolic apical rotation OR = 1.17, P = 0.004 and peak systolic apical rotation rate OR = 1.05, P < 0.001). CONCLUSIONS Patients with diabetes with significant epicardial CAD and normal LVEF exhibit an increase in peak systolic apical counterclockwise rotation and rotation rate detected by echocardiography, suggesting that significant epicardial CAD and its associated myocardial effects in patients with diabetes may be detected noninvasively at rest.
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Affiliation(s)
- Ravi Rasalingam
- Cardiovascular Division, Boston Veterans Affairs Medical Center, West Roxbury, Massachusetts
| | - Mark R Holland
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Indiana
| | - Daniel H Cooper
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Michael W Rich
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - James G Miller
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri
| | - Julio E Pérez
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
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Toerper MF, Flanagan E, Siddiqui S, Appelbaum J, Kasper EK, Levin S. Cardiac catheterization laboratory inpatient forecast tool: a prospective evaluation. J Am Med Inform Assoc 2015; 23:e49-57. [PMID: 26342217 DOI: 10.1093/jamia/ocv124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/11/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To develop and prospectively evaluate a web-based tool that forecasts the daily bed need for admissions from the cardiac catheterization laboratory using routinely available clinical data within electronic medical records (EMRs). METHODS The forecast model was derived using a 13-month retrospective cohort of 6384 catheterization patients. Predictor variables such as demographics, scheduled procedures, and clinical indicators mined from free-text notes were input to a multivariable logistic regression model that predicted the probability of inpatient admission. The model was embedded into a web-based application connected to the local EMR system and used to support bed management decisions. After implementation, the tool was prospectively evaluated for accuracy on a 13-month test cohort of 7029 catheterization patients. RESULTS The forecast model predicted admission with an area under the receiver operating characteristic curve of 0.722. Daily aggregate forecasts were accurate to within one bed for 70.3% of days and within three beds for 97.5% of days during the prospective evaluation period. The web-based application housing the forecast model was used by cardiology providers in practice to estimate daily admissions from the catheterization laboratory. DISCUSSION The forecast model identified older age, male gender, invasive procedures, coronary artery bypass grafts, and a history of congestive heart failure as qualities indicating a patient was at increased risk for admission. Diagnostic procedures and less acute clinical indicators decreased patients' risk of admission. Despite the site-specific limitations of the model, these findings were supported by the literature. CONCLUSION Data-driven predictive analytics may be used to accurately forecast daily demand for inpatient beds for cardiac catheterization patients. Connecting these analytics to EMR data sources has the potential to provide advanced operational decision support.
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Affiliation(s)
- Matthew F Toerper
- Johns Hopkins Department of Emergency Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287, USA Johns Hopkins Health System Operations Integration, 600 N. Wolfe Street, Administration Bldg. Suite 420, Baltimore, MD 21287, USA
| | - Eleni Flanagan
- Johns Hopkins Heart and Vascular Institute, 600 N. Wolfe Street, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Sauleh Siddiqui
- Department of Civil Engineering, Johns Hopkins Systems Institute, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218, USA Department of Applied Mathematics and Statistics, Johns Hopkins Systems Institute, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Jeff Appelbaum
- Johns Hopkins Health System Operations Integration, 600 N. Wolfe Street, Administration Bldg. Suite 420, Baltimore, MD 21287, USA
| | - Edward K Kasper
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Scott Levin
- Johns Hopkins Department of Emergency Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287, USA Johns Hopkins Health System Operations Integration, 600 N. Wolfe Street, Administration Bldg. Suite 420, Baltimore, MD 21287, USA
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Sakamoto H, Matsushita S, Hyodo K, Tokunaga C, Sato F, Hiramatsu Y. A new technique of in vivo synchrotron radiation coronary microangiography in the rat. Acta Radiol 2015; 56:1105-7. [PMID: 25260415 DOI: 10.1177/0284185114549570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/15/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previously, in our laboratory, synchrotron radiation coronary microangiography (SRCA) using Langendorff-perfused rat hearts could visualize a coronary artery of 50 µm in diameter. However, in vivo rat SRCA poses the problem of compromised temporal resolution due to the rapid heart rate of rats. PURPOSE To establish a simple method of in vivo rat SRCA with bradycardia induced by intravenous injection of adenosine triphosphate disodium hydrate (ATP). MATERIAL AND METHODS SRCA was performed at the Photon Factory of the High Energy Accelerator Research Organization (Tsukuba, Japan). Eight male Wistar rats were anesthetized. A catheter for injecting the contrast material was inserted into the carotid artery. Temporary bradycardia was induced by an intravenous bolus injection of 5 mg of ATP, and SRCA was performed immediately thereafter. RESULTS After ATP administration, the average heart rate decreased from 388 to 73 beats per minute. As a result, we could detect a coronary artery as small as 45 µm in diameter. CONCLUSION Our SRCA system which has a high resolution of 9 µm per pixel could detect a coronary artery as small as 45 µm in diameter in the in vivo rat.
