JRSM Cardiovascular Disease最新文献

{"title":"Is there an association between orthostatic hypotension and cerebral white matter hyperintensities in older people? The Irish longitudinal study on ageing.","authors":"Anne Buckley,&nbsp;Daniel Carey,&nbsp;James M Meaney,&nbsp;RoseAnne Kenny,&nbsp;Joseph Harbison","doi":"10.1177/2048004020954628","DOIUrl":"https://doi.org/10.1177/2048004020954628","url":null,"abstract":"<p><strong>Introduction: </strong>Orthostatic Hypotension (OH) is an abnormal drop in blood pressure (BP) that occurs following orthostatic challenge. OH is associated with increased risk of falls, cognitive impairment and death. White Matter Hyperintensities (WMH) on MR Brain are associated with vascular risk factors such as hypertension, diabetes and age. We examined whether extent White matter intensities were associated with presence of OH detected in a community dwelling population of older people.</p><p><strong>Methods: </strong>Individuals from the MR sub-study of the Irish Longitudinal Study of Ageing underwent a 3 Tesla MR Brain scan to assess WMH severity (Schelten's Score). The scans were performed during the Wave 3 TILDA health assessment phase when the subjects also underwent assessment for OH with an active stand protocol. Data was analysed for association between WMH and vascular risks and orthostatic change in BP 10 second intervals during the OH evaluation.</p><p><strong>Results: </strong>440 subjects were investigated; median age 72 years (65-92 years) and 228 (51.5%) female. Range of Scheltens' Scores was 0-32. Mean score was 9.72 (SD 5.87). OH was detected in 68.4% (301). On linear regression, positive associations were found between Scheltens' Score and age, hypertension, prior history of stroke and TIA, and with OH at 30, 70, 90 and 100 seconds following standing (p < 0.05, O.R. 1.9-2.5).</p><p><strong>Conclusion: </strong>WMD is associated with OH detected at multiple time points using active stand in community dwelling older subjects. Further research is necessary to evaluate the direction of this association.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020954628"},"PeriodicalIF":1.6,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004020954628","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38399993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart rate fragmentation gives novel insights into non-autonomic mechanisms governing beat-to-beat control of the heart's rhythm.","authors":"Irene S Lensen,&nbsp;Oliver J Monfredi,&nbsp;Robert T Andris,&nbsp;Douglas E Lake,&nbsp;J Randall Moorman","doi":"10.1177/2048004020948732","DOIUrl":"https://doi.org/10.1177/2048004020948732","url":null,"abstract":"<p><p>To demonstrate how heart rate fragmentation gives novel insights into non-autonomic mechanisms of beat-to-beat variability in cycle length, and predicts survival of cardiology clinic patients, over and above traditional clinical risk factors and measures of heart rate variability. <b>Approach:</b> We studied 2893 patients seen by cardiologists with clinical data including 24-hour Holter monitoring. Novel measures of heart rate fragmentation alongside canonical time and frequency domain measures of heart rate variability, as well as an existing local dynamics score were calculated. A proportional hazards model was utilized to relate the results to survival. <b>Main results:</b> The novel heart rate fragmentation measures were validated and characterized with respect to the effects of age, ectopy and atrial fibrillation. Correlations between parameters were determined. Critically, heart rate fragmentation results could not be accounted for by undersampling respiratory sinus arrhythmia. Increased heart rate fragmentation was associated with poorer survival (p ≪ 0.01 in the univariate model). In multivariable analyses, increased heart rate fragmentation and more abnormal local dynamics (p 0.045), along with increased clinical risk factors (age (p ≪ 0.01), tobacco use (p ≪ 0.01) and history of heart failure (p 0.019)) and lower low- to high-frequency ratio (p 0.022) were all independent predictors of 2-year mortality. <b>Significance:</b> Analysis of continuous ECG data with heart rate fragmentation indices yields information regarding non-autonomic control of beat-to-beat variability in cycle length that is independent of and additive to established parameters for investigating heart rate variability, and predicts mortality in concert with measures of local dynamics, frequency content of heart rate, and clinical risk factors.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020948732"},"PeriodicalIF":1.6,"publicationDate":"2020-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004020948732","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38473454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal salvage using stent graft placement after acute renal artery occlusion with prolonged ischemic time.","authors":"Yue Gao,&nbsp;Dimitrios Miserlis,&nbsp;G Matthew Longo,&nbsp;Nitin Garg","doi":"10.1177/2048004020940520","DOIUrl":"https://doi.org/10.1177/2048004020940520","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a patient with acute renal artery occlusion who underwent successful revascularization procedure after experiencing a protracted ischemic period, which resulted in successful retrieval of renal function.