Subject(s)
Cardiac Catheterization/instrumentation , Electrophysiologic Techniques, Cardiac , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Imaging, Three-Dimensional , Mitral Valve/surgery , Surgery, Computer-Assisted/instrumentation , Action Potentials , Echocardiography, Three-Dimensional , Heart Rate , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Predictive Value of Tests , Prosthesis Design , Treatment OutcomeABSTRACT
AIMS: The primary patency of superficial femoral artery (SFA) stents is evaluated by measuring PSVR. However, each trial uses a different definition of PSVR. We investigated the impact of changing PSVR thresholds on the patency rates of SFA recanalisation with self-expanding nitinol stents. METHODS AND RESULTS: A single-centre retrospective study was conducted. Between 2003 and 2006, 76 consecutive patients (83 limbs) were treated using nitinol self-expanding stents for SFA disease. Primary patency was defined as categories 1 (PSVR <2.0), 2 (PSVR <2.4) and 3 (PSVR <2.85). The mean follow-up time was 51±27 months. For one, five, and seven years, Kaplan-Meier estimates for primary patency rates were 62.6%, 36.8%, and 27.6%, respectively, in category 1; 75.2%, 46.5%, and 37.1%, respectively, in 2; and 75.2%, 46.1%, and 46.1%, respectively, in 3. The primary patency between categories 1 and 3 (p=0.038) was significantly different. No difference was observed between categories 2 and 3 (p=0.786), and a trend for differences was observed between categories 1 and 2 (p=0.069). CONCLUSIONS: PSVR definition may influence the reported long-term patency rate of a SFA stent. We should consider the definition of restenosis in each trial.
Subject(s)
Alloys , Femoral Artery , Stents , Vascular Patency/physiology , Aged , Aged, 80 and over , Constriction, Pathologic , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Vascular Patency/drug effectsABSTRACT
AIMS: The aims of this study were to evaluate the effects of renal stenting on cardiac function using echocardiographic parameters, and to clarify whether changes in clinical and echocardiographic variables after renal stenting differ between atherosclerotic renal artery stenosis (ARAS) patients with and without cardiac symptoms. METHODS AND RESULTS: A total of 61 patients who underwent renal stenting and echocardiography were included in the study. Left ventricular (LV) filling pressure and LV relaxation were evaluated with tissue Doppler imaging. The ratio of the peak early diastolic mitral inflow velocity to the peak early mitral annular velocity (E/e' ratio) and the e'-velocity were measured to assess diastolic function. LV ejection fraction remained unchanged, but the E/e' ratio (P<0.001) and the e'-velocity (P=0.004) improved after renal stenting. In particular, the E/e' ratio improved from 13.7±5.6 to 11.9±4.0 (P=0.002) within 24 hours after renal stenting and remained low at 11.2±3.8 after a mean follow-up period of 7±4 months (P=0.001). Patients with cardiac symptoms showed significantly better change in E/e' ratio (P=0.002) and E-velocity (P=0.005) compared to those without cardiac symptoms. Cardiac symptoms also significantly improved after renal stenting (New York Heart Association functional class: 2.5±0.6 at baseline to 1.4±0.6 at follow-up; P<0.001). CONCLUSIONS: Renal stenting improved echocardiographic parameters that reflect LV diastolic function, and yielded a higher benefit for E/e' ratio and E-velocity in patients with cardiac symptoms than in those without cardiac symptoms.
Subject(s)
Echocardiography , Renal Artery Obstruction/physiopathology , Renal Artery Obstruction/therapy , Stents , Ventricular Function, Left , Aged , Aged, 80 and over , Diastole , Female , Humans , Male , Middle AgedABSTRACT
OBJECTIVES: The value of renal duplex ultrasonography for the detection of angiographical renal artery stenosis (RAS) has been demonstrated in many clinical studies. None of the published studies, however, have adequately scrutinized the performance of this modality for the detection of hemodynamically significant RAS. The purpose of this study is to investigate the correlation and accuracy between renal duplex parameters and translesional pressure gradient (TLPG). METHODS: A total of 60 patients, with 75 stenotic lesions in the renal arteries determined by angiography, underwent duplex ultrasonography before angiography and the measurement of TLPG using a 0.014'' pressure wire in the single setting of angiography were prospectively included. Peak systolic velocity (PSV) in the renal artery and a ratio of PSV in the renal artery to the aorta (RAR) were examined as duplex ultrasonography parameters. Angiographical stenosis was evaluated by percent diameter stenosis (%DS) derived from quantitative angiographic analysis. RESULTS: The correlation with TLPG proved to be stronger in the following order, PSV (r = 0.743, P < 0.001), %DS (r = 0.701, P < 0.001), and RAR (r = 0.572, P < 0.001). The best performing parameter for TLPG of 20 mm Hg was revealed to be PSV, as the areas under the receiver operator characteristics curves using %DS, PSV, and RAR were 0.888, 0.939, and 0.834, respectively. A PSV cutoff value of 219 cm/sec provided the best predictive value with a sensitivity of 89%, a specificity of 89%, and an accuracy of 89%. The positive predictive value was 83% and the negative predictive value was 93%. CONCLUSIONS: The measurement of PSV is not only noninvasive but also highly accurate in detecting patients who have hemodynamically significant RAS. The authors emphasize that an enthusiastic application of renal duplex ultrasonography, particularly the measurement of PSV, is warranted.
