Salil Sethi

Aortic stiffness: pathophysiology, clinical implications, and approach to treatment.

Aortic stiffness is a hallmark of aging, and classic cardiovascular risk factors play a role in accelerating this process. Current changes in medicine, which focus on preventive care, have led to a growing interest in noninvasive evaluation of aortic stiffness. Aortic stiffness has emerged as a good tool for further risk stratification because it has been linked to increased risk of atherosclerotic heart disease, myocardial infarction, heart failure, and stroke. This has led to the invention and validation of multiple methods to measure aortic stiffness. Pulse wave velocity is emerging as the gold standard for evaluation of aortic stiffness. This review focuses on the pathophysiology involved in aortic stiffness, methods available for evaluation of aortic stiffness, the importance of central pressure as a predictor of future cardiovascular events, and therapies that affect aortic stiffness.

The use of the AVERT system to limit contrast volume administration during peripheral angiography and intervention

The AVERTTM Contrast Modulation System (AVERT) (Osprey Medical, MN) is designed to reduce contrast volume administration during angiography. The AVERT provides an adjustable resistance circuit which decreases the pressure head delivering contrast towards the patient. The AVERT has not been previously studied in patients undergoing peripheral digital subtraction angiography (DSA). The purpose of this study was (1) to evaluate contrast savings with the AVERT and (2) to evaluate the ability to generate clinically acceptable DSA images in the process. To better define the mechanism of action in the peripheral circulation, we also developed a bench model to study the effects of the AVERT on the hydrodynamics of contrast delivery.

Transcatheter embolization of a giant coronary artery pseudoaneurysm

A 53-year-old diabetic male with sternal dehiscence presented with recurrent staphylococcus bacteremia 2years after coronary artery bypass grafting (CABG). He was found to have a giant right coronary artery (RCA) pseudoaneurysm and a coronary cameral fistula on imaging. Due to excessive surgical risk, the patient underwent percutaneous treatment with a 5mm Amplatzer vascular plug 4 (St. Jude Medical, St.Paul, MN). Post-procedure imaging showed successful cessation of flow into the pseudoaneurysm and follow-up CT scan demonstrated significant improvement in the size of the pseudoaneurysm.

Myocardial Infarction Secondary to Inflammatory Myofibroblastic Tumor Obstruction of the Left Main: Treated With Primary PCI

Introduction Cardiac inflammatory myofibroblastic tumor is a rare tumor that can cause potentially fatal outcomes. Case Presentation We describe a case where the tumor originated on the mitral valve and extended through the left ventricular outflow tract and aortic valve and into the left main artery obstructing it. Due to the hemodynamic instability of the patient, we proceeded for cardiac catheterization with the intention to aspirate the mass but were forced to do percutaneous intervention to stabilize the patient and bridge him to surgery. Conclusions The patient underwent surgery several days later with complete resection of the tumor and coronary stent retrieval but his left ventricular ejection fraction remained poor after several months and he was referred for cardiac transplantation.

Intestinal Microbiota: An Emerging Target for Modifying CardiovascularHealth

The rising prevalence of obesity and Type 2 diabetes mellitus (T2DM) worldwide is a primary public health concern as it heavily impacts risk of cardiovascular disease (CVD) and other comorbid diseases. Promising research in the last decade implicates gut microbiota as an important contributor to risk of developing obesity, T2DM and CVD. Animal models of obesity and insulin resistance identify that germ free mice have decreased risk of obesity and insulin resistance despite being on high fat sugar rich diet compared to conventional mice. Obesity is shown to be transmissible through faecal microbiome transplantation from obese phenotype mice to germ free mice. There is also growing evidence that gut microbiota metabolism of choline to Trimethylamine-N-Oxide (TMAO) is directly linked to increased cardiovascular risk. TMAO is a proatherogenic molecule which has been shown to increase atherosclerotic plaque burden in murine atherosclerosis model. Also, clinical cohort studies have established increased TMAO levels as an independent predictor for major adverse cardiovascular events including death, myocardial infarction and stroke. As it stands, intestinal microbiota-mediated pathogenesis of obesity, T2DM and CVD is still an emerging research direction and has the potential for leading to new diagnostic and therapeutic strategies.