</p><p><strong>Case report: </strong>A 58-year-old male with a history of left renal artery stenosis and stent graft placement presented with symptoms of chest pain, shortness of breath, and flank pain. The patient was admitted to the Intensive Care Unit with the diagnosis of multiorgan failure and subsequent anuria that led to the initiation of hemodialysis. Computed tomography angiography demonstrated an aortic occlusion along with bilateral proximal renal artery occlusion with reconstitution of the mid to distal renal arteries via collateralization. The patient underwent angioplasty with bilateral renal artery stent-graft placement and successful revascularization of proximal renal arteries. Post-operatively, his renal function and urine output improved, and the patient was able to be weaned off hemodialysis along with the benefit of concurrent amelioration of his renovascular hypertension.</p><p><strong>Conclusion: </strong>For select patients with renal artery occlusion, revascularization of the renal arteries may result in dialysis independence and stabilization of renovascular hypertension, despite prolonged time of ischemia.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020940520"},"PeriodicalIF":1.6,"publicationDate":"2020-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004020940520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38376167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examination of physicians' adherence to the 2013 ACC/AHA statin/cholesterol guidelines using a framework of awareness to adherence: A cross-sectional study.","authors":"Marc L Fleming,&nbsp;Sanika Rege,&nbsp;Michael L Johnson,&nbsp;Omar Serna,&nbsp;Tara Esse,&nbsp;Jeannie Choi,&nbsp;Susan M Abughosh","doi":"10.1177/2048004020947298","DOIUrl":"https://doi.org/10.1177/2048004020947298","url":null,"abstract":"<p><strong>Background: </strong>Currently, limited data exists regarding primary care physicians' awareness and implementation of the 2013 cholesterol guidelines.</p><p><strong>Objectives: </strong>To evaluate primary care physicians' adherence to the 2013 ACC/AHA cholesterol management guidelines using the framework of the awareness-to-adherence model.</p><p><strong>Methods: </strong>The study was a cross-sectional pre-post survey design based on the constructs of the awareness-to-adherence model to capture physicians' awareness of, agreement with, adoption of, and adherence to the 2013 ACC/AHA guidelines for cholesterol treatment and statin and cholesterol management software applications. Physicians with a Medicare Advantage organization in Texas were surveyed before and after educational interventions.</p><p><strong>Results: </strong>A total of 170 responses were considered usable (post-survey). A significant difference was observed when physicians were divided into 2 groups (any intervention vs no intervention) (<i>P</i> = .027). Physicians with a higher level of agreement were 4.8 times more likely to be adherent to the guidelines (<i>P</i> = .011), compared with those with a lower level of agreement. Also, physicians practicing in the Rio Grande Valley area were 4.7 times more likely to be adherent to the guidelines (<i>P</i> = .001) compared with those from the Greater Houston area.</p><p><strong>Conclusion: </strong>A high level of awareness, but a lower level of adherence to the guidelines was reported among responding physicians. The awareness-to-adherence model was useful in examining physicians' level of adherence to the cholesterol guidelines and the utilization of statin and cholesterol management cellular apps and online websites. Future studies are required to examine physicians' adoption and adherence of new guidelines.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020947298"},"PeriodicalIF":1.6,"publicationDate":"2020-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004020947298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38334754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A brief report on the effects of vasoactive agents on peripheral venous waveforms in a porcine model.","authors":"Monica Polcz,&nbsp;Kyle M Hocking,&nbsp;Devin Chang,&nbsp;Philip Leisy,&nbsp;Jenna H Sobey,&nbsp;Jessica Huston,&nbsp;Susan Eagle,&nbsp;Colleen Brophy,&nbsp;Bret D Alvis","doi":"10.1177/2048004020940857","DOIUrl":"https://doi.org/10.1177/2048004020940857","url":null,"abstract":"<p><strong>Objectives: </strong>Non-invasive venous waveform analysis (NIVA) is a recently described, novel technique to assess intravascular volume status. Waveforms are captured with a piezoelectric sensor; analysis in the frequency domain allows for calculation of a \"NIVA value\" that represents volume status. The aim of this report was to determine the effects of vasoactive agents on the venous waveform and calculated NIVA values.