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Coronary Patients (coronary + patient)

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Selected Abstracts

Biocompatibility of Heparin-Coated Cardiopulmonary Bypass Circuits in Coronary Patients With Left Ventricular Dysfunction Is Superior to PMEA-Coated Circuits

JOURNAL OF CARDIAC SURGERY, Issue 6 2006
Veysel Kutay M.D.
The aim of this study was to evaluate the clinical effectiveness and biocompatibility of heparin-coated and poly-2-methoxyethylacrylate (PMEA)-coated CPB circuits on coronary patients with left ventricular systolic dysfunction. Methods: Thirty-six patients who underwent elective coronary artery bypass grafting were divided into two equal groups: group H (n = 18), heparin-coated; group P (n = 18), PMEA coated. Clinical outcomes, hematologic variables, cardiac enzymes, malondialdehyde (MDA), and acute phase inflammatory response (including myeloperoxidase (MPO), catalase, hsCRP, and IL-8) were analyzed perioperatively. Results: Demographic, CPB, and clinical outcome data were similar for both groups. Plasma fibrinogen, total protein, albumin, and platelet count decreased, neutrophil count, MDA, IL-8, MPO, and catalase levels increased during CPB. During CPB, MPO and catalase values were significantly higher in group P (p = 0.02 and p = 0.01) and postoperative MDA concentration was lower in group H (p = 0.03). Platelet counts were better preserved in group H during and after CPB but neutrophil count and IL-8 level did not differ between the groups. Postoperative total protein, albumin, and fibrinogen levels were higher in group H (p < 0.05). The postoperative first day levels of troponin-I, CK-MB, and CRP increased in both groups without any significant differences between the groups. Conclusions: Heparin-coated circuit provided better suppression of perioperative inflammatory markers and exhibited more favorable effects on hematologic variables than PMEA-coated circuit. [source]

Relationship Between Heart Rate Turbulence and Heart Rate, Heart Rate Variability, and Number of Ventricular Premature Beats in Coronary Patients

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2004
IWONA CYGANKIEWICZ M.D., Ph.D.
Introduction: Heart rate variability (HRV) illustrates regulation of the heart by the autonomic nervous system whereas heart rate turbulence (HRT) is believed to reflect baroreflex sensitivity. The aim of this study was to determine the association between HRT and HRV parameters and the relationship between HRT parameters and heart rate and number of ventricular premature beats (VPBs) used to calculate HRT parameters. Methods and Results: In 146 patients (117 males and 29 females; mean age 62 years) with coronary artery disease, a 24-hour ECG Holter monitoring was performed to calculate mean heart rate (RR interval), number of VPBs, time- and frequency-domain HRV parameters and two HRT parameters: turbulence onset (TO) and turbulence slope (TS). Univariate and multivariate regression analyses were performed to evaluate the association between tested parameters. Significant correlation between TS and mean RR interval was observed (r = 0.42; p < 0.001), while no association for TO vs. RR interval was found. TS values were significantly higher in patients with less than 10 VPBs/24 hours than in patients with more frequent VPBs. Significant associations between HRT and HRV parameters were found with TS showing stronger correlation with HRV parameters than TO (r value ranging from 0.35 to 0.62 for TS vs. ,0.16 to ,0.38 for TO). Conclusion: HRT parameters correlate strongly with HRV parameters indicating that HRT should be considered as a reflection of both baroreceptors response and overall autonomic tone. Heart rate dependence of turbulence slope indicates the need to adjust this parameter for heart rate. (J Cardiovasc Electrophysiol, Vol. 15, pp. 731-737, July 2004) [source]

Biocompatibility of Heparin-Coated Cardiopulmonary Bypass Circuits in Coronary Patients With Left Ventricular Dysfunction Is Superior to PMEA-Coated Circuits

The Role of Intra-Aortic Counterpulsation in High-Risk OPCAB Surgery:

JOURNAL OF CARDIAC SURGERY, Issue 4 2003
A Prospective Randomized Study
This prospective and randomized study evaluates the efficacy and safety of pre- and perioperative IABC in high-risk OPCAB. Material: Group A,IABC started prior to induction of anesthesia (n = 15); group B,no preoperative IABC (n = 15). Adult high-risk coronary patients to undergo OPCAB. High risk = (minimum 2) EF < 0.30, left main stenosis, unstable angina, redo. Bailout if hemodynamic instability CPB or IABC in group B. Study endpoints (a) cardiac protection (troponin 1, cardiac index (CI), ECG), (b) inflammatory response (lactate, IL-6), (c) clinical outcome (mortality, morbidity). Emergency operations 33%, re-operation 13%, unstable angina 100%, left main 60% and EF 0.29, without group differences. Results: No bailout group A, 10 in group B, p < 0.0001. Postoperative IABC six (group A) and seven patients (group B), during 6.8 ± 5.1 hours (group A) versus 41.2 ± 25.5 hours (group B), p = 0.0110. Myocardial protection without group differences, but CI significantly better in group A. Inflammatory response significantly less in group A. Clinical outcomes: one death, one MI and two renal failure in group B, none in group A. Intensive care unit (ICU) stay 27 ± 3 hours (group A) versus 65 ± 28 hours (group B), p = 0.0017. LOS 8 ± 2 days (group A) versus 15 ± 10 (group B), p = 0.0351. No IABC related complications. Conclusions: Pre- and perioperative IABC therapy offers efficient hemodynamic support during high-risk OPCAB surgery, lowers the risk of hemodynamic instability, is safe and shortens both ICU and hospital length of stay significantly, and is a cost-effective therapy. (J Card Surg 2003; 18:286-294) [source]

