Oral Health of Patients Undergoing Percutaneous Coronary Intervention-A Possible Link between Periodontal Disease and In-Stent Restenosis.

Introduction: There is a well-documented association between coronary artery disease (CHD) and periodontal disease (PD) mediated by common inflammatory pathways. This association, however, has not been investigated extensively in the special context of in-stent restenosis. This study aimed to investigate the periodontal status of patients undergoing percutaneous coronary intervention (PCI) for restenotic lesions. Methods and Results: We enrolled 90 patients undergoing percutaneous coronary intervention and 90 age- and gender-matched healthy controls in the present study. All subjects received a full-mouth examination by a periodontist. Plaque index, periodontal status, and tooth loss were determined. The periodontal state was significantly worse (p < 0.0001) in the PCI group, and each periodontal stage increased the odds of belonging to the PCI group. This effect of PD was independent of diabetes mellitus, another strong risk factor for CAD. The PCI group was further divided into two subgroups: PCI for restenotic lesions (n = 39) and PCI for de novo lesions (n = 51). Baseline clinical and procedural characteristics were comparable between the two PCI subgroups. A significant (p < 0.001) association was found between the PCI subgroup and the severity of periodontal disease, with the incidence of severe PD reaching 64.1%. Conclusions: Patients undergoing PCI for in-stent restenosis exhibit more severe forms of periodontal disease not only as compared to healthy controls but also as compared to patients stented for de novo lesions. The potential causality between PD and restenosis must be studied in larger prospective studies.

[18F-fluoro-deoxy-glucose positron emission tomography/computer tomography (18F-FDG-PET/CT) imaging in cardiology]. / 18F-fluoro-dezoxi-glükóz pozitronemissziós tomográfia/komputertomográfia (18F-FDG-PET/CT) képalkotás a kardiológiában.

Over the past decades, 18F-FDG-PET/CT imaging has been recognized as an indispensable tool in the diagnosis, staging and treatment monitoring of cancer. This modern imaging technique combining functional and morphologic information has approved indications not only in oncology but in clinical cardiology as well. In the current review we discuss the specific requirements of patient preparation and image acquisition protocol for cardiac 18F-FDG-PET/CT. We review the literature in some cases highlighted by our own examinations of well-known "gold standard" viability and onco-cardiology examinations while placing special emphasis on inflammatory disorders involving the heart. This relatively newer class of indications includes prosthetic valve endocarditis, cardiac implantable device infection, myocardial inflammation of varying origin such as sarcoidosis where 18F-FDG-PET/CT appears to be particularly useful in the differential diagnosis of cases where standard investigation is non-diagnostic or equivocal. Orv Hetil. 2019; 160(26): 1015-1024.

Comparison of Platelet Function Guided Versus Unguided Treatment With P2Y12 Inhibitors in Patients With Acute Myocardial Infarction (from the Hungarian Myocardial Infarction Registry).

Evidence is conflicting regarding the clinical benefits of selecting P2Y12 inhibitors based on platelet function testing (PFT). Between March 1, 2013 and March 1, 2014, we collected clinical characteristics and platelet function data in a nationwide acute myocardial infarction (AMI) registry from 15 interventional cardiology centers in Hungary. The risk of all-cause mortality at 1 year were compared after propensity score (PS) matching between patients receiving PFT-guided and unguided P2Y12-inhibitor therapies. High platelet reactivity on clopidogrel (HPRoC) was uniformly defined with the Multiplate assay. A total of 5,583 patients with AMI and coronary intervention were registered. After exclusion of cases with contraindication to prasugrel, propensity matching resulted in a sample of 2,104 patients with well-adjusted characteristics. Clopidogrel was the dominant P2Y12 inhibitor in both groups (unguided: 96% vs PFT guided: 85%, p <0.001). In the PFT-guided group, 19% of patients had HPRoC and 77% of them were switched to prasugrel. According to the adjusted analysis, all-cause mortality at 1 year was significantly lower in the PFT-guided compared with the unguided group (hazard ratio 0.57 [95% confidence interval 0.43 to 0.77], p <0.001). Although prasugrel treatment was not associated with lower all-cause mortality in the overall cohort, patients with HPRoC who switched to prasugrel had significantly lower mortality when compared with those continuing clopidogrel (hazard ratio 0.33 [95% confidence interval 0.12 to 0.92], p <0.05). In conclusion, in patients with AMI, PFT-guided treatment with a high rate of switchover to prasugrel was associated with a lower risk of mortality. Prasugrel was a predictor of lower mortality in patients with HPRoC but not in the overall cohort of AMI.

[Relationship between early myocardial reperfusion assessed by videodensitometry and late left ventricular function. Results following invasive treatment of acute myocardial infarction]. / A videodenzitometriával vizsgált korai myocardialis reperfúzió és a kései balkamra-funkció összefüggései. Eredmények acut myocardialis infarctus invazív ellátását követoen.

INTRODUCTION: It is known that there is a relationship between myocardial perfusion and left ventricular function. AIM: The aim of the current study was to examine the relationship between myocardial reperfusion as assessed by videodensitometry on coronary angiograms following invasive treatment of ST elevation myocardial infarction and magnetic resonance imaging-derived late left ventricular function. METHOD: The study included 25 patients with ST elevation myocardial infarction. A quantitative parameter of myocardial (re)perfusion was calculated by the ratio of maximal density (Gmax) and the time to reach maximum density (Tmax) following invasive treatment. Magnetic resonance imaging was performed 387±262 days after ST elevation myocardial infarction for the evaluation of left ventricular function in all cases. RESULTS: Significant correlations were demonstrated between left ventricular ejection fraction and Gmax (r = 0.40, p = 0.05) and Gmax/Tmax (r = 0.41, p = 0.04) following vessel masking. CONCLUSIONS: The results demonstrate significant relationship between densitometric Gmax/Tmax and late left ventricular function following ST elevation myocardial infarction. Orv. Hetil., 2014. 155(5), 187-193.

[Aortic valve stenosis is associated with reduced myocardial perfusion as assessed by videodensitometry in coronary angiograms]. / Az aortabillentyu szukülete együtt jár a koronarográfiás felvételeken videodenzitometria során meghatározott myocardialis perfúzió csökkenésével.

UNLABELLED: Aortic valve stenosis may be accompanied by angina despite coronary arteries free of significant stenosis due to microvascular abnormalities. AIMS: The aim of the current study was to test whether densitometry-derived myocardial perfusion on coronary angiogram is reduced in patients with aortic valve stenosis. METHODS: The study comprised 20 patients with aortic valve stenosis (mean transvalvular gradient: 47.4±15.2 mm Hg) and 30 control subjects without significant epicardial coronary artery stenosis. A quantitative parameter of myocardial perfusion was calculated by the ratio of maximal density (Gmax) and time to reach maximum density (Tmax) on time-density curves in regions of interest of each coronary artery on coronary angiograms. RESULTS: Mean three-vessel Gmax/Tmax proved to be significantly lower in patients with aortic valve stenosis compared to control subjects (2.55±1.02 1/sec vs. 3.39±1.09 1/sec, p<0.01). CONCLUSIONS: Reduced Gmax/Tmax values indicative of myocardial perfusion abnormalities as measured by densitometry on coronary angiograms could be demonstrated in patients with aortic valve stenosis compared to controls.