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Affiliation(s)
- Hiroaki Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Kazuyuki Hyodo
- Photon Factory, High Energy Accelerator Research Organization, Tsukuba, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fujio Sato
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Lee D, Li D, Jug B, Papazian J, Budoff M. Diagnostic accuracy of 64 slice multidetector coronary computed tomographic angiography in left ventricular systolic dysfunction. IJC HEART & VASCULATURE 2015; 8:42-46. [PMID: 28785677 PMCID: PMC5497233 DOI: 10.1016/j.ijcha.2015.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/16/2015] [Indexed: 11/17/2022]
Abstract
Background Detecting coronary artery disease (CAD) is pivotal in etiologic assessment and management of left ventricular (LV) systolic dysfunction. Only a limited number of studies have specifically addressed the accuracy of coronary computed tomographic angiography (CCTA) in detection/exclusion of CAD in patients with LV systolic dysfunction. Methods We included patients who were referred for CCTA and invasive coronary angiography within 6 months of each other because of chest pain, either as part of clinical work-up in two Los Angeles medical centers from September 2006 to May 2010 or as part of the multicenter ACCURACY trial. Sensitivity, specificity, positive and negative predictive value, and likelihood ratios of 64 slice multidetector CCTA against coronary angiography were calculated. Results Five hundred and thirty-seven patients were included: 228 (42.5%) were women, mean age was 62 ± 12 years, 82 (15.3%) had LV systolic dysfunction (defined by LVEF < 50%). On a patient-based model, the sensitivity of CCTA to detect 50% and 70% coronary lesions was excellent across all LVEF-derived cohorts, ranging from 92% to 100%. The negative predictive value was similarly excellent, ranging from 88% to 100%. CCTA was fairly specific for CAD, with specificity ranging from 83% to 93%, and positive predictive value from 81% to 92%. There was no significant between-group difference for any of the accuracy measures for detecting coronary stenosis at 50% or 70% cutoff. Conclusion Sixty-four slice multidetector CCTA is a very sensitive and fairly specific noninvasive diagnostic procedure for detecting coronary stenosis in patients with chest pain regardless of LV systolic function at presentation.
