Treatment of Platypnea-Orthodeoxia Syndrome in a Patient with Normal Cardiac Hemodynamics: A Review of Mechanisms with Implications for Management.

Platypnea-orthodeoxia syndrome is a rare entity characterized by dyspnea and hypoxemia in the sitting position and usually resolved by lying down. Although it is not well understood, it is thought to be associated with either intracardiac or extracardiac factors. Within the group of intracardiac etiologies, it typically occurs in the presence of right heart failure or elevated right-sided filling pressures.

The evaluation of creatinine clearance, estimated glomerular filtration rate and serum creatinine in predicting contrast-induced acute kidney injury among patients undergoing percutaneous coronary intervention.

Purpose: The purpose of the study was to compare creatinine clearance (CrCl), estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) in predicting contrast-induced acute kidney injury (CI-AKI), dialysis and death following percutaneous coronary intervention (PCI).

Methods And Materials: Data were prospectively collected on 7759 consecutive patients within the Dartmouth Dynamic Registry undergoing PCI between January 1, 2000, and December 31, 2006. Renal function was measured at baseline and within 48 h after PCI using three methods: CrCl using the Cockcroft-Gault equation, eGFR using the abbreviated Modification of Diet in Renal Disease equation and SCr.

Outcomes of diabetics receiving bare-metal stents versus drug-eluting stents.

Objectives: We sought to determine if differences existed in in-hospital outcomes, long-term rates of target vessel revascularization (TVR), and/or long-term mortality trends between patients with diabetes mellitus undergoing percutaneous coronary intervention (PCI) with either a drug-eluting stent(s) (DES) or a bare metal stent(s) (BMS).

Background: Short- and long-term clinical outcomes of patients with diabetes mellitus undergoing PCI with DES versus BMS remain inconsistent between randomized-controlled trials (RCTs) and observational studies.

Methods: Data were collected prospectively on diabetics undergoing PCI with either DES or BMS from January 2000 to June 2008.

Real world, long-term outcomes comparison between paclitaxel-eluting and sirolimus-eluting stent platforms.

We compare real-world, extended target vessel revascularization (TVR)-free survival following percutaneous coronary intervention (PCI) for patients receiving either sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES) following an index drug-eluting stent (DES) supported procedure. We analyzed 2,363 consecutive patients having first DES-supported PCI at receiving PES (n = 1,012) or SES (n = 1,332) from April 2004 to July 2006. Baseline clinical and procedural characteristics and in-hospital outcomes were recorded during the time of the index procedure and extended clinical outcomes data were obtained thereafter.

The impact of hematocrit drop on long-term survival after cardiac catheterization: insights from the Dartmouth Dynamic Registry.

Background: The long-term prognostic implication of post-procedural hematocrit drops in patients undergoing cardiac catheterization outside the clinical trial setting is not well defined.

Methods: Data was prospectively collected from 12,661 patients undergoing diagnostic or interventional cardiac catheterization between July 1998 and July 2006. Patients were divided into three cohorts based upon the degree of hematocrit change: drop greater than 6, drop between 3 and 6, and drop less than 3.

Retrograde techniques and the impact of operator volume on percutaneous intervention for coronary chronic total occlusions an early U.S. experience.

Objectives: Our purpose was to determine if "Japanese style" technical strategies can be successfully applied in the U.S. practice environment and to better understand the learning curve for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Classification and atherosclerosis distribution in patients with left main coronary disease.

Objective: The purpose of this investigation was to characterize clinical variables and angiographic distribution of coronary atherosclerosis to classify patients with de novo left main (LM) disease in a real-world population presenting for coronary angiography.

Background: Limited quantitative and angiographic published data exist that provide detailed quantitative information to classify potential target population for elective LM percutaneous coronary intervention (PCI) and guide development of dedicated LM PCI platforms.

Methods: Medical history and clinical presentation were prospectively collected on 177 consecutive patients with LM stenosis > or =50% by coronary angiography.

Interaction of gender and age on post cardiac catheterization contrast-induced acute kidney injury.

The purpose of this study was to determine the relative impact of gender and age on the development of contrast-induced acute kidney injury (CIAKI) after cardiac catheterization. CIAKI is a recognized complication of coronary angiography, but the relative impact of age strata and gender is not well understood. We prospectively enrolled 21,489 consecutive patients undergoing coronary angiography and stratified patients by age and gender into 4 age categories (<50, 51 to 64, 65 to 79, and >80 years).

Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: insights from the Dartmouth Dynamic Registry.

Objectives: We sought to determine if transient and persistent elevations in creatinine following percutaneous coronary intervention (PCI) resulted in poor survival.

Background: Limited survival data exist that defines the natural survival history of transient and persistent renal dysfunction following interventional PCI cases.

Methods: Data were collected prospectively on 7,856 consecutive patients undergoing PCI from January 1, 2000 to July 31, 2006.

Age-based differences of percutaneous coronary intervention in the drug-eluting stent era.

Introduction: Limited data are available on contemporary percutaneous coronary intervention (PCI) practice patterns and outcomes in elderly patients. The objective of this study was to evaluate "real-world" PCI in elderly and nonelderly patients during the first year of availability of drug-eluting stents (DES) in the United States market (May 1, 2003-April 30, 2004).

Methods: One thousand one hundred sixty-six consecutive patients (272 elderly [age > or =75 years] and 894 nonelderly [age <75 years]) having PCI for de novo coronary artery disease (CAD) at Dartmouth-Hitchcock Medical Center were included in this study.

