Evaluation of Intracardiac Pressures Using Subharmonic-aided Pressure Estimation with Sonazoid Microbubbles.

Purpose To investigate if the right ventricular (RV) systolic and left ventricular (LV) diastolic pressures can be obtained noninvasively using the subharmonic-aided pressure estimation (SHAPE) technique with Sonazoid microbubbles. Materials and Methods Individuals scheduled for a left and/or right heart catheterization were prospectively enrolled in this institutional review board-approved clinical trial from 2017 to 2020. A standard-of-care catheterization procedure was performed by advancing fluid-filled pressure catheters into the LV and aorta ( = 25) or RV ( = 22), and solid-state high-fidelity pressure catheters into the LV and aorta in a subset of participants ( = 18).

Noninvasive Evaluation of Cardiac Chamber Pressures Using Subharmonic-Aided Pressure Estimation With Definity Microbubbles.

Background: Noninvasive and accurate assessment of intracardiac pressures has remained an elusive goal of noninvasive cardiac imaging.

Objectives: The purpose of this study was to investigate if errors in intracardiac pressures obtained noninvasively using contrast microbubbles and the subharmonic-aided pressure estimation (SHAPE) technique are <5 mm Hg.

Methods: In a nonrandomized institutional review board-approved clinical trial (NCT03243942), patients scheduled for a left-sided and/or right-sided heart catheterization procedure and providing written informed consent were included.

Comparing Central Aortic Pressures Obtained Using a SphygmoCor Device to Pressures Obtained Using a Pressure Catheter.

Background: This study compared aortic pressures estimated using a SphygmoCor XCEL PWA device (ATCOR, Naperville, IL) noninvasively with aortic pressures obtained using pressure catheters during catheterization procedures and analyzed the impact of a linear-fit function on the estimated pressure values.

Methods: One hundred and thirty-six patients scheduled for cardiac catheterization procedure were enrolled in IRB approved studies. Catheterization procedures were performed according to standard-of-care to acquire aortic pressure measurements.

Percutaneous coronary intervention of totally occluded coronary venous bypass grafts: An exercise in futility?

Background: Percutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG. However, contemporary outcomes after SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy.

The Spontaneous Coronary Slow-Flow Phenomenon: Reversal by Intracoronary Nicardipine.

Objective: An under-recognized cause of chest pain, the coronary slow-flow (CSF) phenomenon is characterized by delayed coronary opacification during diagnostic angiography in the absence of epicardial coronary artery disease (CAD). Given its angiographic resemblance to no-reflow during percutaneous coronary intervention, a condition associated with microvascular spasm responsive to calcium-channel blockers, we hypothesized that spontaneous CSF may similarly be reversed by intracoronary (IC) nicardipine.

Methods: The effect of IC nicardipine was evaluated in 30 patients.

Non-Invasive Intra-cardiac Pressure Measurements Using Subharmonic-Aided Pressure Estimation: Proof of Concept in Humans.

This study evaluated the feasibility of employing non-invasive intra-cardiac pressure estimation using subharmonic signals from ultrasound contrast agents in humans. This institutional review board-approved proof-of-concept study included 15 consenting patients scheduled for left and right heart catheterization. During the catheterization procedure, Definity was infused intra-venously at 4-10 mL/min.

Unrecognized coronary vasospasm in patients referred for percutaneous coronary intervention: Intracoronary nitroglycerin, the forgotten stepchild of cardiovascular guidelines.

Objective: The goal of this study was to demonstrate the importance of intracoronary nitroglycerin (IC NTG) administration during diagnostic coronary angiography and prior to percutaneous coronary intervention (PCI).

Background: PCI has been a mainstay treatment for patients with symptomatic coronary artery disease. While current guidelines emphasize the importance of periprocedural antithrombotic medications, they fail to mention the use of nitroglycerin prior to PCI.

Importance of Adjunct Delivery Techniques to Optimize Deployment Success of Distal Protection Filters During Vein Graft Intervention.

Objectives: This study assessed the impact of adjunct delivery techniques on the deployment success of distal protection filters in saphenous vein grafts (SVGs).

Background: Despite their proven clinical benefit, distal protection devices are underutilized in SVG interventions. Deployment of distal protection filters can be technically challenging in the presence of complex anatomy.

Frequency of Use of Statins and Aspirin in Patients With Previous Coronary Artery Bypass Grafting.

Coronary artery bypass grafting (CABG) is commonly performed to treat ischemic heart disease, but long-term benefits are limited by failed patency of bypass grafts. Both statin medications and aspirin hold class I indications for all post-CABG patients and should be continued indefinitely unless contraindications exist. Unfortunately, there are limited data regarding long-term usage of these essential medications.

Decreased levels of BAG3 in a family with a rare variant and in idiopathic dilated cardiomyopathy.

The most common cause of dilated cardiomyopathy and heart failure (HF) is ischemic heart disease; however, in a third of all patients the cause remains undefined and patients are diagnosed as having idiopathic dilated cardiomyopathy (IDC). Recent studies suggest that many patients with IDC have a family history of HF and rare genetic variants in over 35 genes have been shown to be causative of disease. We employed whole-exome sequencing to identify the causative variant in a large family with autosomal dominant transmission of dilated cardiomyopathy.

