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Cader FA, Arshad N, Tremmel JA. Highlights From the Society for Cardiovascular Angiography & Interventions (SCAI) Scientific Sessions 2023. J Am Heart Assoc 2024; 13:e031067. [PMID: 38533981 DOI: 10.1161/jaha.123.031067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
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Yeh RW, Shlofmitz R, Moses J, Bachinsky W, Dohad S, Rudick S, Stoler R, Jefferson BK, Nicholson W, Altman J, Bateman C, Krishnaswamy A, Grantham JA, Zidar FJ, Marso SP, Tremmel JA, Grines C, Ahmed MI, Latib A, Tehrani B, Abbott JD, Batchelor W, Underwood P, Allocco DJ, Kirtane AJ. Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis: The AGENT IDE Randomized Clinical Trial. JAMA 2024; 331:1015-1024. [PMID: 38460161 PMCID: PMC10924708 DOI: 10.1001/jama.2024.1361] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/30/2024] [Indexed: 03/11/2024]
Abstract
Importance Drug-coated balloons offer a potentially beneficial treatment strategy for the management of coronary in-stent restenosis. However, none have been previously evaluated or approved for use in coronary circulation in the United States. Objective To evaluate whether a paclitaxel-coated balloon is superior to an uncoated balloon in patients with in-stent restenosis undergoing percutaneous coronary intervention. Design, Setting, and Participants AGENT IDE, a multicenter randomized clinical trial, enrolled 600 patients with in-stent restenosis (lesion length <26 mm and reference vessel diameter >2.0 mm to ≤4.0 mm) at 40 centers across the United States between May 2021 and August 2022. One-year clinical follow-up was completed on October 2, 2023. Interventions Participants were randomized in a 2:1 allocation to undergo treatment with a paclitaxel-coated (n = 406) or an uncoated (n = 194) balloon. Main Outcomes and Measures The primary end point of 1-year target lesion failure-defined as the composite of ischemia-driven target lesion revascularization, target vessel-related myocardial infarction, or cardiac death-was tested for superiority. Results Among 600 randomized patients (mean age, 68 years; 157 females [26.2%]; 42 Black [7%], 35 Hispanic [6%] individuals), 574 (95.7%) completed 1-year follow-up. The primary end point at 1 year occurred in 17.9% in the paclitaxel-coated balloon group vs 28.6% in the uncoated balloon group, meeting the criteria for superiority (hazard ratio [HR], 0.59 [95% CI, 0.42-0.84]; 2-sided P = .003). Target lesion revascularization (13.0% vs 24.7%; HR, 0.50 [95% CI, 0.34-0.74]; P = .001) and target vessel-related myocardial infarction (5.8% vs 11.1%; HR, 0.51 [95% CI, 0.28-0.92]; P = .02) occurred less frequently among patients treated with paclitaxel-coated balloon. The rate of cardiac death was 2.9% vs 1.6% (HR, 1.75 [95% CI, 0.49-6.28]; P = .38) in the coated vs uncoated balloon groups, respectively. Conclusions and Relevance Among patients undergoing coronary angioplasty for in-stent restenosis, a paclitaxel-coated balloon was superior to an uncoated balloon with respect to the composite end point of target lesion failure. Paclitaxel-coated balloons are an effective treatment option for patients with coronary in-stent restenosis. Trial Registration ClinicalTrials.gov Identifier: NCT04647253.
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Affiliation(s)
- Robert W. Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Jeffrey Moses
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
| | | | - Suhail Dohad
- Cedars Sinai Medical Center, Los Angeles, California
| | - Steven Rudick
- Lindner Center for Research and Education at Christ Hospital, Cincinnati, Ohio
| | - Robert Stoler
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | | | | | | | | | | | | | | | - Steven P. Marso
- Overland Park Regional Medical Center, Overland Park, Kansas
| | | | - Cindy Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | | | - Azeem Latib
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Behnam Tehrani
- The Inova Schar Heart and Vascular Institute, Falls Church, Virginia
| | - J. Dawn Abbott
- Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence
| | - Wayne Batchelor
- The Inova Schar Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Ajay J. Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
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3
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Samuels BA, Shah SM, Widmer RJ, Kobayashi Y, Miner SES, Taqueti VR, Jeremias A, Albadri A, Blair JA, Kearney KE, Wei J, Park K, Barseghian El-Farra A, Holoshitz N, Janaszek KB, Kesarwani M, Lerman A, Prasad M, Quesada O, Reynolds HR, Savage MP, Smilowitz NR, Sutton NR, Sweeny JM, Toleva O, Henry TD, Moses JW, Fearon WF, Tremmel JA. Comprehensive Management of ANOCA, Part 1-Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1245-1263. [PMID: 37704315 DOI: 10.1016/j.jacc.2023.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 09/15/2023]
Abstract
Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for suspected ischemic heart disease. This working diagnosis encompasses coronary microvascular dysfunction, microvascular and epicardial spasm, myocardial bridging, and other occult coronary abnormalities. Patients with ANOCA often face a high burden of symptoms and may experience repeated presentations to multiple medical providers before receiving a diagnosis. Given the challenges of establishing a diagnosis, patients with ANOCA frequently experience invalidation and recidivism, possibly leading to anxiety and depression. Advances in scientific knowledge and diagnostic testing now allow for routine evaluation of ANOCA noninvasively and in the cardiac catheterization laboratory with coronary function testing (CFT). CFT includes diagnostic coronary angiography, assessment of coronary flow reserve and microcirculatory resistance, provocative testing for endothelial dysfunction and coronary vasospasm, and intravascular imaging for identification of myocardial bridging, with hemodynamic assessment as needed.
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Affiliation(s)
- Bruce A Samuels
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - R Jay Widmer
- Baylor Scott and White Health, Temple, Texas, USA
| | - Yuhei Kobayashi
- New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Steven E S Miner
- Southlake Regional Medical Centre, Newmarket, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen Jeremias
- St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Ahmed Albadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John A Blair
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kathleen E Kearney
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Noa Holoshitz
- Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA
| | | | - Manoj Kesarwani
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Megha Prasad
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Michael P Savage
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
| | - Nadia R Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Joseph M Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Olga Toleva
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Jeffery W Moses
- St Francis Hospital and Heart Center, Roslyn, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Smilowitz NR, Prasad M, Widmer RJ, Toleva O, Quesada O, Sutton NR, Lerman A, Reynolds HR, Kesarwani M, Savage MP, Sweeny JM, Janaszek KB, Barseghian El-Farra A, Holoshitz N, Park K, Albadri A, Blair JA, Jeremias A, Kearney KE, Kobayashi Y, Miner SES, Samuels BA, Shah SM, Taqueti VR, Wei J, Fearon WF, Moses JW, Henry TD, Tremmel JA. Comprehensive Management of ANOCA, Part 2-Program Development, Treatment, and Research Initiatives: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1264-1279. [PMID: 37704316 DOI: 10.1016/j.jacc.2023.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 09/15/2023]
Abstract
Centers specializing in coronary function testing are critical to ensure a systematic approach to the diagnosis and treatment of angina with nonobstructive coronary arteries (ANOCA). Management leveraging lifestyle, pharmacology, and device-based therapeutic options for ANOCA can improve angina burden and quality of life in affected patients. Multidisciplinary care teams that can tailor and titrate therapies based on individual patient needs are critical to the success of comprehensive programs. As coronary function testing for ANOCA is more widely adopted, collaborative research initiatives will be fundamental to improve ANOCA care. These efforts will require standardized symptom assessments and data collection, which will propel future large-scale clinical trials.