Direct adsorption of low-density lipoprotein and lipoprotein(a) from whole blood: Results of the first clinical long-term multicenter study using DALI apheresis,

JOURNAL OF CLINICAL APHERESIS, Issue 4 2002
T. Bosch
Abstract Direct adsorption of lipoproteins (DALI) is the first low-density lipoprotein (LDL)-apheresis technique by which atherogenic LDL and lipoprotein(a) (Lp(a)) can be selectively removed from whole blood without plasma separation. The present study was performed to evaluate the efficacy, selectivity and safety of long-term DALI apheresis. Sixty-three hypercholesterolemic coronary patients were treated by weekly DALI sessions. Initial LDL-cholesterol (C) plasma levels averaged 238 ± 87 mg/dl (range 130,681 mg/dl). On average, 34 sessions (1,45) were performed processing 1.5 patient blood volumes. The primary aim was to acutely reduce LDL-C by ,60% per session. To this end, three different adsorber sizes could be employed, i.e., DALI 500, 750, and 1,000, which were used in 4, 73, and 23% of the 2,156 sessions, respectively. On average, 7,387 ml of blood were processed in 116 min per session. This resulted in the following mean acute changes: LDL-C 198 , 63 mg/dl (,69%), Lp(a) 86 , 32 mg/dl (,64%), triglycerides 185 , 136 mg/dl (,27%). HDL-C (,11%) and fibrinogen (,15%) were not significantly influenced. The mean long-term reduction of LDL-C was 42% compared to baseline while HDL-C slightly increased in the long run (+4%). The selectivity of LDL removal was good as recoveries of albumin, immunoglobulins, and other proteins exceeded 85%. Ninety-five percent of 2,156 sessions were completely uneventful. The most frequent adverse effects were hypotension (1.2% of sessions) and paresthesia (1.1%), which were probably due to citrate anticoagulation. Access problems had to be overcome in 1.5%, adsorber and hardware problems in 0.5% of the sessions. In this multicenter long-term study, DALI apheresis proved to be an efficient, safe, and easy procedure for extracorporeal LDL and Lp(a) elimination. J. Clin. Apheresis 17:161,169, 2002. © 2002 Wiley-Liss, Inc. [source]

The Prognostic Value of Combined Fractional Flow Reserve and TIMI Frame Count Measurements in Patients with Stable Angina Pectoris and Acute Coronary Syndrome

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2010
ALI M. ESEN M.D.
Background:,The aim of this study was to evaluate the prognostic value of different fractional flow reserve (FFR) cutoff values and corrected thrombolysis in myocardial infarction frame (TIMI) count (CTFC) measurements in a series of consecutive patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction, and/or positive noninvasive functional test findings. Methods:,We included 162 consecutive coronary patients in whom revascularization of a moderate coronary lesion was deferred based on a FFR value ,0.75. Patients were divided according to the results of the intracoronary pressure and flow measurements into four groups: group A: 0.75 , FFR , 0.85 and CTFC > 28 (n=22), group B: 0.75 , FFR , 0.85 and CTFC , 28 (n = 55), group C: 0.85 < FFR and CTFC > 28 (n = 19), and group D: 0.85 < FFR and CTFC , 28 (n = 66). Adverse cardiac events and the presence of angina were evaluated at follow-up. Results:,At a mean follow-up of 18 ± 10 months, cardiac event rate in patients with 0.75 , FFR , 0.85 and FFR > 0.85 were 22% and 9%, respectively (P = 0.026) and also, a trend was observed toward a higher cardiac event rate in case of an abnormal CTFC (CTFC > 28) compared to a normal CTFC (24% vs 12%, P = 0.066). Furthermore, a significantly higher cardiac event rate was observed when group A was compared to group D (31.8% vs 7.6%, respectively, P = 0.004). Conclusion:,Patients with potential microvascular dysfunction and borderline FFR values should be interpreted with caution, and management strategies should be guided not only by pressure measurement, but also by possibly supplementary clinical risk stratification and noninvasive tests. (J Interven Cardiol 2010;23:421,428) [source]

