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Ozaki Y, Hong SJ, Heg D, Frigoli E, Vranckx P, Morice MC, Chevalier B, Onuma Y, Windecker S, Di Biasi M, Whitbourn R, Dudek D, Raffel OC, Shimizu K, Calabrò P, Fröbert O, Cura F, Berg JT, Smits PC, Valgimigli M. Geographical variations in the effectiveness and safety of abbreviated or standard antiplatelet therapy after PCI in patients at high bleeding risk. Can J Cardiol 2024:S0828-282X(24)00080-1. [PMID: 38309468 DOI: 10.1016/j.cjca.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024] Open
Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Sung-Jin Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
| | - Dik Heg
- Clinical Trial Unit, University of Bern, Bern, Switzerland
| | - Enrico Frigoli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Jessa ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Marie-Claude Morice
- Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France; Cardiovascular European Research Center, Massy, France
| | | | - Yoshinobu Onuma
- University of Galway, Galway University Hospital, Galway, Ireland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Interventional Cardiology Unit GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Owen Christopher Raffel
- Cardiology Department, The Prince Charles Hospital Brisbane Queensland Australia; Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy; Azienda Ospedaliera di Rilievo Nazionale "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Ole Fröbert
- Faculty of Health, Department of Cardiology, Örebro University, Södra Grev Rosengatan, Örebro, Sweden
| | - Fernando Cura
- Instituto Cardiovascularde Buenos Aires, Buenos Aires, Argentina
| | - Jurrien Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Cardiology, University Medical Center Maastricht, Maastricht, the Netherlands
| | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
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Savage ML, Hay K, Vollbon W, Doan T, Murdoch DJ, Hammett C, Poulter R, Walters DL, Denman R, Ranasinghe I, Raffel OC. Prehospital Activation of the Cardiac Catheterization Laboratory in ST-Segment-Elevation Myocardial Infarction for Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2023:e029346. [PMID: 37449585 PMCID: PMC10382081 DOI: 10.1161/jaha.122.029346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
Background Prehospital activation of the cardiac catheter laboratory is associated with significant improvements in ST-segment-elevation myocardial infarction (STEMI) performance measures. However, there are equivocal data, particularly within Australia, regarding its influence on mortality. We assessed the association of prehospital activation on performance measures and mortality in patients with STEMI treated with primary percutaneous coronary intervention from the Queensland Cardiac Outcomes Registry (QCOR). Methods and Results Consecutive ambulance-transported patients with STEMI treated with primary percutaneous coronary intervention were analyzed from January 1, 2017 to December 31, 2020 from the QCOR. The total and direct effects of prehospital activation on the primary outcomes (30-day and 1-year cardiovascular mortality) were estimated using logistic regression analyses. Secondary outcomes were STEMI performance measures. Among 2498 patients (mean age: 62.2±12.4 years; 79.2% male), 73% underwent prehospital activation. Median door-to-balloon time (34 minutes [26-46] versus 86 minutes [68-113]; P<0.001), first-electrocardiograph-to-balloon time (83.5 minutes [72-98] versus 109 minutes [81-139]; P<0.001), and proportion of patients meeting STEMI targets (door-to-balloon <60 minutes 90% versus 16%; P<0.001), electrocardiograph-to-balloon time <90 minutes (62% versus 33%; P<0.001) were significantly improved with prehospital activation. Prehospital activation was associated with significantly lower 30-day (1.6% versus 6.6%; P<0.001) and 1-year cardiovascular mortality (2.9% versus 9.5%; P<0.001). After adjustment, no prehospital activation was strongly associated with increased 30-day (odds ratio [OR], 3.6 [95% CI, 2.2-6.0], P<0.001) and 1-year cardiovascular mortality (OR, 3.0 [95% CI, 2.0-4.6]; P<0.001). Conclusions Prehospital activation of cardiac catheterization laboratory for primary percutaneous coronary intervention was associated with significantly shorter time to reperfusion, achievement of STEMI performance measures, and lower 30-day and 1-year cardiovascular mortality.
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Affiliation(s)
- Michael L Savage
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Karen Hay
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - William Vollbon
- Queensland Cardiac Outcomes Registry Brisbane Queensland Australia
| | - Tan Doan
- Queensland Ambulance Service Brisbane Queensland Australia
| | - Dale J Murdoch
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Christopher Hammett
- Cardiology Department The Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Rohan Poulter
- Queensland Cardiac Outcomes Registry Brisbane Queensland Australia
- Cardiology Department Sunshine Coast University Hospital Brisbane Queensland Australia
| | - Darren L Walters
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Russell Denman
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Isuru Ranasinghe
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Owen Christopher Raffel
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
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Wang J, Fang R, Wu H, Xiang Y, Mendieta JB, Paritala PK, Fan Z, Anbananthan H, Amaya Catano JA, Raffel OC, Li Z. Impact of cyclic bending on coronary hemodynamics. Biomech Model Mechanobiol 2023; 22:729-738. [PMID: 36602717 DOI: 10.1007/s10237-022-01677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023]
Abstract
It remains unknown that the degree of bias in computational fluid dynamics results without considering coronary cyclic bending. This study aims to investigate the influence of different rates of coronary cyclic bending on coronary hemodynamics. To model coronary bending, a multi-ring-controlled fluid-structural interaction model was designed. A coronary artery was simulated with various cyclic bending rates (0.5, 0.75 and 1 s, corresponding to heart rates of 120, 80 and 60 bpm) and compared against a stable model. The simulated results show that the hemodynamic parameters of vortex Q-criterion, temporal wall shear stress (WSS), time-averaged WSS (TaWSS) and oscillatory shear index (OSI) were sensitive to the changes in cyclic rate. A higher heart rate resulted in higher magnitude and larger variance in the hemodynamic parameters. Whereas, the values and distributions of flow velocity and relative residence time (RRT) did not show significant differences between different bending periods. This study suggests that a stable coronary model is not sufficient to represent the hemodynamics in a bending coronary artery. Different heart rate conditions were found to have significant impact on the hemodynamic parameters. Thus, cyclic bending should be considered to mimic the realistic hemodynamics in future patient-specific coronary hemodynamics studies.