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Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA
| | - Megha Prasad
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
| | | | - Olga Toleva
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Manoj Kesarwani
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Michael P Savage
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Noa Holoshitz
- Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Ahmed Albadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John A Blair
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Allen Jeremias
- St Francis Hospital & Heart Center, Roslyn, New York, USA
| | - Kathleen E Kearney
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Yuhei Kobayashi
- New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Steven E S Miner
- Southlake Regional Medical Centre, Newmarket, Ontario, Canada, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Samuels
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jeffery W Moses
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA; St Francis Hospital & Heart Center, Roslyn, New York, USA
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
| | - Jennifer A Tremmel
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Marschner S, Mukherjee S, Watts M, Min H, Beale AL, O'Brien J, Juneja A, Tremmel JA, Zaman S. Prevention of Cardiovascular Disease in Women With Pregnancy-Related Risk Factors: A Prospective Women's Heart Clinic Study. J Am Heart Assoc 2023; 12:e030015. [PMID: 37642017 PMCID: PMC10547318 DOI: 10.1161/jaha.123.030015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023]
Abstract
Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small-for-gestational-age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy-related conditions is lacking. Methods and Results A 6-month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small-for-gestational age baby in Melbourne, Australia. The co-primary end points were (1) blood pressure <140/90 mm Hg or <130/80 mm Hg if diabetes and (2) total cholesterol to high-density lipoprotein cholesterol ratio <4.5. The study recruited 156 women with a mean age of 41.0±4.2 years, 3.9±2.9 years from last delivery, 68.6% White, 20.5% South/East Asian, and 80.5% university-educated. The proportion meeting blood pressure target increased (69.2% to 80.5%, P=0.004), with no significant change in lipid targets (80.6% to 83.7%, P=0.182). Systolic blood pressure (-6.9 mm Hg [95% CI, -9.1 to -4.7], P<0.001), body mass index (-0.6 kg/m2 [95% CI, -0.8 to -0.3], P<0.001), low-density lipoprotein cholesterol (-4.2 mg/dL [95% CI, -8.2 to -0.2], P=0.042), and total cholesterol (-4.6 mg/dL [95% CI, -9.1 to -0.2] P=0.042) reduced. Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, P=0.012), decreased fast food consumption (33.8% to 11.0%, P<0.001), and increased physical activity (84.0% to 92.9%, P=0.025). Conclusions Women at high risk for cardiovascular disease due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors after attending a Women's Heart Clinic, potentially improving long-term cardiovascular disease outcomes. Registration URL: https://www.anzctr.org.au; Unique identifier: ACTRN12622000646741.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Swati Mukherjee
- Department of CardiologyCabrini HealthMelbourneAustralia
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medicine, Nursing & Health SciencesMonash UniversityMelbourneAustralia
| | - Monique Watts
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medical EducationUniversity of MelbourneMelbourneAustralia
| | - Haeri Min
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Anna L. Beale
- Department of CardiologyAlfred HospitalMelbourneAustralia
| | | | - Aashima Juneja
- Department of MedicineThe Northern HospitalMelbourneAustralia
| | - Jennifer A. Tremmel
- Department of Medicine (Cardiovascular)Stanford University School of MedicineStanfordCA
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneAustralia
- Department of CardiologyWestmead HospitalSydneyAustralia
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Tanaka S, Okada K, Kitahara H, Luikart H, Yock PG, Yeung AC, Schnittger I, Tremmel JA, Fitzgerald PJ, Khush KK, Fearon WF, Honda Y. Impact of myocardial bridging on coronary artery plaque formation and long-term mortality after heart transplantation. Int J Cardiol 2023; 379:24-32. [PMID: 36893856 PMCID: PMC10085846 DOI: 10.1016/j.ijcard.2023.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES This study aimed to explore the impact of myocardial bridging (MB) on early development of cardiac allograft vasculopathy and long-term graft survival after heart transplantation. BACKGROUND MB has been reported to be associated with acceleration of proximal plaque development and endothelial dysfunction in native coronary atherosclerosis. However, its clinical significance in heart transplantation remains unclear. METHODS In 103 heart-transplant recipients, serial (baseline and 1-year post-transplant) volumetric intravascular ultrasound (IVUS) analyses were performed in the first 50 mm of the left anterior descending (LAD) artery. Standard IVUS indices were evaluated in 3 equally divided LAD segments (proximal, middle, and distal segments). MB was defined by IVUS as an echolucent muscular band lying on top of the artery. The primary endpoint was death or re-transplantation, assessed for up to 12.2 years (median follow-up: 4.7 years). RESULTS IVUS identified MB in 62% of the study population. At baseline, MB patients had smaller intimal volume in the distal LAD than non-MB patients (p = 0.002). During the first year, vessel volume decreased diffusely irrespective of the presence of MB. Intimal growth diffusely distributed in non-MB patients, whereas MB patients demonstrated significantly augmented intimal formation in the proximal LAD. Kaplan-Meier analysis revealed significantly lower event-free survival in patients with versus without MB (log-rank p = 0.02). In multivariate analysis, the presence of MB was independently associated with late adverse events [hazard ratio 5.1 (1.6-22.2)]. CONCLUSION MB appears to relate to accelerated proximal intimal growth and reduced long-term survival in heart-transplant recipients.
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Affiliation(s)
- Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Helen Luikart
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Huie LC, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circ Cardiovasc Interv 2023; 16:e000088. [PMID: 36795800 DOI: 10.1161/hcv.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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11
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Vaikunth SS, Murphy DJ, Tremmel JA, Schnittger I, Mitchell RS, Maeda K, Rogers IS. Symptomatic Myocardial Bridging in D-Transposition of the Great Arteries Post-Arterial Switch. JACC Case Rep 2023; 8:101730. [PMID: 36860558 PMCID: PMC9969547 DOI: 10.1016/j.jaccas.2022.101730] [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: 09/06/2022] [Revised: 11/17/2022] [Accepted: 12/09/2022] [Indexed: 01/21/2023]
Abstract
We present Stanford's experience with patients post-arterial switch operation presenting with chest pain found to have hemodynamically significant myocardial bridging. The evaluation of symptomatic patients post-arterial switch should not only include assessment for coronary ostial patency but also for nonobstructive coronary conditions such as myocardial bridging. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Sumeet S. Vaikunth
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Division of Cardiology, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Address for correspondence: Dr Sumeet S. Vaikunth, Perelman Center for Advanced Medicine, 11th Floor, South Pavilion, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104-5127, USA.
| | - Daniel J. Murphy
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer A. Tremmel
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ingela Schnittger
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Robert Scott Mitchell
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Katsuhide Maeda
- Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ian S. Rogers
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA,Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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12
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Khan MO, Nishi T, Imura S, Seo J, Wang H, Honda Y, Nieman K, Rogers IS, Tremmel JA, Boyd J, Schnittger I, Marsden A. Colocalization of Coronary Plaque with Wall Shear Stress in Myocardial Bridge Patients. Cardiovasc Eng Technol 2022; 13:797-807. [PMID: 35296987 DOI: 10.1007/s13239-022-00616-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/17/2021] [Accepted: 02/25/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Patients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque. METHODS We identified N = 10 patients from a previously reported cohort of 50 symptomatic MB patients, all of whom had plaque in the proximal vessel. Dynamic 3D models were reconstructed from coronary computed tomography angiography (CCTA), intravascular ultrasound (IVUS) and catheter angiograms. CFD simulations were performed to compute WSS proximal to, within and distal to the MB. Plaque was quantified from IVUS images in 2 mm segments and registered to CFD model. Plaque area was compared to absolute and patient-normalized WSS. RESULTS WSS was lower in the proximal segment compared to the bridge segment (6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cm2, p value < 0.01). Plaque area and plaque burden measured from IVUS peaked at 1-3 cm proximal to the MB entrance, coinciding with the first diagonal branch. Normalized WSS showed a statistically significant moderate correlation with plaque area (r = 0.41, p < 0.01). CONCLUSION WSS may be obtained non-invasively in MB patients and provides a surrogate marker of plaque area. Using CFD, it may be possible to non-invasively assess the extent of plaque area, and identify patients who could benefit from frequent monitoring or medical management.
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Affiliation(s)
- Muhammad Owais Khan
- Department of Pediatrics, Stanford University School of Medicine, 318 Campus Drive, Clark Center E100b, Stanford, CA, 94305-5428, USA.,Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Shinji Imura
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Jongmin Seo
- Department of Pediatrics, Stanford University School of Medicine, 318 Campus Drive, Clark Center E100b, Stanford, CA, 94305-5428, USA.,Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Koen Nieman
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA.,Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Jack Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Alison Marsden
- Department of Pediatrics, Stanford University School of Medicine, 318 Campus Drive, Clark Center E100b, Stanford, CA, 94305-5428, USA. .,Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA. .,Department of Bioengineering, Stanford University, Stanford, CA, USA.
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13
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Takahashi T, Samuels BA, Li W, Parikh MA, Wei J, Moses JW, Fearon WF, Henry TD, Tremmel JA, Kobayashi Y. Safety of Provocative Testing With Intracoronary Acetylcholine and Implications for Standard Protocols. J Am Coll Cardiol 2022; 79:2367-2378. [PMID: 35710187 DOI: 10.1016/j.jacc.2022.03.385] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 03/04/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Heterogeneity in diagnostic criteria and provocation protocols has posed challenges in understanding the safety of coronary provocation testing with intracoronary acetylcholine (ACh) for the contemporary diagnosis of epicardial and microvascular spasm. OBJECTIVES We examined the safety of testing and subgroup differences in procedural risks based on ethnicity, diagnostic criteria, and provocation protocols. METHODS PubMed and Embase were searched in November 2021 to identify original articles reporting procedural complications associated with intracoronary ACh administration. The primary outcome was the pooled estimate of the incidence of major complications including death, myocardial infarction, ventricular tachycardia/fibrillation, and shock. RESULTS A total of 16 studies with 12,585 patients were included in the meta-analysis. The overall pooled estimate of the incidence of major complications was 0.5% (95% CI: 0.0%-1.3%) without any reports of death. Exploratory subgroup analyses revealed that the pooled incidence of major complications was significantly higher in the studies that followed the contemporary diagnosis criteria for epicardial spasm defined as ≥90% diameter reduction (1.0%; 95% CI: 0.3%-2.0%) but significantly lower in Western populations (0.0%; 95% CI: 0.0%-0.45%). The rate of positive epicardial spasm and the incidence of major complications were similar between provocation protocols using the maximum ACh doses of 100 μg and 200 μg. CONCLUSIONS Intracoronary ACh administration for the contemporary diagnosis of epicardial and microvascular spasm is a safe procedure. Moreover, excellent safety records are observed in Western populations primarily presenting with myocardial ischemia and/or infarction with nonobstructive coronary arteries. This study will help standardize ACh testing to improve clinical diagnosis and ensure procedural safety.
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Affiliation(s)
- Tatsunori Takahashi
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bruce A Samuels
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Weijia Li
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Manish A Parikh
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Weill Cornell Medicine, Brooklyn, New York, USA
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jeffery W Moses
- Department of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA
| | - Yuhei Kobayashi
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Weill Cornell Medicine, Brooklyn, New York, USA.
