scholarly journals Simplified Assessment of the Index of Microvascular Resistance

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Monika Kodeboina ◽  
Sakura Nagumo ◽  
Daniel Munhoz ◽  
Jeroen Sonck ◽  
Niya Mileva ◽  
...  
Keyword(s):  
Primary Objective ◽  
Catheterization Laboratory ◽  
Measurement Results ◽  
Index Of Microvascular Resistance ◽  
Invasive Method ◽  
Procedural Time ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Time Required ◽  
Microvascular Resistance

Background. To validate a simplified invasive method for the calculation of the index of microvascular resistance (IMR). Methods. This is a prospective, single-center study of patients with chronic coronary syndromes presenting with nonobstructive coronary artery disease. IMR was obtained using both intravenous (IV) adenosine and intracoronary (IC) papaverine. Each IMR measurement was obtained in duplicate. The primary objective was the agreement between IMR acquired using adenosine and papaverine. Secondary objectives include reproducibility of IMR and time required for the IMR measurement. Results. One hundred and sixteen IMR measurements were performed in 29 patients. The mean age was 68.8 ± 7.24 years, and 27.6% was diabetics. IMR values were similar between papaverine and adenosine (17.7 ± 7.26 and 20.1 ± 8.6, p = 0.25 ; Passing-Bablok coefficient A 0.58, 95% CI −2.42 to 3.53; coefficient B 0.90, 95% CI −0.74 to 1.07). The reproducibility of IMR was excellent with both adenosine and papaverine (ICC 0.78, 95% CI 0.63 to 0.88 and ICC 0.93, 95% CI 0.87 to 0.97). The time needed for microvascular assessment was significantly shortened by the use of IC papaverine (3.23 (2.84, 3.78) mins vs. 5.48 (4.94, 7.09) mins, p < 0.0001 ). Conclusion. IMR can be reliably measured using IC papaverine with similar results compared to intravenous infusion of adenosine with increased reproducibility and reduced procedural time. This approach simplifies the invasive assessment of the coronary microcirculation in the catheterization laboratory.

The role of coronary physiology in contemporary percutaneous coronary interventions.

2021 ◽  
Vol 17 ◽  
Author(s):  
Federico Marin ◽  
Roberto Scarsini ◽  
Dimitrios Terentes-Printzios ◽  
Rafail A. Kotronias ◽  
Flavio Ribichini ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Myocardial Revascularization ◽  
Coronary Microcirculation ◽  
Coronary Physiology ◽  
Catheterization Laboratory ◽  
Procedural Time ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Epicardial Stenosis

: Invasive assessment of coronary physiology has radically changed the paradigm of myocardial revascularization in patients with coronary artery disease. Despite the prognostic improvement associated with ischemia-driven revascularization strategy, functional assessment of angiographic intermediate epicardial stenosis remains largely underused in clinical practice. Multiple tools have been developed or are under development in order to reduce the invasiveness, cost, and extra procedural time associated with the invasive assessment of coronary physiology. Besides epicardial stenosis, a growing body of evidence highlights the role of coronary microcirculation in regulating coronary flow with consequent pathophysiological and clinical and prognostic implications. Adequate assessment of coronary microcirculation function and integrity has then become another component of the decision-making algorithm for optimal diagnosis and treatment of coronary syndromes. This review aims at providing a comprehensive description of tools and techniques currently available in the catheterization laboratory to obtain a thorough and complete functional assessment of the entire coronary tree (both for the epicardial and microvascular compartments).

scholarly journals GLP-1 vasodilatation in humans with coronary artery disease is not adenosine mediated.

2020 ◽  
Author(s):  
Muhammad Aetesam-ur-Rahman ◽  
Joel P. Giblett ◽  
Bharat Khialani ◽  
Stephen Kyranis ◽  
Sophie J. Clarke ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Intervention ◽  
Infusion Group ◽  
Pressure Wire ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
Index Of Microvascular Resistance ◽  
Artery Disease ◽  
Incretin Therapies ◽  
Microvascular Resistance

Abstract Background Incretin therapies appear to provide cardioprotection and improve cardiovascular outcomes in patients with diabetes, but the mechanism of this effect remains elusive. We have previously shown that glucagon-like peptide (GLP)-1 is a coronary vasodilator and we sought to investigate if this is an adenosine-mediated effect.Methods We recruited 41 patients having percutaneous coronary intervention (PCI) for stable angina and allocated them into four groups administering a specific study-related infusion following successful PCI: GLP-1 infusion (Group G) (n = 10); Placebo, normal saline infusion (Group P) (n = 11); GLP-1 + Theophylline infusion (Group GT)(n = 10); and Theophylline infusion (Group T) (n = 10). A pressure wire assessment of coronary distal pressure and flow velocity (thermodilution transit time – Tmn) at rest and hyperaemia was performed after PCI and repeated following the study infusion to derive basal and index of microvascular resistance (BMR and IMR).Results There were no significant differences in the demographics of patients recruited to our study. Most of the patients were not diabetic. GLP-1 caused significant reduction of resting Tmn that was not attenuated by theophylline: mean delta Tmn (SD) group G -0.23 s (0.27) vs. group GT -0.18 s (0.37), p = 0.65. Theophylline alone (group T) did not significantly alter resting flow velocity compared to group GT: delta Tmn in group T 0.04 s (0.15), p = 0.30. The resulting decrease in BMR observed in group G persisted in group GT: -20.83 mmHg.s (24.54 vs. -21.20 mmHg.s (30.41), p = 0.97. GLP-1 did not increase circulating adenosine levels in group GT more than group T: delta median adenosine − 2.0 ng/ml (-117.1, 14.8) vs. -0.5 ng/ml (-19.6, 9.4); p = 0.60.Conclusion The vasodilatory effect of GLP-1 is not abolished by theophylline and GLP-1 does not increase adenosine levels, indicating an adenosine-independent mechanism of GLP-1 coronary vasodilatation..

