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1.
J Cardiol Cases ; 27(3): 93-96, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36910038

RESUMO

A 56-year-old man presented with fever, cough, and bloody sputum. He had undergone mitral valve replacement with mechanical prosthesis 14 months prior for mitral valve disease. Subsequently, the patient was taking warfarin and amiodarone. Chest imaging revealed dense, infiltrative shadows, and blood tests showed prolonged prothrombin time and eosinophilia. Warfarin was withdrawn, and antibiotics were started, but bloody sputum and respiratory failure persisted. Considering that eosinophilia was observed after the administration of amiodarone, the drug was discontinued, and bronchoalveolar lavage was performed. Cytology showed foam cells, eosinophils, and hemosiderin-laden macrophages; amiodarone-induced diffuse alveolar hemorrhage (DAH) and acute eosinophilic pneumonia (AEP) were diagnosed, and the patient was treated with corticosteroids. This report describes the first documented case of amiodarone-induced DAH and AEP. When a patient taking amiodarone presents with antibiotic-refractory pneumonia with bloody sputum and eosinophilia, amiodarone-induced DAH and AEP should be considered. Learning objective: We report the first case of amiodarone-induced diffuse alveolar hemorrhage (DAH) and acute eosinophilic pneumonia (AEP) diagnosed by foam cells, eosinophils, and hemosiderin-laden macrophages on bronchoalveolar lavage cytology. When a patient taking amiodarone presents with antibiotic-refractory pneumonia with bloody sputum and eosinophilia, amiodarone-induced DAH and AEP should be considered.

2.
Circ J ; 87(6): 783-790, 2023 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-36990778

RESUMO

BACKGROUND: Angiographic fractional flow reserve (angioFFR) is a novel artificial intelligence (AI)-based angiography-derived fractional flow reserve (FFR) application. We investigated the diagnostic accuracy of angioFFR to detect hemodynamically relevant coronary artery disease.Methods and Results: Consecutive patients with 30-90% angiographic stenoses and invasive FFR measurements were included in this prospective, single-center study conducted between November 2018 and February 2020. Diagnostic accuracy was assessed using invasive FFR as the reference standard. In patients undergoing percutaneous coronary intervention, gradients of invasive FFR and angioFFR in the pre-senting segments were compared. We assessed 253 vessels (200 patients). The accuracy of angioFFR was 87.7% (95% confidence interval [CI] 83.1-91.5%), with a sensitivity of 76.8% (95% CI 67.1-84.9%), specificity of 94.3% (95% CI 89.5-97.4%), and area under the curve of 0.90 (95% CI 0.86-0.93%). AngioFFR was well correlated with invasive FFR (r=0.76; 95% CI 0.71-0.81; P<0.001). The agreement was 0.003 (limits of agreement: -0.13, 0.14). The FFR gradients of angioFFR and invasive FFR were comparable (n=51; mean [±SD] 0.22±0.10 vs. 0.22±0.11, respectively; P=0.87). CONCLUSIONS: AI-based angioFFR showed good diagnostic accuracy for detecting hemodynamically relevant stenosis using invasive FFR as the reference standard. The gradients of invasive FFR and angioFFR in the pre-stenting segments were comparable.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Humanos , Estudos Prospectivos , Estenose Coronária/diagnóstico por imagem , Inteligência Artificial , Angiografia Coronária/métodos , Índice de Gravidade de Doença , Valor Preditivo dos Testes
3.
Circ J ; 85(11): 2043-2049, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-34148928

RESUMO

BACKGROUND: Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established.Methods and Results:We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs <0.80. However, MPI-negative lesions had an extremely low lesion rate with FFR <0.65 (6%). Conversely, 78% and 41% of MPI-positive lesions had FFR <0.80 and <0.65, respectively. CONCLUSIONS: The data confirmed that decisions based on MPI are reasonable because MPI-negative patients have an extremely low rate of lesions with a FFR below the cutoff point for a hard event, and MPI-positive lesions include many lesions with FFR <0.65.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Isquemia Miocárdica , Imagem de Perfusão do Miocárdio , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Imagem de Perfusão do Miocárdio/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
4.
Cardiovasc Interv Ther ; 36(1): 74-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32048184