</p><p><strong>Design: </strong>Porcine experimental model.</p><p><strong>Setting: </strong>Operating theatre.</p><p><strong>Participants: </strong>A piezoelectric sensor was secured over the surgically exposed saphenous vein in eight anesthetized pigs.</p><p><strong>Main outcome measures: </strong>NIVA value, pulmonary capillary wedge pressure (PCWP), and mean arterial pressure prior to and post intravenous administration of 150-180 µg of phenylephrine or 100 µg of sodium nitroprusside.</p><p><strong>Results: </strong>Phenylephrine led to a decrease in NIVA value (mean 9.2 vs. 4.6, <i>p</i> < 0.05), while sodium nitroprusside led to an increase in NIVA value (mean 9.5 vs. 11.9, <i>p</i> < 0.05). Mean arterial pressure increased after phenylephrine (<i>p</i> < 0.05) and decreased after sodium nitroprusside (<i>p</i> < 0.05). PCWP did not change significantly after phenylephrine (<i>p</i> = 0.25) or sodium nitroprusside (<i>p</i> = 0.06).</p><p><strong>Conclusions: </strong>Vasoactive agents lead to changes in non-invasively obtained venous waveforms in euvolemic pigs, highlighting a potential limitation in the ability to NIVA to estimate static volume in this setting. Further studies are indicated to understand the effects of vasoactive agents in the setting of hypovolemia and hypervolemia.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020940857"},"PeriodicalIF":1.6,"publicationDate":"2020-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004020940857","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38325593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of ambulatory blood pressure measurement in diagnosing hypotension in hypertensive diabetic patients with medication-controlled BP.","authors":"Kamal Alghalayini","doi":"10.1177/2048004020930883","DOIUrl":"https://doi.org/10.1177/2048004020930883","url":null,"abstract":"<p><strong>Background: </strong>Hypotension is a common clinical finding in diabetic patients on anti-hypertensive medications. In the absence of clearly defined and documented hypotensive episodes, clinicians are faced with the challenge of modifying antihypertensive medication in potentially symptomatic diabetic patients.</p><p><strong>Objective: </strong>To determine the value of ambulatory blood pressure monitor (ABPM) in diagnosing hypotensive episodes in hypertensive diabetic patients with medication-controlled blood pressure.</p><p><strong>Patients and methods: </strong>The records of all hypertensive diabetic patients with medication-controlled were obtained between 2017 and 2018. Patients' demographic data, comorbid conditions, hypotensive symptoms and echocardiography results were obtained and compared to office-based blood pressure and ABPM.</p><p><strong>Results: </strong>Of 926 patients screened in the department of medicine outpatient clinics, 231 patients had diabetes and hypertension and were taking antihypertension medications, so only 86 patients were recruited. Using 24 h ABPM, hypotensive events were documented in 65 (75.6%) patients without correlated hypotensive symptoms in the patient sheet. Patients who had hypotensive episodes recorded by ABPM tended to have these between 5 and 10 a.m. and were significantly older - 60.71 versus 58.76 (<i>P</i> = .022) - and more likely to have lower ejection fractions by echocardiography 46.31 versus 62.85 (EF) (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>In treated hypertensive diabetic patients with antihypertensive medication, ABPM may be beneficial in capturing bouts of asymptomatic (silent) hypotension readings that occur in the out-of-hospital setting. Diabetic patients with controlled hypertension based on office reading showed a significant number of asymptomatic hypotensive readings detected with ambulatory BP monitoring that can have a role in following up such patients.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020930883"},"PeriodicalIF":1.6,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004020930883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38099579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in C-reactive protein in response to anti-inflammatory therapy as a predictor of cardiovascular outcomes: A systematic review and meta-analysis.","authors":"Annie Berkley,&nbsp;Albert Ferro","doi":"10.1177/2048004020929235","DOIUrl":"https://doi.org/10.1177/2048004020929235","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of aggressive lipid-lowering strategies, many patients remain at risk of cardiovascular events. C-reactive protein is a marker of inflammation elevated in patients at high risk of cardiovascular events. C-reactive protein has demonstrated value as a predictor of cardiovascular risk; however, it is unclear whether targeting C-reactive protein levels improves outcomes. This systematic review aimed to characterise the relationship between C-reactive protein and cardiovascular outcomes and to assess whether the magnitude of C-reactive protein reduction correlates to the extent of cardiovascular risk reduction.