Noninvasive Assessment of Coronary Artery Disease – Anatomical versus Functional Imaging and the Marginal Role of Exercise Electrocardiograms

Praxis ◽  
2020 ◽  
Vol 109 (14) ◽  
pp. 1141-1149
Author(s):  
Martina Boscolo Berto ◽  
Dominik C. Benz ◽  
Christoph Gräni
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Functional Imaging ◽  
Clinical Aspects ◽  
Industrialized Countries ◽  
Coronary Syndromes ◽  
Pros And Cons ◽  
Noninvasive Assessment ◽  
Artery Disease ◽  
European Society Of Cardiology

Abstract. Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the industrialized countries. Assessment of symptomatic patients with suspected obstructive CAD is a common reason for a clinical visit. Noninvasive anatomical and functional imaging are established tools to rule-in and rule-out CAD, to assess the severity of disease and to determine the potential risk of future cardiovascular events. In this review, we discuss the updated Guidelines from the European Society of Cardiology on Chronic Coronary Syndromes and explore the different imaging modalities used in current clinical practice for the noninvasive assessment of CAD. The pros and cons of each method, especially comparing anatomical and functional testing, are presented. Furthermore we we address the practical clinical aspects in the selection of the optimal noninvasive tests according to clinical need.

scholarly journals Effect of transradial ECG guided immediate intervention on culprit lesion with a single guiding catheter on door to balloon time

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G.J.C Guo ◽  
W.G.Z Wang ◽  
L.Z.J Liu ◽  
L.H.D Li ◽  
N.D Niu ◽  
...  
Keyword(s):  
Fluoroscopy Time ◽  
Health Improvement ◽  
Funding Source ◽  
Primary Pci ◽  
Culprit Lesion ◽  
Catheterization Laboratory ◽  
Catheter Group ◽  
Procedural Time ◽  
Door To Balloon ◽  
Guiding Catheter

Abstract Objective There is limited literature on procedure of primary PCI in catheterization laboratory. This study was designed to assess the impact of electrocardiogram-guided immediate intervention on culprit lesion with a single guiding catheter in ST-elevation myocardial infarction (STEMI) patients on door-to-balloon (D2B) time and clinical outcomes. Methods In this prospective, randomized single center study, 560 patients with STEMI who underwent primary PCI from February 2017 to July 2019 were randomized into two groups. In single catheter group, a single guiding catheter (MAC3.5 or JL 3.5 guiding catheter) was used to perform angiogram and PCI of culprit vessel, followed by contralateral angiography (n=280). In contral group, 280 patients underwent primary PCI after complete diagnostic angiography. The primary evaluation was D2B time and second endpoint include catheterization laboratory-to-balloon (C2B) time, major adverse cardiac events (MACE) at 30 days. This trial was registered with ClinicalTrials.gov, NCT03272451. Results Baseline characteristics were not different between the two groups. The median D2B time (54.83 [IQR 40.00–68.0] min versus 58.32 [IQR 44.12–78.40] min, P=0.007), C2B time (16.91 [IQR 13.88–21.42] min versus 23.80 [IQR 18.92–28.52] min, P&lt;0.001), total procedural time (45.17 [34.06–59.48] min versus 48.51 [37.04–64.60] min, P=0.012) and fluoroscopy time (9.70 [6.50–14.15] min versus 11.26 [8.01–14.27] min, P=0.025)were significantly shorter in single catheter group Compared with control group. The proportion of patients achieving D2B time within 60 minutes increased significantly in the single catheter group (61.79% vs. 52.14%, P=0.021). The rate of radial perforation was significantly reduced in single catheter group (0.71% vs. 3.21%, P=0.033). The total number of catheters was significantly less in single catheter group (1.18±0.54 vs. 2.23±0.60, p&lt;0.001). There was no significant difference in the MACE at 30 days (2.5% vs. 4.64%, P=0.172) between the 2 groups. Conclusion ECG-guided immediate intervention on culprit lesion with a single guiding catheter in STEMI patients can reduce D2B time, C2B time, procedural time and fluoroscopy time. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Capital's Funds for Health Improvement and Research

Accessibility, Mobility and Spatial Patterns of Primary Health Care use in Ajedabiya: a Household Interview Survey

2010 ◽  
Vol 41 ◽  
pp. 47-62
Author(s):  
Salem F. Salem
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Service Use ◽  
Primary Objective ◽  
Health Care Use ◽  
International Standards ◽  
Consultation Rate ◽  
General Evaluation ◽  
Primary Health ◽  
Time Required

AbstractThe primary objective of this study is to examine the type of Primary Health Care (PHC) facility used by a sample of households in Ajedabiya, taking into account the respondents' living standards and their perception of the quality of the care provided, as well as the mode of travel and travel time required to reach the health care centres. The overall level of service use has been increasing over time, reaching an annual consultation rate of up to four visits per person per year, a high level by international standards. Three major groupings of disease were identified for which the four selected PHC facilities were preferred. Satisfaction with care was analysed by looking at key variables, including staff behaviour, availability of doctors, vector distance to the PHC facility, general evaluation of health services and qualified doctors. Household incomes did not appear to be an important factor except for attending private clinics. Unlike income, distance had a strong effect on utilisation, leading to the conclusion that PHC should continue to be provided within the community, and developed further to achieve equity, effectiveness and affordability.

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