RESUMO

The diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR) are considered to be almost identical to the instantaneous wave-free ratio (iFR) in the retrospective analysis of pooled data. The aim of this study was to investigate the direct comparison of iFR and these new resting indexes in real world practice. Two pressure wires were inserted and placed in the distal part of the same coronary artery. The measurement of the iFR and the other resting indexes was performed simultaneously. A total of 54 lesions from 23 patients were subject to physiological study. In 49 lesions, iFR and other resting indexes were also measured in hyperemic conditions. The general correlation between iFR and other resting indexes was excellent in both resting and hyperemic conditions (r2 = 0.99; mean difference - 0.001 ± 0.021; p < 0.001; and r2 = 0.99; mean difference - 0.012 ± 0.025; p < 0.001, respectively). This correlation was maintained in various subgroup analyses. A diagnostic change between iFR and other resting indexes occurred in three cases (3%) when a fixed cut-off point (≤ 0.89) was applied. There was no diagnostic change when a hybrid zone (0.86 ≤ iFR ≤ 0.93) was considered. The new resting indexes and iFR showed very high correlation in real world practice. A diagnostic change only occurred in three cases (3%) when a fixed cut-off point (≤ 0.89) was applied.


Assuntos
Pressão Sanguínea/fisiologia , Estenose Coronária/diagnóstico , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Descanso/fisiologia , Idoso , Cateterismo Cardíaco , Angiografia Coronária , Estenose Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Diástole , Feminino , Humanos , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença
5.
JACC Cardiovasc Interv ; 13(22): 2688-2698, 2020 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-33129819

RESUMO

OBJECTIVES: The aim of this study was to investigate the accuracy of pre-percutaneous coronary intervention (PCI) predicted nonhyperemic pressure ratios (NHPRs) with actual post-PCI NHPRs and to assess the efficacy of PCI strategy using pre-PCI NHPR pullback. BACKGROUND: Predicting the functional results of PCI is feasible using pre-PCI longitudinal vessel interrogation with the instantaneous wave-free ratio (iFR), a pressure-based, adenosine-free NHPR. However, the reliability of novel NHPRs (resting full-cycle ratio [RFR] and diastolic pressure ratio [dPR]) for this purpose remains uncertain. METHODS: In this prospective, multicenter, randomized controlled trial, vessels were randomly assigned to receive pre-PCI iFR, RFR, or dPR pullback (50 vessels each). The pre-PCI predicted NHPRs were compared with actual NHPRs after contemporary PCI using intravascular imaging. The number and the total length of treated lesions were compared between NHPR pullback-guided and angiography-guided strategies. RESULTS: The predicted NHPRs were strongly correlated with actual NHPRs: iFR, r = 0.83 (95% confidence interval: 0.72 to 0.90; p < 0.001); RFR, r = 0.84 (95% confidence interval: 0.73 to 0.91; p < 0.001), and dPR, r = 0.84 (95% confidence interval: 0.73 to 0.91; p < 0.001). The number and the total length of treated lesions were lower with the NHPR pullback strategy than with the angiography-guided strategy, leading to physiological improvement. CONCLUSIONS: Predicting functional PCI results on the basis of pre-procedural RFR and dPR pullbacks yields similar results to iFR. Compared with an angiography-guided strategy, a pullback-guided PCI strategy with any of the 3 NHPRs reduced the number and the total length of treated lesions. (Study to Examine Correlation Between Predictive Value and Post PCI Value of iFR, RFR and dPR; UMIN000033534).


