Improvement of left ventricular function after percutaneous transluminal coronary angioplasty

Sigwart, Ulrich; Grbić, M; Essinger, A; Bischof-Delaloye, A.; Sadeghi, H; Rivier, Jean-Louis

doi:10.1016/0002-9149(82)91942-7

Cited by 43 publications

(11 citation statements)

References 15 publications

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“…As shown in figure 2, the results of videodensitometric analysis performed on these angiograms correlated well with results of quantitative coronary angiography (r -.77). The changes in size of the coronary lumen in patients in group A (figure 3), group B (figure 4), and group C ( figure 5) 28 This study provides additional objective documentation of the results of angioplasty by defining in absolute terms, using two methods of computer-assisted analysis of coronary angiograms (quantitative coronary angiography and videodensitometry), the change in area of the lumen that occurs during and after angioplasty. In this study, as in previous studies,3-' we found that approximately one-third of lesions (35% in our study) restenose during the follow-up period.…”

Section: Resultsmentioning

confidence: 94%

Changes in cross-sectional area of the coronary lumen in the six months after angioplasty: a quantitative analysis of the variable response to percutaneous transluminal angioplasty.

Johnson¹,

Brayden²,

Ericksen³

et al. 1986

Circulation

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Although immediate and late changes in coronary stenoses after percutaneous transluminal coronary angioplasty (PTCA) have been reported, most investigators have employed qualitative or semiquantitative techniques to analyze the angiograms. Such data is not optimal because of considerable interobserver variability and the use of relative instead of absolute changes in lesion geometry. Analysis is further compounded by the indistinct edges that characterize coronary lesions immediately after angioplasty. To quantify the changes in minimal cross-sectional area (MCSA) of the coronary lumen that occur during and after PTCA, we analyzed the angiograms of 23 patients before PTCA, immediately after PTCA, and at 7.2 + 3.0 (mean ± SD) months follow-up using two computerassisted methods of angiographic analysis quantitative coronary angiography (QCA) and videodensitometry (VID). QCA provides an absolute measure of the area of the lumen; VID is a nongeometric method that is not dependent on exact border recognition. Based on these quantitative methods, we found that successful angioplasty is associated with about a three-fold increase in the MCSA of the lesion (from 1.0 to 3.2 mm2). This area is, however, well below normal and is less than half of the average MCSA of the inflated dilating balloon. Analysis of follow-up angiograms demonstrated that eight of 23 patients had a substantial late increase in the MCSA of the lesion (from 2.7 to 4.1 mm2) after the angioplasty procedure. Clinical, hemodynamic, and angiographic characteristics immediately after PTCA were not predictive of MCSA of the lumen at follow-up. Because substantial late increases in MCSA of the lumen occur in about one-third of patients, angiographic and noninvasive analyses performed immediately after PTCA will not define the ultimate adequacy of coronary dilation in many patients undergoing PTCA.Circulation 73, No. 3, 467-475, 1986. PERCUTANEOUS transluminal coronary angioplasty (PTCA) has gained wide clinical acceptance as a treatment for coronary artery disease.1' 2 Despite widespread use, however, neither the mechanisms responsible for the initial coronary luminal enlargement

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Section: Resultsmentioning

confidence: 94%

Changes in cross-sectional area of the coronary lumen in the six months after angioplasty: a quantitative analysis of the variable response to percutaneous transluminal angioplasty.

Johnson¹,

Brayden²,

Ericksen³

et al. 1986

Circulation

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“…LV hemodynamics and specifically diastolic function have been explored during handgrip [1-4] or dynamic [5-8] exercise as well as with pacing [9, 10] and during short coronary occlusion [11-14]. …”

Section: Invasive Assessment Of LV Diastolic Behaviour Using Pressurementioning

confidence: 99%

“…[5] have shown an extensive LVEDP rise during bicycle exercise in CAD patients before percutaneous transluminal coronary angioplasty that is significantly reduced after this procedure in average at 183% and 46% of baseline, respectively. Caroll et al .…”

Section: Invasive Assessment Of LV Diastolic Behaviour Using Pressurementioning

confidence: 99%

“…Min dP/dt was either decreased with pacing induced ischemia associated with angina by 11% [10] or increased with dynamic exercise by 34% above rest value [5]. Finally, the early LV filling was not blunted in CAD patients, but was maintained during dynamic exercise-induced ischemia, whereas late filling was restricted [6].…”

