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Obstructive Coronary Artery Disease (obstructive + coronary_artery_disease)
Selected AbstractsComparison of LVEF Obtained with Single-Plane RAO Ventriculography and Echocardiography in Patients with and without Obstructive Coronary Artery DiseaseECHOCARDIOGRAPHY, Issue 6 2009Vijayasree Kudithipudi M.D. The left ventricular ejection fraction (LVEF) determined by invasive ventriculography (routine cardiac cath; LV-gram) was compared with that determined by echocardiography in 100 patients scheduled for angiography (86% had LV-gram and 2DE during same hospital admission). Seventy percent of patients had at least single-vessel obstructive coronary artery disease, defined as more than 50% stenosis. By all estimates, the LVEF was higher in patients without coronary artery disease (CAD) compared to patients with CAD. There was an excellent correlation between the LVEF by cath and echo, but this correlation was noticeably less strong in patients with CAD, especially with involvement of the left circumflex artery. (ECHOCARDIOGRAPHY, Volume 26, July 2009) [source] Dobutamine Stress Cardiac Magnetic Resonance Imaging to Detect Myocardial Ischemia in WomenPREVENTIVE CARDIOLOGY, Issue 3 2008Subha V. Raman MD This study sought to evaluate dobutamine stress cardiac magnetic resonance imaging (DCMRI) in women with abnormal stress nuclear testing results. Women with findings on stress nuclear exams, including electrocardiography and/or perfusion, thought to require further evaluation with invasive coronary angiography were prospectively enrolled. Multiplane cine imaging was obtained at rest and at each stage of inotropic stress with atropine as needed to achieve target heart rate. DCMRI results were compared with stress nuclear and invasive cardiac catheterization results. Of 23 patients enrolled successfully, 22 completed DCMRI examination without complications. In all cases, DCMRI imaging demonstrated appropriate stress response with no ischemia despite abnormalities on stress nuclear testing. In the 18 patients who also underwent invasive coronary angiography, no significant obstructive disease was identified. DCMRI may be a useful alternative to stress nuclear examination in women; larger studies are warranted to determine its potential to more accurately predict obstructive coronary artery disease. [source] Frequent Premature Ventricular Complexes Originating from the Right Ventricular Outflow Tract Are Associated with Left Ventricular DysfunctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2008Yumiko Kanei M.D. Background: Recent case series have shown reversal of left ventricular (LV) dysfunction after catheter ablation of frequent premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT). We conducted a retrospective study to evaluate the prevalence of patients with frequent RVOT PVCs (,10 per hour) and LV dysfunction. Methods: RVOT PVC was defined as PVC with left bundle branch block morphology and inferior axis on a 12-lead ECG. We included patients with frequent RVOT PVCs on 24-hours Holter monitor who had a recent evaluation of LV function. Patients with structural heart disease, including obstructive coronary artery disease, were excluded. Patients were divided into three groups based on the number of PVCs (<1000/24 hour, 1000,10,000/24 hour, ,10,000/24 hour), and the prevalence of LV dysfunction was evaluated in each group. Results: Our analysis included 108 patients: 24 patients had <1000PVCs/24 hour, 55 patients had 1000,10,000PVCs/24 hour, and 29 patients had ,10,000PVCs/24 hour. The prevalence of LV dysfunction was 4%, 12%, and 34%, respectively (P = 0.02). With logistic regression analysis, non-sustained ventricular tachycardia was an independent predictor of LV dysfunction with odds ratio of 3.6 (1.3,10.1). Conclusion: We demonstrated a significant association between frequent RVOT PVCs and LV dysfunction in patients without structural heart disease. [source] Oral antiplatelet therapy in PCI patients,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue S1 2010Samin K. Sharma MD Abstract The use of percutaneous coronary intervention (PCI) in the treatment of obstructive coronary artery disease has expanded rapidly in the past decade. Despite the extensive technological advancements in the field, pharmacotherapy has remained a cornerstone in the overall treatment strategy. Oral antiplatelet therapy has become an essential component of therapy with acute coronary syndromes and in PCI by improving clinical outcomes. This article reviews the antiplatelet options for patients undergoing PCI, including aspirin, ADP receptor blockers, and glycoprotein IIb/IIIa inhibitors. © 2010 Wiley-Liss, Inc. [source] Double-inversion technique for coronary angiography viewing in dextrocardiaCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2005Pravin K. Goel MD Abstract This report describes a simple angiographic viewing rule for coronary angiography in patients of dextrocardia with obstructive coronary artery disease, which could correct the unfamiliar angulated pictures of the coronary tree in dextrocardia into the familiar conventional angiographic pictures of a normally located heart and its associated ease of interpretation. © 2005 Wiley-Liss, Inc. [source] Current status of rotational atherectomyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2004Erdal Cavusoglu MD Abstract Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calcified or fibrotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation. Other lesion subtypes amenable to treatment with this modality