1,721,339 research outputs found
Transient impairment of vasomotion function after successful chronic total occlusion recanalization
No full textOBJECTIVES: The aim of our study was to assess coronary vasomotion after successful revascularization of chronic total occlusion (CTO).
BACKGROUND: It is largely unknown whether the recovery of anterograde flow after CTO recanalization with drug-eluting stent implantation affects vascular function in distal coronary segments.
METHODS: One hundred consecutive CTOs successfully treated with drug-eluting stents underwent coronary diameter measurement after intracoronary nitroglycerin injection 5, 20, and 35 mm distal to the stented coronary segment using 3-dimensional quantitative coronary angiography. In a subgroup of 14 patients, coronary vasomotion was tested in distal segments: incremental atrial pacing for endothelium-dependent cases; and intracoronary nitroglycerin injection for endothelium-independent cases. In another subgroup of 13 patients, distal vessels were assessed by intracoronary ultrasounds.
RESULTS: Vessel diameters significantly increased at follow-up as compared to baseline values (2.0 ± 0.52 mm vs. 2.25 ± 0.50 mm, 1.76 ± 0.49 mm vs. 2.05 ± 0.58 mm, 1.54 ± 0.53 mm vs. 2.04 ± 0.58 mm, at each segment analyzed; p < 0.001). At baseline, distal segments failed to respond to both endothelium-dependent and -independent stimuli. At follow-up, atrial pacing induced vasoconstriction, whereas nitroglycerine administration resulted in significant vasodilation (p < 0.05). Intracoronary ultrasounds failed to show changes of the cross-sectional area of distal segments at follow-up angiography.
CONCLUSIONS: Recanalization of CTO is followed by a hibernation of vascular wall at distal coronary segments that fail to respond to endothelium-dependent and -independent stimuli. Distal vessel diameter increases over time in the absence of positive remodeling and in spite of persistent endothelial dysfunction. This severe impairment of vasomotor tone after CTO reopening suggests that intracoronary ultrasound assessment is of paramount importance for the selection of stent size
Effectiveness of MitraClip therapy in patients with refractory heart failure
No full textTo assess outcomes for MitraClip therapy in patients with refractory heart failure (HF) and mitral regurgitation (MR) ≥3+
Real-world cost effectiveness of MitraClip combined with medical therapy versus medical therapy alone in patients with moderate or severe mitral regurgitation
No full textBackground:Weevaluated the real-world cost-effectiveness of theMitraClip system (Abbott Vascular Inc., Menlo Park, CA) plusmedical therapy for patientswithmoderate/severe mitral regurgitation, as comparedwithmedical therapy (MT) alone.
Methods: Clinical records of patients with moderate to severe functional mitral regurgitation treated with MitraClip (N=232) or with MT (N=151) were collected and outcome analyzed with propensity score adjustment to reduce selection bias. Twelve-month outcomes were modeled over a lifetime horizon to conduct a costeffectiveness analysis, in the payer's perspective. Costs and benefits were discounted at an annual rate of 3.5%. Results: After propensity score adjustment, the average treatment effect was −9.5% probability of dying at 12 months and, following lifetime modeling, 3.35 ± 0.75 incremental life years and 3.01 ± 0.57 incremental quality-adjusted life years. MitraClip contributed to a higher decrease in re-hospitalizations at 12 months (difference = −0.54 ± 0.08) and generated a more likely improvement in the New York Heart Association (NYHA) class at 12 months versus NYHA at enrollment. Incremental costs, adapted to five possible scenarios, ranged from 14,493 to 29,795 € contributing to an incremental cost-effectiveness ratio ranging from 4796 to 7908 €.
Conclusions: Compared toMT alone and given conventional threshold values, MitraClip can be considered a costeffective procedure. The cost-effectiveness of MitraClip is in line or superior to the one of other nonpharmaceutical strategies for heart failure
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Welcome to the special PCR London Valves 2015 supplement: a new team and venue, the same exceptional content.
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