Cardiac motion analysis to improve pacing site selection in CRT.

Rationale And Objectives: The aim of the study is to build cardiac wall motion models to characterize mechanical dyssynchrony and predict pacing sites for the left ventricle of the heart in cardiac resynchronization therapy (CRT).

Materials And Methods: Cardiac magnetic resonance imaging data from 20 patients are used, in which half have heart failure problems. We propose two spatio-temporal ventricular motion models to analyze the mechanical dyssynchrony of heart: radial motion series and wall motion series (a time series of radial length or wall thickness change).

A prediction framework for cardiac resynchronization therapy via 4D cardiac motion analysis.

We propose a novel framework to predict pacing sites in the left ventricle (LV) of a heart and its result can be used to assist pacemaker implantation and programming in cardiac resynchronization therapy (CRT), a widely adopted therapy for heart failure patients. In a traditional CRT device deployment, pacing sites are selected without quantitative prediction. That runs the risk of suboptimal benefits.

Surface alignment of 3D spherical harmonic models: application to cardiac MRI analysis.

The spherical harmonic (SPHARM) description is a powerful surface modeling technique that can model arbitrarily shaped but simply connected 3D objects and has been used in many applications in medical imaging. Previous SPHARM techniques use the first order ellipsoid for establishing surface correspondence and aligning objects. However, this first order information may not be sufficient in many cases; a more general method for establishing surface correspondence would be to minimize the mean squared distance between two corresponding surfaces.

A cooperative network of trained sites for the conduct of a complex clinical trial: a new concept in multicenter clinical research.

Background: The purpose of this report is to present a model of physicians in full-time clinical practice participating as investigators in multicenter clinical trials, sponsored by a pharmaceutical or medical device company.

Methods: This gas-exchange substudy was conducted as a pilot study to establish the feasibility of the 10-member EXERcise testing group of the Duke University Cooperative Cardiovascular Society (EXERDUCCS) consortium to perform a complex multicenter trial using cardiopulmonary exercise testing. An active interchange of information was established involving the principal investigator for the substudy, a dedicated full-time project coordinator, a medical director of the overall EXERDUCCS network site, the project coordinator for the sponsor, and all the participating EXERDUCCS investigators and coordinators.

Gender-based differences of percutaneous coronary intervention in the drug-eluting stent era.

Objectives: The purpose of this study is to provide insights into percutaneous coronary intervention (PCI) performed in women in the United States by evaluating gender-based PCI-practice patterns and outcomes.

Background: Limited "real world" contemporary data exist on how the introduction of DES has impacted PCI in women.

Methods And Results: Patients (359 women, 807 men) with de novo coronary artery disease having PCI (1,166) were evaluated during the first year, since the introduction of DES in the United States market (May 1, 2003 to April 30, 2004).

Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England.

Background: Randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous coronary interventions (PCIs) for patients with multivessel coronary disease (MVD) report similar long-term survival for CABG and PCI. These studies used a highly selected population of patients and providers, and their results may not be generalizable to actual care. Our goal in this study was to compare long-term survival of MVD patients treated with CABG vs PCI in contemporary practice.

Impact and temporal trends of percutaneous coronary intervention in the drug-eluting stent versus bare metal stent eras.

Limited published data exist about how the introduction of drug-eluting stents (DESs) has affected the technical aspects of percutaneous coronary intervention and in-hospital patient outcomes in clinical practice. A total of 2,215 consecutive patients who underwent percutaneous coronary intervention for de novo coronary artery disease were divided into 2 cohorts: the pre-DES era (May 1, 2002 to April 30, 2003) and the DES era (May 1, 2003 to April 30, 2004). The procedural success rates (94.

Survival in patients with peripheral vascular disease after percutaneous coronary intervention and coronary artery bypass graft surgery.

Background: Patients with peripheral vascular disease (PVD) undergoing coronary revascularization have high rates of adverse outcomes. Whether there are important differences in outcomes for surgical versus percutaneous coronary revascularization is unknown. The objective of this study was to compare survival in patients with PVD who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery for multivessel coronary artery disease.

Outcomes of percutaneous coronary intervention among elderly patients in cardiogenic shock: a multicenter, decade-long experience.

Objectives: The objective of this study was to determine the characteristics and hospital mortality rate for elderly patients in cardiogenic shock undergoing emergent percutaneous coronary intervention (PCI).

Background: Early revascularization for patients with acute myocardial infarction complicated by cardiogenic shock is recommended for patients < 75 years of age. This age-restricted recommendation is based upon evidence that elderly shock patients undergoing early revascularization have extremely high hospital mortality rates.

Predicting vascular complications in percutaneous coronary interventions.

Objectives: Using a large, current, regional registry of percutaneous coronary interventions (PCI), we identified risk factors for postprocedure vascular complications and developed a scoring system to estimate individual patient risk.

Background: A vascular complication (access-site injury requiring treatment or bleeding requiring transfusion) is a potentially avoidable outcome of PCI.

Methods: Data were collected on 18,137 consecutive patients undergoing PCI in northern New England from January 1997 to December 1999.

Gender-related changes in the practice and outcomes of percutaneous coronary interventions in Northern New England from 1994 to 1999.

Objectives: We sought to determine whether the changing practice of interventional cardiology has been associated with improved outcomes for women, and how these outcomes compare with those for men.

Background: Previous work from the early 1990s suggested women are at a higher risk than men for adverse outcomes after percutaneous coronary interventions (PCIs). From 1994 to 1999 data were collected on 33,666 consecutive hospital admissions for a PCI in Northern New England.