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OBJECTIVES: The study evaluated the association between distance from radiation source and radiation exposure. BACKGROUND: Radiation exposure during medical procedures is associated with increased risk of cancer and other adverse effects. METHODS: An American National Standards Institute phantom was used to study the relationship between measured entrance surface exposure (MESE) and distance from the X-ray source in postero-anterior, left anterior oblique, and right anterior oblique projections. Three distance settings for table height were evaluated with "low" defined as 52 cm, "mid" 66 cm, and "high" 80 cm from the focal point of the X-ray source. Air-kerma and dose-area product measurements were recorded. Operator exposure with each of these conditions was measured, in a short operator (150 cm) as well as in a tall operator (190 cm). RESULTS: Aggregate results for the three projections were as follows. MESE (µGy/frame) significantly decreased as table-height increases (median, interquartile range, p-value) (low table-height 192.5 [122.4-201.2], mid table-height 105.8 [82.7-115.8], and high table-height 71.7 [58.4-75], p < .0005). The operator exposure (µGy/frame), significantly increased as the table-height increased (low table-height 0.0943 [0.0598-0.1157], medium table-height 0.1128 [0.0919-0.1397], and high table-height 0.158 [0.1339-0.2165], p < .0005). A shorter operator received higher radiation exposure compared to a taller operator (short operator 0.1405 [0.1155-0.1758] and tall operator 0.0995 [0.0798-0.1212], p < .0005). CONCLUSIONS: Increasing table-height is associated with a significant decrease in MESE. Operator radiation exposure increases with increasing table-height and shorter operators receive greater radiation exposure compared to taller operators.
Subject(s)
Occupational Exposure , Radiation Exposure , Fluoroscopy , Humans , Occupational Exposure/adverse effects , Radiation Dosage , Radiation Exposure/adverse effects , Treatment OutcomeSubject(s)
Humans , Panic , Pneumonia, Viral/psychology , Pneumonia, Viral/epidemiology , Quarantine/psychology , Coronavirus Infections/psychology , Coronavirus Infections/epidemiology , Coronavirus , Fear , Pandemics , ST Elevation Myocardial Infarction/therapy , Cineangiography , Echocardiography/methods , Risk Factors , Coronary Angiography , Collateral Circulation , Coronary Circulation , ST Elevation Myocardial Infarction/diagnosis , Betacoronavirus , SARS-CoV-2 , COVID-19ABSTRACT
Abstract Background: Functional assessment to rule out myocardial ischemia using coronary computed tomography angiography (CCTA) is extremely important and data on the Brazilian population are still limited. Objective: To assess the diagnostic performance of myocardial perfusion by CCTA in the detection of severe obstructive coronary artery disease (CAD) compared with single-photon emission computerized tomography (SPECT). To analyze the importance of anatomical knowledge to understand the presence of myocardial perfusion defects on SPECT imaging that is not identified on computed tomography (CT) scan. Method: A total of 35 patients were evaluated by a simultaneous pharmacologic stress protocol. Fisher's exact test was used to compare proportions. The patients were grouped according to the presence or absence of significant CAD. The area under the ROC curve was used to identify the diagnostic performance of CCTA and SPECT in perfusion assessment. P < 0.05 values were considered statistically significant. Results: For detection of obstructive CAD, CT myocardial perfusion analysis yielded an area under the ROC curve of 0.84 [a 95% confidence interval (CI95%): 0.67-0.94, p < 0.001]. SPECT myocardial perfusion imaging, on the other hand, showed an AUC of 0.58 (95% CI 0.40 - 0.74, p < 0.001). In this study, false-positive results with SPECT are described. Conclusion: Myocardial perfusion analysis by CTA displays satisfactory results compared to SPECT in the detection of obstructive CAD. CCTA can rule out false-positive results of SPECT.