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Cateterismo Cardíaco , Angiografia Coronária , Vasos Coronários , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento
6.
Circ Cardiovasc Interv ; 13(11): e009314, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33106049

RESUMO

BACKGROUND: Given the characteristic differences between intravascular ultrasound (IVUS) and optical frequency domain imaging (OFDI), their approach to therapeutic guidance during percutaneous coronary interventions (PCIs) and arterial healing response after stenting may also vary. METHODS: MISTIC-1 (The Multimodality Imaging Study in Cardiology cohort 1) is a multicenter, randomized-controlled, noninferiority trial that compared imaging end points between OFDI- and IVUS-guided PCI. Patients with stable coronary artery disease were randomly assigned to either OFDI- or IVUS-guided PCI using a Biolimus A9-eluting stent according to a prespecified protocol for imaging guidance. Stent sizing was based on external elastic lamina in IVUS-guided PCI while lumen up-size in OFDI-guided PCI. Postprocedural OFDI was investigated regardless of randomization, while operators in IVUS-guided PCI arm were blinded to the images. The primary end point was in-segment minimum lumen area assessed using OFDI at 8 months, while the secondary end point was a composite of cardiovascular mortality, target-vessel myocardial infarction, or target-lesion revascularization (device-oriented composite end point). Patients were followed up to 3 years after the index procedure. RESULTS: A total of 109 patients (mean age 70 years, male 78%) with 126 lesions were enrolled. Postprocedural minimum stent area was 6.31±1.89 and 6.72±2.08 mm2 in OFDI and IVUS group, respectively (P=0.26). At the 8-month follow-up, in-segment minimum lumen area was 4.56±1.94 and 4.13±1.86 mm2 in OFDI and IVUS group, respectively (Pnon-inferiority <0.001). Both groups had comparable neointimal healing score (median 0.16 [interquartile range, 0.00-3.14] versus 0.90 [0.00-3.30], respectively; P=0.43). The incidence rate of device-oriented composite end point at 3 years was 7.4% and 7.3% in OFDI and IVUS group, respectively (hazard ratio, 1.05 [95% CI, 0.26-4.18]; P=0.95). CONCLUSIONS: OFDI-guided PCI was not inferior to IVUS-guided PCI in terms of in-segment minimum lumen area at 8 months. Although a small sample size was acknowledged, OFDI could be an alternative to IVUS when considering intracoronary imaging-guided PCI in selected populations with coronary artery diseases. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03292081.


Assuntos
Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Stents Farmacológicos , Intervenção Coronária Percutânea/instrumentação , Sirolimo/análogos & derivados , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Japão , Masculino , Neointima , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Desenho de Prótese , Sirolimo/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
8.
J Interv Card Electrophysiol ; 58(3): 289-297, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31367961

RESUMO

PURPOSE: Cryoenergy has been demonstrated to be a safe alternative to radiofrequency ablation for catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT). This study aimed to evaluate the safety and efficacy of cryoablation in patients with AVNRT. METHODS: A multicenter retrospective study was performed. Two hundred eighty-three consecutive patients with AVNRT underwent cryoablation. Cryomapping at - 30 °C and - 80 °C was performed to predict cryoablation outcome and ascertain antegrade conduction. Cryoenergy was delivered subsequently at the same spot (cryoablation at - 80 °C) for 240 s. RESULTS: Ablation procedure was acutely successful in 281 out of 283 patients (99.3%). Of note, 22 patients (10.1%) had transient AV block during the cryoablation, but no injurious effects on AV conduction were provoked during cryomapping. During a follow-up period of 367 ± 35 days, the recurrence rate was 3.9% (11 out of 281). There were no significant differences among the patients with a complete elimination of slow pathway conduction, AH jump without an echo beat, and AH jump with a single echo beat, in terms of the long-term recurrence of AVNRT. CONCLUSIONS: Cryoablation of AVNRT appears to be effective both acutely and during the long-term with a minimal risk of unwanted injuries to the conduction system. It seems to be important to monitor the antegrade conduction during cryoenergy applications, even when cryomapping demonstrates a safe location for cryoablation. The recurrence rate of AVNRT did not differ according to the properties of the residual slow pathway conduction.


