Kefei Dou

Myocardial 18F-FDG Uptake After Exercise-Induced Myocardial Ischemia in Patients with Coronary Artery Disease

We have recently demonstrated the potential of 18F-FDG as an imaging marker of myocardial ischemia if injected at peak exercise. However, how long increased 18F-FDG uptake can be observed after an episode of exercise-induced myocardial ischemia is not known. We performed the current study to determine whether increased regional myocardial 18F-FDG uptake at exercise in patients with coronary artery disease (CAD) persists on rest imaging (24 h later), after an episode of exercise-induced myocardial ischemia. Methods: Twenty-four patients with suspected CAD underwent exercise 99mTc-sestamibi and 18F-FDG imaging. Repeated 18F-FDG imaging was performed 24 h after exercise imaging, after an injection of a second dose of 18F-FDG at rest in 20 patients. Perfusion imaging with 99mTc-sestamibi was simultaneously performed with 18F-FDG imaging. All patients underwent coronary angiography. Results: Eighteen patients had greater than or equal to 70% luminal narrowing of 1 or more coronary vessels. Fifteen patients (83%) showed increased regional 18F-FDG uptake on exercise imaging, but only 11 patients (61%) had perfusion abnormalities. Of these 15 patients with increased regional 18F-FDG uptake on exercise imaging, 8 (53%) had no discernible 18F-FDG uptake, 5 (33%) had decreased 18F-FDG uptake, and only 2 (13%) had persistent 18F-FDG uptake on rest 18F-FDG images. The summed 18F-FDG uptake score significantly decreased, from 14.4 ± 10.3 at exercise to 6.7 ± 9.2 at rest (P = 0.01). Patients with persistent 18F-FDG uptake at rest had more 18F-FDG uptake and lower peak rate–pressure product at exercise, compared with patients with no residual 18F-FDG uptake at rest. Conclusion: Exercise-induced regional myocardial 18F-FDG uptake is highly specific and sensitive for exercise-induced myocardial ischemia. Regional myocardial 18F-FDG uptake may persist 24 h after an episode of exercise-induced myocardial ischemia in some patients.

Intracoronary delivery of autologous bone marrow mononuclear cells radiolabeled by 18F‐fluoro‐deoxy‐glucose: Tissue distribution and impact on post‐infarct swine hearts

Intracoronary injection of the bone marrow‐derived mononuclear cells (MNCs) is emerging as a potentially novel therapy for ischemic heart failure. This study was aimed at assessing the efficacy of intracoronary MNC delivery in the myocardium. The in vivo distribution and myocardial homing of intracoronarily delivered MNCs in experimental Chinese swine with acute myocardial infarction (AMI) created by occlusion of left anterior descending (LAD) coronary artery for 90 min. MNCs radiolabeled with 18F‐fluoro‐deoxy‐glucose (18F‐FDG) were delivered using a coronary catheter into the infarct‐related coronary artery 1 week after AMI. Dual‐nuclide single photon emission computed tomography (SPECT) revealed that 1 h after cell infusion, 6.8 ± 1.8% of 18F‐FDG‐labeled MNCs occurred in the infarcted myocardium with the remaining activity found primarily in the liver and spleen. In the heart, MNCs were detected predominantly in the under‐perfused myocardium. The infused cells retained in the hearts at a rate highly correlated with the under‐perfused lesional sizes. Pathological examination further demonstrated that 6 weeks after infusion, compared to controls, the hearts receiving MNCs exhibited less fibrosis and inflammatory infiltrate, more viable tissue, and higher vascular density. Cardiac function was significantly improved in the MNC‐infused hearts. Thus, 18F‐FDG labeling and dual‐nuclide SPECT imaging is capable of monitoring in vivo distribution and homing of MNCs after intracoronary infusion. MNC coronary delivery may improve cardiac function and positive ventricular remodeling in the heart with AMI. J. Cell. Biochem. 102: 64–74, 2007.

An Angiographic Tool for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention : The RESOLVE Score System (Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion)

