Clinical Outcomes After Implantation of Polyurethane-Covered Cobalt-Chromium Stents: Insights from the Papyrus-Spain Registry.

BACKGROUND/PURPOSE: The main indication of covered stents (CS) is coronary artery perforation (CAP), but, they have been increasingly used in other scenarios. Data on the long-term follow-up of CS is limited, and no studies have been conducted specifically using new-generation polyurethane-covered cobalt-chromium Papyrus CS. PURPOSE: to evaluate the clinical outcomes after hospital discharge of Papyrus CS and to compare their outcome after implantation in CAP or coronary artery aneurysms (CAA). METHODS/MATERIALS: We evaluated the baseline clinical characteristics, lesion subsets, procedural features and the outcomes after initial discharge of Papyrus CS implanted in 17 high-PCI-volume centers. RESULTS: 127 Papyrus CS were implanted in 108 patients (68 ±â€¯1 years; 82.8% male) admitted for stable coronary disease (32.3%), NSTEMI (42.4%) or STEMI (25.3%). The number of CS per patient was 1.2 ±â€¯0.6 (diameter: 3.5 ±â€¯1.7 mm; length: 18.5 ±â€¯3.7 mm). Angiographic success rate was 96%. CS diameter was larger in CAA (CAP:3.04 ±â€¯0.5 mm vs CAA:4.1 ±â€¯2.7 mm; p = .022). Intracoronary imaging techniques were used more frequently in CAA (p < .0001). After a mean follow-up of 22 ±â€¯16 months, the major cardiovascular adverse events (MACE) rate was 7.1% [cardiac death: 2%, Myocardial infarction: 5%, Target Lesion Revascularization: 5% and Stent Thrombosis (ST): 3%]. MACE rate was similar in CAP (7.7%) and CAA (7.1%) (p = .9). However, CAA showed a higher ST rate (CAP: 0% vs CA: 7.1%; p = .04). CONCLUSION: After hospital discharge, clinical outcomes after Papyrus CS implantation are acceptable (considering the clinical scenario and compared with other treatment alternatives) with no significant differences in the MACE rate between those implanted in CAA or in CAP. However, CAA group showed a higher ST rate.

Mejora de la isquemia miocárdica reduciendo el flujo venoso / Myocardial ischemia amelioration reducing venous outflow

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Estrategias para reducir el tiempo de reperfusión en el tratamiento con angioplastia primaria / Strategies for reducing the time to reperfusion with primary angioplasty

La terapia de reperfusión ha supuesto un notable descenso de la morbimortalidad hospitalaria y a largo plazo de los pacientes con infarto agudo de miocardio. En los últimos años, se ha demostrado que la angioplastia es más eficaz que la fibrinolisis siempre que se realice en un intervalo de tiempo adecuado. Sin embargo, la angioplastia primaria no es el tratamiento mayoritariamente utilizado debido a que requiere una infraestructura adecuada y una organización muy eficiente. Para incrementar el uso de la angioplastia primaria y homogeneizar el tratamiento de los pacientes con infarto agudo de miocardio hemos revisado las principales barreras del circuito de la angioplastia primaria. Se describen diferentes estrategias que permiten acortar el tiempo puerta-balón y distintos programas de carácter nacional, regional y local que han facilitado el acceso a la angioplastia primaria y han mejorado los tiempos de reperfusión (AU)

Reperfusion therapy has led to significant reductions in in-hospital and long-term morbidity and mortality in patients with acute myocardial infarction. In recent years, it has been shown that angioplasty is more effective than fibrinolysis if it can be carried out within a short enough timescale. Nevertheless, angioplasty is not widely used because it requires a dedicated infrastructure and highly efficient organization. In order to increase access to primary angioplasty and to standardize treatment for patients with acute myocardial infarction, we carried out a review of the main hurdles to the use of primary angioplasty. This article describes the various strategies available for reducing the door-to-balloon time and reviews national, regional and local programs that have increased access to primary angioplasty and improved the time to reperfusion (AU)

Cardiac phase extraction in IVUS sequences using 1-D Gabor filters.