Assuntos
Ablação por Cateter , Criocirurgia , Taquicardia por Reentrada no Nó Atrioventricular , Humanos , Japão/epidemiologia , Recidiva , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Resultado do Tratamento
9.
Catheter Cardiovasc Interv ; 94(7): 947-955, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31025511

RESUMO

OBJECTIVES: We sought to examine associations between plaque characteristics by intravascular ultrasound (IVUS) and detectability of external elastic lamina (EEL) by optical frequency domain imaging (OFDI) in human coronary arteries. BACKGROUND: It is often challenging to detect EEL which represents vessel size by light-based imaging modalities due to light intensity attenuation through atherosclerotic plaque. METHODS: IVUS and OFDI prior to stent implantation were sequentially investigated per protocol. We identified corresponding cross-sections by minimum lumen area (MLA) or just distally to side branches as anatomical landmarks. Plaque characterization was determined by integrated backscatter IVUS analysis. We categorized detectable EEL arc by OFDI into four groups: 0≤ and <1 quadrant (group 1), 1≤ and <2 quadrants (group 2), 2≤ and <3 quadrants (group 3), or 3≤ and <4 quadrants (group 4). RESULTS: We prospectively studied 103 vessels in 93 patients with stable coronary artery disease. Corresponding 711 cross-sections were analyzed. Cross-sections with detectable EEL arc <2 quadrants (group 1 or 2) were observed in 86.1% of MLA sites but only in 29.3% of non-MLA sites (p < .05). Percentage plaque area (%PA) appeared to be the strongest predictor to detect EEL arc <2 quadrants with the cut-off of 60.3% (AUC 0.90; sensitivity 79.8%, specificity 85.5%). Lipid pool and calcification remained statistically significant in predicting detectable EEL arc <2 quadrants after adjustment with %PA. CONCLUSIONS: Presence of large plaque burden, lipid pool, and calcification significantly predicts the detectability of EEL by OFDI assessment. Locations with detectable EEL arc <2 quadrants should thus be avoided for optimal stent landing zone.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Placa Aterosclerótica , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção , Idoso , Pontos de Referência Anatômicos , Tomada de Decisão Clínica , Doença da Artéria Coronariana/terapia , Feminino , Humanos , Japão , Masculino , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Espalhamento de Radiação , Stents
10.
Catheter Cardiovasc Interv ; 94(2): E61-E66, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30723996

RESUMO

OBJECTIVES: The objective was to evaluate the safety, feasibility, and accuracy of the jailed-pressure wire technique using a durable optical fiber-based pressure wire with high-pressure dilatation using a non-compliant balloon after main vessel stenting. BACKGROUND: Fractional flow reserve (FFR) information can help interventionists determine whether they should treat a jailed-side branch (SB). However, re-crossing a pressure wire into a jailed-SB is sometimes technically difficult. METHODS: Fifty-one consecutive lesions from 48 patients who underwent the jailed-pressure wire technique were retrospectively investigated. The primary endpoint was complication rate and secondary endpoints included success rate of FFR measurement, incidence of wire disruption, and final drift rate. The usability of FFR for percutaneous coronary intervention of coronary bifurcation lesion was also evaluated. RESULTS: Median age of the patients was 69 years and 80.4% were men. The most frequent underlying disease was stable angina (70.6%) and 68.6% were type B2 lesions. Our main findings were: the procedure was performed successfully in all cases without any complications or wire disruption, FFR could be measured without significant final drift in 95.9% of cases, and FFR measurements helped interventionists determine whether to perform a final kissing balloon dilatation in 49.0% cases. CONCLUSIONS: The jailed-pressure wire technique using a durable optical fiber-based pressure wire with high-pressure post-dilatation maneuver was safe, feasible, and accurate.