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Affiliation(s)
- Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
| | - Runxin Fang
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, 210096, Jiangsu, China
| | - Hao Wu
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, 210096, Jiangsu, China
| | - Yuqiao Xiang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Phani Kumari Paritala
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Zhenya Fan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Haveena Anbananthan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Jorge Alberto Amaya Catano
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Owen Christopher Raffel
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.,School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia. .,School of Biological Science & Medical Engineering, Southeast University, Nanjing, 210096, Jiangsu, China. .,Faculty of Sports Science, Ningbo University, Ningbo, 315211, Zhejiang, China.
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Savage ML, Hay K, Murdoch DJ, Doan T, Bosley E, Walters DL, Denman R, Ranasinghe I, Raffel OC. Clinical Outcomes in Pre-Hospital Activation and Direct Cardiac Catheterisation Laboratory Transfer of STEMI for Primary PCI. Heart Lung Circ 2022; 31:974-984. [PMID: 35227611 DOI: 10.1016/j.hlc.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/05/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pre-hospital activation and direct cardiac catheterisation laboratory (CCL) transfer of ST segment elevation myocardial infarction (STEMI) has previously been shown to improve door-to-balloon (DTB) times yet there is limited outcome data in the Australian context. We aimed to assess the impact of pre-hospital activation on STEMI performance measures and mortality. METHODS Prospective cohort study of consecutive ambulance transported STEMI patients treated with primary percutaneous coronary intervention (PCI) patients over a 10-year period (1 January 2008-31 December 2017) at The Prince Charles Hospital, a large quaternary referral centre in Brisbane, Queensland Australia. Comparisons were performed between patients who underwent pre-hospital CCL activation and patients who did not. STEMI performance measures, 30-day and 1-year mortality were examined. RESULTS Amongst 1,009 patients included (mean age: 62.8 yrs±12.6), pre-hospital activation increased over time (26.6% in 2008 to 75.0% in 2017, p<0.001). Median DTB time (35 mins vs 76 mins p<0.001) and percentage meeting targets (DTB<60 mins 92% vs 27%, p<0.001) improved significantly with pre-hospital activation. Pre-hospital activation was associated with significantly lower 30-day (1.0% vs 3.5%, p=0.007) and 1-year (1.2% vs 7.7%, p<0.001) mortality. After adjusting for confounders and mediators, we observed a strong total effect of pre-hospital activation on 1-year mortality (OR 5.3, 95%CI 2.2-12.4, p<0.001) compared to patients who did not have pre-hospital activation. False positive rates were 3.7% with pre-hospital activation. CONCLUSION In patients who underwent primary PCI for STEMI, pre-hospital activation and direct CCL transfer is associated with low false positive rates, significantly reduced time to reperfusion and lower 30-day and 1-year mortality.
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Affiliation(s)
- Michael L Savage
- Cardiology Department, The Prince Charles Hospital, Brisbane, Qld, Australia; School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.
