Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 8 Articles
Balloon aortic valvuloplasty is often used as a palliative measure or as a bridge to\ntranscatheter aortic valve replacement in the management of aortic stenosis in high\nrisk or inoperable patients. Severe aortic stenosis coexisting with coronary artery\ndisease is not uncommon. In these circumstances, adjuvant percutaneous coronary\nintervention may be warranted. The safety and efficacy of combined valve and coronary\nintervention strategies has been recently studied. An increased incidence of\ncomplications when both procedures are performed in the same setting may throw\nnew challenges. We report a case of fatal acute stent thrombosis following balloon\naortic valvuloplasty and percutaneous coronary intervention....
Background: The association of platelet reactivity and clinical outcomes, especially stent thrombosis, was not so\nclear. We sought to investigate whether high platelet reactivity affects clinical outcomes of patients with drug\neluting stents (DESs) implantation.\nMethods: All enrolled individuals treated with DESs implantation were evaluated by PL-11, using sequentially\nplatelet counting method. The primary end point was the occurrence of definite and probable stent thrombosis at\n2 years. The secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including\nall cause death, spontaneous myocardial infarction (MI), target vessel revascularization (TVR), and ischemic stroke.\nResults: A total of 1331consecutive patients were enrolled at our center. There were 91 patients (6.8 %) identified\nwith high platelet reactivity (HPR) on aspirin, and 437 patients (32.9 %) with HPR on clopidogrel. At 2-year followup,\nthe incidence of stent thrombosis was significantly higher in patients with HPR on aspirin (9.9 % vs. 0.4 %, p < 0.\n001), and HPR on clopidogrel (3.0 % vs. 0.1 %, p < 0.001). There were increased MACCE in the HPR on aspirin group\n(16.5 % vs. 8.5 %, p = 0.021), mainly driven by the higher all cause death (7.7 % vs. 1.6 %, p = 0.002) and MI (9.9 % vs.\n1.9 %, p < 0.001) in the HPR on aspirin group. Similarly, the rate of MACCE was higher in the HPR on clopidogrel\ngroup (12.4 % vs. 7.4 %, p = 0.004). No differences in all bleeding and hemorrhagic stroke were observed.\nConclusions: The present study demonstrated that high platelet reactivity on both aspirin and clopidogrel were\nassociated with incremental stent thrombosis following DESs implantation....
Background. Surgical correction of mitral regurgitation (MR) can lead to postoperative low cardiac output state. We aimed to\nassess the acute hemodynamic changes after percutaneous MitraClip therapy (a unique model without influence of factors linked\nto surgical procedure) in patients with functional MR without the influence of general anaesthesia. Methods. We studied invasive\nhemodynamic parameters in 23 patients before procedure (conscious, nonsedated patients), during procedure (intubated patients),\nand the first day after MitraClip implantation (conscious, extubated patients). Results. Mitral valve clipping significantly increased\ncardiac index (CI) (from 2.0 �± 0.5 to 3.3 �± 0.6 L/min/m2; ...
Background: Presence of microvascular obstruction (MVO) derived from cardiac magnetic resonance (CMR) imaging is\namong the strongest outcome predictors after ST-segment elevation myocardial infarction (STEMI). We aimed to\ninvestigate the comparative predictive values of different biomarkers for the occurrence of MVO in a large cohort of\nreperfused STEMI patients.\nMethods: This study included 128 STEMI patients. CMR imaging was performed within the first week after infarction to\nassess infarct characteristics, including MVO. Admission and peak concentrations of high-sensitivity cardiac troponin T\n(hs-cTnT), creatine kinase (CK), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein\n(hs-CRP), lactate dehydrogenase (LDH), aspartate transaminase (AST) and alanine transaminase (ALT) were measured.\nResults: MVO was detected in 69 patients (54%). hs-cTnT, CK, hs-CRP, LDH, AST and ALT peak concentrations showed\nsimilar prognostic value for the prediction of MVO (area under the curve (AUC) = 0.77, 0.77, 0.68, 0.79, 0.78 and 0.73, all\np > 0.05), whereas the prognostic utility of NT-proBNP was weakly lower (AUC = 0.64, p < 0.05). Combination of these\nbiomarkers did not increase predictive utility compared to hs-cTnT alone (p = 0.349).\nConclusions: hs-cTnT, CK, hs-CRP, LDH, AST and ALT peak concentrations provided similar prognostic value for the\nprediction of MVO. The prognostic utility of NT-proBNP was lower. Combining these biomarkers could not further\nimprove predictive utility compared to hs-cTnT alone....