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Affiliation(s)
- Danny Lee
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, United States
| | - Dong Li
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, United States
| | - Borut Jug
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, United States.,Department of Vascular Diseases, Division of Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Jenny Papazian
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, United States
| | - Matthew Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, United States.,David Geffen School of Medicine UCLA, Los Angeles, CA, United States
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Johri AM, Behl P, Hétu MF, Haqqi M, Ewart P, Day AG, Parfrey B, Matangi MF. Carotid Ultrasound Maximum Plaque Height-A Sensitive Imaging Biomarker for the Assessment of Significant Coronary Artery Disease. Echocardiography 2015; 33:281-9. [DOI: 10.1111/echo.13007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Amer M. Johri
- Cardiovascular Imaging Network at Queen's; Department of Medicine; Division of Cardiology; Queen's University; Kingston Ontario Canada
| | - Pearl Behl
- Cardiovascular Imaging Network at Queen's; Department of Medicine; Division of Cardiology; Queen's University; Kingston Ontario Canada
| | - Marie-France Hétu
- Cardiovascular Imaging Network at Queen's; Department of Medicine; Division of Cardiology; Queen's University; Kingston Ontario Canada
| | - Mohammad Haqqi
- Cardiovascular Imaging Network at Queen's; Department of Medicine; Division of Cardiology; Queen's University; Kingston Ontario Canada
| | - Paul Ewart
- Cardiovascular Imaging Network at Queen's; Department of Medicine; Division of Cardiology; Queen's University; Kingston Ontario Canada
| | - Andrew G. Day
- Cardiovascular Imaging Network at Queen's; Department of Medicine; Division of Cardiology; Queen's University; Kingston Ontario Canada
| | - Brendan Parfrey
- Cardiovascular Imaging Network at Queen's; Department of Medicine; Division of Cardiology; Queen's University; Kingston Ontario Canada
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Cirillo T, Latini G, Castaldi MA, Dipaola L, Fasano E, Esposito F, Scognamiglio G, Francesco FD, Cobellis L. Exposure to di-2-ethylhexyl phthalate, di-n-butyl phthalate and bisphenol A through infant formulas. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2015; 63:3303-3310. [PMID: 25730646 DOI: 10.1021/jf505563k] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Phthalates and bisphenol A (BPA) are ubiquitous contaminants identified as endocrine disruptors. Phthalates are worldwide used as plasticizers, in particular to improve the mechanical properties of polymers such as polyvinyl chloride. Because they are not chemically bound to the polymer, they tend to leach out with time and use. Di-2-ethylhexyl phthalate (DEHP) and di-n-butyl phthalate (DnBP) are the two most common phthalates. BPA is an estrogenic compound used to manufacture polycarbonate containers for food and drink, including baby bottles. It can migrate from container into foods, especially at elevated temperatures. Diet is a predominant source of exposure for phthalates and BPA, especially for infants. The aim of this study was to test the presence of DEHP, DnBP, and BPA in infant formulas. DEHP, DnBP, and BPA concentrations were measured in 22 liquid and 28 powder milks by gas chromatography with flame ionization detection and high performance liquid chromatography with fluorimetric detection, respectively. DEHP concentrations in our samples were between 0.005 and 5.088 μg/g (median 0.906 μg/g), DnBP concentrations were between 0.008 and 1.297 μg/g (median 0.053 μg/g), and BPA concentrations were between 0.003 and 0.375 μg/g (median 0.015 μg/g). Concentrations of the investigated contaminants in liquid and powder milks were not significantly different, even though samples were packed in different types of containers. These data point out potential hazards for infants fed with baby formulas. Contamination seems more related to the production of formulas than to a release from containers.
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Affiliation(s)
- Teresa Cirillo
- †Department of Agriculture, "Federico II" University, Via Università, 100 80055 Portici, Naples Italy
| | - Giuseppe Latini
- ‡Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Via Andrea Bafile, 6, 72100 Brindisi, Italy
| | - Maria Antonietta Castaldi
- §Department of the Woman, the Child, and General and Specialized Surgery, Second University of NaplesVia Costantinopoli, 104 80138 Naples, Italy
| | - Lucia Dipaola
- ‡Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Via Andrea Bafile, 6, 72100 Brindisi, Italy
| | - Evelina Fasano
- †Department of Agriculture, "Federico II" University, Via Università, 100 80055 Portici, Naples Italy
| | - Francesco Esposito
- †Department of Agriculture, "Federico II" University, Via Università, 100 80055 Portici, Naples Italy
| | - Gelsomina Scognamiglio
- †Department of Agriculture, "Federico II" University, Via Università, 100 80055 Portici, Naples Italy
| | - Fabio Di Francesco
- ‡Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Via Andrea Bafile, 6, 72100 Brindisi, Italy
- ∥Department of Chemistry and Industrial Chemistry, University of PisaVia Giuseppe Moruzzi, 3 56124 Pisa, Italy
| | - Luigi Cobellis
- §Department of the Woman, the Child, and General and Specialized Surgery, Second University of NaplesVia Costantinopoli, 104 80138 Naples, Italy
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Scaglione M, Ebrille E, Clemente FD, Gaita F, Bradfield JS. Catheter Ablation of Atrial Fibrillation Without Radiation Exposure Using A 3D Mapping System. J Atr Fibrillation 2015; 7:1167. [PMID: 27957146 DOI: 10.4022/jafib.1167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 11/10/2022]
Abstract
Transcatheter ablation procedures have been traditionally performed under fluoroscopic guidance. However, x-ray exposure is afflicted by the risk of developing malignancies as well as other deterministic effects of radiation. For this reason, radiation doses in the interventional laboratory should be reduced "As Low As Reasonably Achievable", with respect to the safety of the patients and the medical staff. This is of utmost importance in atrial fibrillation (AF) ablations, which are usually lengthy procedures. With the improvement of technology, the development of additional imaging tools and the widespread of 3D electroanatomic mapping systems (EAM), near-zero fluoroscopy AF ablation procedure is becoming a reality, limiting fluoroscopy use mainly to guide transseptal puncture. In the present paper we reviewed the risks to health related to x-ray exposure and we discussed the current state of knowledge of catheter ablation of AF without fluoroscopy in the 3D EAM system era.