Assuntos
Angioplastia Coronária com Balão/instrumentação , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Doença da Artéria Coronariana/terapia , Tecnologia de Fibra Óptica/instrumentação , Fibras Ópticas , Transdutores de Pressão , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
11.
Circ J ; 82(11): 2837-2844, 2018 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-30175800

RESUMO

BACKGROUND: This study compared the diagnostic value of myocardial perfusion imaging (MPI) between the rest-stress 99 mTc-tetrofosmin protocol (Tc/Tc protocol) and simultaneous acquisition rest 99 mTc-tetrofosmin/stress 201Tl dual-isotope protocol (SDI protocol) with a semiconductor camera.Methods and Results: We retrospectively studied 147 patients who underwent stress MPI using a cadmium-zinc-telluride camera and invasive coronary angiography within a 3-month interval. The Tc/Tc and SDI protocols were used in 59 and 88 patients, respectively. The sensitivity, specificity, and accuracy of the summed difference score in per-patient analysis were 56%, 85%, and 69%, respectively, for the Tc/Tc protocol and 89%, 82%, and 85%, respectively, for the SDI protocol. The area under the receiver operating characteristic curve was significantly better for the SDI than Tc/Tc protocol for the left anterior descending artery (0.836 vs. 0.674; P=0.0380), the left circumflex artery (0.754 vs. 0.599; P=0.0441), and in per-patient analysis (0.875 vs. 0.707; P=0.0135). There was no significant difference in the diagnostic accuracy of the summed stress score for any vessel or in per-patient analysis between the 2 protocols. CONCLUSIONS: The SDI protocol had a higher diagnostic accuracy for the detection of coronary ischemia than the Tc/Tc protocol.


Assuntos
Angiografia Coronária , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Imagem de Perfusão do Miocárdio , Compostos Organofosforados/administração & dosagem , Compostos de Organotecnécio/administração & dosagem , Radioisótopos de Tálio/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Idoso de 80 Anos ou mais , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Pacing Clin Electrophysiol ; 41(4): 376-382, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29380388

RESUMO

BACKGROUND: Cryoballoon (CB) applications to pulmonary veins (PVs) can cause stenosis just as radiofrequency (RF) energy deliveries. The goal of the present study was to clarify whether or not there was any difference in the extent of acute or chronic PV narrowing after PV isolation between the two different energy sources. METHODS: Consecutive patients with paroxysmal atrial fibrillation who were scheduled to undergo a PV isolation were randomized 1:1 to receive CB or RF ablation. The endpoints were any acute PV narrowing assessed with the use of intracardiac ultrasound during the procedure and PV stenosis measured with cardiac computed tomography at the 3-month follow-up. RESULTS: An acute reduction in the luminal area of the left superior PV (mean ± standard deviation, -6.8 ± 8.7 vs -19.9 ± 14.7%; P < 0.001) and left inferior PV (-5.1 ± 20.2 vs -15.3 ± 11.6%; P = 0.03) was significantly smaller in the CB arm (N = 25) than the RF arm (N = 25). There was no difference in the extent of PV stenosis 3 months after the ablation between the arms (0-25% stenosis, 90% vs 88%, 25-50% stenosis, 10% vs 12%, >50% stenosis, both 0%; P = 0.82). A greater acute PV narrowing was likely to lead to chronic stenosis in the RF arm (P = 0.004). CONCLUSIONS: CB ablation may reduce the acute narrowing of the left-sided PVs as compared to RF ablation.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Estenose de Veia Pulmonar/etiologia , Doença Aguda , Idoso , Doença Crônica , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estenose de Veia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
J Cardiol ; 71(5): 458-463, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29203079