Background: Platelet aggregation monitoring in diabetic patients treated with coronary interventions (PCI) for an\nacute coronary syndrome (ACS) is a promising way of optimizing treatment and outcomes in this high risk group.\nThe aim of the study was to verify whether clopidogrel response measured by Multiplate analyzer (ADPtest) in\ndiabetic ACS patients treated with PCI predicts the risk of stent thrombosis or cardiovascular mortality and bleeding.\nMethods: Into this prospective, observational study 206 elective PCI patients were enrolled. Two cutoff points of\nADPtest were used in analysis to divide patients into groups. One (345 AU x min) was calculated based on ROC\ncurve analysis; this cutoff provided the best ROC curve fit, although it did not reach statistical significance. The\nother (468 AU x min) was accepted based on the consensus of the Working Group on On-Treatment Platelet\nReactivity. The risk of stent thrombosis and mortality was assessed using Cox regression analysis and Kaplan-Meier\ncurves.\nResults: The risk of stent thrombosis was higher in the group of patients with impaired clopidogrel response for\neither cutoff value (for >354 AU x min - HR 12.33; 95% CI 2.49ââ?¬â??61.1; P = 0.002). Cardiovascular mortality was also\nhigher in the impaired clopidogrel response group (for >354 AU x min - HR 10.58; 95% CI 2.05ââ?¬â??54.58; P = 0.005).\nWe did not find a clear relation of increased clopidogrel response to the risk of bleeding.\nConclusions: The results of this study show that in diabetic ACS patient group treated with PCI an impaired\nplatelet response to clopidogrel measured by the Multiplate analyzer results in increased risk of stent thrombosis\nand cardiac death....
Coronary collateral circulation (CCC), an alternative blood supply for ischemic myocardium, improves survival rates among\npatients with coronary artery disease (CAD). However, there remains a lack of biomarkers to discriminate between patients with\npoor or good CCC. In this study, we aimed to observe the relationship between plasma microRNA-146a (miR-146a) levels and the\ncoronary collateral circulation (CCC). Additionally, we aimed to explore whether the plasma miR-146a level could serve as a bloodbased\nbiomarker for CCC in patients with CAD.Wemeasured the plasma levels of vascular endothelial growth factor A (VEGF-A)\nand miR-146a in patients with CCC by ELISA and real-time PCR, respectively, according to the Rentrop grades. The results showed\nthat the plasma miR-146a level is significantly increased in CAD patients with good CCC and significantly decreased in those with\npoor CCC. In contrast, although VEGFA expression in patients followed a similar trend as the CCC, the differences between the\ngroups were not statistically significant. There was a positive correlation between plasma miR-146a levels and the Rentrop grading.\nIn addition, receiver operator characteristic analysis showed that miR-146a could be a potent biomarker for identifying patients\nwith poor CCC....
The composition and condition of membrane lipids, the morphology of erythrocytes, and hemoglobin distribution were explored\nwith the help of laser interference microscopy (LIM) and Raman spectroscopy. It is shown that patients with cardiovascular diseases\n(CVD) have significant changes in the composition of their phospholipids and the fatty acids of membrane lipids. Furthermore,\nthe microviscosity of the membranes and morphology of the erythrocytes are altered causing disordered oxygen transport by\nhemoglobin. Basic therapy carried out with the use of antiaggregants, statins, antianginals, beta-blockers, and calcium antagonists\ndoes not help to recover the morphofunctional properties of erythrocytes. Based on the results the authors assume that, for the relief\nof the ischemic crisis and further therapeutic treatment, it is necessary to include, in addition to cardiovascular disease medicines,\nmedication that increases the ability of erythrocytes� hemoglobin to transport oxygen to the tissues. We assume that the use of\nLIM and Raman spectroscopy is advisable for early diagnosis of changes in the structure and functional state of erythrocytes when\ncardiovascular diseases develop....
Background: In Madagascar, the last study on sickle cell disease (SCD) was done in the early 1980s. The country is\nknown as endemic for malaria and respiratory infections. The main objective of this study was to estimate the\nprevalence of SCD; the secondary objective was to evaluate its association with malaria and respiratory infections.\nMethods: This is a cross-sectional study which was carried out in a rural village in the south east coast of\nMadagascar between May 2011 and November 2013. Participants were children aged between 2ââ?¬â??59 months\npresenting with fever measured by axillary temperature ââ?°Â¥37.5 Ã?°C at inclusion. Genotyping of haemoglobin S was\ndone by PCR and malaria was diagnosed by Rapid Diagnostic Test. Research for viral and atypical bacterial\nrespiratory pathogens was performed on nasopharyngeal swabs. Uni-and multivariate polytomous logistic\nregression was done to assess associations between microbiological results and SCD status, with HbAA phenotype\nas reference.\nResults: A total of 807 children were analysed. Prevalence of SCD among febrile children was 2.4% (95% CI, 1.5ââ?¬â??3.\n7%) and that of SCT was 23.8% (95% CI, 20.9ââ?¬â??26.9%). There was no difference in the prevalence of malaria infection\naccording to haemoglobin status (p = 0.3). Rhinovirus (22.5%), adenovirus (14.1%), and bocavirus (11.6%) were the\nmost common respiratory pathogens detected. After univariate analysis, patients with SCD were more frequently\ninfected by parechovirus (p = 0.01), while patients with SCT were more prone to RSV A or B infection (p = 0.01).\nAfter multivariate analysis, HbAS phenotype was associated with higher risk of RSV A and B infection compared to\nHbAA (adjusted OR = 1.9; 95% CI: 1.2ââ?¬â??3.1, p = 0.009), while HbSS phenotype was associated with higher risk of\nparechovirus infection (adjusted OR = 6.0; 95% CI: 1.1ââ?¬â??31.3, p = 0.03) compared to HbAA, independently of age,\ngender, period per quarter, and the other viruses.\nConclusion: The prevalence of SCD among under-five children presenting with fever was high in the study\npopulation. No association was found between SCT and malaria but few viruses, especially parechovirus, seem to\nplay an important role in the occurrence of pneumoniae among SCD patients....
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