Interpretation of radial pulse contour during fentanyl/nitrous oxide anesthesia and mechanical ventilation

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2002
S. Söderström
Background: Peripheral arterial blood pressure is not a reliable substitute for proximal aortic pressure. Recognition of this phenomenon is important for correct appreciation of cardiac afterload. Our aim was to evaluate the utility of the radial pulse wave to better understand ventriculo-vascular coupling during anesthesia. Methods: We observed the differences between aortic systolic pressure (AoSAP, tipmanometry) and radial systolic pressure in 15 patients, (including two women) aged 53,78 years, before coronary artery bypass surgery. We studied the induction of anesthesia with fentanyl (20 µg kg,1), moderate volume loading, and thereafter the addition of 70% nitrous oxide. The circulatory effects of mechanical ventilation were studied by doubling the tidal volumes. Pulse wave contours were assessed by calculation of radical and aortic augmentation indices (AI), which measure the second systolic pressure peak. Results: Radial systolic pressure was higher than AoSAP in the control situation (8±2 mmHg), and this SAP gradient increased further with fentanyl (12±2 mmHg). The gradient persisted throughout the study, but was partially reduced by volume loading and nitrous oxide, respectively. Radial augmentation index was the only parameter remaining in a stepwise multivariate model to explain the variance in the SAP gradient (r2=0.48). Radial augmentation index also correlated with aortic pulse pressure (r2=0.71). Mechanical ventilation had significant and similar effects on pulse wave augmentation both in the aorta and in the radial artery, and did not affect the radial to aortic SAP gradient. Conclusion: These elderly coronary patients had stiff vasculature (high aortic AI) and considerable pulse wave reflection, which was beneficially delayed by fentanyl. Changes in the radial pulse wave augmentation during mechanical ventilation were mainly a result of cyclic changes in the stroke volume, and were seldom associated with an increased systolic pressure gradient from the aorta to the radial artery. [source]

Long term effects of exercise training on physical activity level and quality of life in elderly coronary patients , A three- to six-year follow-up

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2003
Camilla Hage
Abstract Background and Purpose Physical activity and exercise as part of cardiac rehabilitation after an acute coronary event improves exercise capacity and quality of life in most patients. The aim of the present study was to evaluate physical activity level, health-related quality of life (HRQL) and perceived health three to six years after an acute myocardial infarction or an episode of unstable angina pectoris in elderly patients and compare this to earlier follow-up examination data. Method Study design: three to six years (mean 4.4 years) after randomization a questionnaire about physical activity level, HRQL and perceived health was mailed to all subjects alive (n = 93) (response rate 96 Results Since the one-year follow-up examination eight subjects had died: five in the intervention group and three in the control group. At randomization, the level of physical activity level was similar in the two groups. Those in the intervention group improved their level of physical activity significantly over time (p = 0.05) in contrast to the control group. Measurements of HRQL showed no statistical difference between the groups by use of the EuroQol instrument. However, a small advantage for the intervention group measured over time was noted. Conclusion It is important to include elderly patients in cardiac rehabilitation programmes after an acute coronary event, since even a short period of supervised exercise training has the potential to positively influence physical activity level for as long as three to six years. Copyright © 2003 Whurr Publishers Ltd. [source]

Platelet CD62 expression and PDGFAB secretion in patients undergoing PTCA and treatment with abciximab

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 6 2001
J. Graff
Aims, To investigate a correlation of the platelet activation marker CD62 and secretion of the growth factor PDGF from platelets in coronary patients under therapy with the GPIIb/IIIa-inhibitor abciximab. Methods, Flow cytometric assessment of fibrinogen binding (GPIIb/IIIa-binding site) and CD62 expression, as well as PDGF release of human platelets (immunoassay) and platelet aggregation with 20 µm ADP and 2 µg ml,1 collagen were evaluated in nine patients with stable coronary artery disease. Patients were undergoing elective balloon angioplasty and were treated with aspirin (100 mg day,1), heparin (ACT < 220 s) and abciximab (bolus and infusion over 12 h). Blood samples were obtained before initiation of abciximab therapy (under aspirin and heparin) (I), 3 h after angioplasty under abciximab (II) and 12 h after termination of abciximab infusion (III). Results, Compared with sample I before abciximab therapy, fibrinogen binding was reduced to 37% (± 34 s.d., P < 0.05) (II) and 55% (± 40 s.d., P < 0.05) (III). Reduced fibrinogen binding also led to a significant reduction of the aggregation response to ADP (down to 37% ± 20) and collagen (down to 0%). Mean fluorescence intensity of CD62-expression was 78 units (± 20 s.d.) (I), 72 units (± 14 s.d.) (II) and 64 units (± 12 s.d., P < 0.05) (III). PDGF release from isolated, washed platelets was 99 (± 33 s.d.) ng/109 platelets at (I), 82 (± 31 s.d.) ng/109 platelets and 96 (± 30 s.d.) ng/109 platelets. Conclusions, The results indicate that despite a strong reduction of GPIIb/IIIa-binding and platelet aggregation, CD62 as a marker of platelet secretion and the secretion product PDGF were only slightly reduced under abciximab treatment. No direct correlation between CD62 expression and PDGF release could be demonstrated. [source]