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14
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Blankstein R, Shaw LJ, Gulati M, Atalay MK, Bax J, Calnon DA, Dyke CK, Ferencik M, Heitner JF, Henry TD, Hung J, Knuuti J, Lindner JR, Phillips LM, Raman SV, Rao SV, Rybicki FJ, Saraste A, Stainback RF, Thompson RC, Williamson E, Nieman K, Tremmel JA, Woodard PK, Di Carli MF, Chandrashekhar YS. Implications of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline for Cardiovascular Imaging: A Multisociety Viewpoint. JACC Cardiovasc Imaging 2022; 15:912-926. [PMID: 35512960 DOI: 10.1016/j.jcmg.2022.02.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Leslee J Shaw
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Martha Gulati
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Michael K Atalay
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Jeroen Bax
- Heart Center, Turku University Hospital, Turku, Finland; Leiden University Medical Centre, Leiden, the Netherlands
| | - Dennis A Calnon
- Ohio Health Heart & Vascular Physicians, Columbus, Ohio, USA
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Turku, Finland
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Subha V Raman
- Indiana University CV Institute and Krannert CV Research Center, Indianapolis, Indiana, USA
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frank J Rybicki
- University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland; Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Raymond F Stainback
- Texas Heart Institute and Baylor College of Medicine, Division of Cardiology, Houston, Texas, USA
| | - Randall C Thompson
- St. Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Koen Nieman
- Stanford University, Palo Alto, California, USA
| | | | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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15
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McLaughlin T, Schnittger I, Nagy A, Zanley E, Xu Y, Song Y, Nieman K, Tremmel JA, Dey D, Boyd J, Sacks H. Relationship Between Coronary Atheroma, Epicardial Adipose Tissue Inflammation, and Adipocyte Differentiation Across the Human Myocardial Bridge. J Am Heart Assoc 2021; 10:e021003. [PMID: 34726081 PMCID: PMC8751937 DOI: 10.1161/jaha.121.021003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Inflammation in epicardial adipose tissue (EAT) may contribute to coronary atherosclerosis. Myocardial bridge is a congenital anomaly in which the left anterior descending coronary artery takes a "tunneled" course under a bridge of myocardium: while atherosclerosis develops in the proximal left anterior descending coronary artery, the bridged portion is spared, highlighting the possibility that geographic separation from inflamed EAT is protective. We tested the hypothesis that inflammation in EAT was related to atherosclerosis by comparing EAT from proximal and bridge depots in individuals with myocardial bridge and varying degrees of atherosclerotic plaque. Methods and Results Maximal plaque burden was quantified by intravascular ultrasound, and inflammation was quantified by pericoronary EAT signal attenuation (pericoronary adipose tissue attenuation) from cardiac computed tomography scans. EAT overlying the proximal left anterior descending coronary artery and myocardial bridge was harvested for measurement of mRNA and microRNA (miRNA) using custom chips by Nanostring; inflammatory cytokines were measured in tissue culture supernatants. Pericoronary adipose tissue attenuation was increased, indicating inflammation, in proximal versus bridge EAT, in proportion to atherosclerotic plaque. Individuals with moderate-high versus low plaque burden exhibited greater expression of inflammation and hypoxia genes, and lower expression of adipogenesis genes. Comparison of gene expression in proximal versus bridge depots revealed differences only in participants with moderate-high plaque: inflammation was higher in proximal and adipogenesis lower in bridge EAT. Secreted inflammatory cytokines tended to be higher in proximal EAT. Hypoxia-inducible factor 1a was highly associated with inflammatory gene expression. Seven miRNAs were differentially expressed by depot: 3192-5P, 518D-3P, and 532-5P were upregulated in proximal EAT, whereas miR 630, 575, 16-5P, and 320E were upregulated in bridge EAT. miR 630 correlated directly with plaque burden and inversely with adipogenesis genes. miR 3192-5P, 518D-3P, and 532-5P correlated inversely with hypoxia/oxidative stress, peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PCG1a), adipogenesis, and angiogenesis genes. Conclusions Inflammation is specifically elevated in EAT overlying atherosclerotic plaque, suggesting that EAT inflammation is caused by atherogenic molecular signals, including hypoxia-inducible factor 1a and/or miRNAs in an "inside-to-out" relationship. Adipogenesis was suppressed in the bridge EAT, but only in the presence of atherosclerotic plaque, supporting cross talk between the vasculature and EAT. miR 630 in EAT, expressed differentially according to burden of atherosclerotic plaque, and 3 other miRNAs appear to inhibit key genes related to adipogenesis, angiogenesis, hypoxia/oxidative stress, and thermogenesis in EAT, highlighting a role for miRNA in mediating cross talk between the coronary vasculature and EAT.
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Affiliation(s)
- Tracey McLaughlin
- Division of Endocrinology Stanford University School of Medicine Stanford CA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Anna Nagy
- Division of Endocrinology Stanford University School of Medicine Stanford CA
| | - Elizabeth Zanley
- Division of Endocrinology Stanford University School of Medicine Stanford CA
| | - Yue Xu
- Division of Endocrinology Stanford University School of Medicine Stanford CA
| | - Yanqiu Song
- Cardiovascular Institute Tianjin Chest Hospital Tianjin China
| | - Koen Nieman
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Damini Dey
- Department of Biomedical Sciences and Medicine Cedars-Sinai Medical Center Biomedical Imaging Research Institute Los Angeles CA
| | - Jack Boyd
- Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA
| | - Harold Sacks
- Division of Endocrinology Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
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16
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Hashikata T, Honda Y, Wang H, Pargaonkar VS, Nishi T, Hollak MB, Rogers IS, Nieman K, Yock PG, Fitzgerald PJ, Schnittger I, Boyd JH, Tremmel JA. Impact of Diastolic Vessel Restriction on Quality of Life in Symptomatic Myocardial Bridging Patients Treated With Surgical Unroofing: Preoperative Assessments With Intravascular Ultrasound and Coronary Computed Tomography Angiography. Circ Cardiovasc Interv 2021; 14:e011062. [PMID: 34665656 DOI: 10.1161/circinterventions.121.011062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Takehiro Hashikata
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Hanjay Wang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Vedant S Pargaonkar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.).,Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan (T.N.)
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Koen Nieman
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.).,Department of Radiology, Stanford University School of Medicine, CA (K.N.)
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Jack H Boyd
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.H., Y.H., H.W., V.S.P., T.N., M.B.H., I.S.R., K.N., P.G.Y., P.J.F., I.S., J.H.B., J.A.T.)
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17
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Wu EB, Brilakis ES, Mashayekhi K, Tsuchikane E, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Behnes M, Bhindi R, Boudou N, Boukhris M, Bozinovic NZ, Bryniarski L, Bufe A, Buller CE, Burke MN, Buttner A, Cardoso P, Carlino M, Chen JY, Christiansen EH, Colombo A, Croce K, de Los Santos FD, de Martini T, Dens J, di Mario C, Dou K, Egred M, Elbarouni B, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Gasparini G, Ge J, Ge L, Goel PK, Goktekin O, Gonzalo N, Grancini L, Hall A, Hanna Quesada FL, Hanratty C, Harb S, Harding SA, Hatem R, Henriques JPS, Hildick-Smith D, Hill JM, Hoye A, Jaber W, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Khatri J, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Lamelas PM, Lee SW, Lefevre T, Leung R, Li Y, Li Y, Lim ST, Lo S, Lombardi W, Maran A, McEntegart M, Moses J, Munawar M, Navarro A, Ngo HM, Nicholson W, Oksnes A, Olivecrona GK, Padilla L, Patel M, Pershad A, Postu M, Qian J, Quadros A, Rafeh NA, Råmunddal T, Prakasa Rao VS, Reifart N, Riley RF, Rinfret S, Saghatelyan M, Sianos G, Smith E, Spaedy A, Spratt J, Stone G, Strange JW, Tammam KO, Thompson CA, Toma A, Tremmel JA, Trinidad RS, Ungi I, Vo M, Vu VH, Walsh S, Werner G, Wojcik J, Wollmuth J, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q. Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:840-853. [PMID: 34412818 DOI: 10.1016/j.jacc.2021.05.055] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [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: 03/19/2021] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
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Affiliation(s)
- Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, II University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Khaldoon Alaswad
- Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan, USA
| | - Mario Araya
- Clinica Alemana, Hospital Militar de Santiago, Santiago, Chile
| | | | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Ravinay Bhindi
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | - Marouane Boukhris
- Cardiology Department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Alexander Bufe
- Heart Center Krefeld, University Witten/Herdecke, Witten, Germany
| | - Christopher E Buller
- Teleflex, Markham, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Pedro Cardoso
- Santa Maria University Hospital, Lisbon Academic Medical Centre and Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal
| | - Mauro Carlino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Ji-Yan Chen
- Guangdong General Hospital, Guangdong, China
| | | | - Antonio Colombo
- Cardiology, Humanitas University, Humanitas IRCCS, Rozzano, Milan, Italy
| | - Kevin Croce
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Carlo di Mario
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Kefei Dou
- Research Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Mohaned Egred
- Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK
| | - Basem Elbarouni
- St. Boniface Hospital & University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Javier Escaned
- Hospital Clinico San Carlos, IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Sergey Furkalo
- National Institute of Surgery and Transplantology NAMS, Kiev, Ukraine
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Alfredo R Galassi
- Cardiovascular Medicine Department of PROMISE University of Palermo, Palermo, Italy
| | - Roberto Garbo
- Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Gabriele Gasparini
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pravin Kumar Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - Nieves Gonzalo
- Interventional Cardiology, Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Allison Hall
- Eastern Health/Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | | | - Stefan Harb
- Medical University of Graz, University Heart Center, Graz, Austria
| | - Scott A Harding
- Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Raja Hatem
- Hôpital du Sacré-Coeur de Montréal Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Angela Hoye
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Risto Jussila
- Interventional Cardiology, Helsinki Heart Hospital, Helsinki, Finland
| | - Artis Kalnins
- Clinic of Cardiovascular Diseases, Riga East Clinical University Hospital, Riga, Latvia
| | | | - David E Kandzari
- Piedmont Heart Institute and Cardiovascular Services, Atlanta, Georgia, USA
| | - Hsien-Li Kao
- Department of Internal Medicine, Cardiology Division, Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Hussien Heshmat Kassem
- Kasr Alainy Medical School, Cairo University, Cairo, Egypt, and Fujairah Hospital, Ministry of Health, Fujairah, United Arab Emirates
| | | | - Paul Knaapen
- Heart Center of the Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - A V Ganesh Kumar
- Department of Cardiology, Dr. L.H. Hiranandani Hospital, Mumbai, India
| | - Pablo Manuel Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud, Hôpital Prive Jacques Cartier, Massy, France