RESUMO

BACKGROUND: Instantaneous wave-free ratio (iFR) has the potential to improve the accuracy of the prediction of the physiological result of percutaneous coronary intervention (PCI). The aim of this study was to evaluate the accuracy of iFR to predict the final physiological results following PCI, and investigate the factors for failed prediction. METHODS: In 73 lesions, iFR pullback recordings were measured and comparisons were made between the predicted improvement following PCI and the observed result. RESULTS: iFR predicted-observed difference was 0.036±0.037. Multivariate analysis showed residual iFR pressure gradient across the implanted stent (odds ratio, 2.329; 95% confidence interval, 1.408-3.853; p=0.0010) as an independent risk factor for error in iFR prediction. CONCLUSIONS: iFR predicted-observed difference was 0.036±0.037. Residual in-stent iFR pressure gradient following PCI is the only independent risk factor for failed prediction.


Assuntos
Estenose Coronária/terapia , Stents Farmacológicos , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Idoso , Cateterismo Cardíaco , Angiografia Coronária , Vasos Coronários/patologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pressão , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
14.
Cardiovasc Interv Ther ; 33(3): 270-276, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28674929

RESUMO

The frequency of a large pressure signal drift (PDs) caused by pressure wire using optical fibers and its effect on fractional flow reserve (FFR)-based decision-making is not clear. We used pressure wires using optical fibers as "workhorse wires" for 95 consecutive lesions. The wire was normalized at the tip of the guiding catheter just before performing the percutaneous coronary intervention (PCI) and was used without re-normalization until the end of the PCI. The drift value at the end of the procedures was evaluated. Four per cent (n = 4) of patients showed a large drift (PD >3 mmHg). Classification discordance between read-out and PD-corrected FFR values was detected in 8 (8%) measurements in total. The decision changed from FFR ≤0.80 to >0.80 in 7 (7%) measurements and vice versa in 1 (1%) measurement. PD showed no effect on decision-making when the FFR read-out value was <0.78 or >0.82. The frequency of large drifts caused by pressure wires using optical fibers was 4%. However, no case showed decision changes when the FFR gray zone was considered.


Assuntos
Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Fibras Ópticas/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Vasos Coronários/fisiopatologia , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos
15.
Circ Cardiovasc Interv ; 10(12)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29246913

RESUMO

BACKGROUND: Postocclusional hyperemia caused by balloon occlusion is a potential alternative method of inducing hyperemia for measuring post-percutaneous coronary intervention fractional flow reserve (FFR). The aim of this study was to investigate postocclusional hyperemia as a method of inducing hyperemia. METHODS AND RESULTS: FFR measured by postocclusional hyperemia (FFRoccl) caused by balloon occlusion after percutaneous coronary intervention was compared with FFR measured by drug-induced hyperemia (FFR measured by intravenous ATP; and FFR measured by intracoronary papaverine injection [FFRpap]) in 98 lesions from 98 patients. The hyperemia duration was also measured for FFRoccl and FFRpap. The correlation coefficient between FFRoccl, FFR measured by intravenous ATP (r=0.973; P<0.01), and FFRpap (r=0.975; P<0.01) showed almost identical values to those obtained for the correlation coefficient between FFR measured by intravenous ATP and FFRpap (r=0.967; P<0.01). No clear difference was observed on Bland-Altman analysis. Hyperemia duration was significantly longer with FFRoccl than with FFRpap (70±22 versus 51±25 s; P<0.01). CONCLUSIONS: Strong correlations were found between FFRoccl and FFR measured by intravenous ATP and FFRoccl and FFRpap. Hyperemia caused by FFRoccl was significantly longer than that caused by FFRpap.