A main issue in the automatic analysis of Intravascular Ultrasound (IVUS) images is the presence of periodic changes provoked by heart motion during the cardiac cycle. Although the Electrocardiogram (ECG) signal can be used to gate the sequence, few IVUS systems incorporate the ECG-gating option, and the synchronization between them implies several issues. In this paper, we present a fast and robust method to assign a phase in the cardiac cycle to each image in the sequence directly from in vivo clinical IVUS sequences. It is based on the assumption that the vessel wall is significantly brighter than the blood in each IVUS beam. To guarantee stability in this assumption, we use normalized reconstructed images. Then, the wall boundary is extracted for all the radial beams in the sequence and a matrix with these positions is formed. This matrix is filtered using a bank of 1-D Gabor filters centered at the predominant frequency of a given number of windows in the sequence. After filtering, we combine the responses to obtain a unique phase within the cardiac cycle for each image. For this study, we gate the sequence to make the sequence comparable with other ones of the same patient. The method is tested with 12 pullbacks of real patients and 15 synthetic tests.

Using reconstructed IVUS images for coronary plaque classification.

Coronary plaque rupture is one of the principal causes of sudden death in western societies. Reliable diagnostic of the different plaque types are of great interest for the medical community the predicting their evolution and applying an effective treatment. To achieve this, a tissue classification must be performed. Intravascular Ultrasound (IVUS) represents a technique to explore the vessel walls and to observe its histological properties. In this paper, a method to reconstruct IVUS images from the raw Radio Frequency (RF) data coming from ultrasound catheter is proposed. This framework offers a normalization scheme to compare accurately different patient studies. The automatic tissue classification is based on texture analysis and Adapting Boosting (Adaboost) learning technique combined with Error Correcting Output Codes (ECOC). In this study, 9 in-vivo cases are reconstructed with 7 different parameter set. This method improves the classification rate based on images, yielding a 91% of well-detected tissue using the best parameter set. It also reduces the inter-patient variability compared with the analysis of DICOM images, which are obtained from the commercial equipment.

Statistical strategy for anisotropic adventitia modelling in IVUS.

Vessel plaque assessment by analysis of intravascular ultrasound sequences is a useful tool for cardiac disease diagnosis and intervention. Manual detection of luminal (inner) and media-adventitia (external) vessel borders is the main activity of physicians in the process of lumen narrowing (plaque) quantification. Difficult definition of vessel border descriptors, as well as, shades, artifacts, and blurred signal response due to ultrasound physical properties trouble automated adventitia segmentation. In order to efficiently approach such a complex problem, we propose blending advanced anisotropic filtering operators and statistical classification techniques into a vessel border modelling strategy. Our systematic statistical analysis shows that the reported adventitia detection achieves an accuracy in the range of interobserver variability regardless of plaque nature, vessel geometry, and incomplete vessel borders.

Increased exercise capacity after surgically induced weight loss in morbid obesity.

OBJECTIVE: To investigate the effects of surgically induced weight loss on exercise capacity in patients with morbid obesity (MO). RESEARCH METHODS AND PROCEDURES: A prospective 1-year follow-up study was carried out, with patients being their own controls. A symptom-limited cardiopulmonary exercise stress test was performed in 31 MO patients (BMI > 40 kg/m2) before and 1 year after undergoing bariatric surgery. RESULTS: At 1 year after surgery, weight was reduced from 146 +/- 33 to 95 +/- 19 kg (p < 0.001), and BMI went from 51 +/- 4 to 33 +/- 6 kg/m2 (p < 0.001). After weight loss, obese patients performed each workload with lower oxygen consumption, heart rate, systolic arterial pressure, and ventilatory volume (p < 0.001). This reduced energy expenditure allowed them to increase the duration of their effort test from 13.8 +/- 3.8 to 21 +/- 4.2 minutes (p < 0.001). Upon finishing the exercise, MO patients before surgery were able to reach only 83% of their age-predicted maximal heart rate, and their respiratory exchange ratio was 0.87 +/- 0.06. After weight loss, those values were 90% and 1 +/- 0.08, respectively (p < 0.01). When we compared the peak O2 pulse corrected by fat free mass before and after surgery, no significant differences between the groups were found. DISCUSSION: After surgically induced weight loss, MO patients markedly improved their exercise capacity. This is due to the fact that they were able to perform the external work with lower energy expenditure and also to increase cardiovascular stress, optimizing the use of cardiac reserve. There were no differences in cardiac function before and after surgery.