| | - Raymond Leung
- C.K. Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Yu Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Sidney Lo
- Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia
| | | | - Anbukarasi Maran
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | | | - Jeffrey Moses
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Muhammad Munawar
- Binawaluya Cardiac Center and Department of Cardiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, and Department of Cardiology, Faculty of Medicine, Universitas Gadjahmada, Yogyakarta, Indonesia
| | - Andres Navarro
- Hospital de los Valles, Hospital de Especialidades Eugenio Espejo, Universidad San Francisco de Quito, Quito, Ecuador
| | - Hung M Ngo
- Choray University Hospital, Hochiminh City, Vietnam
| | | | - Anja Oksnes
- Heart Department, Haukeland University Hospital, Bergen, Norway
| | | | - Lucio Padilla
- Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina
| | - Mitul Patel
- Division of Cardiovascular Medicine, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Ashish Pershad
- Chandler Regional Medical Center, Chandler, Arizona, USA
| | - Marin Postu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof Dr C.C. Iliescu," Bucharest, Romania
| | - Jie Qian
- Beijing Fuwai Hospital, Beijing, China
| | - Alexandre Quadros
- Interventional Cardiology Division and Post Graduate Course of Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nidal Abi Rafeh
- St. George Hospital University Medical Center, Beirut, Lebanon, and North Oaks Healthcare System, Hammond, Louisiana, USA
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany
| | - Robert F Riley
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | | | | | | | - Elliot Smith
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - James Spratt
- St. George's University Hospital NHS Foundation Trust, London, UK
| | - Gregg Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julian W Strange
- Bristol Royal Infirmary, University Hospital Bristol NHS Trust, Bristol, UK
| | - Khalid O Tammam
- Department at the International Medical Center, Jeddah, Saudi Arabia
| | | | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Imre Ungi
- University of Szeged, Department of Invasive Cardiology, Szeged, Hungary
| | - Minh Vo
- Royal Columbian Hospital, Vancouver, British Columbia, Canada
| | - Vu Hoang Vu
- Heart Center University Medical Center, Ho Chi Minh City, Vietnam
| | - Simon Walsh
- Belfast Health and Social Care Trust, Belfast, UK
| | - Gerald Werner
- Medizinische Klinik I Klinikum Darmstadt, Darmstadt, Germany
| | - Jaroslaw Wojcik
- Hospital of Invasive Cardiology IKARDIA, Nałęczów/Lublin, Poland
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Portland, Oregon, USA
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Qi Zhang
- Shanghai East Hospital, Tongji University, Shanghai, China
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Yong ASC, Pargaonkar VS, Wong CCY, Javadzdegan A, Yamada R, Tanaka S, Kimura T, Rogers IS, Sen I, Kritharides L, Schnittger I, Tremmel JA. Abnormal shear stress and residence time are associated with proximal coronary atheroma in the presence of myocardial bridging. Int J Cardiol 2021; 340:7-13. [PMID: 34375705 DOI: 10.1016/j.ijcard.2021.08.011] [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: 05/19/2021] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atheromatous plaques tend to form in the coronary segments proximal to a myocardial bridge (MB), but the mechanism of this occurrence remains unclear. This study evaluates the relationship between blood flow perturbations and plaque formation in patients with an MB. METHODS AND RESULTS A total of 92 patients with an MB in the mid left anterior descending artery (LAD) and 20 patients without an MB were included. Coronary angiography, intravascular ultrasound, and coronary physiology measurements were performed. A moving-boundary computational fluid dynamics algorithm was used to derive wall shear stress (WSS) and peak residence time (PRT). Patients with an MB had lower WSS (0.46 ± 0.21 vs. 0.96 ± 0.33 Pa, p < 0.001) and higher maximal plaque burden (33.6 ± 15.0 vs. 14.2 ± 5.8%, p < 0.001) within the proximal LAD compared to those without. Plaque burden in the proximal LAD correlated significantly with proximal WSS (r = -0.51, p < 0.001) and PRT (r = 0.60, p < 0.001). In patients with an MB, the site of maximal plaque burden occurred 23.4 ± 13.3 mm proximal to the entrance of the MB, corresponding to the site of PRT. CONCLUSIONS Regions of low WSS and high PRT occur in arterial segments proximal to an MB, and this is associated with the degree and location of coronary atheroma formation.
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Affiliation(s)
- Andy S C Yong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia
| | | | - Christopher C Y Wong
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ashkan Javadzdegan
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Ryotaro Yamada
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Shigemitsu Tanaka
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Takumi Kimura
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Ian S Rogers
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Itsu Sen
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ingela Schnittger
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
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19
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Wang H, Pargaonkar VS, Hironaka CE, Bajaj SS, Abbot CJ, O'Donnell CT, Miller SL, Honda Y, Rogers IS, Tremmel JA, Fischbein MP, Mitchell RS, Schnittger I, Boyd JH. Off-Pump Minithoracotomy Versus Sternotomy for Left Anterior Descending Myocardial Bridge Unroofing. Ann Thorac Surg 2020; 112:1474-1482. [PMID: 33333083 DOI: 10.1016/j.athoracsur.2020.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 06/10/2020] [Revised: 10/01/2020] [Accepted: 11/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Myocardial bridge (MB) of the left anterior descending (LAD) coronary artery occurs in approximately 25% of the population. When medical therapy fails in patients with a symptomatic, hemodynamically significant MB, MB unroofing represents the optimal surgical management. Here, we evaluated minimally invasive MB unroofing in selected patients compared with sternotomy. METHODS MB unroofing was performed in 141 adult patients by sternotomy on-pump (ST-on, n = 40), sternotomy off-pump (ST-off, n = 62), or minithoracotomy off-pump (MT, n = 39). Angina symptoms were assessed preoperatively and 6 months postoperatively using the Seattle Angina Questionnaire. Matching included all MT patients and 31 ST-off patients with similar MB characteristics, no previous cardiac operations or coronary interventions, and no concomitant procedures. RESULTS MT patients tended to have a shorter MB length than ST-on and ST-off patients (2.57 vs 2.93 vs 3.09 cm, P = .166). ST-on patients had a longer hospital stay than ST-off and MT patients (5.0 vs 4.0 vs 3.0 days, P < .001), and more blood transfusions (15.2% vs 0.0% vs 2.6%, P = .002). After matching, MT patients had a shorter hospital stay than ST-off patients (3.0 vs 4.0 days, P = .005). No deaths or major complications occurred in any group. In all groups, MB unroofing yielded significant symptomatic improvement regarding physical limitation, angina stability, angina frequency, treatment satisfaction, and quality of life. CONCLUSIONS We report our single-center experience of off-pump minimally invasive MB unroofing, which may be safely performed in carefully selected patients, yielding dramatic improvements in angina symptoms at 6 months after the operation.
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Affiliation(s)
- Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Vedant S Pargaonkar
- Department of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Camille E Hironaka
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Simar S Bajaj
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Chad J Abbot
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | | | - Shari L Miller
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Yasuhiro Honda
- Department of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Ian S Rogers
- Department of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Jennifer A Tremmel
- Department of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - R Scott Mitchell
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Ingela Schnittger
- Department of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
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20
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Tremmel JA. Perforation Mechanisms, Risk Stratification, and Management in the Non-post Coronary Artery Bypass Graft Patient. Interv Cardiol Clin 2020; 10:93-99. [PMID: 33223111 DOI: 10.1016/j.iccl.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jennifer A Tremmel
- Stanford University Medical Center, 300 Pasteur Drive, Room H2103, Stanford, CA 94305, USA.
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21
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Riley RF, Henry TD, Mahmud E, Kirtane AJ, Brilakis ES, Goyal A, Grines CL, Lombardi WL, Maran A, Rab T, Tremmel JA, Truesdell AG, Yeh RW, Zhao DX, Jaffer FA. SCAI
position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease. Catheter Cardiovasc Interv 2020; 96:346-362. [DOI: 10.1002/ccd.28994] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education The Christ Hospital Cincinnati Ohio USA
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center University of California San Diego La Jolla California USA
| | - Ajay J. Kirtane
- Center for Interventional Vascular Therapy Columbia University Medical Center New York New York USA
| | | | | | | | | | - Anbukarasi Maran
- Medical University of South Carolina North Charleston South Carolina USA
| | | | | | | | - Robert W. Yeh
- Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - David X. Zhao
- Wake Forest University School of Medicine Winston‐Salem North Carolina USA
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22
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Pargaonkar VS, Tremmel JA, Schnittger I, Khandelwal A. Effect of ranolazine on symptom and quality of life in patients with angina in the absence of obstructive coronary artery disease: A case control study. Int J Cardiol 2020; 309:8-13. [PMID: 32220488 DOI: 10.1016/j.ijcard.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/02/2020] [Accepted: 02/05/2020] [Indexed: 12/11/2022]
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23
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Yong CM, Tremmel JA, Lansberg MG, Fan J, Askari M, Turakhia MP. Sex Differences in Oral Anticoagulation and Outcomes of Stroke and Intracranial Bleeding in Newly Diagnosed Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015689. [PMID: 32394763 PMCID: PMC7660841 DOI: 10.1161/jaha.120.015689] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Female sex is an independent predictor of stroke in patients with atrial fibrillation (AF). Older data suggest undertreatment with anticoagulation among women compared with men. However, it is unknown if novel therapies and updated guidelines have impacted sex differences in AF treatment and outcomes. Methods and Results We performed a retrospective cohort study of 2.3 million women and men with a new diagnosis of AF and CHA2DS2‐VASc ≥2 from Marketscan US commercial claims data from 2008 to 2015 to determine whether women with AF remain undertreated and whether this difference mediates observed differences in outcomes. There were 358 649 patients with newly diagnosed AF (43% women). Compared with men, women were older, with higher CHA2DS2‐VASc scores, and higher comorbidity burden (P<0.0001 for all). Oral anticoagulation‐eligible women with CHA2DS2‐VASc scores ≥2 were more likely to not receive anticoagulation (50.0% women versus 43.9% men). Women, compared with men, had a higher risk of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.21–1.32; P<0.0001) and hospitalization (aHR, 1.06; 95% CI, 1.05–1.07, P<0.0001) but had a lower risk of intracranial bleeding (aHR, 0.91; 95% CI, 0.83–0.99, P=0.03). In mediation analysis, nonreceipt of oral anticoagulation partially mediated the observed increased risk of stroke and decreased risk of intracranial bleeding in women. Conclusions In the care of newly diagnosed AF in the United States, women, compared with men, are less likely to receive oral anticoagulation. This appears to mediate the increased risk of both stroke and hospitalization but also appears to mediate lower observed intracranial bleeding risk.