| | - Karen Hay
- School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Dale J Murdoch
- Cardiology Department, The Prince Charles Hospital, Brisbane, Qld, Australia; School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Tan Doan
- Queensland Ambulance Service, Brisbane, Qld, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Qld, Australia
| | - Darren L Walters
- Cardiology Department, The Prince Charles Hospital, Brisbane, Qld, Australia; School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Russell Denman
- Cardiology Department, The Prince Charles Hospital, Brisbane, Qld, Australia; School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Isuru Ranasinghe
- Cardiology Department, The Prince Charles Hospital, Brisbane, Qld, Australia; School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Owen Christopher Raffel
- Cardiology Department, The Prince Charles Hospital, Brisbane, Qld, Australia; School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
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Crowhurst J, Savage M, Hay K, Murdoch D, Aroney N, Dautov R, Walters DL, Raffel OC. Impact of Patient BMI on Patient and Operator Radiation Dose During Percutaneous Coronary Intervention. Heart Lung Circ 2021; 31:372-382. [PMID: 34654649 DOI: 10.1016/j.hlc.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022]
Abstract
AIMS This study sought to investigate patient and operator radiation dose in patients undergoing percutaneous coronary intervention (PCI) and the impact of body mass index (BMI) on patient and operator dose. METHODS In patients undergoing PCI, radiation dose parameters, baseline characteristics and procedural data were collected in a tertiary centre for 3.5 years. Operators wore real time dosimeters. Patients were grouped by BMI. Dose area product (DAP) and operator radiation dose were compared across patient BMI categories. Multivariable analysis was performed to investigate the impact of patient BMI and other procedural variables on patient and operator dose. RESULTS 2,043 patients underwent 2,197 PCI procedures. Each five-unit increase in BMI increased patient dose (expressed as DAP) by an average 31% (95% CI: 29-33%) and operator dose by 27% (95% CI: 20-33%). Patient dose was 2.3 times higher and operator dose was 2.4 times higher in patients with a BMI>40 than for normal BMI patients. Multivariable analysis indicated that there were many procedural factors that were predictors for increasing operator dose and patient dose but that patient BMI was a major contributor for both operator dose and patient dose. CONCLUSION Increasing BMI increases the DAP and operator dose for PCI procedures and BMI is demonstrated to be a major factor that contributes to both patient and operator radiation dose.
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Affiliation(s)
- James Crowhurst
- The Prince Charles Hospital, Brisbane, Qld, Australia; Queensland University of Technology, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia.
| | - Michael Savage
- The Prince Charles Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Karen Hay
- QIMR Berghoffer Medical Research Institute, Brisbane, Qld, Australia
| | - Dale Murdoch
- The Prince Charles Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | | | - Rustem Dautov
- The Prince Charles Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Darren L Walters
- The Prince Charles Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia; St. Vincent's Northside Private Hospital, Brisbane, Qld, Australia
| | - Owen Christopher Raffel
- The Prince Charles Hospital, Brisbane, Qld, Australia; Queensland University of Technology, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
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Luis SA, Luis CR, Habibian M, Lwin MT, Gadowski TC, Chan J, Hamilton-Craig C, Raffel OC. Prognostic Value of Cardiac Magnetic Resonance Imaging in Acute Coronary Syndrome Patients With Troponin Elevation and Nonobstructive Coronary Arteries. Mayo Clin Proc 2021; 96:1822-1834. [PMID: 33992454 DOI: 10.1016/j.mayocp.2020.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To define the diagnostic yield of cardiac magnetic resonance (CMR) in differentiating the underlying causes of myocardial infarction with nonobstructive coronary arteries (MINOCA) and to determine the long-term prognostic implications of such diagnoses. METHODS Cardiac magnetic resonance evaluation was performed in 227 patients (mean age, 56.4±14.9 years; 120 [53%] female) with a "working diagnosis" of MINOCA as defined by presentation with a troponin-positive acute coronary syndrome (troponin I >0.04 μg/L) and nonobstructed coronary arteries between January 1, 2007, and February 28, 2013. Follow-up was performed to assess the primary composite end point of myocardial infarction, heart failure, and all-cause mortality. RESULTS Cardiac magnetic resonance identified nonstructural cardiomyopathies in 97 (43%) patients, myocardial infarction in 55 (24%) patients, structural cardiomyopathies in 27 (12%) patients, and pulmonary embolism in 1 patient. No CMR abnormalities were identified in the remaining patients. Kaplan-Meier analysis demonstrated the ability of a CMR diagnosis to predict the risk of the primary composite end point (P=.005) at 5-year follow-up. Worse outcomes were seen among patients with "true" MINOCA and a normal CMR image compared with those with CMR-confirmed myocardial infarction (P=.02). Use of antiplatelets (78% [37/45] vs 95% [52/55]; P=.01), beta blockers (56% [25/45] vs 82% [45/55]; P=.004), and statins (64% [29/45] vs 85% [47/55]; P=.01) was significantly lower in patients with true MINOCA with normal CMR imaging compared with those with CMR-confirmed myocardial infarction. CONCLUSIONS Cardiac magnetic resonance carries a high diagnostic yield in patients with MINOCA and predicts long-term prognosis. Patients with MINOCA with normal CMR imaging had an increased rate of major adverse cardiac events and lower use of guideline-recommended myocardial infarction therapy compared with those with CMR-confirmed myocardial infarction.
