Clinical, angiographic and procedural characteristics of longitudinal stent deformationGuler, A.; Guler, Y.; Acar, E.; Aung, S.; Efe, S.; Kilicgedik, A.; Karabay, C.; Barutcu, S.; Tigen, M.; Pala, S.; İzgi, A.; Esen, A.; Kirma, C.
doi: 10.1007/s10554-016-0905-1pmid: 27198891
Recently, longitudinal stent deformation (LSD) has been reported increasingly. Even though the reported cases included almost all stent designs, most cases were seen in the Element™ stent design (Boston Scientific, Natick, MA, USA). It is considered that stent design, lesion and procedural characteristics play a role in the etiology of LSD. Yet, the effect of LSD on long-term clinical outcomes has not been studied well. Element stents implanted between January 2013 and April 2015 in our hospital were examined retrospectively. Patients were grouped into two according to the presence of LSD, and their clinical, lesion and procedural characteristics were studied. Twenty-four LSD’s were detected in 1812 Element stents deployed in 1314 patients (1.83 % of PCI cases and 1.32 % of all Element stents). LMCA lesions (16.7 % vs 1.6 %, p < 0.001), complex lesions (75 % vs 35.1 %, p < 0.001), bifurcation lesions (37.5 % vs 18.3 %, p = 0.017), ostial lesions (33.3 % vs 12.8 %, p = 0.003), using of extra-support guiding catheter (54.2 % vs 22.3 %, p < 0.001) and extra-support guidewire (37.5 % vs 16.2 %, p = 0.005) were found to be more frequent in cases with LSD than in cases without it. In addition, the number of stents, stent inflation pressure and the use of post-dilatation were significantly different between the two groups. Two patients had an adverse event during the follow-up period. LSD is a rarely encountered complication, and is more common in complex lesions such as ostial, bifurcation and LMCA lesions. The use of extra-support guiding catheter, extra-support guidewires and low stent inflation pressure increases the occurrence of LSD. Nevertheless, with increased awareness of LSD and proper treatment, unwanted long-term outcomes can be successfully prevented.
Prevalence of previously undiagnosed abdominal aortic aneurysms in the area of Como: the ComoCuore “looking for AAA” ultrasonography screeningCorrado, Giovanni; Durante, Alessandro; Genchi, Vincenzo; Trabattoni, Loris; Beretta, Sandro; Rovelli, Enza; Foglia-Manzillo, Giovanni; Ferrari, Giovanni
doi: 10.1007/s10554-016-0911-3pmid: 27215751
The prognosis for abdominal aortic aneurysm (AAA) rupture is poor. Long-term follow-up of population-based randomized trials has demonstrated that ultrasound (US) screening for abdominal aortic aneurysms (AAAs) measuring 3 cm or greater decreases AAA-related mortality rates and is cost-effective. We though to prospectively perform during a 26-month period a limited US examination of the infrarenal aorta in volunteers of both gender aged 60–85 years without history of AAA living in the area of Como, Italy. From September 2010 to November 2013 ComoCuore, a no-profit nongovernmental association, enrolled 1555 people (aged 68.8 ± 6.8 years; 48.6 % males). Clinical data and a US imaging of the aorta were collected for each participant. AAA was found in 22 volunteers (1.4 %) mainly males (2.5 % in males vs. 0.4 % in females p = 0.005). Overall, the prevalence of cardiovascular risk factors was higher in patients with vs. without AAA (mean 2.9 ± 3.0 vs. 1.4 ± 1.0 respectively, p < 0.0001). Independent predictors of AAA on multivariate analysis were age (OR 1.14, 1.06–1.22; p < 0.0001), male gender (OR 8.23, 1.79–37.91; p = 0.007), and both current (OR 4.98, 1.57–15.79; p = 0.007) and previous smoking (OR 2.76, 1.12–8.94; p = 0.03). Our study confirms the feasibility of one time US screening for AAA in a large cohort of asymptomatic people. Independent predictors of AAA were male sex, older age and a history of smoking. Accordingly to recent data the prevalence of AAA seems to be declining, maybe due to a reduction of smoking in Italy.