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Affiliation(s)
- Celina M Yong
- VA Palo Alto Healthcare System Palo Alto CA.,Department of Medicine (Cardiovascular Medicine) Stanford University and Cardiovascular Institute (CVI) Stanford CA
| | - Jennifer A Tremmel
- Department of Medicine (Cardiovascular Medicine) Stanford University and Cardiovascular Institute (CVI) Stanford CA
| | | | - Jun Fan
- VA Palo Alto Healthcare System Palo Alto CA
| | | | - Mintu P Turakhia
- VA Palo Alto Healthcare System Palo Alto CA.,Department of Medicine (Cardiovascular Medicine) Stanford University and Cardiovascular Institute (CVI) Stanford CA.,Center for Digital Health Stanford University Stanford CA
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24
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Pargaonkar VS, Lee JH, Chow EKH, Nishi T, Ball RL, Kobayashi Y, Kimura T, Lee DP, Stefanick ML, Fearon WF, Yeung AC, Tremmel JA. Dose-Response Relationship Between Intracoronary Acetylcholine and Minimal Lumen Diameter in Coronary Endothelial Function Testing of Women and Men With Angina and No Obstructive Coronary Artery Disease. Circ Cardiovasc Interv 2020; 13:e008587. [PMID: 32279562 DOI: 10.1161/circinterventions.119.008587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/16/2022]
Abstract
BACKGROUND Intracoronary acetylcholine (Ach) provocation testing is the gold standard for assessing coronary endothelial function. However, dosing regimens of Ach are quite varied in the literature, and there are limited data evaluating the optimal dose. We evaluated the dose-response relationship between Ach and minimal lumen diameter (MLD) by sex and studied whether incremental intracoronary Ach doses given during endothelial function testing improve its diagnostic utility. METHODS We evaluated 65 men and 212 women with angina and no obstructive coronary artery disease who underwent endothelial function testing using the highest tolerable dose of intracoronary Ach, up to 200 μg. Epicardial endothelial dysfunction was defined as a decrease in MLD >20% after intracoronary Ach by quantitative coronary angiography. We used a linear mixed effects model to evaluate the dose-response relationship. Deming regression analysis was done to compare the %MLD constriction after incremental doses of intracoronary Ach. RESULTS The mean age was 53.5 years. Endothelial dysfunction was present in 186 (68.1%). Among men with endothelial dysfunction, there was a significant decrease in MLD/10 µg of Ach at doses above 50 μg and 100 µg, while this decrease in MLD was not observed in women (P<0.001). The %MLD constriction at 20 μg versus 50 μg and 50 μg versus 100 μg were not equivalent while the %MLD constriction at 100 μg versus 200 μg were equivalent. CONCLUSIONS Women and men appear to have different responses to Ach during endothelial function testing. In addition to having a greater response to intracoronary Ach at all doses, men also demonstrate an Ach-MLD dose-response relationship with doses up to 200 μg, while women have minimal change in MLD with doses above 50 µg. An incremental dosing regimen during endothelial function testing appears to improve the diagnostic utility of the test and should be adjusted based on the sex of the patient.
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Affiliation(s)
- Vedant S Pargaonkar
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Justin H Lee
- Quantitative Sciences Unit, Department of Medicine (J.H.L., E.K.H.C., R.L.B.), Stanford School of Medicine, CA
| | - Eric K H Chow
- Quantitative Sciences Unit, Department of Medicine (J.H.L., E.K.H.C., R.L.B.), Stanford School of Medicine, CA
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Robyn L Ball
- Quantitative Sciences Unit, Department of Medicine (J.H.L., E.K.H.C., R.L.B.), Stanford School of Medicine, CA
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA.,Department of Cardiology, Iwate Medical University, Morioka, Japan (T.K.)
| | - David P Lee
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Marcia L Stefanick
- Stanford Prevention Research Center (M.L.S.), Stanford School of Medicine, CA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
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25
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Pargaonkar VS, Rogers IS, Su J, Forsdahl SH, Kameda R, Schreiber D, Chan FP, Becker HC, Fleischmann D, Tremmel JA, Schnittger I. Accuracy of a novel stress echocardiography pattern for myocardial bridging in patients with angina and no obstructive coronary artery disease - A retrospective and prospective cohort study. Int J Cardiol 2020; 311:107-113. [PMID: 32145938 DOI: 10.1016/j.ijcard.2020.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/03/2019] [Revised: 12/30/2019] [Accepted: 02/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Myocardial bridge (MB) may cause angina in patients with no obstructive coronary artery disease (CAD). We previously reported a novel stress echocardiography (SE) pattern of focal septal buckling with apical sparing in the end-systolic to early-diastolic phase that is associated with the presence of an MB. We evaluated the diagnostic accuracy of this pattern, and prospectively validated our results. METHODS The retrospective cohort included 158 patients with angina who underwent both SE and coronary CT angiography (CCTA). The validation cohort included 37 patients who underwent CCTA in the emergency department for angina, and prospectively underwent SE. CCTA was used as a reference standard for the presence/absence of an MB, and also confirmed no obstructive CAD. RESULTS In the retrospective cohort, an MB was present in 107 (67.7%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 91.6%, 70.6%, 86.7% and 80%, respectively. On logistic regression, focal septal buckling and Duke treadmill score were associated with an MB. In the validation cohort, an MB was present in 31 (84%). The sensitivity, specificity PPV and NPV were 90.3%, 83.3%, 96.5% and 62.5%, respectively. On logistic regression, focal septal buckling was associated with an MB. CONCLUSION Presence of focal septal buckling with apical sparing on SE is an accurate predictor of an MB in patients with angina and no obstructive CAD. This pattern can reliably be used to screen patients who may benefit from advanced non-invasive/invasive testing for an MB as a cause of their angina.
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Affiliation(s)
- Vedant S Pargaonkar
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Ian S Rogers
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jessica Su
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Signe Helene Forsdahl
- Department of Radiology, Stanford School of Medicine, Stanford, CA, USA; Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Ryo Kameda
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Donald Schreiber
- Department of Emergency Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Frandics P Chan
- Department of Radiology, Stanford School of Medicine, Stanford, CA, USA
| | | | | | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA, USA.
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Daniels DV, Pargaonkar VS, Nishi T, Tremmel JA. Antegrade Dissection Re-Entry After Subintimal Wiring of an Occluded Vessel From Spontaneous Coronary Artery Dissection. JACC Case Rep 2020; 2:72-76. [PMID: 34316968 PMCID: PMC8301708 DOI: 10.1016/j.jaccas.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- David V. Daniels
- Cardiology Department, Sutter Health Palo Alto Medical Foundation, Burlingame, California
| | - Vedant S. Pargaonkar
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford California
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford California
| | - Jennifer A. Tremmel
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford California
- Address for correspondence: Dr. Jennifer A. Tremmel, Division of Cardiovascular Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room H2103, MC 5218, Stanford, California 94305.
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27
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Kang G, Sarraju A, Nishi T, Rogers I, Tremmel JA, Kim JB. Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction in an Anomalous LAD Artery. JACC Case Rep 2020; 2:45-50. [PMID: 34316962 PMCID: PMC8301712 DOI: 10.1016/j.jaccas.2019.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/31/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 11/30/2022]
Abstract
Spontaneous coronary artery dissection is an increasingly recognized cause of acute coronary syndrome in younger patients. Management remains challenging and involves weighing the benefits of revascularization with the potential to worsen the dissection. We present a case of spontaneous coronary artery dissection with the superimposed complexity of an anomalous intramural coronary artery. (Level of Difficulty: Intermediate.)
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Affiliation(s)
| | | | | | | | | | - Juyong Brian Kim
- Address for correspondence: Dr. Juyong Brian Kim, Division of Cardiovascular Medicine, 300 Pasteur Drive, CV273, Falk CVRC, MC 5406, Stanford, California 94305.
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Affiliation(s)
- Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford School of Medicine, 300 Pasteur Dr, Rm H2157, MC 5233, Stanford, CA 94305.
| | - Jack H Boyd
- Department of Cardio-Thoracic Surgery, Stanford University Medical Center, Stanford, California
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California
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29
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Parikh RV, Pargaonkar V, Ball RL, Kobayashi Y, Kimura T, Yeung AC, Cooke JP, Tremmel JA. Asymmetric dimethylarginine predicts impaired epicardial coronary vasomotion in patients with angina in the absence of obstructive coronary artery disease. Int J Cardiol 2019; 299:7-11. [PMID: 31416658 DOI: 10.1016/j.ijcard.2019.07.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/29/2018] [Revised: 06/17/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impaired epicardial coronary vasomotion is a potential mechanism of angina and a predictor of adverse cardiovascular outcomes in patients without angiographic evidence of obstructive coronary artery disease (CAD). We sought to evaluate the association of asymmetric dimethylarginine (ADMA)-a marker of nitric oxide-mediated vascular dysfunction-with epicardial coronary vasomotor dysfunction in this select population. METHODS Invasive testing for epicardial vasomotor dysfunction was performed using intracoronary acetylcholine in the left anterior descending coronary artery. Impaired vasomotor response was defined as a luminal constriction of >20% on quantitative coronary angiography. Plasma ADMA levels were measured using high performance liquid chromatography. A robust multivariate linear mixed-effect model approach and Akaike information criterion were used to determine predictors of vasomotor dysfunction. RESULTS In 191 patients with angina in the absence of obstructive CAD, abnormal epicardial vasomotion was observed in 137 (71.7%) patients. Median ADMA rose as the extent of impairment progressed: none (0.48 [0.44-0.59] μM), any (0.51 [0.46-0.60] μM, p = 0.12), focal (0.54 [0.49,0.61] μM, p = 0.17), and diffuse (0.55 [0.49,0.63] μM, p = 0.02). In unadjusted analysis, ADMA was highly predictive of vasomotor dysfunction (χ2=15.1, p = 0.002). Notably, ADMA remained a significant predictor even after adjusting for other factors in the best fit model (χ2=10.0, p = 0.02). CONCLUSIONS ADMA is an independent predictor of epicardial coronary vasomotor dysfunction in patients with angina in the absence of obstructive CAD. These data support a very early mechanistic role of ADMA in the continuum of atherosclerotic heart disease.