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Affiliation(s)
- Sushil Allen Luis
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Chris R Luis
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Mohsen Habibian
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Myo T Lwin
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Tahlia C Gadowski
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, Griffith University, Gold Coast, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Owen Christopher Raffel
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
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Wang J, Mendieta JB, Paritala PK, Xiang Y, Raffel OC, McGahan T, Lloyd T, Li Z. Case Report: Evaluating Biomechanical Risk Factors in Carotid Stenosis by Patient-Specific Fluid-Structural Interaction Biomechanical Analysis. Cerebrovasc Dis 2021; 50:262-269. [PMID: 33744885 DOI: 10.1159/000514138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Carotid atherosclerosis is one of the main underlying inducements of stroke, which is a leading cause of disability. The morphological feature and biomechanical environment have been found to play important roles in atherosclerotic plaque progression. However, the biomechanics in each patient's blood vessel is complicated and unique. METHOD To analyse the biomechanical risk of the patient-specific carotid stenosis, this study used the fluid-structure interaction (FSI) computational biomechanical model. This model coupled both structural and hemodynamic analysis. Two patients with carotid stenosis planned for carotid endarterectomy were included in this study. The 3D models of carotid bifurcation were reconstructed using our in-house-developed protocol based on multisequence magnetic resonance imaging (MRI) data. Patient-specific flow and pressure waveforms were used in the computational analysis. Multiple biomechanical risk factors including structural and hemodynamic stresses were employed in post-processing to assess the plaque vulnerability. RESULTS Significant difference in morphological and biomechanical conditions between 2 patients was observed. Patient I had a large lipid core and serve stenosis at carotid bulb. The stenosis changed the cross-sectional shape of the lumen. The blood flow pattern changed consequently and led to a complex biomechanical environment. The FSI results suggested a potential plaque progression may lead to a high-risk plaque, if no proper treatment was performed. The patient II had significant tandem stenosis at both common and internal carotid artery (CCA and ICA). From the results of biomechanical factors, both stenoses had a high potential of plaque progression. Especially for the plaque at ICA branch, the current 2 small plaques might further enlarge and merge as a large vulnerable plaque. The risk of plaque rupture would also increase. CONCLUSIONS Computational biomechanical analysis is a useful tool to provide the biomechanical risk factors to help clinicians assess and predict the patient-specific plaque vulnerability. The FSI computational model coupling the structural and hemodynamic computational analysis, better replicates the in vivo biomechanical condition, which can provide multiple structural and flow-based risk factors to assess plaque vulnerability.
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Affiliation(s)
- Jiaqiu Wang
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Phani Kumari Paritala
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yuqiao Xiang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Owen Christopher Raffel
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Tim McGahan
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Thomas Lloyd
- Department of Radiology, Princess Alexandra Hospital Brisbane, Brisbane, Queensland, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia, .,School of Biological Science & Medical Engineering, Southeast University, Nanjing, China,
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Abstract
Although coronary angiography is the standard method employed to assess the severity of coronary artery disease and to guide treatment strategies, it provides only 2D image of the intravascular lesions. In contrast, intravascular imaging modalities such as optical coherence tomography (OCT) produce cross-sectional images of the coronary arteries at a far greater spatial resolution, capable of accurately determining vessel size as well as plaque morphology, eliminating many of the disadvantages inherent to angiography. This review will discuss the role of OCT in the catherization laboratory for the assessment and management of coronary disease.
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Affiliation(s)
- Vijayakumar Subban
- Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
| | - Owen Christopher Raffel
- CardioVascular Clinics, St. Andrews War Memorial Hospital, Queensland, Australia.,Cardiology Program, The Prince Charles Hospital, Queensland, Australia.,Queensland University of Technology, Queensland, Australia.,University of Queensland, Queensland, Australia
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Wang J, Paritala PK, Mendieta JB, Gu Y, Raffel OC, McGahan T, Lloyd T, Li Z. Carotid Bifurcation With Tandem Stenosis-A Patient-Specific Case Study Combined in vivo Imaging, in vitro Histology and in silico Simulation. Front Bioeng Biotechnol 2019; 7:349. [PMID: 31824937 PMCID: PMC6879432 DOI: 10.3389/fbioe.2019.00349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/06/2019] [Indexed: 11/13/2022] Open
Abstract
A patient-specific carotid bifurcation with tandem stenosis found at both internal carotid artery (ICA) and common carotid artery (CCA) was studied. The in vivo pre-carotid endarterectomy (pre-CEA) multi-spectral magnetic resonance imaging (MRI) were performed and in vitro post-CEA carotid plaque tissue sample was collected. MR imaging data and tissue sample staining histology were used to recognize the plaque components. Further, the computational fluid dynamics (CFD) were performed on four MR-based reconstructed 3D carotid bifurcation models (the patient-specific geometry with tandem stenosis and three presumptive geometries by removing the stenosis part). The flow and shear stress behavior affected by the tandem stenosis was analyzed. From the results of MR segmentation and histology analysis, plaque lipid pool and calcification were found at both ICA and CCA. From the result of CFD simulation, the flow shear stress behavior suggested the tandem stenosis as a more “dangerous” situation than a single-stenosis artery. Besides, the CFD results deduced that the stenosis at the CCA location formed initially and led to the subsequent formation of stenosis at ICA. This study suggests that when planning CEA, CFD simulation on the presumptive models could help clinicians to estimate the blood flow behavior after surgery. Particular attention should be paid to the case of tandem stenosis, as the local hemodynamic environment is more complex and treatment of one stenosis may lead to a variation in the hemodynamic loading on the second plaque, which may result in either a higher risk of plaque rupture or restenosis.
