Publications by authors named "Kaleab Asrress"
Article Synopsis
- The study analyzes two main percutaneous treatments for significant unprotected ostial left anterior descending artery (LAD) disease: ostial stenting (OS) and crossover stenting (CS), focusing on how effectively they prevent target lesion revascularization (TLR).
- After reviewing seven studies with 1,181 patients, the results indicated that CS significantly reduced the rate of TLR compared to OS, with additional benefits when intracoronary imaging was used during procedures.
- Although CS showed better outcomes, it also led to a higher need for unintended interventions in the left circumflex artery (LCx), which could potentially be managed with a technique called final kissing balloon inflation, though the
Using a network meta-analysis, this study compared fractional flow reserve (FFR) guided with angiography-guided revascularization of non-culprit lesions in ST elevation myocardial infarction (STEMI). We also assessed if early complete revascularization is superior to delayed revascularization. We conducted a network meta-analysis using Net Meta XL of trials of STEMI patients with multivessel disease and compared revascularization strategies.
View Article and Find Full Text PDFBackground: Advances in percutaneous coronary intervention (PCI) has made the possibility of facilitating same day discharge (SDD) of patients undergoing intervention. We sought to investigate the feasibility, safety and economic impact of such a service.
Methods: We retrospectively collected data on all patients undergoing outpatient PCI at our institution over a 12-month period.
Article Synopsis
- Coronary artery disease (CAD) negatively impacts the heart's left ventricular performance during exercise by hindering its ability to contract effectively, especially when there is increased afterload.* -
- Researchers measured left ventricular pressure and blood flow in 16 patients with CAD during exercise, revealing that those with flow-limiting CAD experienced decreased contractile function and poorer cardiovascular performance compared to a control group.* -
- The study found that while exercise improved contractile function in patients without CAD, those with flow-limiting conditions had contrasting results, indicating that intense exercise can exacerbate heart issues in CAD patients.*
Understanding the cardiac-coronary interaction is fundamental to developing treatment strategies for ischemic heart disease. We sought to examine the impact of afterload reduction following isosorbide dinitrate (ISDN) administration on LV properties and coronary hemodynamics to further our understanding of the cardiac-coronary interaction. Novel methodology enabled real-time simultaneous acquisition and analysis of coronary and LV hemodynamics in vivo using coronary pressure-flow wires (used to derive coronary wave energies) and LV pressure-volume loop assessment.
View Article and Find Full Text PDFDuring the COVID-19 pandemic there has been a reduction in hospital admissions for acute myocardial infarction. This manuscript presents the analysis of Google Trends meta-data and shows a marked spike in search volume for chest pain that is strongly correlated with COVID-19 case numbers in the United States. This raises a concern that fear of contracting COVID-19 may be leading patients to self-triage using internet searches.
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- Inflammation significantly impacts acute coronary syndromes (ACS), and colchicine, traditionally used for gout, shows promise for treating ACS due to its anti-inflammatory effects.
- A double-blind trial with 795 patients compared colchicine treatment (0.5 mg twice daily) with a placebo, alongside standard medication, over 12 months.
- Results indicated fewer adverse events in the colchicine group (24 vs. 38), but a higher total death rate (8 vs. 1) and more non-cardiovascular deaths, while adverse effects were similar between both groups, primarily involving gastrointestinal issues.
Background Cold air inhalation during exercise increases cardiac mortality, but the pathophysiology is unclear. During cold and exercise, dual-sensor intracoronary wires measured coronary microvascular resistance ( MVR ) and blood flow velocity ( CBF ), and cardiac magnetic resonance measured subendocardial perfusion. Methods and Results Forty-two patients (62±9 years) undergoing cardiac catheterization, 32 with obstructive coronary stenoses and 10 without, performed either (1) 5 minutes of cold air inhalation (5°F) or (2) two 5-minute supine-cycling periods: 1 at room temperature and 1 during cold air inhalation (5°F) (randomized order).
View Article and Find Full Text PDFResting Coronary Flow Varies With Normal Cardiac Catheter Laboratory Stimuli.
Cardiovasc Revasc Med
August 2019
Background: Growing evidence supports physiology-guided revascularization, with Fractional Flow Reserve (FFR) the most commonly used invasive measure of coronary blood flow impairment at the time of diagnostic angiography. Recently, there has been growing interest in stenosis severity indices measured at rest, such as Instantaneous Wave Free Ratio (iFR) and the ratio of distal coronary to aortic pressure at rest (resting Pd/Pa). Their reliability may, theoretically, be more susceptible to changes in microvascular tone and coronary flow.