Resumo Fundamento: A avaliação funcional para descartar a isquemia miocárdica utilizando a angiotomografia computadorizada (angio-TC) de coronárias é de extrema importância e dados na população brasileira ainda são escassos. Objetivo: Avaliar o desempenho diagnóstico da perfusão miocárdica pela angio-TC de coronárias na detecção de doença arterial coronariana (DAC) obstrutiva significativa em comparação com a tomografia computadorizada por emissão de fóton único (SPECT; do inglês, single photon emission computerized tomography). Analisar a importância do conhecimento anatômico para entender a presença de defeito de perfusão miocárdica pela SPECT que não é identificado pela tomografia computadorizada (TC). Método: Trinta e cinco pacientes foram avaliados por um protocolo de estresse farmacológico simultâneo. O teste exato de Fisher foi utilizado para comparação entre as proporções. Os pacientes foram agrupados de acordo com a presença ou não de DAC significativa. A área sob a curva foi utilizada para identificar o desempenho diagnóstico da avaliação da perfusão pela angio-TC de coronárias e pela SPECT. Os valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Para detecção de DAC obstrutiva a avaliação da perfusão miocárdica pela TC teve uma área sob a curva de 0,84 [intervalo de confiança de 95% (IC95%): 0,67 a 0,94, p < 0,001]. Já o estudo da perfusão miocárdica pela SPECT foi de 0,58 (IC95%: 0,40 a 0,74, p < 0,001). Neste estudo, foram descritos falso-positivos pela SPECT. Conclusão: A avaliação da perfusão miocárdica pela angio-TC apresenta resultados satisfatórios em comparação com os da SPECT na detecção de DAC obstrutiva. A angio-TC de coronárias tem capacidade de afastar falso-positivos da SPECT.
Subject(s)
Humans , Male , Female , Middle Aged , Coronary Artery Disease/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Coronary Angiography/methods , Myocardial Perfusion Imaging/methods , Coronary Artery Disease/physiopathology , Cineangiography/methods , Myocardial Reperfusion Injury/physiopathology , Myocardial Reperfusion Injury/diagnostic imaging , ROC Curve , Sensitivity and Specificity , Computed Tomography AngiographyABSTRACT
Objective To study the clinical value of multi-slice spiral CT angiography in the diagnosis of abdominal tumors. Methods From January 2015 to December 2017,90 patients with abdominal neoplasms in the First People's Hospital of Yongkang were divided into two groups according to double-blind randomized method,with 45 patients in each group. The patients with conventional CT scan were included in the control group,and the patients with multislice spiral CT angiography were selected as the observation group. The scan results,invasion range and location of abdominal tumor, vascular display and perfusion parameters were compared between the two groups. Results The diagnostic accuracy of abdominal tumor and invasion range in the observation group ( 93. 33% , 80. 00% ) was higher than those of the control group(χ2=5. 414,5. 086,all P<0. 05). The proportions of abnormal thickening of one supply artery(27 cases) and two blood supply arteries(8 cases) in patients with malignant and borderline venereal lesions with normal diameter were higher than those of patients with benign lesions(χ2=31. 765, 8. 372,all P<0. 05). The contrast medium through time,blood flow,blood volume and capillary surface permeability in patients with benign lesions and normal average diameter were (10. 55 ± 3. 02) s,(21. 54 ± 5. 58) mL·min-1· 100 g-1,(4.04 ±0.76) mL/100 g,(10.16 ±2.73)mL·min-1·100 g-1,respectively,which were lower than those of patients with malignant and border venereal focal lesions (t =3. 016,5. 005,4. 982,6. 989,all P <0. 05). Conclusion Application of multislice spiral CT angiography in the clinical diagnosis of abdominal tumors has high accuracy and can better display the abnormal condition of blood vessels.
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INTRODUCTION: Reduction of radiation dosage in the pediatric cardiac catheterization laboratory (PCL) is important to reduce the risk of its stochastic effect in children with congenital heart disease. Lowering the frame rate would reduce radiation dosage possibly at the expense of image quality, potentially resulting in higher fluoroscopic time and procedural complication rate. METHODS: The data were retrospectively analyzed in three eras: era 1 (n = 234), cineangiography 30 frames/sec (f/s) and fluoroscopy 15 pulse/sec (p/s); era 2 (n = 381), cineangiography 30 f/s and fluoroscopy 6 p/s; and era 3 (n = 328), cineangiography 15 f/s and fluoroscopy 6 p/s. Also, three operators blinded to the frame rate setting evaluated cineangiography image quality. In this study, the impact of lowering the default frame rates on radiation dosage, fluoroscopic time, contrast volume, diagnostic image quality, and complication rates in the PCL was assessed. RESULTS: Overall radiation dosage progressively declined during these eras (70.0 vs 64.1 vs 36.6 µGym2 /kg, P < .001) without a difference in significant adverse event rates. There was no significant increase in either fluoroscopy time or contrast volume. There was no difference in the diagnostic image quality between cineangiography 30 and 15 f/s. Lowering the default frame/pulse rates of both fluoroscopy and cineangiography significantly decreased the overall radiation dosage in the PCL. Importantly, fluoroscopy time, contrast volume, and complication rates did not increase while maintaining diagnostic image quality. CONCLUSION: This quality improvement project proved successful in lowering radiation dosage without compromising the efficacy and safety of catheterizations.