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Affiliation(s)
- Jiaqiu Wang
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Phani Kumari Paritala
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jessica Benitez Mendieta
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Yuantong Gu
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Owen Christopher Raffel
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Tim McGahan
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Thomas Lloyd
- Department of Radiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Zhiyong Li
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, Australia.,School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
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Yu W, Huang J, Jia D, Chen S, Raffel OC, Ding D, Tian F, Kan J, Zhang S, Yan F, Chen Y, Bezerra HG, Wijns W, Tu S. Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity. EUROINTERVENTION 2019; 15:189-197. [PMID: 31147309 DOI: 10.4244/eij-d-19-00182] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS A novel method for computation of fractional flow reserve (FFR) from optical coherence tomography (OCT) was developed recently. This study aimed to evaluate the diagnostic accuracy of a new OCT-based FFR (OFR) computational approach, using wire-based FFR as the reference standard. METHODS AND RESULTS Patients who underwent both OCT and FFR prior to intervention were analysed. The lumen of the interrogated vessel and the ostia of the side branches were automatically delineated and used to compute OFR. Bifurcation fractal laws were applied to correct the change in reference lumen size due to the step-down phenomenon. OFR was compared with FFR, both using a cut-off value of 0.80 to define ischaemia. Computational analysis was performed in 125 vessels from 118 patients. Average FFR was 0.80±0.09. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for OFR to identify FFR ≤0.80 was 90% (95% CI: 84-95), 87% (95% CI: 77-94), 92% (95% CI: 82-97), 92% (95% CI: 82-97), and 88% (95% CI: 77-95), respectively. The AUC was higher for OFR than minimal lumen area (0.93 [95% CI: 0.87-0.97] versus 0.80 [95% CI: 0.72-0.86], p=0.002). Average OFR analysis time was 55±23 seconds for each OCT pullback. Intra- and inter-observer variability in OFR analysis was 0.00±0.02 and 0.00±0.03, respectively. CONCLUSIONS OFR is a novel and fast method allowing assessment of flow-limiting coronary stenosis without pressure wire and induced hyperaemia. The good diagnostic accuracy and low observer variability bear the potential of improved integration of intracoronary imaging and physiological assessment.
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Affiliation(s)
- Wei Yu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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11
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Wang J, Paritala PK, Mendieta JB, Komori Y, Raffel OC, Gu Y, Li Z. Optical coherence tomography-based patient-specific coronary artery reconstruction and fluid–structure interaction simulation. Biomech Model Mechanobiol 2019; 19:7-20. [DOI: 10.1007/s10237-019-01191-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/21/2019] [Indexed: 01/14/2023]
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12
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Bellapart J, Cuthbertson K, Dunster K, Diab S, Platts DG, Raffel OC, Gabrielian L, Barnett A, Paratz J, Boots R, Fraser JF. Cerebral Microcirculation and Histological Mapping After Severe Head Injury: A Contusion and Acceleration Experimental Model. Front Neurol 2018; 9:277. [PMID: 29867710 PMCID: PMC5949334 DOI: 10.3389/fneur.2018.00277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/09/2018] [Indexed: 11/21/2022] Open
Abstract
Background Cerebral microcirculation after severe head injury is heterogeneous and temporally variable. Microcirculation is dependent upon the severity of injury, and it is unclear how histology relates to cerebral regional blood flow. Objective This study assesses the changes of cerebral microcirculation blood flow over time after an experimental brain injury model in sheep and contrasts these findings with the histological analysis of the same regions with the aim of mapping cerebral flow and tissue changes after injury. Methods Microcirculation was quantified using flow cytometry of color microspheres injected under intracardiac ultrasound to ensure systemic and homogeneous distribution. Histological analysis used amyloid precursor protein staining as a marker of axonal injury. A mapping of microcirculation and axonal staining was performed using adjacent layers of tissue from the same anatomical area, allowing flow and tissue data to be available from the same anatomical region. A mixed effect regression model assessed microcirculation during 4 h after injury, and those results were then contrasted to the amyloid staining qualitative score. Results Microcirculation values for each subject and tissue region over time, including baseline, ranged between 20 and 80 ml/100 g/min with means that did not differ statistically from baseline flows. However, microcirculation values for each subject and tissue region were reduced from baseline, although their confidence intervals crossing the horizontal ratio of 1 indicated that such reduction was not statistically significant. Histological analysis demonstrated the presence of moderate and severe score on the amyloid staining throughout both hemispheres. Conclusion Microcirculation at the ipsilateral and contralateral site of a contusion and the ipsilateral thalamus and medulla showed a consistent decline over time. Our data suggest that after severe head injury, microcirculation in predefined areas of the brain is reduced from baseline with amyloid staining in those areas reflecting the early establishment of axonal injury.