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Affiliation(s)
- Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Vedant Pargaonkar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Robyn L Ball
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Palo Alto, CA, United States of America
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - John P Cooke
- Department of Cardiovascular Sciences, Texas Methodist Research Institute, Houston, TX, United States of America
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.
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30
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Edwards KS, Hekler AC, Baum J, Nejedly M, Tsai S, Khandelwal A, Naderi S, Hoover V, Tremmel JA. Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic. Am J Cardiol 2019; 123:2026-2030. [PMID: 31006484 DOI: 10.1016/j.amjcard.2019.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 01/17/2023]
Abstract
Female cardiac patients are at greater risk for mental health disorders than their male counterparts, and these mental health disorders have been associated with increased cardiac morbidity and mortality. However, few studies have closely examined the mental health disorders found among the female cardiac population. The primary aim of this study was to examine the prevalence of psychological distress in a sample of female cardiac outpatients at an academic medical center. A secondary aim was to determine whether different demographic variables, cardiac risk factors, or cardiac diagnoses were associated with different levels of emotional distress. A survey, including demographic information, medical status, and standardized symptom measures was completed by 117 female patients scheduled for medical visits at an outpatient women's heart health clinic over a 4-month period. Using standardized self-report questionnaires, 38% scored in the moderate-to-severe range for at least 1 mental disorder and 50% endorsed current insomnia. Symptoms of clinical depression (20%) and anxiety (42)% were endorsed at higher rates than predominantly male or mixed comparison samples. Although there was no apparent relation between the severity of cardiac problems and the degree of psychological distress, women with diagnoses of hyperlipidemia, prediabetes, and diabetes reported greater psychological distress than those without these problems. Women with lower income also reported more psychological distress. In conclusion, our findings suggest an unmet need for integrated mental health services for female cardiac patients.
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Rajmohan D, Sung YK, Kudelko K, Perez VDJ, Haddad F, Tremmel JA, Schnittger I, Zamanian RT, Spiekerkoetter E. EXPRESS: Myocardial Bridge - An Unrecognized Cause of Chest Pain in Pulmonary Arterial Hypertension. Pulm Circ 2019; 10:2045894019860738. [PMID: 31187693 PMCID: PMC7029537 DOI: 10.1177/2045894019860738] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/05/2019] [Indexed: 11/22/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by an increased pulmonary vascular resistance resulting in progressive right ventricular hypertrophy and failure. While dyspnea on exertion is the leading symptom at diagnosis, the occurrence of chest pain, although less frequently observed, is an alarming symptom that requires immediate diagnostic work-up. Here we report the case of a 44-year-old woman with severe end-stage group 1 PAH who had repetitive occurrences of chest pain that led to frequent emergency room visits with documented signs of myocardial ischemia on EKG and troponin leaks. A computed tomography (CT) angiogram of the coronary arteries revealed the presence of a myocardial bridge (MB). An invasive coronary angiogram confirmed a MB over the left anterior descending (LAD) artery compressing the lumen of the LAD. As the patient was deteriorating on maximal medical PAH therapy, she was listed for, and subsequently received, a bilateral lung transplantation. Recognizing that the MB would pose a significant risk for ischemia during surgery as well as continuing source for chest pain after lung transplantation, the MB was surgically “unroofed” during the transplant surgery. The patient did well after surgery and did not complain of any residual chest pain. In conclusion, a MB compressing a segment of the coronary artery could be an under-diagnosed, but potentially not so rare cause of recurrent chest pain in PAH patients, which requires specialized diagnostic evaluation and treatment
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Affiliation(s)
- Divya Rajmohan
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Wall Center for Pulmonary Vascular Disease, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Yon K. Sung
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristina Kudelko
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Vinicio de Jesus Perez
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Wall Center for Pulmonary Vascular Disease, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A. Tremmel
- Wall Center for Pulmonary Vascular Disease, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Wall Center for Pulmonary Vascular Disease, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Roham T. Zamanian
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Edda Spiekerkoetter
- Division Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Affiliation(s)
- Jennifer A. Tremmel
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, CA
| | - William F. Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, CA
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Maeda K, Schnittger I, Murphy DJ, Tremmel JA, Boyd JH, Peng L, Okada K, Pargaonkar VS, Hanley FL, Mitchell RS, Rogers IS. Surgical unroofing of hemodynamically significant myocardial bridges in a pediatric population. J Thorac Cardiovasc Surg 2018; 156:1618-1626. [PMID: 30005887 DOI: 10.1016/j.jtcvs.2018.01.081] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 05/15/2017] [Revised: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although myocardial bridges (MBs) are traditionally regarded as incidental findings, it has been reported that adult patients with symptomatic MBs refractory to medical therapy benefit from unroofing. However, there is limited literature in the pediatric population. The aim of our study was to evaluate the indications and outcomes for unroofing in pediatric patients. METHODS We retrospectively reviewed all pediatric patients with MB in our institution who underwent surgical relief. Clinical characteristics, relevant diagnostic data, intraoperative findings, and postoperative outcomes were evaluated. RESULTS Between 2012 and 2016, 14 pediatric patients underwent surgical unroofing of left anterior descending artery MBs. Thirteen patients had anginal symptoms refractory to medical therapy, and 1 patient was asymptomatic until experiencing aborted sudden cardiac arrest during exercise. Thirteen patients underwent exercise stress echocardiography, all of which showed mid-septal dys-synergy. Coronary computed tomography imaging confirmed the presence of MBs in all patients. Intravascular ultrasound imaging confirmed the length of MBs: 28.2 ± 16.3 mm, halo thickness: 0.59 ± 0.24 mm, and compression of left anterior descending artery at resting heart rate: 33.0 ± 11.6%. Invasive hemodynamic assessment with dobutamine confirmed the physiologic significance of the MBs with diastolic fractional flow reserve: 0.59 ± 0.13. Unroofing was performed with the patient under cardiopulmonary bypass (CPB) in the initial 9 cases and without CPB in the subsequent 5 cases. All patients were discharged without complications. The 13 symptomatic patients reported resolution of symptoms on follow-up, and improvement in symptoms and quality of life was documented using the Seattle Angina Questionnaire version 7. CONCLUSIONS Unroofing of MBs can be safely performed in pediatric patients, with or without use of CPB. In symptomatic patients, unroofing can provide relief of symptoms refractory to medical therapy.
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Affiliation(s)
- Katsuhide Maeda
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
| | - Ingela Schnittger
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
| | - Daniel J Murphy
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
| | - Jennifer A Tremmel
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Lynn Peng
- Department of Pediatric Cardiology, Stanford University, Stanford, Calif
| | - Kozo Okada
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
| | | | - Frank L Hanley
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | | | - Ian S Rogers
- Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
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Nishikii-Tachibana M, Pargaonkar VS, Schnittger I, Haddad F, Rogers IS, Tremmel JA, Wang PJ. Myocardial bridging is associated with exercise-induced ventricular arrhythmia and increases in QT dispersion. Ann Noninvasive Electrocardiol 2017; 23:e12492. [PMID: 28921787 PMCID: PMC6931813 DOI: 10.1111/anec.12492] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/27/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A myocardial bridge (MB) has been associated with ventricular arrhythmia and sudden death during exercise. QT dispersion (QTd) is a measure of abnormal repolarization and may predict ventricular arrhythmia. We investigated the frequency of ventricular arrhythmias during exercise and the QTd at rest and after exercise, in patients with an MB compared to a normal cohort. METHODS We studied the rest and stress ECG tracings of patients with an MB suspected by focal septal buckling on exercise echocardiography (EE) (Echo-MB group, N = 510), those with an MB confirmed by another examination (MB group, N = 110), and healthy controls (Control group, N = 198). RESULTS The frequency of exercise-induced premature ventricular contractions (PVCs) was significantly higher in the Echo-MB and MB groups compared with the Control group (both p < .001). In all, 25 patients (4.9%) in the Echo-MB group, seven patients (6.4%) in the MB group and no patients in the Control group had exercise-induced non-sustained ventricular tachycardia (NSVT). There was no difference in the baseline QTd between the groups. In the Echo-MB and MB groups, QTd postexercise increased significantly when compared with baseline (both p < .001). Patients with NSVT had a higher frequency of male gender and an even greater increase in QTd with exercise compared with the non-NSVT group. DISCUSSION There is an increased frequency of exercise-induced PVCs and NSVT in patients with MBs. Exercise significantly increases QTd in MB patients, with an even greater increase in QTd in MB patients with NSVT. Exercise in MB patients results in ventricular arrhythmias and abnormalities in repolarization.
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Affiliation(s)
- Makiko Nishikii-Tachibana
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Vedant S Pargaonkar
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ian S Rogers
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A Tremmel
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul J Wang
- The Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
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35
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Forsdahl SH, Rogers IS, Schnittger I, Tanaka S, Kimura T, Pargaonkar VS, Chan FP, Fleischmann D, Tremmel JA, Becker HC. Myocardial Bridges on Coronary Computed Tomography Angiography - Correlation With Intravascular Ultrasound and Fractional Flow Reserve. Circ J 2017; 81:1894-1900. [PMID: 28690285 DOI: 10.1253/circj.cj-17-0284] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 11/09/2022]
Abstract
BACKGROUND Myocardial bridges (MB) are commonly seen on coronary CT angiography (CCTA) in asymptomatic individuals, but in patients with recurrent typical angina symptoms, yet no obstructive coronary artery disease (CAD), evaluation of their potential hemodynamic significance is clinically relevant. The aim of this study was to compare CCTA to invasive coronary angiography (ICA), including intravascular ultrasound (IVUS), to confirm MB morphology and estimate their functional significance in symptomatic patients.Methods and Results:We retrospectively identified 59 patients from our clinical databases between 2009 and 2014 in whom the suspicion for MB was raised by symptoms of recurrent typical angina in the absence of significant obstructive CAD on ICA. All patients underwent CCTA, ICA and IVUS. MB length and depth by CCTA agreed well with length (0.6±23.7 mm) and depth (CT coverage) as seen on IVUS. The product of CT length and depth (CT coverage), (MB muscle index (MMI)), ≥31 predicted an abnormal diastolic fractional flow reserve (dFFR) ≤0.76 with a sensitivity and specificity of 74% and 62% respectively (area under the curve=0.722). CONCLUSIONS In patients with recurrent symptoms of typical angina yet no obstructive CAD, clinicians should consider dynamic ischemia from an MB in the differential diagnosis. The product of length and depth (i.e., MMI) by CCTA may provide some non-invasive insight into the hemodynamic significance of a myocardial bridge, as compared with invasive assessment with dFFR.