Subject(s)
Cardiac Catheterization/adverse effects , Heart Defects, Congenital/diagnosis , Quality Improvement , Radiation Exposure/adverse effects , Radiation Injuries/prevention & control , Radiography, Interventional/methods , Adolescent , Cardiac Catheterization/methods , Child , Child, Preschool , Female , Humans , Incidence , Infant , Male , Michigan/epidemiology , Radiation Dosage , Radiation Injuries/epidemiology , Radiation Injuries/etiology , Radiography, Interventional/adverse effects , Retrospective Studies , Young AdultABSTRACT
OBJETIVO: Descrever o perfil de pacientes internados com diagnóstico de síndrome coronariana aguda. MÉTODOS: Estudo analítico, observacional e transversal, com dados obtidos da análise dos prontuários de cem pacientes internados em um hospital, de fevereiro de 2014 a janeiro de 2015, os quais tiveram diagnóstico de síndrome coronariana aguda e foram regulados para a realização da cineangiocoronariografia. Foi traçado o perfil epidemiológico e fisiopatológico desta população. RESULTADOS: Em nossa amostra, 49 (55,7%) pacientes eram do sexo masculino, com média de idade de 63,88±13,3 anos, sendo 60,2% acima de 60 anos. O quadro clínico mais prevalente foi angina instável (41%). Constatou-se maior prevalência de portadores de hipertensão arterial (88,7%), além de associação positiva entre os pacientes com idade avançada e doença multiarterial. Também foi encontrada obstrução coronariana significativa em cerca de 90% dos pacientes diabéticos. Cineangiocoronariografia sem lesão significativa foi duas vezes mais identificada, em comparação com dados da American College of Cardiology. CONCLUSÃO: Fatores de risco modificáveis devem ser controlados, visando à redução do número de casos de doenças cardiovasculares agudas e daqueles com desfechos desfavoráveis. Sugere-se que a divulgação dos sintomas de infarto seja ampliada, para que os pacientes cheguem à emergência em tempo hábil de receber o tratamento.(AU)
OBJECTIVE: To describe the profile of patients admitted to Hospital with a diagnosis of acute coronary syndrome METHODS: This is an analytical, observational and crosssectional study with data obtained from the analyses of the medical records of 100 patients admitted to a hospital from February/2014 to January / 2015), who were diagnosed with acute coronary syndrome, and were regulated for undergoing coronary angiography. The epidemiological and pathophysiological profile of this population was described. RESULTS: In our sample, there were 49 (55.7 %) male patients with a mean age of 63.88±13.3 years, with 60.2 % being over 60 years. The most prevalent clinical condition was unstable angina (41%). A higher prevalence of patients with hypertension (88.7 %) was found, as well as a positive association of patients with advanced age and multivessel disease. We also find significant coronary obstruction in about 90 % of diabetic patients. Coronary angiographywith no significant lesion was twice as identified if compared with the American College of Cardiology data. CONCLUSION: The modifiable risk factors should be monitored, in order to reduce the number of cases of acute cardiovascular disease and those with unfavorable outcomes. The dissemination of information about infarction should be enhanced for the patients to search for emergent care in a timely manner.(AU)
Subject(s)
Humans , Male , Female , Aged , Cineangiography/methods , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/epidemiology , Myocardial Infarction/physiopathology , Myocardial Infarction/epidemiology , Risk FactorsABSTRACT
BACKGROUND: Noninvasive measurement of myocardial contractility (end-systolic wall stress-adjusted change in left ventricular ejection fraction from rest to exercise [ΔLVEF - ΔESS]) predicts heart failure, subnormal LVEFrest, and sudden death in asymptomatic patients with chronic severe aortic regurgitation (AR). Here we assess the relation of preoperative ΔLVEF - ΔESS to survival after aortic valve replacement (AVR). METHODS: Patients who underwent AVR for chronic, isolated, pure severe AR (n = 66) were followed for 13.0 ± 6.4 event-free years. Preoperative ΔLVEF - ΔESS (from combined echocardiographic and radionuclide cineangiographic data) enabled cohort stratification into 3 terciles (-1 to -11% [normal or mild] contractility deficit, -12 to -16% [moderate], and ≤-17% [severe], identical with segregation in our earlier study) to relate preoperative contractility to postoperative survival and to age- and gender-matched US census data. RESULTS: Since AVR, 22 patients died (average annual risk [AAR] for all-cause mortality for the entire co hort = 3.15%). Preoperative ΔLVEF - ΔESS predicted postoperative survival (p = 0.009, log rank test). By contractility terciles, all-cause AARs were 1.44, 2.58, and 6.40%. Survival was lower than among US census comparators (p < 0.02), but the "mild" tercile was indistinguishable from census data (p = ns). By multivariable Cox regression, survival prediction by pre-AVR ΔLVEF - ΔESS was independent of, and superior to, prediction by age at surgery, gender, preoperative functional class, LVEFrest, LVEFexercise, change in LVEFrest to exercise, and LV diastolic or systolic dimensions (p ≤ 0.01, pre-AVR ΔLVEF - ΔESS vs. other covariates). CONCLUSION: In severe AR, preoperative contractility predicts post-AVR survival and may be prognostically superior to clinical, geometric and performance descriptors, potentially impacting on patient selection for surgery.
