Scott Shurmur

Intravascular ultrasound study of angiographically mildly diseased coronary arteries

OBJECTIVESnWe hypothesized that intravascular ultrasound may identify significant coronary artery narrowing in the mildly diseased coronary artery of patients with insignificant or one- or two-vessel coronary artery disease.nnnBACKGROUNDnNecropsy studies have revealed that coronary angiography may underestimate stenosis severity in vessels that appear mildly diseased. Intravascular ultrasound has been shown to detect atherosclerotic changes in angiographically normal coronary arteries and to correlate better with histologic findings.nnnMETHODSnIn 20 patients, we performed intravascular ultrasound imaging (3.5F catheter, 30-MHz transducer) in 37 coronary arteries that were considered mildly diseased (<50% diameter narrowing) by qualitative angiography. The angiographic diagnosis was no significant coronary artery disease in eight patients, one-vessel disease in seven and two-vessel disease in five. Each vessel, except for the left main coronary artery, was divided into proximal, mid and distal segments. Percent area narrowing and minimal lumen diameter were subsequently quantified by both ultrasound and quantitative angiography.nnnRESULTSnMean maximal arterial area narrowing by ultrasound in the 67 segments studied was 36 +/- 20% (range 0% to 80.2%) and 19 +/- 23% (range 0% to 82%) by quantitative angiography of these same segments (p < 0.001, paired t test). Mean minimal lumen diameter of the segment was 3.3 +/- 0.9 mm by ultrasound and 2.7 +/- 0.8 mm by quantitative angiography. In 10 patients there were 19 angiographically mildly diseased segments where the percent arterial area narrowing by ultrasound was > or = 50%. Intravascular ultrasound revealed that the more proximal (reference) segment had > 25% intimal thickening in 12 of the 19 underestimated segments. In six stenosed segments (32%), total vessel area increased compared with that of the adjacent proximal vessel segment because of compensatory dilation.nnnCONCLUSIONSnIntravascular ultrasound identifies potentially significant coronary artery disease in vessels that appear to be only mildly diseased by angiography.

Unique Antibody Responses to Malondialdehyde-Acetaldehyde (MAA)-Protein Adducts Predict Coronary Artery Disease

Malondialdehyde-acetaldehyde adducts (MAA) have been implicated in atherosclerosis. The purpose of this study was to investigate the role of MAA in atherosclerotic disease. Serum samples from controls (nu200a=u200a82) and patients with; non-obstructive coronary artery disease (CAD), (nu200a=u200a40), acute myocardial infarction (AMI) (nu200a=u200a42), or coronary artery bypass graft (CABG) surgery due to obstructive multi-vessel CAD (nu200a=u200a72), were collected and tested for antibody isotypes to MAA-modifed human serum albumin (MAA-HSA). CAD patients had elevated relative levels of IgG and IgA anti-MAA, compared to control patients (p<0.001). AMI patients had a significantly increased relative levels of circulating IgG anti-MAA-HSA antibodies as compared to stable angina (p<0.03) or CABG patients (p<0.003). CABG patients had significantly increased relative levels of circulating IgA anti-MAA-HSA antibodies as compared to non-obstructive CAD (p<0.001) and AMI patients (p<0.001). Additionally, MAA-modified proteins were detected in the tissue of human AMI lesions. In conclusion, the IgM, IgG and IgA anti-MAA-HSA antibody isotypes are differentially and significantly associated with non-obstructive CAD, AMI, or obstructive multi-vessel CAD and may serve as biomarkers of atherosclerotic disease.

Effects of partners together in health intervention on physical activity and healthy eating behaviors: a pilot study.

Background:Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. Objective:The objective of this feasibility study was to test the Partners Together in Health (PaTH) intervention versus usual care in improving physical activity and healthy eating behaviors in coronary artery bypass graft surgery patients and their spouses. Methods:An experimental, 2-group (n = 17 couples/group), repeated-measures design was used. Coronary artery bypass surgery patients in both groups participated in phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients did. Spouses in the usual care attended educational classes with patients. It was theorized that “2 persons would be better than 1” at making changes and sticking with them in the long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), at 3 months (post-CR), and at 6 months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. Results:The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and usual care patients or spouses at 3 or 6 months in the number of minutes per week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥150 min/wk at >3 metabolic equivalents). Conclusions:The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR.