Section: Invasive Assessment Of LV Diastolic Behaviour Using Pressurementioning

confidence: 99%

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Invasive and Noninvasive Assessment of Exercise-induced Ischemic Diastolic Response Using Pressure Transducers

Manolas

2014

CCR

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Left ventricular (LV) pressure curve shows early high-magnitude changes in the presence of induced ischemia. A dramatic rise in LV and left atrial end-diastolic pressures occurs within seconds to minutes in the presence of ischemia induced by dynamic or handgrip exercise as well as pacing of 38 to 183% and during short coronary balloon occlusion of 32 to 208% of baseline. Changes in relaxation or volumetric filling rate or ejection fraction were significantly less pronounced. Similar end-diastolic abnormalities occurring mainly in patients with coronary artery disease (CAD) have been shown in noninvasive recordings obtained by pressure transducer placed over the point of maximal LV beat (pressocardiograms). Specifically, the amplitude of the A wave to total excursion of pressocardiogram showed a similar high-magnitude increase after dynamic or handgrip exercise in average by 60 to 142% of baseline; however, changes in pressocardiographic relaxation time indexes were only slightly abnormal. A well-defined “ischemic pattern” of pressocardiographic diastolic changes with handgrip, showed a high prevalence in CAD patients. The assessment of diastolic changes in the presence of handgrip-inducible ischemia using noninvasive pressure transducers might provide after further studies a simple complementary diagnostic tool to assist in identification of patients with atypical or asymptomatic CAD.

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“…It has been over three decades since Sigwart first described that brief occlusion of the septal artery with a balloon catheter leads to transient reductions in the outflow gradient across the aortic valve [1]. In 1995, Sigwart went on to describe the induction of localized infarction of the septum with infusion of ethanol in the septal coronary artery in three patients, all of whom continued to have symptomatic improvement 12 months later [2].…”

Section: Introductionmentioning

confidence: 99%

How Can we Improve Non-Surgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy?

Cleator¹,

Kasasbeh²

2016

J Cardiovasc Dis Diagn

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The goal for treatment of medical refractory Hypertrophic Obstructive Cardiomyopathy (HCM) is reduction of the hypertrophied left ventricular septum which obstructs blood flow. A surgical approach consists of an open-heart myomectomy, while the less invasive percutaneous approach involves creating a myocardial infarction by injecting 95 to 100% ethanol through a septal artery, a procedure termed alcohol septal ablation (ASA). Although less invasive than myomectomy, there are several limitations of alcohol septal ablation. The most important appears to be full thickness infarction that is often complicated by heart block and ventricular tachycardia/fibrillation. The ideal therapy for septal hypertrophy would be to find an agent that induces a less severe injury and/or atrophy of the hypertrophied septum. We review several alternative techniques for selective injury of the septum and describe the ideal characteristics of such an ideal agent. Our central hypothesis is that the anthracycline antibiotic such as doxorubicin may be the perfect agent. Anthracycline-based chemotherapies have been used in the treatment of solid and hematological tumors for many years. These agents have known cardiotoxic side effects that are related to cumulative dose which can lead to heart failure. Although the mechanism of action of doxorubicin cardiotoxicity is controversial, it is very clear that these agents cause atrophy of the myocardium, induce apoptosis and necrosis, as well as anti-angiogenic effects. We propose that selectively treating the hypertrophied septum of HCM patients with injection of the anthracycline doxorubicin will lead to superior outcomes compared to ASA.

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Improvement of left ventricular function after percutaneous transluminal coronary angioplasty

Cited by 43 publications

References 15 publications

Changes in cross-sectional area of the coronary lumen in the six months after angioplasty: a quantitative analysis of the variable response to percutaneous transluminal angioplasty.

Changes in cross-sectional area of the coronary lumen in the six months after angioplasty: a quantitative analysis of the variable response to percutaneous transluminal angioplasty.

Invasive and Noninvasive Assessment of Exercise-induced Ischemic Diastolic Response Using Pressure Transducers

How Can we Improve Non-Surgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy?

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