30 research outputs found
Lowering glucose to prevent adverse cardiovascular outcomes in a critical care setting
No full textHigh admission blood glucose levels after acute myocardial infarction are common and associated with an increased risk of death in patients with or without diabetes. Hyperglycemia is associated with altered myocardial blood flow and energetics and can lead to a pro-oxidative/proinflammatory state. The use of intensive insulin treatment has shown superior benefits in the treatment of hyperglycemia versus glucose-insulin-potassium infusion, particularly in critical care settings. (J Am Coll Cardiol 2009;53:S9-13) (C) 2009 by the American College of Cardiology Foundatio
Serial Evaluation of Microcirculatory Dysfunction in Patients With Takotsubo Cardiomyopathy by Myocardial Contrast Echocardiography
No full text
Determining the Significance of Coronary Plaque Lesions: Physiological Stenosis Severity and Plaque Characteristics
No full textThe evaluation of coronary lesions has evolved in recent years. Physiologic-guided revascularization (particularly with pressure-derived fractional flow reserve (FFR)) has led to superior outcomes compared to traditional angiographic assessment. A greater importance, therefore, has been placed on the functional significance of an epicardial lesion. Despite the improvements in the limitations of angiography, insights into the relationship between hemodynamic significance and plaque morphology at the lesion level has shown that determining the implications of epicardial lesions is rather complex. Investigators have sought greater understanding by correlating ischemia quantified by FFR with plaque characteristics determined on invasive and non-invasive modalities. We review the background of the use of these diagnostic tools in coronary artery disease and discuss the implications of analyzing physiological stenosis severity and plaque characteristics concurrently
Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed Doppler echocardiography
No full textAbstractIndexes of left ventricular diastolic filling were measured by pulsed Doppler echocardiography in 21 insulin-dependent diabetic patients and 21 control subjects without clinical evidence of heart disease. No patient had chest pain or electrocardiographic changes during exercise testing. The mean age of patients was 32 years. All patients had a normal ejection fraction.Six (29%) of the 21 diabetic patients had evidence of diastolic dysfunction as assessed by the presence of at least two abnormal variables of mitral inflow velocity. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (1.24 ± 0.21 versus 1.66 ± 0.30, p. < 0.001). Atrial filling velocity was significantly increased in diabetic patients (74.3 ± 16.7 versus 60.3 ± 12.2 cm/s, p < 0.004), whereas early filling velocity was reduced by a nearly significant degree (88.8 ± 12.6 versus 98.5 ± 18.8 cm/s, p < 0.057). The atrial contribution to stroke volume as assessed by area under the late diastolic filling envelope compared to total diastolic area was also significantly increased in diabetic compared with control subjects (35 versus 27%, p < 0.001).Left ventricular diastolic filling abnormalities in diabetic patients did not correlate with duration of diabetes, retinopathy, nephropathy or peripheral neuropathy. These data suggest that approximately one-third of such patients have subclinical myocardial dysfunction unrelated to accelerated atherosclerosis. Doppler echocardiography may offer a reliable noninvasive means to assess diastolic function and to follow up diabetic patients serially for any deterioration in cardiac status before the appearance of clinical symptoms
Effect of autonomic nervous system dysfunction on the circadian pattern of myocardial ischemia in diabetes mellitus
No full textVariability in the measurement of intracoronary ultrasound images: implicatioNs for the identification of atherosclerotic plaque regression
No full textEffectiveness of a Multidisciplinary Quality Improvement Initiative in Reducing Door‐to‐Balloon Times in Primary Angioplasty
No full textInvasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance
No full textAcute myocardial infarction (AMI) is one of the most common causes of death in both the developed and developing world. It has high associated morbidity despite prompt institution of recommended therapy. The focus over the last few decades in ST-segment elevation AMI has been on timely reperfusion of the epicardial vessel. However, microvascular consequences after reperfusion, such as microvascular obstruction (MVO), are equally reliable predictors of outcome. The attention on the microcirculation has meant that traditional angiographic/anatomic methods are insufficient. We searched PubMed and the Cochrane database for English-language studies published between January 2000 and November 2019 that investigated the use of invasive physiologic tools in AMI. Based on these results, we provide a comprehensive review regarding the role for the invasive evaluation of the microcirculation in AMI, with specific emphasis on coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR)