</p><p><strong>Methods: </strong>A systematic review was conducted to identify randomised controlled trials that measured C-reactive protein before and after administration of therapies for cardiovascular disease and measured incidence of cardiovascular events. A meta-analysis of placebo-controlled studies assessed the relationship between extent of C-reactive protein reduction and cardiovascular risk reduction. Placebo-controlled studies where low-density lipoprotein and triglyceride data were available were also included in a meta-regression to assess the influence of these established risk factors on the efficacy of treatment when compared to C-reactive protein.</p><p><strong>Results: </strong>Fifteen studies met the criteria for inclusion in this review, of which six were active comparator studies and nine were placebo controlled. Six placebo-controlled studies had data available for meta-regression. Eight studies demonstrated a reduction in events that could be explained by changes in lipid levels, whereas the results of five studies suggested that the association between C-reactive protein reduction and event rates cannot be explained by changes in lipid levels alone. No correlation was found between magnitude of C-reactive protein reduction and cardiovascular risk reduction. A strong correlation was found between C-reactive protein and low-density lipoprotein reduction (adjusted <i>r</i> ² = 0.8).</p><p><strong>Conclusions: </strong>Targeting C-reactive protein does not offer additional benefit over targeting low-density lipoprotein across the general population in terms of cardiovascular risk reduction. However, there is value in targeting C-reactive protein in patients at high residual inflammatory risk despite non-elevated lipid levels or use of lipid-lowering therapy.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020929235"},"PeriodicalIF":1.6,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004020929235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38052039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-exertional increase in first-phase ejection fraction in recreational marathon runners.","authors":"Luca Faconti, Iain Parsons, Bushra Farukh, Ryan McNally, Lorenzo Nesti, Lingyun Fang, Michael Stacey, Neil Hill, David Woods, Phil Chowienczyk","doi":"10.1177/2048004020926366","DOIUrl":"10.1177/2048004020926366","url":null,"abstract":"<p><strong>Objectives: </strong>Running a marathon has been equivocally associated with acute changes in cardiac performance. First-phase ejection fraction is a novel integrated echocardiographic measure of left ventricular contractility and systo-diastolic coupling which has never been studied in the context of physical activity. The aim of this study was to assess first-phase ejection fraction following recreational marathon running along with standard echocardiographic indices of systolic and diastolic function.Design and participants: Runners (n = 25, 17 males), age (mean ± standard deviation) 39 ± 9 years, were assessed before and immediately after a marathon race which was completed in 4 h, 10 min ± 47 min.</p><p><strong>Main outcome measures: </strong>Central hemodynamics were estimated with applanation tonometry; cardiac performance was assessed using standard M-mode two-dimensional Doppler, tissue-doppler imaging and speckle-tracking echocardiography. First-phase ejection fraction was calculated as the percentage change in left ventricular volume from end-diastole to the time of peak aortic blood flow.</p><p><strong>Results: </strong>Conventional indices of systolic function and cardiac performance were similar pre- and post-race while aortic systolic blood pressure decreased by 9 ± 8 mmHg (<i>P</i> < 0.001) and first-phase ejection fraction increased by approximately 48% from 16.3 ± 3.9% to 22.9 ± 2.5% (<i>P</i> < 0.001). The ratio of left ventricular transmitral Doppler early velocity (E) to tissue-doppler imaging early annular velocity (e') increased from 5.1 ± 1.8 to 6.2 ± 1.3 (<i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>In recreational marathon runners, there is a marked increase in first-phase ejection fraction after the race despite no other significant change in cardiac performance or conventional measure of systolic function. More detailed physiological studies are required to elucidate the mechanism of this increase.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"9 ","pages":"2048004020926366"},"PeriodicalIF":1.4,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/35/10.1177_2048004020926366.PMC7238440.