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Affiliation(s)
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | | | - Frandics P Chan
- Department of Radiology, Stanford University School of Medicine
| | | | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine
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36
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Abstract
A myocardial bridge is a segment of a coronary artery that travels into the myocardium instead of the normal epicardial course. Although it is general perception that myocardial bridges are normal variants, patients with myocardial bridges can present with symptoms, such as exertional chest pain, that cannot be explained by a secondary etiology. Such patients may benefit from individualized medical/surgical therapy. This article describes the prevalence, clinical presentation, classification, evaluation, and management of children and adults with symptomatic myocardial bridges.
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Affiliation(s)
- Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA.,Division of Pediatric Cardiology, Stanford University, Stanford, California, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
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37
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Watanabe R, Shirai T, Namkoong H, Zhang H, Berry GJ, Wallis BB, Schaefgen B, Harrison DG, Tremmel JA, Giacomini JC, Goronzy JJ, Weyand CM. Pyruvate controls the checkpoint inhibitor PD-L1 and suppresses T cell immunity. J Clin Invest 2017; 127:2725-2738. [PMID: 28604383 PMCID: PMC5490755 DOI: 10.1172/jci92167] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/27/2017] [Indexed: 01/12/2023] Open
Abstract
Patients with coronary artery disease (CAD) are at high risk for reactivation of the varicella zoster virus (VZV) and development of herpes zoster (HZ). Here, we found that macrophages from patients with CAD actively suppress T cell activation and expansion, leading to defective VZV-specific T cell immunity. Monocyte-derived and plaque-infiltrating macrophages from patients with CAD spontaneously expressed high surface density of the immunoinhibitory ligand programmed death ligand-1 (PD-L1), thereby providing negative signals to programmed death-1+ (PD-1+) T cells. We determined that aberrant PD-L1 expression in patient-derived macrophages was metabolically controlled. Oversupply of the glycolytic intermediate pyruvate in mitochondria from CAD macrophages promoted expression of PD-L1 via induction of the bone morphogenetic protein 4/phosphorylated SMAD1/5/IFN regulatory factor 1 (BMP4/p-SMAD1/5/IRF1) signaling pathway. Thus, CAD macrophages respond to nutrient excess by activating the immunoinhibitory PD-1/PD-L1 checkpoint, leading to impaired T cell immunity. This finding indicates that metabolite-based immunotherapy may be a potential strategy for restoring adaptive immunity in CAD.
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Affiliation(s)
- Ryu Watanabe
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Tsuyoshi Shirai
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hong Namkoong
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Hui Zhang
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Gerald J. Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Barbara B. Wallis
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Benedikt Schaefgen
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David G. Harrison
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jennifer A. Tremmel
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - John C. Giacomini
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jörg J. Goronzy
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Cornelia M. Weyand
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Seto AH, Dehghani P, Shah B, Anwaruddin S, Safirstein J, Tremmel JA. Late breaking trials of 2016 in coronary artery disease: Commentary covering SCAI, ACC, TCT, EuroPCR, ESC, and AHA. Catheter Cardiovasc Interv 2017; 89:1028-1034. [PMID: 28276150 DOI: 10.1002/ccd.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 01/01/2017] [Accepted: 01/03/2017] [Indexed: 11/06/2022]
Abstract
The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2016, including SCAI, ACC, TCT, EuroPCR, ESC, and AHA. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnold H Seto
- Division of Cardiology, Department of Medicine, Long Beach Veterans Affairs Medical Center, Long Beach, California
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Binita Shah
- Veterans Affairs New York Harbor Health Care System, New York University School of Medicine, New York, New York
| | - Saif Anwaruddin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordan Safirstein
- Department of Cardiology, The Gagnon Cardiovascular Institute at the Morristown Memorial Hospital, Morristown, New Jersey
| | - Jennifer A Tremmel
- Department of Medicine (Cardiovascular), Stanford University Medical Center, Stanford, California
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Perl L, Daniels D, Schwartz J, Tanaka S, Yeung A, Tremmel JA, Schnittger I. Myocardial Bridge and Acute Plaque Rupture. J Investig Med High Impact Case Rep 2017; 4:2324709616680227. [PMID: 28251167 PMCID: PMC5317013 DOI: 10.1177/2324709616680227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 09/18/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
A myocardial bridge (MB) is a common anatomic variant, most frequently located in the left anterior descending coronary artery, where a portion of the coronary artery is covered by myocardium. Importantly, MBs are known to result in a proximal atherosclerotic lesion. It has recently been postulated that these lesions predispose patients to acute coronary events, even in cases of otherwise low-risk patients. One such mechanism may involve acute plaque rupture. In this article, we report 2 cases of patients with MBs who presented with acute coronary syndromes despite having low cardiovascular risk. Their presentation was life-risking and both were treated urgently and studied with coronary angiographies and intravascular ultrasound. This latter modality confirmed a rupture of an atherosclerotic plaque proximal to the MB as a likely cause of the acute events. These cases, of unexplained acute coronary syndrome in low-risk patients, raise the question of alternative processes leading to the event and the role MB play as an underlying cause of ruptured plaques. In some cases, an active investigation for this entity may be warranted, due to the prognostic implications of the different therapeutic modalities, should an MB be discovered.
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Affiliation(s)
- Leor Perl
- Stanford University Medical Center, Stanford, CA, USA
| | | | | | - Shige Tanaka
- Stanford University Medical Center, Stanford, CA, USA
| | - Alan Yeung
- Stanford University Medical Center, Stanford, CA, USA
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Feldman DN, Aronow HD, Swaminathan RV, Dawn Abbott J, Tremmel JA, Kapur NK, Breinholt JP, Asgar AW, Pinto DS, Tu TM, Rosenfield KM, Naidu SS. Investing in our future: Update on the SCAI Emerging Leader Mentorship (ELM) Program. Catheter Cardiovasc Interv 2016; 88:674-677. [DOI: 10.1002/ccd.26814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/10/2022]
Affiliation(s)
| | - Herbert D. Aronow
- Warren Alpert Medical School of Brown University; Providence; Rhode Island
| | - Rajesh V. Swaminathan
- Duke University Medical Center; Duke Clinical Research Institute; Durham North Carolina
| | - J. Dawn Abbott
- Warren Alpert Medical School of Brown University; Providence; Rhode Island
| | - Jennifer A. Tremmel
- Stanford University Medical Center, Department of Medicine (Cardiovascular); Stanford California
| | | | | | | | - Duane S. Pinto
- Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - Thomas M. Tu
- Louisville Cardiology Group, Interventional Cardiology; Louisville Kentucky
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Boyd JH, Pargaonkar VS, Scoville DH, Rogers IS, Kimura T, Tanaka S, Yamada R, Fischbein MP, Tremmel JA, Mitchell RS, Schnittger I. Surgical Unroofing of Hemodynamically Significant Left Anterior Descending Myocardial Bridges. Ann Thorac Surg 2016; 103:1443-1450. [PMID: 27745841 DOI: 10.1016/j.athoracsur.2016.08.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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] [Received: 05/13/2016] [Revised: 07/13/2016] [Accepted: 08/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Left anterior descending artery myocardial bridges (MBs) range from clinically insignificant incidental angiographic findings to a potential cause of sudden cardiac death. Within this spectrum, a group of patients with isolated, symptomatic, and hemodynamically significant MBs despite maximally tolerated medical therapy exist for whom the optimal treatment is controversial. We evaluated supraarterial myotomy, or surgical unroofing, of the left anterior descending MBs as an isolated procedure in these patients. METHODS In 50 adult patients, we prospectively evaluated baseline clinical characteristics, risk factors, and medications for coronary artery disease, relevant diagnostic data (stress echocardiography, computed tomography angiography, stress coronary angiogram with dobutamine challenge for measurement of diastolic fractional flow reserve, and intravascular ultrasonography), and anginal symptoms using the Seattle Angina Questionnaire. These patients then underwent surgical unroofing of their left anterior descending artery MBs followed by readministration of the Seattle Angina Questionnaire at 6.6-month (range, 2 to 13) follow-up after surgery. RESULTS Dramatic improvements were noted in physical limitation due to angina (52.0 versus 87.1, p < 0.001), anginal stability (29.6 versus 66.4, p < 0.001), anginal frequency (52.1 versus 84.7, p < 0.001), treatment satisfaction (76.1 versus 93.9, p < 0.001), and quality of life (25.0 versus 78.9, p < 0.001), all five dimensions of the Seattle Angina Questionnaire. There were no major complications or deaths. CONCLUSIONS Surgical unroofing of carefully selected patients with MBs can be performed safely as an independent procedure with significant improvement in symptoms postoperatively. It is the optimal treatment for isolated, symptomatic, and hemodynamically significant MBs resistant to maximally tolerated medical therapy.