Contrast cine left ventriculography: comparison of two pigtail catheter shapes and analysis of factors determining the final quality.

Ventricular arrhythmias or inadequate opacification of the ventricular cavity during contrast-cine left ventriculography frequently interfere with evaluation of regional wall motion, ejection fraction or mitral regurgitation. In this prospective, randomized study traditional (straight) pigtail catheter was compared with a new, large loop pigtail catheter (both 6 French, large lumen) in terms of the quality of the cine left ventriculograms. Straight (Group I) and curved pigtail (Group II) groups were further subdivided randomly into a preset (13 cc per second for 3 seconds with a pressure rise time of 0.5 seconds) injection rate (Group IA, n = 46, and Group IIA, n = 48) or operator definded injection rate (Group IB, n = 49, and Group IIB, n = 45) subgroups. The ventricular tachycardia and couplets occurred at similar frequency among the groups. The curved pigtail subgroups showed significantly more frequent catheter induced mitral regurgitation. However, the opacification and overall quality of the left ventriculograms were distributed similarly between the groups. Because the catheter type and injection protocol did not affect the left ventriculogram quality in our study, variables determining opacification and overall quality rating are analyzed in the overall group of 190 patients. Left ventricular opacification was excellent in 72, acceptable in 108 and marginal in 10 patients. The patients with marginal opacification were significantly heavier (P = .004) with larger left ventricular enddiastolic volumes (P = .019), and smaller amount of contrast volume per enddiastolic volume (P = .005) and kilogram body weight (P = .003). The overall quality of left ventriculograms were excellent in 38, acceptable in 133, and marginal in 19 patients. The patients with excellent left ventriculograms were significantly younger (P = .019) and slightly less heavy (P = 0.09). Significantly more female patients were also in this group (P = .036). Ventricular tachycardia was the most common cause of unsatisfactory left ventriculograms. In the RAO view, deeper (more apical) placement of the catheter was associated with higher incidence of ventricular tachycardia (53%). The most silent area was the posterobasal area. In conclusion, the perfect left ventriculogram remains to be an elusive goal in routine clinical practice. When using 6F highflow pigtail catheters and nonionic contrast agents, more basal catheter position and higher contrast volume increase the quality of the left ventriculograms.

Cardiovascular risk factors among college students: Knowledge, perception, and risk assessment

ABSTRACT Objective: To assess college students knowledge and perception of cardiovascular risk factors and to screen for their cardiovascular risks. Participants: The final sample that responded to recruitment consisted of 158 college students from a midwestern university. Methods: A cross-sectional, descriptive study was performed using convenience sampling. Results: College students were knowledgeable about cardiovascular risk factors but did not perceive themselves at risk for cardiovascular disease (CVD). Knowledge of cardiovascular risk factors was correlated with the lifetime risk estimates (ρ = .17, p = .048), and perception of cardiovascular risk was positively associated with 30-year CVD risk estimates (ρ = .16, p = .048). More than 50% of the participants had 1 or more cardiovascular risk factors. Conclusions: High knowledge level of cardiovascular risk factors was not sufficient to lower cardiovascular risks within this study population, but changing perception of cardiovascular risk factors may play a bigger role in reducing long-term cardiovascular risks.

Reducing Cardiovascular Risk in Spouses of Cardiac Patients A Randomized Controlled Trial

Few studies have examined risk-reducing interventions in spouses of coronary artery bypass patients. This study examined the effects of the Partners Together in Health (PaTH) intervention versus usual care on cardiovascular risk factors. Spouses in the experimental group (n = 17/group) attended cardiac rehabilitation with patients and made the same physical activity and healthy eating changes as patients. Spouses in the usual care group attended educational classes with patients. Spouses’ 30-year cardiovascular risk was calculated using the Lifetime Risk Scale before and after cardiac rehabilitation (3 months), and at 6 months. Spouses in both groups significantly reduced 30-year risk scores at 3 and 6 months. Exercise was the key ingredient in lowering risk. There was a trend toward reduction in systolic blood pressure and an increase in high-density lipoprotein cholesterol in both groups. Although there were no group differences, having spouses participate in cardiac rehabilitation with the patient was effective for reducing spouses’ cardiovascular risk.