Assuntos
Oclusão com Balão , Doença da Artéria Coronariana/terapia , Reserva Fracionada de Fluxo Miocárdico , Hiperemia/fisiopatologia , Intervenção Coronária Percutânea , Trifosfato de Adenosina/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Oclusão com Balão/efeitos adversos , Cateterismo Cardíaco , Circulação Colateral , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papaverina/administração & dosagem , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Resultado do Tratamento , Vasodilatadores/administração & dosagem
16.
J Phys Chem B ; 119(11): 4284-93, 2015 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-25697812

RESUMO

The property development of the ethylene-tetrafluoroethylene copolymer (ETFE) membrane induced by simultaneous biaxial drawing was investigated. Commonly, tensile strength can be increased by drawing; conversely, tear resistance decreases. In this study, the balance between tensile strength and tear resistance for the resultant ETFE membrane was optimized achieved by a combination of lamination of low molecular weight (LMW) and high molecular weight (HMW) layers and subsequent biaxial drawing. The structural factor determining tear resistance of these biaxially drawn membranes was determined based on in situ small-angle X-ray scattering (SAXS) measurement during tensile deformation simulating tearing tests. Lozenge shaped scattering, which indicated inclined lamellae, was observed during such tensile deformation of the resultant membranes. Remarkably, this inclined lamellar structure was observed for the pure LMW membrane; however, it also appeared at the interface between LMW and HMW layers within biaxially drawn membranes. For the membrane exhibiting the highest tearing strength, the fraction of such inclined lamella increased up to the critical strain corresponding to the actual sample breaking. These results confirm that the inclined lamellar structure absorbed strain during membrane tearing.

17.
Sleep Med ; 14(7): 622-7, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23719478

RESUMO

BACKGROUND: Sleep-disordered breathing (SDB) frequently is induced by sedation during ablation of atrial fibrillation (AF). We tested whether or not sedative-induced SDB is associated with clinical sleep apnea syndrome (SAS). METHODS: We examined SDB observed during intra-ablation sedation with a novel portable respiratory monitor (PM), SD-101, in 140 patients undergoing AF ablation without any known SAS. A sleep study was repeated the next night of the ablation with the simultaneous use of the SD-101 and type 3 PM, APNOMONITOR V. RESULTS: The respiratory disturbance index (RDI) during sedation (20.0±7.8 events/h) was significantly correlated with the RDI measured by the SD-101 during the night (15.8±13.7 events/h; r=0.50) and the RDI assessed by the APNOMONITOR V during the night (12.7±12.3 events/h; r=0.55). An excellent agreement was found between the RDIs simultaneously measured with the 2 PMs (intraclass correlation coefficient, 0.84), especially for an RDI of ≥30 events/h (κ statistic value, 0.82). The area under the receiver-operating characteristic curve for the RDI with the use of the SD-101 during sedation to identify the patients with an RDI of ≥30 events/h by both PMs during the night was 0.92. A left atrial diameter of >40 mm (odds ratio [OR], 4.10) and an RDI during sedation of >20 events/h (OR, 17.75) were independently associated with having an RDI of ≥30 events/h with both PMs during the night. CONCLUSIONS: Frequent episodes of sedative-induced SDB may have a diagnostic value for SAS in patients with AF.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Hipnóticos e Sedativos/efeitos adversos , Monitorização Fisiológica/métodos , Síndromes da Apneia do Sono/induzido quimicamente , Síndromes da Apneia do Sono/diagnóstico , Idoso , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Curva ROC , Mecânica Respiratória , Sono/efeitos dos fármacos , Síndromes da Apneia do Sono/fisiopatologia
18.
Pacing Clin Electrophysiol ; 36(2): 172-9, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23121681

