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Dehghani P, Singh J, Singer Z, Booker J, Lavoie AJ, Zimmermann RH, Shavadia JS, Webb JG, Clavel MA, Pibarot P. Catheter-Induced Postextrasystolic Potentiation in the Assessment of Severity of Low-Gradient Aortic Valve Stenosis. Circ Cardiovasc Interv 2023; 16:e012892. [PMID: 37125538 DOI: 10.1161/circinterventions.123.012892] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND Deciphering which patients with low-gradient aortic valve disease have severe stenosis can be difficult. We aimed to correlate the postextrasystolic potentiation (PESP) with dobutamine stress echocardiography and multidetector computed tomography in patients with low-gradient aortic valve stenosis. METHODS Patients with an aortic valve area ≤1 cm2 and a mean gradient <40 mm Hg were included. Aortic valve stenosis severity was assessed by a core lab with dobutamine stress echocardiography, followed by a multidetector computed tomography aortic valve score if indeterminate. A premature ventricular contraction was induced by intentional catheter contact with the myocardium within the left ventricle. PESP was calculated as a percent change of pre-to-post mean gradient. Multidetector computed tomography was used to measure the aortic valve calcification score, and subsequently, aortic valve calcification density. RESULTS Twenty-eight patients (age, 77±10 years; 19 female) were included. Dobutamine stress echocardiography increased mean gradient from baseline of 25±7 mm Hg to 36±11 mm Hg; pre-premature ventricular contraction mean gradient was 25±7 mm Hg and increased to post-premature ventricular contraction mean gradient of 32±10 mm Hg, representing a PESP of 24±11%. A ≥20% in PESP resulted in 100% sensitivity, 77% specificity, 83% positive predictive value, and 100% negative predictive value for diagnosing severe aortic valve stenosis. There was a significant correlation between PESP and projected aortic valve area and aortic valve calcification density (R=-0.64, P=0.0003; R=0.057, P=0.014, respectively). CONCLUSIONS In patients with low-gradient aortic valve stenosis, catheter-induced premature ventricular contractions during cardiac catheterization causing ≥20% PESP has a 100% sensitivity for severe aortic valve stenosis. Validation of this 20% cutoff in larger groups with correlation to clinical end points is required.
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Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Zachary Singer
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Jeffrey Booker
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Andrea J Lavoie
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Rodney H Zimmermann
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Jay S Shavadia
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - John G Webb
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Marie-Annick Clavel
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
| | - Philippe Pibarot
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (P.D., J.S., J.B., A.J.L., R.H.Z.)
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Rinfret S, Jahan I, McKenzie K, Dendukuri N, Bainey KR, Mansour S, Natarajan M, Ybarra LF, Chong AY, Bérubé S, Breton R, Curtis MJ, Rodés-Cabau J, Amlani S, Bagherli A, Ball W, Barolet A, Beydoun HK, Brass N, Chan AW, Colizza F, Constance C, Fam NP, Gobeil F, Haghighat T, Hodge S, Joyal D, Kim HH, Lutchmedial S, MacDougall A, Malik P, Miner S, Minhas K, Orvold J, Palisaitis D, Parfrey B, Potvin JM, Puley G, Radhakrishnan S, Spaziano M, Tanguay JF, Vijayaraghaban R, Webb JG, Zimmermann RH, Wood DA, Brophy JM. COVID-19 pandemic and coronary angiography for ST-elevation myocardial infarction, use of mechanical support and mechanical complications in Canada; a Canadian Association of Interventional Cardiology national survey. CJC Open 2021; 3:1125-1131. [PMID: 33997751 PMCID: PMC8114614 DOI: 10.1016/j.cjco.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/15/2022] Open
Abstract
Background As a result of the COVID-19 pandemic first wave, reductions in ST-elevation myocardial infarction (STEMI) invasive care, ranging from 23% to 76%, have been reported from various countries. Whether this change had any impact on coronary angiography (CA) volume or on mechanical support device use for STEMI and post-STEMI mechanical complications in Canada is unknown. Methods We administered a Canada-wide survey to all cardiac catheterization laboratory directors, seeking the volume of CA use for STEMI performed during the period from March 1 2020 to May 31, 2020 (pandemic period), and during 2 control periods (March 1, 2019 to May 31, 2019 and March 1, 2018 to May 31, 2018). The number of left ventricular support devices used, as well as the number of ventricular septal defects and papillary muscle rupture cases diagnosed, was also recorded. We also assessed whether the number of COVID-19 cases recorded in each province was associated with STEMI-related CA volume. Results A total of 41 of 42 Canadian catheterization laboratories (98%) provided data. There was a modest but statistically significant 16% reduction (incidence rate ratio [IRR] 0.84; 95% confidence interval 0.80-0.87) in CA for STEMI during the first wave of the pandemic, compared to control periods. IRR was not associated with provincial COVID-19 caseload. We observed a 26% reduction (IRR 0.74; 95% confidence interval 0.61-0.89) in the use of intra-aortic balloon pump use for STEMI. Use of an Impella pump and mechanical complications from STEMI were exceedingly rare. Conclusions We observed a modest 16% decrease in use of CA for STEMI during the pandemic first wave in Canada, lower than the level reported in other countries. Provincial COVID-19 caseload did not influence this reduction.