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Affiliation(s)
- Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Vedant S Pargaonkar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - David H Scoville
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Ryotaro Yamada
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert Scott Mitchell
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
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Kobayashi Y, Fearon WF, Honda Y, Tanaka S, Pargaonkar V, Fitzgerald PJ, Lee DP, Stefanick M, Yeung AC, Tremmel JA. Effect of Sex Differences on Invasive Measures of Coronary Microvascular Dysfunction in Patients With Angina in the Absence of Obstructive Coronary Artery Disease. JACC Cardiovasc Interv 2016; 8:1433-1441. [PMID: 26404195 DOI: 10.1016/j.jcin.2015.03.045] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [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: 02/24/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study investigated sex differences in coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) in patients with angina in the absence of obstructive coronary artery disease. BACKGROUND Coronary microvascular dysfunction is associated with worse long-term outcomes, especially in women. Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) are 2 methods of assessing the coronary microcirculation. METHODS We prospectively enrolled 117 women and 40 men with angina in the absence of obstructive coronary artery disease. We performed CFR, IMR, fractional flow reserve, and quantitative coronary angiography in the left anterior descending artery. Coronary flow was assessed with a thermodilution method by obtaining mean transit time (Tmn) (an inverse correlate to absolute flow) at rest and hyperemia. RESULTS All patients had minimal atherosclerosis by quantitative coronary angiography (% diameter stenosis: 23.2 ± 12.3%), and epicardial disease was milder in women (fractional flow reserve: 0.88 ± 0.04 vs. 0.87 ± 0.04; p = 0.04). IMR was similar between the sexes (20.7 ± 9.8 vs. 19.1 ± 8.0; p = 0.45), but CFR was lower in women (3.8 ± 1.6 vs. 4.8 ± 1.9; p = 0.004). This was primarily due to a shorter resting Tmn in women (p = 0.005), suggesting increased resting coronary flow, whereas hyperemic Tmn was identical (p = 0.79). In multivariable analysis, female sex was an independent predictor of lower CFR and shorter resting Tmn. CONCLUSIONS Despite similar microvascular function in women and men by IMR, CFR is lower in women. This discrepancy appears to be due to differences in resting coronary flow between the sexes. The effect of sex differences should be considered in interpretation of physiological indexes using resting coronary flow.
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Affiliation(s)
- Yuhei Kobayashi
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - William F Fearon
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Yasuhiro Honda
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Shigemitsu Tanaka
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Vedant Pargaonkar
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Peter J Fitzgerald
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - David P Lee
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Marcia Stefanick
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Alan C Yeung
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Jennifer A Tremmel
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California.
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Yamada R, Tremmel JA, Tanaka S, Lin S, Kobayashi Y, Hollak MB, Yock PG, Fitzgerald PJ, Schnittger I, Honda Y. Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque. J Am Heart Assoc 2016; 5:e001735. [PMID: 27098967 PMCID: PMC4843493 DOI: 10.1161/jaha.114.001735] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The presence of a myocardial bridge (MB) has been shown to promote atherosclerotic plaque formation proximal to the MB, presumably because of hemodynamic disturbances provoked by retrograde blood flow toward this segment in cardiac systole. We aimed to determine the anatomic and functional properties of an MB related to the extent of atherosclerosis assessed by intravascular ultrasound. Methods and Results We enrolled 100 patients with angina but no significant obstructive coronary artery disease who had an intravascular ultrasound–detected MB in the left anterior descending artery (median age 54 years, 36% male). The MB was identified with intravascular ultrasound by the presence of an echolucent band (halo). Anatomically, the MB length was 22±13 mm, and halo thickness was 0.7±0.6 mm. Functionally, systolic arterial compression was 23±12%. The maximum plaque burden up to 20 mm proximal to the MB entrance was significantly greater than the maximum plaque burden within the MB segment. Among the intravascular ultrasound–defined MB properties, arterial compression was the sole MB parameter that demonstrated a significant positive correlation with maximum plaque burden up to 20 mm proximal to the MB entrance (r=0.254, P=0.011 overall; r=0.545, P<0.001 low coronary risk). In multivariate analysis, adjusting for clinical characteristics and coronary risk factors, arterial compression was independently associated with maximum plaque burden up to 20 mm proximal to the MB entrance. Conclusions In patients with an MB in the left anterior descending artery, the percentage of arterial compression is related directly to the burden of atherosclerotic plaque located proximally to the MB, particularly in patients who otherwise have low coronary risk. This may prove helpful in identifying high‐risk MB patients.
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Affiliation(s)
- Ryotaro Yamada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shin Lin
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - M Brooke Hollak
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
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45
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Seto AH, Jordan Safirstein, Anwaruddin S, Dehghani P, Shah B, Tremmel JA. Late breaking trials of 2015 in coronary artery disease: Commentary covering ACC, EuroPCR, SCAI, TCT, ESC, and AHA. Catheter Cardiovasc Interv 2016; 87:1224-30. [PMID: 26946364 DOI: 10.1002/ccd.26474] [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: 01/11/2016] [Accepted: 01/17/2016] [Indexed: 11/11/2022]
Abstract
The SCAI Publications Committee and Emerging Leadership Mentorship (ELM) Fellows concisely summarize and provide context on the most important coronary trials presented at large international meetings in 2015, including the MATRIX, ABSORB, and TOTAL trials. The intent is to allow quick assimilation of trial results into interventional practice, and enable busy interventional cardiologists to stay up to date. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnold H Seto
- Division of Cardiology, Department of Medicine, Long Beach Veterans Affairs Medical Center, Long Beach, California
| | - Jordan Safirstein
- Department of Cardiology, the Gagnon Cardiovascular Institute at the Morristown Memorial Hospital, Morristown, New Jersy
| | - Saif Anwaruddin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Binita Shah
- Veterans Affairs New York Harbor Health Care System, New York University School of Medicine, New York, New York
| | - Jennifer A Tremmel
- Department of Medicine (Cardiovascular), Stanford University Medical Center, Stanford, California
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Affiliation(s)
- William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California.
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California
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Kobayashi Y, Tremmel JA, Kobayashi Y, Amsallem M, Tanaka S, Yamada R, Rogers IS, Haddad F, Schnittger I. Exercise Strain Echocardiography in Patients With a Hemodynamically Significant Myocardial Bridge Assessed by Physiological Study. J Am Heart Assoc 2015; 4:JAHA.115.002496. [PMID: 26581225 PMCID: PMC4845237 DOI: 10.1161/jaha.115.002496] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Although a myocardial bridge (MB) is often regarded as a benign coronary variant, recent studies have associated MB with focal myocardial ischemia. The physiological consequences of MB on ventricular function during stress have not been well established. Methods and Results We enrolled 58 patients with MB of the left anterior descending artery, diagnosed by intravascular ultrasound. Patients underwent invasive physiological evaluation of the MB by diastolic fractional flow reserve during dobutamine challenge and exercise echocardiography. Septal and lateral longitudinal strain (LS) were assessed at rest and immediately after exercise and compared with strain of matched controls. Absolute and relative changes in strain were also calculated. The mean age was 42.5±16.0 years. Fifty‐five patients had a diastolic fractional flow reserve ≤0.76. At rest, there was no significant difference between the 2 groups in septal LS (19.0±1.8% for patients with MB versus 19.2±1.5% for control, P=0.53) and lateral LS (20.1±2.0% versus 20.0±1.6%, P=0.83). With stress, compared with controls, patients with MB had a lower peak septal LS (18.9±2.6% versus 21.7±1.6%, P<0.001) and lower absolute (−0.1±2.1% versus 2.5±1.3%, P<0.001) and relative change (−0.6±11.2% versus 13.1±7.8%, P<0.001) in septal LS, whereas there was no significant difference in lateral LS. In multivariate analysis, diastolic fractional flow reserve and length were independent determinants of lower changes in septal LS. Conclusions Patients with a hemodynamically significant MB, determined by invasive diastolic fractional flow reserve, have significantly lower change in septal LS on exercise echocardiography, suggesting that septal LS may be useful for noninvasively assessing the hemodynamic significance of an MB.
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Affiliation(s)
- Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
| | - Ryotaro Yamada
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
| | - Ian S Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA (I.S.R.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.) Stanford Cardiovascular Institute, Stanford, CA (Y.K., J.A.T., Y.K., M.A., S.T., R.Y., I.S.R., F.H., I.S.)
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Tremmel JA, Fearon WF, Lee BK, Lim HS, Yong AS, Yamada R, Tanaka S, Lee DP, Yeung AC. Response to Letters Regarding Article, "Invasive Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease". Circulation 2015; 132:e244. [PMID: 26572677 DOI: 10.1161/circulationaha.115.017741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Andy S Yong
- Department of Cardiology, Royal Prince Alfred and Concord Hospitals, University of Sydney, Sydney, Australia
| | - Ryotaro Yamada
- Department of Cardiology, Tokai University Oiso Hospital, Oiso, Japan
| | | | - David P Lee
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
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Kimura T, Tanaka S, Okada K, Kitahara H, Kobayashi Y, Kobayashi Y, Pargaonkar VS, Yock P, Fitzgerald PJ, Honda Y, Rogers IS, Tremmel JA, Schnittger I. TCT-346 Association between Increased Number of Septal Branches within the Myocardial Bridge and Abnormal Diastolic-Fractional Flow Reserve. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.964] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Tremmel JA, Bhatt DL, Pinto DS, Grines CL. Late breaking trials of 2014 in coronary artery disease: Commentary covering ACC, EuroPCR, SCAI, TCT, ESC, and AHA. Catheter Cardiovasc Interv 2015; 86:73-9. [PMID: 25854985 DOI: 10.1002/ccd.25942] [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: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 11/08/2022]
Abstract
With the plethora of clinical trials, it is difficult for busy interventional cardiologists to stay up to date. Therefore, the SCAI Publications Committee concisely summarizes and provides editorial commentary on the most important coronary trials from the large international meetings of 2014. The intent is to allow quick assimilation of trial results into interventional practice.
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Affiliation(s)
- Jennifer A Tremmel
- Department of Medicine (Cardiovascular), Stanford University Medical Center, Stanford, California
| | - Deepak L Bhatt
- Department of Medicine (Cardiovascular), VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Duane S Pinto
- Department of Medicine (Cardiovascular), Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts
| | - Cindy L Grines
- Department of Medicine (Cardiovascular), Detroit Medical Center Cardiovascular Institute, Detroit, Michigan
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