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- The study compares two methods of measuring coronary microvascular resistance—Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR)—to see which is better at predicting microvascular dysfunction in patients with heart conditions.
- A total of 54 patients were analyzed, and results showed that hMR had significantly higher diagnostic accuracy than IMR, with better sensitivity and specificity for predicting coronary flow reserve and myocardial perfusion reserve index.
- The findings suggest that hMR and IMR only have a modest correlation and are not equivalent in measuring microvascular function, with hMR demonstrating a stronger relationship with other invasive and noninvasive measures
Article Synopsis
- Identification and management of major cardiovascular risk factors (SMuRFs) have significantly improved heart health, but cardiovascular disease still leads globally in deaths.
- A study analyzing STEMI patients from 2006 to 2014 showed that the number of patients without traditional risk factors (SMuRFless) increased from 11% to 27%.
- The findings suggest that while the rates of high cholesterol and smoking decreased, there are many individuals whose heart conditions cannot be fully explained by known risk factors, signaling a need for further research into new causes and treatment methods.
Background: The mechanisms governing exercise-induced angina and its alleviation by the most commonly used antianginal drug, nitroglycerin, are incompletely understood. The purpose of this study was to develop a method by which the effects of antianginal drugs could be evaluated invasively during physiological exercise to gain further understanding of the clinical impact of angina and nitroglycerin.
Methods: Forty patients (mean age, 65.
Article Synopsis
- Cardiogenic shock during acute STEMI is challenging to manage and leads to high mortality rates, especially with cardiac arrest cases.
- Traditional treatments like inotropes can worsen outcomes, while options like the intra-aortic balloon pump (IABP) and ECMO are not widely accessible or proven effective.
- A unique case is presented where an Autopulse™ device was used for mechanical compression during a cardiac arrest in STEMI, followed by Impella insertion for support, resulting in a successful recovery after a prolonged period without spontaneous output.
Objective: Coronary wave intensity analysis (cWIA) has increasingly been applied in the clinical research setting to distinguish between the proximal and distal mechanical influences on coronary blood flow. Recently, a cWIA-derived clinical index demonstrated prognostic value in predicting functional recovery postmyocardial infarction. Nevertheless, the known operator dependence of the cWIA metrics currently hampers its routine application in clinical practice.
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- * New P2Y inhibitors, like ticagrelor and prasugrel, outperform clopidogrel in STEMI patients receiving primary percutaneous coronary intervention.
- * Future trials will further evaluate non-culprit lesion PCI, bioresorbable vascular scaffolds, mechanical devices for persistent ischaemia, and the use of early implantable cardioverter-defibrillators.
Background: Severe aortic stenosis (AS) can manifest as exertional angina even in the presence of unobstructed coronary arteries.
Objectives: The authors describe coronary physiological changes during exercise and hyperemia in the healthy heart and in patients with severe AS.
Methods: Simultaneous intracoronary pressure and flow velocity recordings were made in unobstructed coronary arteries of 22 patients with severe AS (mean effective orifice area 0.
This work presents a mathematical model of the metabolic feedback and adrenergic feedforward control of coronary blood flow that occur during variations in the cardiac workload. It is based on the physiological observations that coronary blood flow closely follows myocardial oxygen demand, that myocardial oxygen debts are repaid, and that control oscillations occur when the system is perturbed and so are phenomenological in nature. Using clinical data, we demonstrate that the model can provide patient-specific estimates of coronary blood flow changes between rest and exercise, requiring only the patient's heart rate and peak aortic pressure as input.
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- Management of cardiac arrest involves a structured, protocol-driven approach that emphasizes early identification of causes and requires parallel diagnosis and treatment, with echocardiography playing a key role.
- A case study of a 71-year-old patient illustrates the progression from post-operative respiratory failure to cardiac arrest, leading to the discovery of a massive pulmonary embolism through focused echocardiography.
- The successful use of thrombolytic therapy, after initial CPR and the administration of adrenaline, stabilized the patient, showcasing the importance of timely interventions in critical care situations.
Aims: To demonstrate the feasibility of implanting the Lotus second-generation transcatheter heart valve (THV) (designed for a transfemoral procedure) via a transaortic approach.
Methods And Results: We describe a case with severe aortic stenosis in the presence of small calibre and calcified femoral access and severe chronic obstructive pulmonary disease. The transaortic approach was the ideal approach for this patient and we successfully implanted a 25 mm Lotus valve without any complication.