Subject(s)
Aortic Valve Insufficiency/mortality , Exercise Test/methods , Myocardial Contraction/physiology , Adult , Aged , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/surgery , Censuses , Coronary Angiography , Disease Progression , Echocardiography , Female , Follow-Up Studies , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Risk Factors , Survival , Treatment Outcome , United States/epidemiology , Ventricular Function, Left , Young AdultABSTRACT
Abstract Background: The importance of coronary anatomy in predicting cardiovascular events is well known. The use of traditional anatomical scores in routine angiography, however, has not been incorporated to clinical practice. SYNTAX score (SXscore) is a scoring system that estimates the anatomical extent of coronary artery disease (CAD). Its ability to predict outcomes based on a baseline diagnostic angiography has not been tested to date. Objective: To evaluate the performance of the SXscore in predicting major adverse cardiac events (MACE) in patients referred for diagnostic angiography. Methods: Prospective cohort of 895 patients with suspected CAD referred for elective diagnostic coronary angiography from 2008 to 2011, at a university-affiliated hospital in Brazil. They had their SXscores calculated and were stratified in three categories: no significant CAD (n = 495), SXscoreLOW-INTERMEDIATE: < 23 (n = 346), and SXscoreHIGH: ≥ 23 (n = 54). Primary outcome was a composite of cardiac death, myocardial infarction, and late revascularization. Secondary endpoints were the components of MACE and death from any cause. Results: On average, patients were followed up for 1.8 ± 1.4 years. The primary outcome occurred in 2.2%, 15.3%, and 20.4% in groups with no significant CAD, SXscoreLOW-INTERMEDIATE, and SXscoreHIGH, respectively (p < 0.001). All-cause death was significantly higher in the SXscoreHIGH compared with the 'no significant CAD' group, 16.7% and 3.8% (p < 0.001), respectively. After adjustment for confounding factors, all outcomes remained associated with the SXscore. Conclusions: SXscore independently predicts MACE in patients submitted to diagnostic coronary angiography. Its routine use in this setting could identify patients with worse prognosis.