Intervention Fidelity in a Translational Study: Lessons Learned

This article examined the intervention fidelity strategies used and lessons learned in a translational study. In this study, the behavioral intervention was delivered within an existing clinical practice environment, outpatient cardiac rehabilitation (CR). The primary lessons learned were that the fidelity components of design, training, and delivery of the intervention were the most different from fidelity strategies used in typical intervention studies. The design component needed to take into account the unique characteristics of the clinical environments where the study was conducted and build these unique differences into the study design. Training and delivery of the intervention was different because existing CR staff delivered the intervention in this study; which is unlike typical intervention studies where research staff are trained to deliver the intervention. Monitoring receipt and enactment fidelity components were similar to monitoring in usual intervention studies probably because these components focus on monitoring the behaviors of the research participant. Translational research presents unique challenges and requires the development of a flexible and novel intervention fidelity plan tailored to a particular study.

Impact of a high-fat meal on assessment of clopidogrel-induced platelet inhibition in healthy subjects

BackgroundIdeal conditions for platelet reactivity testing are critical for optimal selection of a P2Y12 inhibitor. Data are inconsistent regarding the impact of high-fat meals on test assessment.MethodsParticipants included 12 healthy subjects not taking antiplatelet drugs after a 12-hour fast. After baseline assessment, subjects were given a 600xa0mg dose of clopidogrel. Four hours later, maximum platelet inhibition was tested in the fasting state by light transmission aggregometry (LTA), VerifyNow P2Y12, vasodilator-stimulated phosphoprotein (VASP), and whole blood aggregometry (WBA). Subjects were then provided a high-fat meal, and platelet function was evaluated two hours later. Change in measured platelet aggregation by LTA was the primary endpoint of the study. The Wilcoxon Rank Sum test was used to compare the change in platelet reactivity between fasting and non-fasting conditions. The Spearman rho (ρ) correlation coefficient was used to evaluate the association between fasting platelet reactivity and the change following a high-fat meal.ResultsNo significant change occurred in maximal light transmission, as assessed by LTA with 5xa0μM ADP (pu2009=u20090.15) and with 20xa0μM ADP (pu2009=u20090.07). There was a significant change in the area under the curve with 5xa0μM ADP (pu2009=u20090.03) but not with 20xa0μM ADP (pu2009=u20090.18). Although there was no significant change with the VerifyNow P2Y12 assay (pu2009=u20090.16), the change was correlated with the initial fasting value (Spearman’s rho pu2009=u20090.008). The VASP assay and WBA varied minimally.ConclusionThe high-fat meal did not significantly alter platelet function assessment of commonly used platelet function tests. Greater intra-subject variability existed for the optically-dependent compared with non-optically dependent tests.Trial registrationNCT01307657.

TCT-249 Should Moderate to Severe Ischemic Mitral Regurgitation Be Repaired: Meta-Analysis of RCT's

