ABSTRACT
Background: the intravascular ultrasound [IVUS] is an invasive access technique that allows analysis of characteristics [qualitative and quantitative] of coronary atherosclerosis. Percutaneous coronary intervention [PCI] of complex lesions [i.e., American College of Cardiology/ American Heart Association class type C] remains challenging and the outcome may be compromised. The use of intravascular ultrasound [IVUS] to guide PCI was suggested to improve outcome
Objectives: aim of this study was to compare intravascular ultrasound-guided and angiography-guided Intervention for Type C coronary lesions regarding major adverse cardiac events [MACE]
Patients and Methods: Our study was conducted on patients undergoing elective PCI for type C coronary lesions in Cardiology Department in Ain Shams University hospitals. The study included 50 patients who underwent IVUS guidance PCI for Type C lesions and 50 patients who underwent only angiographic guidance PCI for Type C lesions. We evaluated the impact of IVUS guidance on clinical outcomes of patients undergoing PCI for complex lesions defined as ACC/AHA type C. Major adverse cardiovascular events [MACE], a composite end-point of all-cause mortality, Q-wave myocardial infarction and target lesion revascularization, were compared between the 2 groups. Mean follow-up duration was 12 months
Results: baseline clinical characteristics were similar in both patient groups. Adding IVUS to the procedure lengthened the procedure time. On the other hand, lower amount of radiographic contrast was required in the IVUS guided group during the procedure. Regarding the target coronary vessel in our study was similar in both groups with no significant difference. In addition, the number of ostial, proximal, mid and distal lesions was similar between the two studied groups. Patients with IVUS-guided PCI underwent more direct stenting, more postdilatation, larger maximal stent diameter and greater number of implanted stents. Consequently, the final diameter stenosis was significantly better in IVUS guided group. A strategy of routine IVUS for drug-eluting stent implantation in complex coronary lesions did not improve the 1-year MACE rates
Conclusion: use of intravascular ultrasound [IVUS] is associated with lower amount of radiographic contrast used during the procedure, more procedural time, more post dilatation and less postintervention final diameter stenosis. In addition, use of intravascular ultrasound [IVUS] in complex lesions allows proper assessment of minimal lumen area, optimizing PCI procedures and confirming stent well apposition
ABSTRACT
Background: vitamin D is a fat-soluble vitamin; it has skeletal and non-skeletal functions. The effect of Vitamin D on CV disease had several mechanisms including elevated PTH and Calcium-phosphate metabolism. It decreases the pro- remodeling of Angiotensin II on the cardiomyocytes
The Objectives: To study relation between serum levels of vitamin D and echocardiographic determinants of systolic and diastolic functions in patients with and without cardio-renal syndrome
Patients and Methods: Prospective study was conducted on 90 patients of all age groups and both sexes, admitted to Ain-Shams University hospital. The study included 3 groups of patients: Group 1: systolic dysfunction and renal insufficiency [30 patients], Group 2: systolic dysfunction only [30 patients]. Group 3: renal insufficiency only [30 patients], in addition 10 healthy controls were taken as controls. Patients were subjected to full comprehensive echocardiography and KFT with estimation of creatinine clearance, and Vitamin D level that was statistically studied against echocardiographic parameters of cardiac systolic and diastolic function
Results: Our study found that, compared to patients with normal vitamin D level, patients with vitamin D deficiency [defined as having vitamin D level <20 ng/ml] had significantly higher ventricular thickness [IVS, PW and mean wall thickness] [P value < 0.001], and higher LV mass which seems to be linked eventually to worse outcomes with no significant impact on worsening Diastolic dysfunction. A ROC curve was done revealing a sensitivity of 80% for the mean wall thickness [>/= 10 mm] to identify patients with vitamin D deficiency
Conclusion: Vitamin D deficiency was associated with ventricular hypertrophy with worsening outcomes with no impact on diastolic function