Resumo Fundamento: A importância da anatomia coronariana na predição de eventos cardiovasculares é bem conhecida. O uso de escores anatômicos tradicionais na cineangiocoronariografia de rotina, entretanto, não foi incorporado à prática clínica. O SYNTAX escore (SXescore) é um sistema de escore que estima a extensão anatômica da doença arterial coronariana (DAC). Sua capacidade para predizer desfechos com base na cineangiocoronariografia diagnóstica de base ainda não foi testada. Objetivo: Avaliar o desempenho do SXescore para predizer eventos cardíacos adversos maiores (MACE) em pacientes encaminhados para cineangiocoronariografia diagnóstica. Métodos: Coorte prospectiva de 895 pacientes com suspeita de DAC encaminhados para cineangiocoronariografia diagnóstica eletiva de 2008 a 2011, em hospital universitário no Brasil. Os pacientes tiveram seus SXescores calculados e foram estratificados em três categorias: 'sem DAC significativa' (n = 495); SXescoreBAIXO-INTERMEDIÁRIO: < 23 (n = 346); e SXescoreALTO: ≥ 23 (n = 54). O desfecho primário foi composto de morte cardíaca, infarto do miocárdio e revascularização tardia. Os desfechos secundários foram MACE e morte por todas as causas. Resultados: Em média, os pacientes foram acompanhados por 1,8 ± 1,4 anos. Desfecho primário ocorreu em 2,2%, 15,3% e 20,4% nos grupos 'sem DAC significativa', SXescoreBAIXO-INTERMEDIÁRIO e SXescoreALTO, respectivamente (p < 0,001). Morte por todas as causas foi significativamente mais frequente no grupo de SXescoreALTO comparado ao grupo 'sem DAC significativa', 16,7% e 3,8% (p < 0,001), respectivamente. Após ajuste para fatores de confusão, todos os desfechos permaneceram associados com o SXescore. Conclusão: O SXescore prediz independentemente MACE em pacientes submetidos a cineangiocoronariografia diagnóstica. Seu uso rotineiro nesse contexto poderia identificar pacientes de pior prognóstico.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/pathology , Coronary Artery Disease/diagnostic imaging , Coronary Angiography/methods , Risk Assessment/methods , Prognosis , Reference Values , Time Factors , Coronary Artery Disease/surgery , Coronary Artery Disease/mortality , Brazil , Cineangiography/methods , Coronary Artery Bypass , Predictive Value of Tests , Prospective Studies , Risk Factors , Kaplan-Meier Estimate , Percutaneous Coronary Intervention , Hospitals, UniversityABSTRACT
BACKGROUND AND OBJECTIVES: Coronary angiography (CAG) is the gold standard for diagnosing coronary artery disease. However, exposure to ionizing radiation delivered during CAG has various negative biological effects on humans. In this study, there was an evaluation of whether fluorography resulted in decreased radiation exposure, as compared with cineangiography. SUBJECTS AND METHODS: Fifty-five patients were prospectively enrolled and divided into two CAG groups, in accordance with the operator's professional discretion: a conventional cineangiography group versus a fluorography group. Fluorography refers to the photography of fluoroscopic images that are retrospectively stored, e.g., using the "Store fluoro" function of the Siemens cardiac angiography system. The primary outcomes included the air kinetic energy released per unit mass {air kerma (AK) mGy} and the dose (kerma)-area product (DAP; µGy · m(2)), both measured using built-in software in the Siemens system. The secondary outcomes included the total procedure time and amount of contrast agent used with each CAG method. RESULTS: The total AK and DAP were significantly lower in the fluorography group (159.3±64.9 mGy and 1337.9±629.6 µGy · m(2), respectively) than in the cineangiography group (326.9±107.5 mGy and 2341.1±849.9 µGy · m(2), respectively; p=0.000 for both). The total procedure time (cineangiography vs. fluorography, 12.8±4.7 vs. 12.5±2.9 min; p=0.779) and contrast agent amount (136.1±28.3 vs. 126.3±25.7, p=0.214) were comparable between the two groups. CONCLUSION: Fluorography is a useful method to decrease the radiation exposure in selected patients requiring CAG.
Subject(s)
Aged , Female , Humans , Inferior Wall Myocardial Infarction/pathology , Inferior Wall Myocardial Infarction/physiopathology , Shock, Cardiogenic/pathology , Shock, Cardiogenic/physiopathology , Coronary Angiography , Coronary Vessels/pathology , Electrocardiography , Fatal Outcome , Ventricular Septal Rupture/pathology , Ventricular Septal Rupture/physiopathologyABSTRACT
Paravalvular regurgitation (PVR) following transcatheter aortic valve replacement is a known complication associated with poorer outcomes. This article discusses the current techniques for assessing the severity of PVR, including angiography, hemodynamics, MRI, and echocardiography. The strengths and pitfalls of each modality are reviewed.