OBJECTIVES The purpose of this study was to establish a scoring system to evaluate the risk of side branch (SB) occlusion in patients undergoing coronary bifurcation intervention. BACKGROUND The risk of SB occlusion is the most important consideration affecting the selection of an optimal intervention strategy. METHODS A total of 1,545 consecutive patients undergoing percutaneous coronary intervention for bifurcation lesions (1,601 lesions treated with a single stent technique or main vessel [MV] stenting first strategy) were studied. A total of 1,200 lesions were used to construct the risk model and score system, and 401 lesions were used to validate the model. A multivariable risk score (RESOLVE [Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion]) was constructed with incremental weights attributed to each component variable according to its estimated coefficients. SB occlusion after MV stenting was defined as any decrease in Thrombolysis in Myocardial Infarction flow grade or absence of flow in SB after MV stenting. RESULTS SB occlusion occurred in 118 (7.37%) of 1,601 bifurcation lesions. In multivariable analyses, 6 variables were independently associated with the risk of SB occlusion (model C-statistic = 0.80 [95% confidence interval: 0.75 to 0.85] with good calibration). For the 401 lesions included in the validation cohort, the RESOLVE score had a C-statistic of 0.77 (95% confidence interval: 0.69 to 0.86), with good calibration. SB occlusion rates in the validation cohort increased significantly across different risk groups, from 0.0% in the low-risk group, to 3.8% in the intermediate-risk group, and to 19.8% in the high-risk group (p < 0.001). CONCLUSIONS The RESOLVE score, a novel angiographic risk stratification tool, can help identify patients at risk for SB occlusion during bifurcation intervention.

How bifurcation angle impacts the fate of side branch after main vessel stenting: A retrospective analysis of 1,200 consecutive bifurcation lesions in a single center

We aimed to investigate the effect of bifurcation angle (BA) on side branch (SB) occlusion after main vessel (MV) stenting. Background: BA is thought to impact the risk of SB occlusion in coronary bifurcation patients undergoing percutaneous coronary intervention (PCI).

Nine-month angiographic and 2-year clinical follow-up of the NOYA biodegradable polymer sirolimus-eluting stent in the treatment of patients with de novo native coronary artery lesions: the NOYA I trial

AIMS This study sought to evaluate the safety and efficacy of the NOYA stent which is a cobalt chromium-based sirolimus-eluting stent (SES) with DL-polylactide biodegradable polymer (Medfavour Medical, Beijing, China) in treating de novo coronary artery lesions. METHODS AND RESULTS The NOYA I trial was designed to compare the NOYA stent with the FIREBIRD2™ stent, a durable polymer SES widely used in China (MicroPort Medical, Shanghai, China); the trial was a non-inferiority trial with a primary angiographic endpoint of the in-stent late lumen loss (LLL) at nine-month follow-up. The secondary endpoints were binary restenosis rates within nine months, major adverse cardiac events (MACE) defined as the composite of cardiac death, myocardial infarction (MI) or target lesion revascularisation (TLR), and definite/probable stent thrombosis (ST) at 24-month follow-up. A total of 300 patients (n=150 in each group) were enrolled in the study from 16 Chinese centres. The LLL in the NOYA group at nine-month follow-up was similar to the FIREBIRD2 group (0.11±0.18 mm vs. 0.14±0.23 mm, p=0.16; non-inferiority p<0.001). The rates of MACE, death, MI and TLR at 24-month follow-up were comparable between these two devices (p>0.05, respectively). CONCLUSIONS The biodegradable polymer NOYA stent was non-inferior to the FIREBIRD2 durable polymer stent with respect to the primary non-inferiority endpoint of in-stent LLL at nine-month follow-up. Clinical outcomes at 24-month follow-up were comparable between the two stents. (ClinicalTrials.gov number, NCT01226355).

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

Background Transradial percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice, given its potential advantages over transfemoral intervention; however, the impact of different access strategies on costs and clinical outcomes remains poorly defined, especially in the developing world. Methods and Results Using data from a consecutive cohort of 5306 patients undergoing PCI in China in 2010, we compared total hospital costs and in‐hospital outcomes for transradial intervention (TRI) and transfemoral intervention. Patients receiving TRI (n=4696, 88.5%) were slightly younger (mean age 57.4 versus 59.5 years), less often women (21.6% versus 33.1%), more likely to undergo PCI for single‐vessel disease, and less likely to undergo PCI for triple‐vessel or left main diseases. The unadjusted total hospital costs were 57 900 Chinese yuan (¥57 900; equivalent to 9190 US dollars [

Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play?

9190]) for TRI and ¥67 418 (

Predictors and Periprocedural Myocardial Injury Rate of Small Side Branches Occlusion in Coronary Bifurcation Intervention.

10,701) for transfemoral intervention. After adjusting for all observed patient and procedural characteristics using the propensity score inverse probability weighting method, TRI was associated with a lower total cost (adjusted difference ¥8081 [

Comparison of Transradial and Transfemoral Approaches in Women Undergoing Percutaneous Coronary Intervention in China: A Retrospective Observational Study

1283]). More than 80% of the cost difference was related to lower PCI‐related costs (adjusted difference −¥5162 [−

Clinical and Angiographic Predictors of Major Side Branch Occlusion after Main Vessel Stenting in Coronary Bifurcation Lesions

819]), which were likely driven by exclusive use of vascular closure devices in transfemoral intervention, and lower hospitalization costs (−¥1399 [−