Bilateral symmetry of human carotid artery atherosclerosis: a multi-contrast weighted MR studyLi, Feiyu; Wang, Xiaoying
doi: 10.1007/s10554-016-0890-4pmid: 27139458
The systemic nature of atherosclerotic disease may entail an association in disease severity between left and right carotid arteries. However, the etiology of plaque features in high-risk lesions is presumably attributed to local risk factors. We explored the symmetry of plaque morphology and composition across a broad range of atherosclerotic disease severities. All participants underwent carotid MR imaging on a 3.0 T scanner with a bilateral four-element phased-array surface coil. Vessel boundary and plaque components [calcification, lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH)] of bilateral carotid arteries were outlined. Normalized wall index (NWI) was calculated as follows: NWI = wall volume/total vessel volume. Carotid atherosclerosis score (CAS) was computed for plaque risk stratification. Associations of volume measurements between sides were evaluated using Pearson’s correlation. Cohen’s kappa was used to assess agreement between dichotomous variables. In the 177 participants with images of sufficient quality, there were very strong correlations between left and right lumen volumes (r = 0.85), total vessel volumes (r = 0.88), and strong correlations between wall volumes (r = 0.79), mean wall thickness (r = 0.66) and NWI (r = 0.71), and a moderate correlation between max wall thickness (r = 0.56) (all P < 0.001). There were moderate between-side agreements for the presence of calcification (κ = 0.54) and LRNC (κ = 0.49), but only fair agreement for IPH (κ = 0.31). The correlation of volume between left and right carotid arteries was strong for calcification (r = 0.62, P < 0.001) and weak for LRNC (r = 0.39, P < 0.001), but there was no significant correlation for IPH (r = 0.01, P = 0.99). Fair agreement (κ = 0.34) for CAS between paired carotid arteries was observed. Only 16 of 47 participants with CAS = 4 on at least one side had the same CAS on the contralateral side. Plaque morphology, calcification, and LRNC may develop symmetrically, but there is a relatively poor correlation for lipid content between sides. The weak symmetry of IPH and CAS indicates that the development of atherosclerosis into high-risk lesions may be regulated by local rather than systemic factors.
Proximal culprit lesion and coronary artery occlusion independently predict the risk of microvascular obstruction in acute myocardial infarctionAbanador-Kamper, N.; Kamper, L.; Karamani, V.; Haage, P.; Seyfarth, M.
doi: 10.1007/s10554-016-0897-xpmid: 27139461
Microvascular obstruction (MO) and coronary flow have been independently described to have a high prognostic impact after acute myocardial infarction (AMI). Their interdependence has not been precisely elucidated, so far. Aim of this study was to investigate the impact of coronary flow on the occurrence of MO in patients with AMI. 336 patients with revascularized AMI were examined by cardiac magnetic resonance imaging. Patients were categorised into two groups based on the presence of MO. Procedural characteristics and marker of infarct size were analyzed. MO was present in 110 (33 %) and absent in 226 (67 %) patients. Both groups differed significantly regarding pre- and post-interventional thrombolysis in myocardial infarction (TIMI) flow. After multivariable regression analysis pre-interventional TIMI-flow 0, proximal culprit lesion, post-interventional TIMI-flow <III and creatine-kinase–myocardial band (CK-MB) remained strong independent predictors for MO. Odds ratios for pre-interventional TIMI-flow 0 were 2.31 (95 % CI 1.04–5.11, P = 0.034); for proximal culprit lesion 11.94 (95 % CI 5.70–25.01, P < 0.001); for post-interventional TIMI-flow III 0.28 (95 % CI 0.10–0.74, P = 0.010) and for CK-MB 1.50 (95 % CI 1.24–1.82, P < 0.001). Pre-interventional proximal coronary artery occlusion (TIMI 0) and insufficient post-interventional coronary reperfusion (TIMI-flow <III) have a high impact on the occurrence of MO in AMI.
Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertensionOstenfeld, E.; Stephensen, S.; Steding-Ehrenborg, K.; Heiberg, E.; Arheden, H.; Rådegran, G.; Holm, J.; Carlsson, M.
doi: 10.1007/s10554-016-0898-9pmid: 27142431
To develop more sensitive measures of impaired cardiac function in patients with pulmonary hypertension (PH), since detection of impaired right ventricular (RV) function is important in these patients. With the hypothesis that a change in septal function in patients with PH is associated with altered longitudinal and lateral function of both ventricles, as a compensatory mechanism, we quantified the contributions of these parameters to stroke volume (SV) in both ventricles using cardiac magnetic resonance (CMR). Seventeen patients (10 females) evaluated for PH underwent right heart catheterization (RHC) and CMR. CMR from 33 healthy adults (13 females) were used as controls. Left ventricular (LV) atrioventricular plane displacement (AVPD) and corresponding longitudinal contribution to LVSV was lower in patients (10.8 ± 3.2 mm and 51 ± 12 %) compared to controls (16.6 ± 1.9 mm and 59 ± 9 %, p < 0.0001 and p < 0.01, respectively). This decrease did not differ in patient with ejection fraction (EF) >50 % and <50 % (p = 0.5) and was compensated for by increased LV lateral contribution to LVSV in patients (49 ± 13 % vs. 37 ± 7 %, p = 0.001). Septal motion contributed less to LVSV in patients (5 ± 8 %) compared to controls (8 ± 4 %, p = 0.05). RV AVPD was lower in patients (12.0 ± 3.6 mm vs. 21.8 ± 2.2 mm, p < 0.0001) but longitudinal and lateral contribution to RVSV did not differ between patients (78 ± 17 % and 29 ± 16 %) and controls (79 ± 9 % and 31 ± 6 % p = 0.7 for both) explained by increased RV cross sectional area in patients. LV function is affected in patients with PH despite preserved global LV function. The decreased longitudinal contribution and increased lateral contribution to LVSV was not seen in the RV, contrary to previous findings in patients with volume loaded RVs.