The impact of micro troponin leak on long-term outcomes following elective percutaneous coronary intervention,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2009
Richard V. Milani MD
Abstract Objective: To evaluate the clinical impact of microleaks of troponin, which are below the reference standard defining troponin elevation, on cardiovascular outcomes in stable coronary patients undergoing elective percutaneous coronary intervention (PCI). Background: Troponin elevation, either pre- or post-PCI, has been shown to predict poor cardiovascular outcomes. However, troponin measurements that are above the limit of detection but below the 99th percentile limit defining elevation ("microleak") have uncertain clinical significance. Methods: We assessed subsequent myocardial infarction (MI) and death over a mean follow-up of 4.2 years in 2,272 patients undergoing elective PCI, where baseline troponins were normal and follow-up troponins were obtained 12,24 hr post-PCI. Patients were divided into three groups based on post-PCI troponin levels: Group 1 (n = 1,313) nondetectable; group 2 (n = 587) microleak, and group 3 (n = 372) elevated suggesting myocardial necrosis. Results: The combined endpoint of MI and death was similar in groups 2 and 3 (50.3 vs. 51.9%, respectively, P = NS), which was significantly more than group 1 patients (35.6%, P < 0.01) over the follow-up period. Multivariate analysis of patients in groups 1 and 2 demonstrated that troponin microleak was an independent predictor of MI and death (P = 0.01). Conclusions: Microleak of troponin following elective PCI suggests myocardial injury and predicts an increased risk of subsequent MI and death. Troponins should be routinely assessed following PCI, and preventive therapies are needed to reduce micro and macro troponin elevation in the PCI setting. © 2009 Wiley-Liss, Inc. [source]

Oral antidiabetic treatment in patients with coronary disease: Time-related increased mortality on combined glyburide/metformin therapy over a 7.7-year follow-up

CLINICAL CARDIOLOGY, Issue 2 2001
Enriqe Z. Fisman M.D.
Abstract Background: A sulfonylurea ,usually glyburide,plus metformin constitute the most widely used oral antihyperglycemic combination in clinical practice. Both medications present undesirable cardiovascular effects. The issue whether the adverse effects of each of these pharmacologic agents may be additive and detrimental to the prognosis for coronary patients has not yet been specifically addressed. Hypothesis: This study was designed to examine the survival in type 2 diabetics with proven coronary artery disease (CAD) receiving a combined glyburide/metformin antihyperglycemic treatment over a long-term follow-up period. Methods: The study sample comprised 2,275 diabetic patients, aged 45,74 years, with proven CAD, who were screened but not included in the bezafibrate infarction prevention study. In addition. 9,047 nondiabetic patients with CAD represented a reference group. Diabetics were divided into four groups on the basis of their therapeutic regimen: diet alone (n = 990), glyburide (n = 953), metformin (n = 79), and a combination of the latter two (n = 253). Results: The diabetic groups presented similar clinical characteristics upon recruitment. Crude mortality rate after a 7.7-year follow-up was lower in nondiabetics (14 vs. 31.6%, p<0.001). Among diabetics, 720 patients died: 260 on diet (mortality 26.3%). 324 on glyburide (34%), 25 on metformin alone (31.6%), and 111 patients (43.9%) on combined treatment (p<0.000001). Time-related mortality was almost equal for patients on metformin and on combined therapy over an intermediate follow-up period of 4 years (survival rates 0.80 and 0.79, respectively). The group on combined treatment presented the worst prognosis over the long-term follow-up, with a time-related survival rate of 0.59 after 7 years, versus 0.68 and 0.70 for glyburide and metformin, respectively. After adjustment to variables for prognosis, the use of the combined treatment was associated with an increased hazard ratio (HR) for all-cause mortality of 1.53 (95% confidence interval [CI] 1.20,1.96), whereas glyburide and metformin alone yielded HR 1.22 (95% CI 1.02,1.45) and HR 1.26 (95% CI 0.81,1.96), respectively. Conclusions: We conclude that after a 7.7-year follow-up, monotherapy with either glyburide or metformin in diabetic patients with CAD yielded a similar outcome and was associated with a modest increase in mortality. However, time-related mortality was markedly increased when a combined glyburide/metformin treatment was used. [source]