include ostial and branch-ostial lesions, chronic total occlusions, and in-stent restenosis. This review discusses the technique and principles of rotational atherectomy, the various treatment strategies for its use (including adjunctive pharmacotherapy), the lesion-specific applications for this device, and the complications unique to this modality. Recommendations are also made for its use in the current interventional era. Catheter Cardiovasc Interv 2004;62:485,498. © 2004 Wiley-Liss, Inc. [source] Beyond peripheral arteries in Buerger's disease: Angiographic considerations in thromboangiitis obliteransCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2002Bobbi Hoppe MD Abstract Thromboangiitis obliterans is an inflammatory peripheral vascular disease that is strongly associated with smoking. It predominantly affects distal small- and medium-sized blood vessels of both the upper and lower extremities. We present histological evidence of this disease process affecting the internal mammary arteries. This can be of paramount clinical significance for patients with Buerger's disease who present with obstructive coronary artery disease and require coronary artery bypass grafting surgery (CABG). Internal mammary arteries involved with thromboangiitis obliterans cannot be utilized as arterial conduits during CABG and other alternatives have to be used. Therefore, we recommend preoperative angiography of both internal mammary arteries in patients with Buerger's disease requiring CABG to prevent extensive intraoperative dissection of diseased internal mammary arteries. Cathet Cardiovasc Intervent 2002;57:363,366. © 2002 Wiley-Liss, Inc. [source] The Brain First or the Heart: The Approach to Revascularizing Severe Co-Existing Carotid and Coronary Artery DiseaseCLINICAL CARDIOLOGY, Issue 8 2009Raed Aqel MD Combined symptomatic severe cerebralvascular disease and significant obstructive coronary artery disease frequently exist.1,2 For the past few decades, clinicians have debated the various treatment strategies for these high-risk patients including staged procedures and hybrid revascularization. While some recommend addressing the more unstable vascular territory first, others prefer to intervene on the carotids prior to performing coronary revascularization. Both surgical and percutaneous options have been explored in various clinical settings, but there are no treatment guidelines to date. Given the frequency and magnitude of this problem, we performed an extensive review of the literature in an attempt to add some much needed clarity. An illustrative case and recommendations are provided. Copyright © 2009 Wiley Periodicals, Inc. [source] Coronary artery ectasia,Is it time for a reappraisal?CLINICAL CARDIOLOGY, Issue 5 2007P. Ramappa M.D. Abstract Coronary artery ectasia (CAE) is a well recognized clinical entity encountered during diagnostic cardiac catheterization. The etiopathogenesis of this condition is poorly understood. Due to the frequent presence of associated obstructive coronary artery disease it is considered to be a maladaptive process of atherosclerosis. Based on its association with aortic aneurysm, coronary ectasia is considered to be caused by genetic abnormalities. It is usually not a benign condition, as normal smooth laminar flow is disrupted with a potential of thrombus formation. The role of long-term anticoagulation in this condition has not been well established. It is speculated that with increasing use of newer, noninvasive modalities the incidence of ectasia may rise, therefore necessitating this review. Copyright © 2007 Wiley Periodicals, Inc. [source] Comparison of echocardiography and electron beam tomography in differentiating the etiology of heart failureCLINICAL CARDIOLOGY, Issue 6 2000Thuy Le M.D. Abstract Background: The clinical manifestations in patients with ischemic cardiomyopathy are often indistinguishable from those in patients with primary dilated cardiomyopathy (DCM). Clinicians often base work-up of patients with heart failure on echocardiographic wall motion abnormalities; however misclassification can lead to unnecessary coronary angiography. Hypothesis: The study was undertaken to evaluate the diagnostic ability of echocardiography and electron beam tomography (EBT) to differentiate between ischemic and nonischemic cardiomyopathy. Methods: The accuracy of EBT and echocardiography was compared in 111 patients undergoing coronary angiography for the evaluation of heart failure. The presence of coronary calcification (CC) by EBT or segmental wall motion abnormalities by echocardiography was used as evidence of coronary-induced cardiomyopathy. Results: Of 63 patients, 61 (97%) with obstructive coronary artery disease had CC by EBT. This sensitivity was significantly higher compared with 43 of 63 patients (68%) with segmental wall motion abnormalities by echocardiography (p < 0.001). Of 48 patients without obstructive coronary artery disease by angiography, 39 (81%) had no CC by EBT and 35 (73%) had no segmental wall motion (global hypokinesis) by echocardiography (p = 0.33). The overall accuracy of EBT to differentiate ischemic from nonischemic cardiomyopathy was 90%, significantly higher than echocardiography (70%, p < 0.001). Conclusion: This double-blind study demonstrates that the presence of CC by EBT is superior to that of segmental wall motion abnormalities by echocardiography to distinguish ischemic from nonischemic cardiomyopathy. This modality may prove to be an important diagnostic tool when the etiology of the cardiomyopathy is not clinically evident. [source] | ||||||||||