Safety, effectiveness, and outcomes of cardiac catheterization in nonagenarians.

With an aging population, nonagenarians (≥90 years of age) are increasingly being considered for cardiac catheterization. Because of the paucity of outcomes data in this population, we sought to evaluate the acute and intermediate outcomes of nonagenarians undergoing cardiac catheterization. A retrospective cohort of 44 nonagenarians undergoing 53 cardiac catheterizations from 2002 to 2010 was identified.

Management of clopidogrel hypersensitivity without drug interruption.

Clopidogrel hypersensitivity affects up to 6% of treated patients, often leading to discontinuation of the drug. Conventional desensitization protocols incorporate a washout period off medication that may be problematic after percutaneous coronary intervention because premature discontinuation of dual antiplatelet therapy is a major risk factor for stent thrombosis. The purpose of this study was to evaluate a strategy for treating clopidogrel hypersensitivity without drug interruption using corticosteroids and antihistamines to facilitate development of physiologic tolerance.

Accuracy of MDCT in assessing the degree of stenosis caused by calcified coronary artery plaques.

Objective: Because of beam-hardening and blooming artifacts, it is difficult to determine the degree of stenosis caused by calcified coronary artery plaques at coronary CT angiography (CTA). Our goal was to determine how accurate coronary CTA is in evaluating these lesions.

Materials And Methods: Thirty-one patients who had one or more calcified coronary artery plaques at coronary CTA underwent invasive coronary angiography.

Facilitated stent delivery using applied topical lubrication.

Objectives: The goal of this study was to assess the utility of topical lubrication to aid stent delivery in challenging anatomy and its effects on long-term clinical outcome.

Background: Failed stent delivery is encountered in up to 5% of percutaneous coronary interventions (PCI).

Methods: The effectiveness of topically applied lubrication to facilitate stent delivery after failed stent placement was evaluated in 20 (2.

Efficacy of intracoronary nicardipine in the treatment of no-reflow during percutaneous coronary intervention.

Objectives: The goal of this study was to evaluate the safety and efficacy of nicardipine in reversing no-reflow during percutaneous coronary intervention (PCI).

Background: No-reflow is a common complication of PCI in patients with acute coronary syndromes or venous bypass graft disease. Although nicardipine has an attractive pharmacological profile and has been used clinically to treat no-reflow, there is a paucity of published data regarding its effectiveness in this setting.

Effect of NADPH oxidase inhibition on cardiopulmonary bypass-induced lung injury.

Cardiopulmonary bypass (CPB) causes acute lung injury. Reactive oxygen species (ROS) from NADPH oxidase may contribute to this injury. To determine the role of NADPH oxidase, we pretreated pigs with structurally dissimilar NADPH oxidase inhibitors.

Advanced cardiac life support. Reviewing recommendations from the AHA guidelines.

Cardiovascular disease is prevalent in the older population, making older patients susceptible to complications, including cardiac arrest. Early intervention via cardiopulmonary resuscitation or another form of emergency cardiovascular care can reduce mortality in this population. In 2000, the American Heart Association, in conjunction with various international organizations, published guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, which include a section on advanced cardiac life support (ACLS).

Effect of bronchial artery blood flow on cardiopulmonary bypass-induced lung injury.

Cardiovascular surgery requiring cardiopulmonary bypass (CPB) is frequently complicated by postoperative lung injury. Bronchial artery (BA) blood flow has been hypothesized to attenuate this injury. The purpose of the present study was to determine the effect of BA blood flow on CPB-induced lung injury in anesthetized pigs.

Wall tension is a potent negative regulator of in vivo thrombomodulin expression.

Thrombomodulin (TM), a key component of the anticoagulant protein C pathway, is a major contributor to vascular thromboresistance. We previously found that TM protein expression is dramatically reduced in autologous vein grafts during the first two weeks after implantation, coincident to a local inflammatory response, and remains suppressed for at least 6 weeks. To determine the proximate cause of TM loss, in vivo gene expression was quantified by real-time PCR.

Left atrial-inferior vena cava bypass achieves retroperfusion of the porcine spinal cord: morphologic and preliminary physiologic studies.

Background: Spinal cord injury remains a devastating complication after procedures on the descending thoracic aorta. A new model for retrograde perfusion of the spinal cord during aortic cross-clamping was evaluated for its potential role in preventing spinal cord injury after thoraco-abdominal aortic surgery.

Methods: Retrograde perfusion of the spinal cord was established in juvenile pigs using partial bypass from the left atrium to the isolated inferior vena cava.

Early loss of thrombomodulin expression impairs vein graft thromboresistance: implications for vein graft failure.

Thrombosis is the major cause of early vein graft failure. Our aim was to determine whether alterations in the expression of the anticoagulant proteins, thrombomodulin (TM) and the endothelial cell protein C receptor (EPCR), impair endothelial thromboresistance that may contribute to vein graft failure. Immunohistochemical staining of autologous rabbit vein graft sections revealed that the expression of TM, but not EPCR, was reduced significantly early after graft implantation.