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Affiliation(s)
- Stéphane Rinfret
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC
| | - Israth Jahan
- Department of medicine and biostatistics, McGill University Health Centre, McGill University, Montreal, QC
| | | | - Nandini Dendukuri
- Department of medicine and biostatistics, McGill University Health Centre, McGill University, Montreal, QC
| | - Kevin R Bainey
- Division of cardiology, Mazankowski Alberta Heart Institute, Edmonton, AB
| | - Samer Mansour
- Division of cardiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC.,Division of cardiology, Hôpital de la Cité-de-la-Santé, Laval, QC
| | - Madhu Natarajan
- Division of cardiology, Hamilton Health Sciences Centre, Hamilton, ON
| | - Luiz F Ybarra
- Division of cardiology, London Health Sciences Centre, London, ON
| | - Aun-Yeong Chong
- Division of cardiology, University of Ottawa Heart Institute, Ottawa, ON
| | - Simon Bérubé
- Division of cardiology, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC
| | - Robert Breton
- Division of cardiology, CIUSSS Saguenay Lac Saint Jean, Saguenay, QC
| | | | - Josep Rodés-Cabau
- Multidisciplinary department of cardiology, Institut universitaire de cardiologie et de pneumologie de Québec-Hôpital Laval, Quebec City, QC
| | - Shy Amlani
- Division of cardiology, William Osler Health System, Brampton, ON
| | | | - Warren Ball
- Division of cardiology, Peterborough Regional Health Centre, Peterborough, ON
| | - Alan Barolet
- Division of cardiology, University Health Network - Toronto General Hospital, Toronto, ON
| | | | - Neil Brass
- Division of cardiology, CK Hui Heart Centre/Royal Alexandra Hospital, Edmonton, AB
| | - Albert W Chan
- Division of cardiology, Royal Columbian Hospital, New Westminster, BC
| | - Franco Colizza
- Division of cardiology, Centre Hospitalier Pierre-Boucher, Longueuil, QC
| | | | - Neil P Fam
- Division of cardiology, St. Michael's Hospital, Montreal, QC
| | - François Gobeil
- Division of cardiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | | | - Steven Hodge
- Division of cardiology, Kelowna General Hospital, Kelowna, BC
| | - Dominique Joyal
- Division of cardiology, Jewish General Hospital, Montreal, QC
| | - Hahn Hoe Kim
- Division of cardiology, St-Mary's Regional Cardiac Care Centre, Kitchener-Waterloo, ON
| | | | - Andrea MacDougall
- Division of cardiology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON
| | - Paul Malik
- Division of cardiology, Kingston General Hospital, Kingston, ON
| | - Steve Miner
- Division of cardiology, Southlake Regional Health Centre, Newmarket, ON
| | - Kunal Minhas
- Division of cardiology, St. Boniface General Hospital, Winnipeg, MB
| | - Jason Orvold
- Division of cardiology, Royal University Hospital, Saskatoon, SK
| | | | - Brendan Parfrey
- Division of cardiology, Health Sciences Center, St-John's, NF
| | | | - Geoffrey Puley
- Division of cardiology, Trillium Health Centre, Mississauga, ON
| | - Sam Radhakrishnan
- Division of cardiology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Marco Spaziano
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC
| | | | | | - John G Webb
- Division of cardiology, St. Paul's Hospital, Vancouver BC
| | | | - David A Wood
- Division of cardiology, Vancouver General Hospital, Vancouver, BC
| | - James M Brophy
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC
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Yang A, Pon Q, Lavoie A, Crawford JJ, Harenberg S, Zimmermann RH, Booker J, Kelly S, Lavi S, Cantor WJ, Mehta SR, Bagai A, Goodman SG, Cheema AN, Dehghani P. Long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI. J Thromb Thrombolysis 2018; 45:225-233. [PMID: 29170875 DOI: 10.1007/s11239-017-1581-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 11/29/2022]
Abstract
The long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in patients undergoing early percutaneous coronary intervention (PCI) after fibrinolytic therapy is unknown. From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel for ST-elevated myocardial infarction (STEMI) were randomized at four Canadian sites to receive additional Clopidogrel or Ticagrelor initiated prior to PCI. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline), at 4 and 24 h post PCI, and follow-up appointment. A mixed-model analysis with time as the repeated measure and drug as the between-subjects factor was calculated using 2 separate 1 × 4 ANOVAs, with students t-tests used to compare drugs within each time point. Complete clinical follow-up data (median 115.0 days; IQR 80.3-168.8) was available in 50 patients (23.6%) randomized to either Clopidogrel (n = 23) or Ticagrelor (n = 27). Analyses revealed significant decreases in PRU from baseline to 4 h (261.4 vs. 71.7; Mdiff = - 189.7; p < 0.001) to 24 h (71.7 vs. 27.7; Mdiff = - 44.0; p < 0.001) to end of follow-up (27.7 vs.17.9; Mdiff = - 9.9. p = 0.016) for those randomized to Ticagrelor and significant decreases in PRU only from baseline to 4 h (271.3 vs. 200.8; Mdiff = - 70.5, p = < 0.001) in patients receiving Clopidogrel, and a significantly greater proportion of patients with adequate platelet inhibition (PRU < 208) on long-term follow-up (Clopidogrel, 82.6% vs. Ticagrelor, 100.0%; p = 0.038). Our results demonstrate that in patients undergoing PCI within 24 h of fibrinolysis for STEMI, Ticagrelor provides prolonged platelet inhibition compared with Clopidogrel.