ABSTRACT
BACKGROUND AND OBJECTIVES: Coronary angiography (CAG) is the gold standard for diagnosing coronary artery disease. However, exposure to ionizing radiation delivered during CAG has various negative biological effects on humans. In this study, there was an evaluation of whether fluorography resulted in decreased radiation exposure, as compared with cineangiography. SUBJECTS AND METHODS: Fifty-five patients were prospectively enrolled and divided into two CAG groups, in accordance with the operator's professional discretion: a conventional cineangiography group versus a fluorography group. Fluorography refers to the photography of fluoroscopic images that are retrospectively stored, e.g., using the "Store fluoro" function of the Siemens cardiac angiography system. The primary outcomes included the air kinetic energy released per unit mass {air kerma (AK) mGy} and the dose (kerma)-area product (DAP; microGy . m2), both measured using built-in software in the Siemens system. The secondary outcomes included the total procedure time and amount of contrast agent used with each CAG method. RESULTS: The total AK and DAP were significantly lower in the fluorography group (159.3+/-64.9 mGy and 1337.9+/-629.6 microGy . m2, respectively) than in the cineangiography group (326.9+/-107.5 mGy and 2341.1+/-849.9 microGy . m2, respectively; p=0.000 for both). The total procedure time (cineangiography vs. fluorography, 12.8+/-4.7 vs. 12.5+/-2.9 min; p=0.779) and contrast agent amount (136.1+/-28.3 vs. 126.3+/-25.7, p=0.214) were comparable between the two groups. CONCLUSION: Fluorography is a useful method to decrease the radiation exposure in selected patients requiring CAG.
Subject(s)
Humans , Angiography , Cineangiography , Coronary Angiography , Coronary Artery Disease , Fluoroscopy , Photography , Prospective Studies , Radiation, Ionizing , Retrospective StudiesABSTRACT
Os autores relatam o caso de um paciente com insuficiência coronariana que desenvolveu quadro de oclusão de artéria central da retina após ser submetido a cateterização cardíaca por via braquial e realização de cineangiocoronariografia. Este procedimento pode desencadear fenômenos embólicos oculares consistentes com o quadro descrito.
The authors report a case of a patient with coronary insufficiency who developed central retinal artery occlusion following cardiac catheterism through the brachial artery and cineangiocoronography. This procedure can lead to embolic phenomena like that which was reported.
Subject(s)
Humans , Male , Middle Aged , Coronary Angiography/adverse effects , Cardiac Catheterization/adverse effects , Retinal Artery Occlusion/etiology , Brachial Artery , Coronary Angiography/methods , Embolism/etiology , Retinal Artery Occlusion/pathologyABSTRACT
We studied the effect of Kampo for the size-limitation of myocardial infarct with morphometrical analysis, utilizing total of 19 male swine. A hand made metal-coil (2×1mm) was inserted in the left anterior descending coronary artery (LAD) of swine with catheterization, in order to induce acute myocardial infarction (AMI). After occurrence of AMI, the swine were divided into two groups, experimental group: Saiko-ka-ryukotsu-borei-to (n=10) and control (n=9). This Kampo formula (0.66/kg/day) was administered via stomach tubes for 4 weeks. The control group received basal rations alone. After serial cross sections of heart, total infarct areas were weighed.<br>An infarct weight to heart weight of the experimental group (2.9±1.6%, n=10) was significantly decreased than that of the control group (8.2±4.8%, n=9). The infarct weight to left ventricular weight of the experimental group (4.9±2.6%) was significantly decreased than that of the control group (13.4±8.0%). Thus the infarct size of the experimental group was significantly smaller than that of the control. The histological character of the infarct in the control was numerous inflammatory cell infiltration and foci of fresh coagulate necrosis in the border zone, while the infarct of the experimental group was apparent in the border zone with marked fibrosis and few inflammatory cells. Angiogenesis in both the infarct and border zone was marked in the experimental group than in the control. We summarize that this Kampo formula inhibits size development of AMI in animal model.
ABSTRACT
BACKGROUND: The clacification of the wall and narrowing of the lumen of the coronary artery is closely related to the process of atherosclerosis and its severity. Thus, the present study of calcified coronary artery lesions by analysis of cineangiography is attempt to define the incidence and factors to affect the coronary artery calcification. METHODS: Our report concerns a consecutive series of 513 patients who underwent coronary angiography between January 1, 1991 and September 30, 1993. We determined the relationship between the coronary artery calcification and sex, age, risk factors, serum calcium, BUN, creatinine, lesional lumen stenosis and severity of coronary artery disease. RESULTS: Among patients with significant coronary artery disease, 22%(62/282 cases) had the coronary artery calcification by cineangiography. Patients with calcification were older(62+/-8 years) than those without calcification(56+/-10 years)(p=0.0001). The distribution of calcified coronary artery was 35 lesions in LAD, 17 in LCX, 16 in RCA and 4 in LM. The calcification rate was 38%(40/104 cases) for patients with multi-vessel disease, compared to 12%(22/178 case) for those with single vessel disease(p=0.0001). Patients with calcification significantly had the long lesion(22.4+/-13.4mm), compared to those without calcification(18.0+/-11.3mm)(=0.012). Coronary artery calcification was correlated with smoking habits. CONCLUSION: Coronary artery calcification was seen in 22 percent and strongly correlated with age, smoking habits, the severity of disease and length of lesion.