RESUMO

BACKGROUND: We aimed to evaluate the feasibility of an oral direct thrombin inhibitor, dabigatran, as a periprocedural anticoagulant for use with ablation of atrial fibrillation (AF). METHODS: Consecutive patients scheduled to undergo an AF ablation were randomly assigned to receive dabigatran (n = 45) or warfarin (n = 45) to compare their clinical feasibility. Both of those oral anticoagulants were discontinued the day before the ablation and were resumed after confirming hemostasis of the venipuncture site. A bridging therapy with heparin was not used in either of the patient groups. RESULTS: Dabigatran was switched to warfarin before the ablation because of dyspepsia in three patients. An occurrence of rebleeding from the venipuncture site was less common in dabigatran-allocated patients than in warfarin-allocated patients (20% vs 44%; P = 0.013). The reduction in the D-dimer level after the initiation of oral anticoagulants was greater in the dabigatran-allocated patients than in the warfarin-allocated patients. The time from the initiation of the anticoagulants to the ablation was significantly shorter in the dabigatran-allocated patients than in the warfarin-allocated patients (43 ± 7 vs 63 ± 13 days; P < 0.0001). There was only one fatal periprocedural complication in a patient receiving warfarin, who had a mesenteric arterial thrombosis after the ablation. CONCLUSIONS: An anticoagulation strategy with dabigatran may surpass that with warfarin in reducing both the periprocedural risk of minor bleeding and a hypercoagulable state, and the time to ablation in patients undergoing ablation of AF.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Benzimidazóis/administração & dosagem , Pré-Medicação/métodos , Trombose/etiologia , Trombose/prevenção & controle , Varfarina/administração & dosagem , beta-Alanina/análogos & derivados , Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Dabigatrana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Resultado do Tratamento , beta-Alanina/administração & dosagem
19.
Chemistry ; 18(50): 16129-35, 2012 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-23138931

RESUMO

Facile synthesis of meso-aryl-substituted 5,15-dithiaporphyrins and 10-thiacorroles has been achieved by sulfidation of α,α'-dichlorodipyrrin metal complexes with sodium sulfide in DMF. Thiacorrole metal complexes exhibit distinct aromaticity due to 18 π-conjugation including the lone pair on sulfur, whereas dithiaporphyrins are nonaromatic judging from (1)H NMR spectra, X-ray analysis, and absorption spectra. We have found that Ni(II) and Al(III) dithiaporphyrin complexes undergo smooth thermal sulfur extrusion reaction to give the corresponding thiacorrole complexes, whereas free base, Zn(II), Pd(II), and Pt(II) dithiaporphyrin complexes did not exhibit the similar reactivity. The DFT calculations have elucidated a reaction pathway involving an episulfide intermediate, which can explain the markedly different reactivity among dithiaporphyrin metal complexes.

20.
J Cardiovasc Electrophysiol ; 23(12): 1289-94, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22913591

RESUMO

INTRODUCTION: It is not common for patients on chronic hemodialysis (HD) to undergo catheter ablation of atrial fibrillation (AF). We aimed to show the outcomes of AF ablation in the HD patients. METHODS AND RESULTS: Thirty HD patients who underwent pulmonary vein (PV) isolation for drug refractory paroxysmal AF were retrospectively studied, and their AF recurrence free rate and frequency of periprocedural complications were compared to 60 age- and gender-matched control patients not requiring HD. A nonirrigated ablation catheter was used in both patient groups. During a mean follow-up period of 821 ± 218 days, 16 (54%) of the HD patients remained free from AF recurrence without any antiarrhythmic agents versus 47 (78%) of the control patients with an initial ablation (P = 0.013). A second ablation procedure was performed in 12 patients with an AF recurrence, and consequently 20 (67%) of the HD patients were in sinus rhythm compared to 53 (88%) of the controls during a follow-up duration of 747 ± 221 after the last ablation (P = 0.012). Bleeding from the venipuncture site requiring a prolonged hospital stay was identified in 2 HD patients and 1 control subject, while no life-threatening complications were observed in either patient group. CONCLUSION: Although the success rate of the PV isolation in HD patients was far from satisfactory, it may be considered as one of the therapeutic options for them.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Sistema de Condução Cardíaco/cirurgia , Falência Renal Crônica/reabilitação , Veias Pulmonares/cirurgia , Diálise Renal , Idoso , Fibrilação Atrial/complicações , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
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