Elizabeth Haag

Left Ventricular Filling Pressure Assessment Using Left Atrial Transit Time by Cardiac Magnetic Resonance Imaging

Background—Left atrial (LA) size and function reflect left ventricular (LV) hemodynamics. In the present study, we developed a novel method to determine LA circulation transit time (LATT) by MRI and demonstrated its close association with LV filling pressure. Methods and Results—All subjects were prospectively recruited and underwent contrast-enhanced MR dynamic imaging. Mean LATT was determined as the time for contrast to transit through the LA during the first pass. In an invasive study group undergoing clinically indicated cardiac catheterization (n=25), LATT normalized by R-R interval (nLATT) was closely associated with LV early diastolic pressure (r=0.850, P=0.001), LV end-diastolic pressure (r=0.910, P<0.001), and mean diastolic pressure (r=0.912, P<0.001). In a larger noninvasive group (n=56), nLATT was prolonged in patients with LV systolic dysfunction (n=47) (10.1±3.0 versus 6.6±0.7 cardiac cycles in normal control subjects, n=9; P<0.001). Using a linear regression equation derived from the invasive group, noninvasive subjects were divided into 3 subgroups by estimated LV end-diastolic pressure: ⩽10 mm Hg, 11 to 14 mm Hg, and ≥15 mm Hg. There were graded increases from low to high LV end-diastolic pressure subgroups in echocardiographic mitral medial E/e′ ratio: 9±5, 11±4, and 13±3 (P=0.023); in B-type natriuretic peptide (interquartile range): 44 (60) pg/mL, 87 (359) pg/mL, and 371 (926) pg/mL (P=0.002); and in N-terminal pro–B-type natriuretic peptide: 57 (163) pg/mL, 208 (990) pg/mL, and 931 (1726) pg/mL (P=0.002), demonstrating the ability of nLATT to assess hemodynamic status. Conclusions—nLATT by cardiac MR is a promising new parameter of LV filling pressure that may provide graded noninvasive hemodynamic assessment.

Application of intravascular brachytherapy: Utilization of beta-irradiation source delivery systems within a community-based cardiac center

PURPOSE There are numerous clinical studies ongoing to assess the outcome, physics, and radiobiology of intravascular brachytherapy and its effect on the reduction of the rate of restenosis after balloon angioplasty procedures. The present study reports on the experience of two different delivery systems as utilized in the community hospital setting. METHODS AND MATERIALS Patients were enrolled into one of four ongoing trials at our institution: the Novoste Beta-Cath trial, the Novoste Stents and Radiation Therapy trial (START), the Novoste START 40/20 trial, and the Guidant Intimal Hyperplasia Inhibition with Beta In-stent Trial (INHIBIT). The Novoste studies utilized the Novoste Beta-Cath System with 90Sr/Y, and the Guidant INHIBIT trial used 32P. Enrollments into the various trials were determined by inclusion and exclusion criteria specified by each protocol. Randomization was conducted per criteria as determined by the participating study protocol. RESULTS Forty-two patients were enrolled in total. Thirty-four were included in the Novoste trials and eight in the Guidant study, according to availability of the trial. Assessment of practicality of treatment was dependent primarily on treatment duration and extension of time of catheterization procedures by the addition of intravascular radiation. Average dwell time within the Novoste trials was 3 min 40 s, and 7 min 46 s for patients in the Guidant study. No acute complications were observed in any of the trials. CONCLUSIONS Intravascular brachytherapy can be performed in the community hospital setting without compromising the efficiency of balloon angioplasty procedures. Pending long-term outcome data and FDA approval for specific delivery systems, endovascular brachytherapy in community hospital cardiac catheterization laboratories can be realized in an efficient and timely manner.

SAFETY OF SAME-DAY DISCHARGE AFTER PERCUTANEOUS CORONARY INTERVENTION WITH ORBITAL ATHERECTOMY

Severely calcified lesions present many challenges to percutaneous coronary intervention (PCI). Orbital Atherectomy (OA) aids vessel preparation and treatment of severely calcified coronary lesions. Same-day discharge (SDD) after PCI has numerous advantages including cost savings and improved

TCT-836 Unique Calcification Patterns in the Left Main Bifurcation in Patients After Coronary Artery Bypass Grafting

Coronary artery bypass grafting (CABG) accelerates calcium (Ca) proximal to the anastomosis of a patent graft. Optical coherence tomography (OCT) is uniquely able to assess coronary Ca. OCT imaging of the LM bifurcation from either the LAD or LCX was performed in 76 pts with at least one patent

A prospective, single-center, randomized study to assess whether automated coregistration of optical coherence tomography with angiography can reduce geographic miss

We sought to evaluate whether automated coregistration of optical coherence tomography (OCT) with angiography reduces geographic miss (GM) during coronary stenting.

Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography

We sought to assess plaque modification and stent expansion following orbital atherectomy (OA) for calcified lesions using optical coherence tomography (OCT).

THE EFFECTIVENESS OF EXCIMER LASER ANGIOPLASTY TO TREAT CORONARY IN-STENT RESTENOSIS WITH PERI-STENT CALCIUM AS ASSESSED BY OPTICAL COHERENCE TOMOGRAPHY

Background: We used optical coherence tomography to evaluate excimer laser coronary angioplasty (ELCA) to treat in-stent restenosis (ISR) due to peri-stent calcium (Ca) related stent underexpansion. Methods: We studied 53 ISR lesions with >90° peri-stent Ca and compared ECLA (n=21) vs no-ELCA (n=

PROCEDURAL CALCIUM FRACTURE AND ITS EFFECT ON STENT EXPANSION ASSESSED BY OPTICAL COHERENCE TOMOGRAPHY

Background: Severe coronary calcium (Ca) may limit stent expansion. We hypothesized that Ca fracture during stent implantation may mitigate its impact. Methods: Pre-intervention and final optical coherence tomography (OCT) were performed in 196 pts. Maximum superficial Ca angle and minimum Ca