Subject(s)
Humans , Atherosclerosis , Calcium , Cineangiography , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Creatinine , Incidence , Risk Factors , Smoke , SmokingABSTRACT
Objetivo - Identificar pacientes que se prestem à estratégia do cateterismo cardíaco ambulatorial, com base nos aspectos sociais, riscos e complicações, por um período de 24 h. Métodos - Dos 2.126 casos submetidos a ca-teterismo cardíaco, no Instituto Dante Pazzanese de Cardiologia, no período de setembro de 1990 a junho de 1991, excluíramse: a) aqueles com idade superior a 75 anos; b) os com síndromes isquêmicas agudas; c) os com descompensação cardíaca classe IV (NYHA); d) os estudados pela técnica femoral com sistemas introdutores de alto perfil; e) os submetidos à anestesia geral, estudos eletrofisiológicos ou biópsias endomiocárdicas. Após a realização do exame, seguia-se período de observação de 3 h e, na ausência de complicacões, os pacientes re-cebiam alta com orientação de retorno obrigatório no dia seguinte, para reavaliação clínica. As eventuais complicacões deste período foram anotadas. Resultados - Dos 719pacientes elegíveis, 68% eram do sexo masculino, e a idade média era de 55,3 anos. Sessenta e um por cento estavam em classefuncional I da NYHA e a maioria (80,8%) foi estudada pela via braquial. Em 83% dos casos realizou-se a coronariografia, dos quais, 52%exibiam aterosclerose coronária. Quatrocentos e quatorze casos não receberam alta, pela seguintes razões: 217 por término do exame após as 18 h, 111 por razões sócio-econômicas, 23 por recusa do médico assistente, 8 devido à lesão do tronco da coronária esquerda e 55 por complicacões diversas. Todos os 305 pacientes que receberam alta ambulatorial não mostraram qualquer complicação na avaliação clínica do dia seguinte. Conclusão - O cateterismo ambulatorial demonstrou ser seguro em pacientes selecionados, viabilizando grande número de exames, com relativa economia de leitos e outros recursos hospitalares
Purpose - To identify patients suitable for out-patient cardiac catheterization strategy, based on social aspects, risks and complications, for a 24 hour period. Methods - In a series of 2.126 cases submitted to cardiac catheterization at the Instituto Dante Pazzanese de Cardiologia, between September 1990 and June 1991, were excluded: a) those over 75 years of age; b) the acute ischemic syndroms; c) those in NYHA functional class IV; d) patients who used 7 or 8 French femoral angiographtc catheters; e) patients who had undergone general anesthesia, electrophysiological study or endomyocardial biopsy. After the procedure, the patients were observed for a 3 hour period and in the absence of any complication, they were discharged from the hospital, returning the next day for clinical evaluation. If any complication occurred it was registered. Results - In a cohort of 719 eligible patients, 68% were male, with a mean age of 55,3 years. Sixty one per cent were in NYHA functional class I and most of them (80,8%) were studied by the brachial approach. Eigthy-three per cent of the patients were submitted to coronary angiography, with 52% of them having coronary artery disease. Four hundred and fourteen patients were not discharged on the same day: 217 did not have their procedures finish after 6p.m., 111forsocial-economical reasons, 23 because of theirphysician's refuse, 8 because of left main coronary disease, 55 because of any kind of complication. All the 305 patients who were discharged on the same day, did not have shown any complication in the next day evaluation. Conclusion - Outpatient cardiac catheterization is a safe technique in selected patients, making possible the accomplishment of a greater number of procedures improving bed utilization and decreasing hospitalar costs
Subject(s)
Humans , Male , Female , Ambulatory Care , Cardiac Catheterization , Middle Aged , Adolescent , Adult , Aged , Ambulatory Care/statistics & numerical data , Brazil/epidemiology , English Abstract , Cardiac Catheterization/adverse effects , Cardiac Catheterization/statistics & numerical data , Hospitalization/statistics & numerical data , Risk Factors , Socioeconomic Factors , Time FactorsABSTRACT
No abstract available.