nos: 250 259 TCT-250 Long-term Clinical Outcomes of Transient and Persistent No-Reflow Following Percutaneous Coronary Intervention (PCI): Insights from a Multi-center Australian Registry Stavroula Papapostolou, Nick Andrianopoulos, Angela Brennan, Andrew Ajani, david clark, Christopher Reid, Gishel New, martin sebastian, Laura Selkrig, Anthony Dart, Stephen Duffy, William Chan Alfred Health, Melbourne, Victoria, Australia; Centre of Cardiovascular Research and Education in Therapeutics; Monash University, melbourne, Victoria, Australia; The Royal Melbourne Hospital; austin health, Melbourne, Victoria, Australia; Monash University, Curtin University; Melbourne, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; Alfred Health; Alfred Health; Alfred Hospital, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia BACKGROUND Few studies have evaluated the long-term outcomes of transient no-reflow (TNR) versus persistent no-reflow (PNR) following PCI. METHODS 20,671 patients (65 12 years) with normal reflow (NR) post PCI enrolled in the Melbourne Interventional Group (MIG) registry from 2005-2013 were compared to 743 patients (3.4%, 65 12 years) with TNR and 191 patients (0.9%, 66 14 years) with PNR. Long-term all-cause mortality was obtained by linkage with National Death Index (NDI) and assessed using Kaplan-Meier survival analysis and CoxProportional Hazards modelling. RESULTS Patients with TNR and PNR were more likely to have presented with ST-elevation myocardial infarction, out-of-hospital cardiac arrest (OHCA), cardiogenic shock and have undergone PCI for more complex lesions (all p<0.01). Baseline left ventricular systolic function was lower in both TNR and PNR with corresponding higher inotrope and intra-aortic balloon pump utilisation (all p<0.01). Longterm NDI-linked all-cause mortality was greatest in PNR (31%) followed by TNR (22%) and NR (14%) over a median follow-up of 5.2, 5.5 and 4.5 years respectively (all p<0.0001). Kaplan-Meier survival estimates showed graded increased mortality from NR, TNR to PNR with greater mortality occurring early (<30 days) in the PNR group (logrank p<0.0001). Multivariate Cox-Proportional Hazards modelling identified GFR <30mL/min (HR 3.7), ejection fraction <30% (HR 2.5), OHCA (2.0), PNR (HR 1.5), and TNR (HR 1.3) as independent predictors of increased hazard. CONCLUSION TNR and PNR following PCI are associated with step-wise reduction in long-term survival. The presence of even TNR during PCI appears to be an important predictor of adverse long-term outcome. CATEGORIES CORONARY: PCI Outcomes TCT-251 Non-procedural Predictors of Stroke After Percutaneous Coronary Intervention Gaurav Patel, Akhil Kher, Sukrut Nanavaty, Tejas Patel, Samir Pancholy The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States; The Commonwealth Medical College, Scranton, PA, USA; Division of Cardiology Careggi Hospital; APEX Heart Institute, Ahmedabad, Gujarat, India; The Wright Center For Graduate Medical Education BACKGROUND Cerebrovascular accident (CVA) after percutaneous coronary intervention (PCI) is a devastating complication with high morbidity and mortality. Non-procedural predictors of CVA after PCI are poorly described.

TCT-720 Clinical Outcomes Of Embolic Protection Devices For TAVR

Patrizia Presbitero, Piera Capranzano, Didier Tchetche, Alessandro Iadanza, Gennaro Sardella, Nicolas Van Mieghem, Emanuele Meliga, Nicolas Dumonteil, Chiara Fraccaro, Daniela Trabattoni, Ghada Mikhail, Samin Sharma, M.C. Ferrer, Christoph Naber, Peter Kievit, Michela Faggioni, Marie-Claude Morice, Roxana Mehran San Raffaele Scientific Institute, Milan, Italy; Ospedale di Cisanello, Pisa, Italy; Munich University Clinic, Munich, Germany; Mount Sinai Hospital, New York, New York, United States; The Icahn School of Medicine at Mount Sinai, New York, New York, United States; Institut Hospitalier Jacques Cartier, Massy, France; Istituto Clinico Humanitas, Rozzano-Milan, Italy; Ferrarotto Hospital, University of Catania, Catania, Palermo, Italy; Clinique Pasteur, Toulouse, France; Le Scotte Hospital, Rapolano Terme, Siena, Italy; Policlinico Umberto I University, Rome, Italy; Erasmus Medical Center, Rotterdam, Netherlands; Torino, Italy; Asklepios Klinik St. Georg; Unknown, Padova, Italy; Centro Cardiologico Monzino, Milano, Milan, Italy; Imperial College Healthcare NHS Trust, London, United Kingdom; The Mount Sinai Medical Center, New York, New York, United States; Institute of Cardiology; Contilia Heart and Vascular Center, Essen, Germany; tRadboud University Nijmegen Medical Center, Nijmegen, the Netherlands; Mount Sinai Medical Center, New York, New York, United States; Institut Cardiovasculaire Paris Sud, Massy, France; Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States