[Cardiopulmonary function and exercise capacity in patients with morbid obesity]. / Función cardiopulmonar y capacidad de ejercicio en pacientes con obesidad mórbida.

INTRODUCTION AND OBJECTIVES: The effect of obesity on cardiac function is still under discussion. The objective of this study was to assess cardiopulmonary capacity in morbidly obese patients. Patients and method. A symptom-limited cardiopulmonary exercise stress test was carried out in 31 morbidly obese patients (BMI 50 9 kg/m2) and 30 normal controls (BMI 24 2 kg/m2. Cardiovascular function was evaluated using the oxygen pulse (oxygen uptake/heart rate). RESULTS: There were no differences in age, sex and height between both groups. During the effort the obese subjects presented greater oxygen uptake, heart rate, systolic arterial pressure and minute ventilation and shorter test duration than control group (14 3 vs 27 4 min; p < 0.001). Oxygen pulse values were higher in obese patients. However, after oxygen uptake indexation by fat free mass, these differences disappeared, suggesting a similar cardiovascular function. At the end of the exercise, the control group reached 96% of their age-predicted maximal heart rate and their respiratory exchange ratio was 1 0.2. Obese patients only reached 86% and 0.87 0.2, respectively. CONCLUSIONS: Due to their need of more energy output to move total body mass morbidly obese patients have a reduced exercise capacity. They finish the test having done a submaximal exercise. However, during this effort they show a normal cardiopulmonar capacity.

Función cardiopulmonar y capacidad de ejercicio en pacientes con obesidad mórbida / Cardiopulmonary function and exercise capacity in patients with morbid obesity

Introducción y objetivos. La repercusión de la obesidad sobre la función cardíaca es motivo de controversia. El propósito del presente estudio ha sido determinar la capacidad cardiopulmonar en pacientes con obesidad mórbida. Pacientes y método. Hemos realizado una ergoespirometría limitada por síntomas a 31 pacientes con obesidad mórbida (IMC 50 ñ 9 kg/m2) y a 30 individuos como grupo control (IMC 24 ñ 2 kg/m2). La función cardiovascular ha sido valorada mediante el pulso de oxígeno (consumo de oxígeno/frecuencia cardíaca).Resultados. No existían diferencias en edad, sexo y talla entre ambos grupos. Durante el esfuerzo, los sujetos obesos presentaron un consumo de oxígeno, frecuencia cardíaca, presión arterial sistólica y ventilación por minuto significativamente más elevados que el grupo control, con menor duración de la prueba (14 ñ 3 frente a 27 ñ 4 min; p < 0,001). Los valores de pulso de oxígeno fueron más altos en los pacientes obesos. Sin embargo, tras corregir el consumo de oxígeno por la masa magra, las diferencias en el pulso de O2 desaparecieron, demostrando una función cardiovascular similar. Al final del ejercicio, el grupo control alcanzó el 96 por ciento de su frecuencia cardíaca máxima teórica y su cociente respiratorio fue de 1 ñ 0,2. Los pacientes obesos sólo alcanzaron el 86 por ciento de la frecuencia cardíaca máxima teórica y su cociente respiratorio fue de 0,87 ñ 0,2.Conclusiones. Los pacientes con obesidad mórbida tienen una capacidad de trabajo reducida debido al gran consumo energético que realizan al mover su masa corporal. Finalizan la prueba habiendo realizado un esfuerzo submáximo. No obstante, durante este esfuerzo demuestran una capacidad cardiopulmonar normal (AU)