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Affiliation(s)
- Judith Bellapart
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Kylie Cuthbertson
- Department of Histopathology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Kimble Dunster
- Critical Care Research Group, University of Queensland, Brisbane, QLD, Australia.,Medical Engineering Research Facility, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sara Diab
- Critical Care Research Group, University of Queensland, Brisbane, QLD, Australia.,Medical Engineering Research Facility, Queensland University of Technology, Brisbane, QLD, Australia
| | - David G Platts
- Critical Care Research Group, University of Queensland, Brisbane, QLD, Australia.,Department of Cardiology, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Owen Christopher Raffel
- Critical Care Research Group, University of Queensland, Brisbane, QLD, Australia.,Department of Cardiology, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Levon Gabrielian
- Medical School, University of South Australia, Adelaide, SA, Australia.,Medical Research Centre, Adelaide, SA, Australia
| | - Adrian Barnett
- Critical Care Research Group, University of Queensland, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jenifer Paratz
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Rob Boots
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, University of Queensland, Brisbane, QLD, Australia.,Medical Engineering Research Facility, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Intensive Care, The Prince Charles Hospital, Chermside, QLD, Australia
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Murdoch D, Shaw E, Raffel OC, Walters DL. Next generation TAVI with the Lotus Valve System: a repositionable and fully retrievable transcatheter aortic valve prosthesis. Minerva Cardioangiol 2015; 63:343-357. [PMID: 25952129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is the new standard of care for selected patients with severe symptomatic aortic stenosis who are at high risk for surgical aortic valve replacement (AVR), or are inoperable. Multicentre randomised controlled trials have demonstrated equivalent or superior clinical outcomes for TAVI compared to AVR in carefully selected patient cohorts. A number of important limitations were observed with early generation TAVI valves and their delivery systems, and rapid evolution of the technology continues. The Lotus Valve System aims to address a number of these limitations - it is repositionable and retrievable, and has an adaptive seal to prevent paravalvular aortic regurgitation. Early clinical outcomes for the Lotus Valve System have recently been published with promising results in terms of paravalvular regurgitation and repositionability.
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Affiliation(s)
- D Murdoch
- Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Australia -
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14
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Saireddy R, Subban V, Lamana A, Clarke A, Scalia GM, Raffel OC, Walters DL. Immediate Closure of Paravalvular Leak After Transcatheter Aortic Valve Implantation. Heart Lung Circ 2014; 23:e251-3. [DOI: 10.1016/j.hlc.2014.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 05/10/2014] [Accepted: 05/25/2014] [Indexed: 11/28/2022]
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15
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Savage ML, Poon KK, Johnston EM, Raffel OC, Incani A, Bryant J, Rashford S, Pincus M, Walters DL. Pre-Hospital Ambulance Notification and Initiation of Treatment of ST Elevation Myocardial Infarction is Associated with Significant Reduction in Door-to-Balloon Time for Primary PCI. Heart Lung Circ 2014; 23:435-43. [DOI: 10.1016/j.hlc.2013.11.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 11/10/2013] [Accepted: 11/28/2013] [Indexed: 11/27/2022]
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Subban V, Incani A, Clarke A, Aroney C, Scalia GM, Crowhurst JA, Raffel OC, Walters DL. Conservative management and resolution of a contained rupture of aortic annulus following transcatheter valve replacement. JACC Cardiovasc Interv 2014; 6:e33-4. [PMID: 23787244 DOI: 10.1016/j.jcin.2013.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/03/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Vijayakumar Subban
- Heart Lung Institute, The Prince Charles Hospital, Brisbane, Queensland, Australia.
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17
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Poon KK, Crowhurst J, James C, Campbell D, Roper D, Chan J, Incani A, Clarke A, Tesar P, Aroney C, Raffel OC, Walters DL. Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements - utility of three-dimensional rotational angiography. EUROINTERVENTION 2013; 8:538-45. [PMID: 22995079 DOI: 10.4244/eijv8i5a84] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS The clinical value of optimising implant angles during transcatheter aortic valve replacements (TAVR) remains undefined. The Aortic Valve Guide (AVG) is a proprietary software that provides structured analysis of three-dimensional images from rotational angiography (DynaCT). This study compares AVG with preprocedural multislice computed tomography (MSCT) and DynaCT in optimal implant angle prediction for TAVR, and evaluates if an optimised implant angle is associated with reduced paravalvular regurgitation (PVR). METHODS AND RESULTS One hundred and six consecutive patients were included, comprising three groups. Group 1 (n=19) underwent no preprocedural MSCT or DynaCT (or AVG); Group 2 (n=44) underwent periprocedural DynaCT, without AVG; Group 3 (n=43) had DynaCT with AVG. Implant angles yielded were graded as excellent, satisfactory or poor. Group 3 were more likely than Groups 2 and 1 to have excellent implant angles (83.7% vs. 52.3% vs. 42.1%, respectively, p=0.001). In 100 patients who had 30-day transthoracic echocardiogram follow-up, an excellent implant angle was significantly more likely to be associated with no PVR than a non-excellent angle (41.3% vs. 21.6%, respectively, p=0.045), independent of operator experience and THV used. CONCLUSIONS Optimising implant angles may be important in reducing PVR. This is significantly more likely to be achieved with AVG rotational angiography.
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Affiliation(s)
- Karl K Poon
- Cardiology Program, The Prince Charles Hospital, Brisbane, Australia.