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Affiliation(s)
- Marco Scaglione
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Elisa Ebrille
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Fiorenzo Gaita
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jason S Bradfield
- Department of Medical Sciences, Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Incremental Value of Hybrid PET/CT in Patients with Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-014-9312-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cheong BYC, Angelini P. Magnetic Resonance Imaging of the Myocardium, Coronary Arteries, and Anomalous Origin of Coronary Arteries. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Pozo E, Álvarez-Acosta L, Alonso D, Pazos-Lopez P, de Siqueira MEM, Jacobi A, Narula J, Fuster V, Sanz J. Diagnostic accuracy of coronary ct for the quantification of the syntax score in patients with left main and/or 3-vessel coronary disease. Comparison with invasive angiography. Int J Cardiol 2015; 182:549-56. [PMID: 25703283 DOI: 10.1016/j.ijcard.2015.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/18/2014] [Accepted: 01/03/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND The SYNTAX score helps in the treatment decision in multivessel coronary disease. Coronary computed tomography angiography (CTA) can measure the SYNTAX score but has been used in few patients with multivessel disease. Our aim was to assess the feasibility, accuracy and reproducibility of SYNTAX score with CCTA compared with invasive coronary angiography (ICA) in de novo left main and/or 3-vessel disease. METHODS 57 patients with new left main and/or 3-vessel disease on ICA and a CCTA performed within the previous month were included. The SYNTAX score was calculated retrospectively for both modalities. Agreement for the global score, vessel score, different components and inter-readers was evaluated with intraclass correlation coefficient (ICC). The ability to classify SYNTAX score categories (low, intermediate and high) was assessed using weighted kappa (K) coefficient. RESULTS CCTA-based SYNTAX score showed an acceptable concordance (ICC=0.64) and good correlation (r=0.65, p<0.001) with ICA. ICC per vessel and component ranged from 0 to 0.73. There was good agreement classifying the SYNTAX score categories (K=0.53) and interobserver reproducibility (ICC=0.85). CCTA demonstrated high diagnostic accuracy (0.84) for detecting patients in the high score group. No patient with a high CCTA SYNTAX score had a low risk score by ICA that would suggest benefit from percutaneous revascularization. CONCLUSIONS CCTA showed good correlation, acceptable concordance, and high reproducibility for the quantification of the SYNTAX score in de novo left main and/or 3-vessel coronary disease. A high CCTA SYNTAX score identified a group of patients less likely to benefit from percutaneous coronary intervention.
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Affiliation(s)
- Eduardo Pozo
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA; Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Madrid, Spain
| | - Luis Álvarez-Acosta
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA; Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain
| | - David Alonso
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA; Servicio de Cardiología, Hospital Universitario de León, León, Spain
| | - Pablo Pazos-Lopez
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA; Servizo de Cardioloxía, Complexo Hospitalario Universitario de Vigo, Pontevedra, Spain
| | - Maria Eduarda Menezes de Siqueira
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA
| | - Adam Jacobi
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA; Department of Radiology, The Mount Sinai Medical Center, New York, NY, USA
| | - Jagat Narula
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA; Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Madrid, Spain
| | - Javier Sanz
- The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, NY, USA.