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9501476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A model based on clinical parameters to identify myocardial late gadolinium enhancement by magnetic resonance in patients with aortic stenosis: An observational study.","authors":"Mariya Kuk, Simon Newsome, Francisco Alpendurada, Marc Dweck, Dudley J Pennell, Vassilios S Vassiliou, Sanjay K Prasad","doi":"10.1177/2048004020922400","DOIUrl":"10.1177/2048004020922400","url":null,"abstract":"<p><strong>Objective: </strong>With increasing age, the prevalence of aortic stenosis grows exponentially, increasing left heart pressures and potentially leading to myocardial hypertrophy, myocardial fibrosis and adverse outcomes. To identify patients who are at greatest risk, an outpatient model for risk stratification would be of value to better direct patient imaging, frequency of monitoring and expeditious management of aortic stenosis with possible earlier surgical intervention. In this study, a relatively simple model is proposed to identify myocardial fibrosis in patients with a diagnosis of moderate or severe aortic stenosis.</p><p><strong>Design: </strong>Patients with moderate to severe aortic stenosis were enrolled into the study; patient characteristics, blood work, medications as well as transthoracic echocardiography and cardiovascular magnetic resonance were used to determine potential identifiers of myocardial fibrosis.</p><p><strong>Setting: </strong>The Royal Brompton Hospital, London, UK.</p><p><strong>Participants: </strong>One hundred and thirteen patients in derivation cohort and 26 patients in validation cohort.</p><p><strong>Main outcome measures: </strong>Identification of myocardial fibrosis.</p><p><strong>Results: </strong>Three blood biomarkers (serum platelets, serum urea, N-terminal pro-B-type natriuretic peptide) and left ventricular ejection fraction were shown to be capable of identifying myocardial fibrosis. The model was validated in a separate cohort of 26 patients.</p><p><strong>Conclusions: </strong>Although further external validation of the model is necessary prior to its use in clinical practice, the proposed clinical model may direct patient care with respect to earlier magnetic resonance imagining, frequency of monitoring and may help in risk stratification for surgical intervention for myocardial fibrosis in patients with aortic stenosis.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020922400"},"PeriodicalIF":1.4,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e7/28/10.1177_2048004020922400.PMC7218314.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37951736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2D perfusion-angiography during endovascular intervention for critical limb threatening ischemia - A feasibility study.","authors":"Håkan N Pärsson,&nbsp;Niklas Lundin,&nbsp;Hans Lindgren","doi":"10.1177/2048004020915392","DOIUrl":"https://doi.org/10.1177/2048004020915392","url":null,"abstract":"<p><strong>Purpose: </strong>Two-dimensional perfusion angiography is a new method to quantify and evaluate tissue perfusion during endovascular intervention. The aim was to evaluate time-patterns and dynamics of contrast arrival and distribution before and after endovascular intervention in patients with critical limb threatening ischemia.</p><p><strong>Methods: </strong>Data were collected from 37 patients with critical limb threatening ischemia due to infra-inguinal occlusive disease having a successful endovascular procedure. two-dimensional perfusion angiography was used as a post-processing software with analysis of numeric parameters related to arrival and distribution patterns of contrast.</p><p><strong>Results: </strong>Thirty-three patients were successfully analysed whereas four patients were excluded due to motion artefacts. All patients were successfully treated with recanalization of the superficial femoral, popliteal, below the knee-vessels or a combination. Short-term improvement at 30-day follow-up was noted both clinically and by ankle-brachial index and toe pressure measurements. A significant reduction in contrast arrival time between pre-and post-angioplasty runs was noted as measured by arrival time median 3.2 and interquartile range (2.5-4.2) vs. 2.6 (1.6-3.4) and time-to-peak 4.1 (3.6-5.0) vs. 3.1 (2.3-3.9) p = 0.009. An increased wash-in rate was also observed 18.3 (12.6-21) vs. 30.1 (22-30.5) p = 0.001 between pre-and post-angioplasty runs.</p><p><strong>Conclusions: </strong>The use of perfusion angiography for evaluation of foot-circulation during endovascular interventions provides new information regarding quantitative assessment of contrast inflow before and after endovascular intervention without the need for extra contrast or runs. No selective catheterisation is necessary. The technique is easily adopted in a clinical setting. Further studies are necessary to create robust clinical endpoints.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":" ","pages":"2048004020915392"},"PeriodicalIF":1.6,"publicationDate":"2020-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2048004020915392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37829239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}