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18
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Yamaki T, Kawasaki M, Jang IK, Raffel OC, Ishihara Y, Okubo M, Kubota T, Hattori A, Nishigaki K, Takemura G, Fujiwara H, Minatoguchi S. Comparison between integrated backscatter intravascular ultrasound and 64-slice multi-detector row computed tomography for tissue characterization and volumetric assessment of coronary plaques. Cardiovasc Ultrasound 2012; 10:33. [PMID: 22867277 PMCID: PMC3495226 DOI: 10.1186/1476-7120-10-33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 07/29/2012] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to determine the cut-off values of Hounsfield units (HU) for the discrimination of plaque components and to evaluate the feasibility of measurement of the volume of plaque components using multi-detector row computed tomography (MDCT). Methods Coronary lesions (125 lesions in 125 patients) were visualized by both integrated backscatter intravascular ultrasound (IB-IVUS) and 64-slice MDCT at the same site. The IB values were used as a gold standard to determine the cut off values of HU for the discrimination of plaque components. Results Plaques were classified as lipid pool (n =50), fibrosis (n =65) or calcification (n =35) by IB-IVUS. The HU of lipid pool, fibrosis and calcification were 18 ± 18 HU (−19 to 58 HU), 95 ± 24 HU (46 to 154 HU) and 378 ± 99 HU (188 to 605 HU), respectively. Using receiver operating characteristic curve analysis, a threshold of 50 HU was the optimal cutoff values to discriminate lipid pool from fibrosis. Lipid volume measured by MDCT was correlated with that measured by IB-IVUS (r =0.66, p <0.001), whereas fibrous volume was not (r =0.21, p =0.059). Conclusion Lipid volume measured by MDCT was moderately correlated with that measured by IB-IVUS. MDCT may be useful for volumetric assessment of the lipid volume of coronary plaques, whereas the assessment of fibrosis volume was unstable.
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Affiliation(s)
- Takahiko Yamaki
- Department of Cardiology, Gifu University Graduate School of Medicine, Yanagido, Japan
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Samardhi H, Raffel OC, Savage M, Sirisena T, Bett N, Pincus M, Small A, Walters DL. Takotsubo cardiomyopathy: an Australian single centre experience with medium term follow up. Intern Med J 2012; 42:35-42. [PMID: 21395961 DOI: 10.1111/j.1445-5994.2011.02474.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is increasingly recognised in patients presenting with features of acute coronary syndrome. We present a single centre experience of TC with medium term follow up. METHODS Fifty-two consecutive patients presenting with a diagnosis of TC were included. The clinical presentation, complications, baseline and follow-up echocardiograms and cardiac magnetic resonance imaging were analysed. RESULTS Fifty-one patients were female. A stressful event preceded presentation in 37 (71%) patients. Chest pain was the most common symptom (83%). Two patients presented with an out-of-hospital cardiac arrest. ST segment elevation (40%) and global T wave inversion (44%) were the most frequent electrocardiogram changes. Left ventricular assessment demonstrated typical apical ballooning in 41 patients and 11 patients demonstrated the mid-wall variant. In-hospital complications occurred in 11 patients (21%) and included acute pulmonary oedema (n = 2), cardiogenic shock (n = 5); two of whom had a significant left ventricular outflow gradient, atrial fibrillation (n = 1), left ventricular thrombus (n = 2) and a cerebrovascular event (n = 2). Left ventricular function at presentation and follow up was compared in 40 patients. The mean ejection fraction in this group at presentation was 47% (20-70%) compared with that at follow up of 63% (44-76%). There were no significant complications or recurrences at follow up. CONCLUSIONS While TC is a reversible condition with low rates of complications and recurrence at follow up it is, as demonstrated in our cohort, associated with significant in-hospital morbidity in a proportion of patients.
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Affiliation(s)
- H Samardhi
- Cardiology Program, The Prince Charles Hospital, Brisbane, Queensland, Australia
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20
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Poon KKC, Clarke A, Luis SA, Wiemers P, Incani A, Scalia G, Tesar P, Raffel OC, Aroney CN, Walters DL. First Australian transapical mitral valve-in-valve implant for a failed mitral bioprosthesis: how to do it. Heart Lung Circ 2012; 21:737-9. [PMID: 22595453 DOI: 10.1016/j.hlc.2012.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 04/07/2012] [Indexed: 11/15/2022]
Abstract
Transcatheter aortic valve replacements lower mortality in patients not suitable for surgical valve replacement compared to conservative treatment. Transcatheter valve-in-valve implants have been shown to be feasible in failed bioprostheses in aortic, mitral, pulmonary and tricuspid positions. We report the first Australasian experience of a transapical mitral valve-in-valve placement with an Edwards Sapien(®) transcatheter valve for a failed mitral bioprosthesis, focussing on the technical aspects of this novel procedure. Whilst the evidence for this niche indication is limited currently to case reports and case series, further evaluation of its long term outcomes may justify its use in this particularly high risk group of re-do sternotomy patients.
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Poon K, Bell B, Raffel OC, Walters DL, Jang IK. Spontaneous coronary artery dissection: utility of intravascular ultrasound and optical coherence tomography during percutaneous coronary intervention. Circ Cardiovasc Interv 2011; 4:e5-7. [PMID: 21505162 DOI: 10.1161/circinterventions.110.959593] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karl Poon
- The Prince Charles Hospital, Chermside, Queensland, Australia.