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Rio P, Ramos R, Pereira-da-Silva T, Barbosa C, Cacela D, Fiarresga A, de Sousa L, Abreu A, Patrício L, Bernardes L, Ferreira RC. Yield of contemporary clinical strategies to detect patients with obstructive coronary artery disease. Heart Int 2015; 10:e12-9. [PMID: 27672432 PMCID: PMC4946384 DOI: 10.5301/heartint.5000224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Noninvasive ischemia testing (NIST) is recommended for most patients suspected to have stable coronary artery disease (CAD) before invasive coronary angiography (ICA). We sought to assess the diagnostic predictive ability of NIST over clinical risk profiling in a contemporary sample of patients undergoing the currently recommended diagnostic triage strategy. METHODS From 2006 to 2011, 2,600 consecutive patients without known CAD undergoing elective ICA in a single tertiary-care center were retrospectively identified and the prevalence of obstructive CAD determined. To understand the incremental value of frequently used clinical parameters in predicting obstructive CAD, receiver operating characteristic curves were plotted for six sequential models starting with Framingham risk score and then progressively adding multiple clinical factors and finally NIST results. RESULTS At ICA 1,268 patients (48.8%) had obstructive CAD. The vast majority (85%) were classified in an intermediate clinical pretest probability of CAD and NIST prior to ICA was used in 86% of the cohort. The most powerful correlate of obstructive CAD was the presence of severe angina (odds ratio (OR) = 9.1; 95% confidence interval (CI) 4.3-19.1). Accordingly, the incorporation of NIST in a sequential model had no significant effect on the predictive ability over that achieved by clinical and symptomatic status model (C-statistic 0.754; 95% CI 0.732-0.776, p = 0.28). CONCLUSIONS Less than half the patients with suspect stable obstructive CAD referred to a tertiary-level center for elective ICA had the diagnosis confirmed. In this clinical setting, the results of NIST may not have the power to change the discriminative ability over clinical judgment alone.
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Affiliation(s)
- Pedro Rio
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Ruben Ramos
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Tiago Pereira-da-Silva
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Carlos Barbosa
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Duarte Cacela
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - António Fiarresga
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Lídia de Sousa
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Ana Abreu
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Lino Patrício
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Luís Bernardes
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar de Lisboa Central, Lisbon - Portugal
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Bradley SM, Spertus JA, Kennedy KF, Nallamothu BK, Chan PS, Patel MR, Bryson CL, Malenka DJ, Rumsfeld JS. Patient selection for diagnostic coronary angiography and hospital-level percutaneous coronary intervention appropriateness: insights from the National Cardiovascular Data Registry. JAMA Intern Med 2014; 174:1630-9. [PMID: 25156821 PMCID: PMC4276416 DOI: 10.1001/jamainternmed.2014.3904] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Diagnostic coronary angiography in asymptomatic patients may lead to inappropriate percutaneous coronary intervention (PCI) due to a diagnostic-therapeutic cascade. Understanding the association between patient selection for coronary angiography and PCI appropriateness may inform strategies to minimize inappropriate procedures. OBJECTIVE To determine if hospitals that frequently perform coronary angiography in asymptomatic patients, a clinical scenario in which the benefit of angiography is less clear, are more likely to perform inappropriate PCI. DESIGN, SETTING, AND PARTICIPANTS Multicenter observational study of 544 hospitals participating in the CathPCI Registry between July 1, 2009, and September 30, 2013. MAIN OUTCOMES AND MEASURES Hospital proportion of asymptomatic patients at diagnostic coronary angiography and hospital rate of inappropriate PCI as defined by 2012 appropriate use criteria for coronary revascularization. RESULTS Of 1 225 562 patients who underwent elective coronary angiography, 308 083 (25.1%) were asymptomatic. The hospital proportion of angiography among asymptomatic patients ranged from 1.0% to 73.6% (median, 24.7%; interquartile range, 15.9%-35.9%). By hospital quartile of asymptomatic patients at angiography, hospitals with higher rates of asymptomatic patients at angiography had higher median rates of inappropriate PCI (14.8% vs 20.2% vs 24.0 vs 29.4% from lowest to highest quartile, P < .001 for trend). This outcome was attributable to more frequent use of inappropriate PCI in asymptomatic patients at hospitals with higher rates of angiography in asymptomatic patients (5.4% vs 9.9% vs 14.7% vs 21.6% from lowest to highest quartile, P < .001 for trend). Hospitals with higher rates of asymptomatic patients at angiography also had lower rates of appropriate PCI (38.7% vs 33.0% vs 32.3% vs 32.9% from lowest to highest quartile, P < .001 for trend). CONCLUSIONS AND RELEVANCE In a national sample of hospitals, performance of coronary angiography in asymptomatic patients was associated with higher rates of inappropriate PCI and lower rates of appropriate PCI. Improving preprocedural risk stratification and thresholds for coronary angiography may be one strategy to improve the appropriateness of PCI.