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Affiliation(s)
- Andrew Yang
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Quin Pon
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Andrea Lavoie
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Jennifer J Crawford
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Sebastian Harenberg
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Rodney H Zimmermann
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Jeff Booker
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Sheila Kelly
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada
| | - Shahar Lavi
- London Health Sciences, University of London, London, ON, Canada
| | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Newmarket, ON, Canada
| | - Shamir R Mehta
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Asim N Cheema
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Payam Dehghani
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office 1440-14th Ave., Regina, SK, Canada.
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4
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Dehghani P, Lavoie A, Lavi S, Crawford JJ, Harenberg S, Zimmermann RH, Booker J, Kelly S, Cantor WJ, Mehta SR, Bagai A, Goodman SG, Cheema AN. Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI. Am Heart J 2017; 192:105-112. [PMID: 28938956 DOI: 10.1016/j.ahj.2017.07.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 04/05/2017] [Accepted: 07/12/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Patients undergoing PCI early after fibrinolytic therapy are at high risk for both thrombotic and bleeding complications. We sought to assess the pharmacodynamic effects of ticagrelor versus clopidogrel in the fibrinolytic-treated STEMI patients undergoing early PCI. METHODS AND RESULTS Patients undergoing PCI within 24 hours of tenecteplase (TNK), aspirin, and clopidogrel for STEMI were randomized to receive additional clopidogrel 300 mg followed by 75 mg daily or ticagrelor 180 mg followed by 90 mg twice daily. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline) at 4 and 24 hours post-PCI. The primary end point was PRU ≤208 at 4 hours. A total of 140 patients (74 in ticagrelor and 66 in clopidogrel group) were enrolled. The mean PRU values at baseline were similar for the 2 groups (257.8±52.9 vs 259.5±56.7, P=.85, respectively). Post-PCI, patients on ticagrelor, compared to those on clopidogrel, had significantly lower PRU at 4 hours (78.7±88 vs 193.6±86.5, respectively, P<.001) and at 24 hours (34.5±35.0 and 153.5±75.5, respectively, P<.001). The primary end point was observed in 87.8% (n=65) in the ticagrelor-treated patients compared to 57.6% (n=38) of clopidogrel-treated patients, P<.001. CONCLUSION Fibrinolysis-treated STEMI patients who received clopidogrel and aspirin at the time of fibrinolysis and were undergoing early PCI frequently had PRU >208. In this high-risk population, ticagrelor provides more prompt and potent platelet inhibition compared with clopidogrel (Funded by Astra Zeneca; NCT01930591, https://clinicaltrials.gov/ct2/show/NCT01930591).
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Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina, Saskatchewan, Canada.
| | - Andrea Lavoie
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Shahar Lavi
- London Health Sciences, University of London, London, Ontario, Canada
| | - Jennifer J Crawford
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Sebastian Harenberg
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Rodney H Zimmermann
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Jeff Booker
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Sheila Kelly
- Prairie Vascular Research Network and Regina Qu'Appelle Health Region, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
| | - Shamir R Mehta
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Asim N Cheema
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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