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Gupta R, Raffel OC, Jang IK. Severe intimal hyperplasia after sirolimus eluting stent deployment: evaluation by optical coherence tomography. Case Reports 2009; 2009:bcr2006091918. [DOI: 10.1136/bcr.2006.091918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Raffel OC, Merchant FM, Tearney GJ, Chia S, Gauthier DD, Pomerantsev E, Mizuno K, Bouma BE, Jang IK. In vivo association between positive coronary artery remodelling and coronary plaque characteristics assessed by intravascular optical coherence tomography. Eur Heart J 2008; 29:1721-8. [PMID: 18577556 DOI: 10.1093/eurheartj/ehn286] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Positive coronary arterial remodelling has been shown to be associated with unstable coronary syndromes and ex vivo histological characteristics of plaque vulnerability such as a large lipid core and high macrophage content. The aim of this study is to evaluate the in vivo association between coronary artery remodelling and underlying plaque characteristics identified by optical coherence tomography (OCT). OCT is a unique imaging modality capable of characterizing these important morphological features of vulnerable plaque. METHODS AND RESULTS OCT and intravascular ultrasound imaging was performed at corresponding sites in patients undergoing catheterization. OCT plaque characteristics for lipid content, fibrous cap thickness, and macrophage density were derived using previously validated criteria. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque (two or more quadrants) with fibrous cap thickness <65 microm. Remodelling index (RI) was calculated as the ratio of the lesion to the reference external elastic membrane area. A total of 54 lesions from 48 patients were imaged. Positive remodelling compared with absent or negative remodelling was more commonly associated with lipid-rich plaque (100 vs. 60 vs. 47.4%, P = 0.01), a thin fibrous cap (median 40.2 vs. 51.6 vs. 87 microm, P = 0.003) and the presence of TCFA (80 vs. 38.5 vs. 5.6%, P < 0.001). Fibrous cap macrophage density was also higher in plaques with positive remodelling showing a positive linear correlation with the RI (r = 0.60, P < 0.001). CONCLUSION Coronary plaques with positive remodelling exhibit characteristic features of vulnerable plaque. This may explain the link between positive remodelling and unstable clinical presentations.
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Affiliation(s)
- Owen Christopher Raffel
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA 02114, USA
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Abstract
OBJECTIVE Statin therapy induces plaque regression and may stabilize atheromatous plaques. Optical coherence tomography (OCT) is a high-resolution in-vivo imaging modality that allows characterization of atherosclerotic plaques. We aimed to demonstrate the potential utility of OCT in evaluating coronary plaques in patients with or without statin therapy. METHODS Patients undergoing cardiac catheterization were enrolled. We identified culprit lesions and performed intracoronary OCT imaging. Plaque lipid pool, fibrous cap thickness, and frequency of thin-cap fibroatheroma were evaluated using previously validated criteria. Macrophage density was determined from optical signals within fibrous caps. Presence of calcification, thrombosis, and rupture was assessed. RESULTS Forty-eight patients were included (26 on statins, 22 without statins). Baseline characteristics were similar apart from lipid profile. Patients on statin therapy had lower total and low-density lipoprotein cholesterol concentrations (4.45+/-1.35 vs. 5.26+/-0.83 mmol/l, P=0.02; 2.23+/-0.78 vs. 3.26+/-0.62 mmol/l, P<0.001, respectively). Frequencies of lipid-rich plaque (69 vs. 82%), thin-cap fibroatheroma (31 vs. 50%), plaque calcification (15 vs. 5%) and thrombosis (15 vs. 32%), and fibrous cap macrophage density were comparable between statin and nonstatin groups (5.9 vs. 6.3%; all P=NS). Ruptured plaques were, however, significantly less frequent in patients on established statin therapy (8 vs. 36%; P=0.03) with a trend toward increased minimum fibrous cap thickness (78 vs. 49 microm; P=0.07). CONCLUSION We demonstrated the use of OCT in plaque characterization and found that patients on prior statin therapy have reduced incidence of ruptured plaques and a trend toward thicker fibrous caps. This suggests that statins may stabilize coronary plaques.
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Affiliation(s)
- Stanley Chia
- Cardiology Division, General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Masamichi Takano
- Department of Internal Medicine, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Guillermo J. Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brett E. Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ik-Kyung Jang
- Cardiology Division, General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kerr AJ, Pasupati S, Zeng I, Van Pelt NC, Gabriel RS, Sharma V, Raffel OC, Stewart RAH. DO CHANGES IN B-TYPE NATRIURETIC PEPTIDE AFTER SYMPTOM-LIMITED EXERCISE REFLECT IMPAIRED CARDIAC FUNCTION? Heart Lung Circ 2008. [DOI: 10.1016/j.hlc.2008.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kerr A, Van Pelt NC, Gabriel RS, Sharma V, Raffel OC, Whalley G, Stewart RAH. COMPARISON OF ATRIAL AND B-TYPE NATRIURETIC PEPTIDE IN MITRAL AND AORTIC VALVE DISEASE. Heart Lung Circ 2008. [DOI: 10.1016/j.hlc.2008.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Owen Christopher Raffel
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, GRB 800, Boston, MA 02114, USA
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