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Affiliation(s)
- Steven M Bradley
- Veterans Affairs Eastern Colorado Health Care System, Denver2University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora3Colorado Cardiovascular Outcomes Research Consortium, Denver
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City
| | | | - Paul S Chan
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City
| | | | | | | | - John S Rumsfeld
- Veterans Affairs Eastern Colorado Health Care System, Denver2University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora3Colorado Cardiovascular Outcomes Research Consortium, Denver
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Haines DE, Beheiry S, Akar JG, Baker JL, Beinborn D, Beshai JF, Brysiewicz N, Chiu-Man C, Collins KK, Dare M, Fetterly K, Fisher JD, Hongo R, Irefin S, Lopez J, Miller JM, Perry JC, Slotwiner DJ, Tomassoni GF, Weiss E. Heart Rythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety. Heart Rhythm 2014; 11:e9-51. [PMID: 24814989 PMCID: PMC7106221 DOI: 10.1016/j.hrthm.2014.03.042] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Indexed: 01/08/2023]
Affiliation(s)
| | - Salwa Beheiry
- California Pacific Medical Center, San Francisco, California
| | - Joseph G. Akar
- Yale University School of Medicine, New Haven Connecticut
| | | | | | | | | | | | | | | | | | | | - Richard Hongo
- Sutter Pacific Medical Foundation, San Francisco, California
| | | | | | - John M. Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - David J. Slotwiner
- Hofstra School of Medicine, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Pappone C, Berto MB, Santinelli V. The Unique MediGuide Technology For CRT Lead Placement And Catheter Ablation. J Atr Fibrillation 2014; 7:1072. [PMID: 27957083 PMCID: PMC5135152 DOI: 10.4022/jafib.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/10/2014] [Accepted: 06/09/2014] [Indexed: 11/10/2022]
Abstract
Electrophysiologic procedures such as catheter ablation and/or cardiac resynchronization therapy (CRT) are usually performed under fluoroscopic guidance alone. Currently, we are witnessing the birth of a new era in which many patients can be safely and effectively treated without the use of fluoroscopy. Using MediGuide technology continuous fluoroscopy is no longer required to ascertain the position of the device/catheter, which minimizes the radiation exposure for both the physician and patient, with a further benefit by minimal need for contrast agent. This novel system provides real time tracking of devices projected into live fluoroscopy or pre-recorded cine-angiography. MediGuide technology is an important step forward facilitating complex ablation procedures such as AF ablation and CRT implantation.
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Affiliation(s)
- Carlo Pappone
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola; Italy
| | - Martina Boscolo Berto
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola; Italy
| | - Vincenzo Santinelli
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola; Italy
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Affiliation(s)
- Michael P Thomas
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System and Center for Clinical Management Research, Ann Arbor, Michigan.
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System and Center for Clinical Management Research, Ann Arbor, Michigan
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System and Center for Clinical Management Research, Ann Arbor, Michigan
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