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  • 1
    Electronic Resource
    Electronic Resource
    Direct Stent Implantation Using the EXPRESS™ Coronary Stent System: (2003)
    350 Main Street , Malden , MA 02148 , USA . : Blackwell Science Inc
    Journal of interventional cardiology 16 (2003), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The aim of this prospective, multicenter, single arm study was to assess the safety and feasibility of EXPRESS™ Coronary Stent implantation in native coronary arteries without balloon predilatation. Forty-two patients with de novo or restenotic lesions were enrolled, of which 38 were eligible for analysis. The coronary lesions were predominantly complex, occurring in arteries with a mean reference diameter of 2.80 ± 0.49 mm. Technical and procedural success were achieved in 89.5% and 84% of the cases respectively. The mean minimal lumen diameter increased from 1.08 ± 0.26 mm to 2.55 ± 0.44 mm and diameter stenosis decreased from 61 ± 7% to 13 ± 8%. The primary endpoint of major adverse cardiac events at 30 days was 2.6% and was limited to only one event (target vessel revascularization, nontarget lesion). No other MACE were observed during the three-month follow-up period. Based on the findings of this study, direct stenting with the EXPRESS™ Stent appears feasible and is well tolerated. (J Interven Cardiol 2003;16:491–497)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8183.2003.01057.x
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  • 2
    Electronic Resource
    Electronic Resource
    Fractional Flow Reserve: The Ideal Parameter for Evaluation of Coronary, Myocardial, and Collateral Blood Flow by Pressure Measurements at PTCA (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 6 (1993), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To overcome the fundamental limitations of coronary arteriography to assess the functional significance of coronary artery disease, it is necessary to obtain direct information about coronary blood flow. Recently we validated three pressure flow equations, which enable calculation of maximum coronary, myocardial, and collateral flow by merely measuring aortic, central venous, and distal coronary pressures under the condition of maximum vasodilation and using an ultra thin pressure monitoring guide wire for distal coronary pressure recording. In this paper, the first clinical experiences of this method are described. For that purpose, the concept of fractional flow reserve (FFR) is important. Fractional coronary flow reserve (FFRcor) is defined as the maximum achievable blood flow in a stenotic artery, divided by normal maximum flow in that same artery, i.e. maximum flow in that artery in the case that it would be completely normal. Fractional myocardial flow reserve (FFRmyo) is defined in a similar way, and recruitable collateral blood flow is expressed as a fraction of normal maximum myocardial flow. Fractional flow reserve, defined in this way, is easy to obtain at percutaneous transluminal coronary angioplasty (PTCA) by the pressure-flow equations, is independent of pressure changes, applicable to three vessel disease, and enables calculation of the separate contribution of coronary and collateral flow to total myocardial perfusion. In 18 patients a very close correlation was demonstrated between FFRmyo, calculated by pressure recordings at PTCA by the first pressure flow equation, and FFRmyo obtained by positron emission tomography, which is considered the gold standard for myocardial perfusion. In 60 other patients, maximum recruitable collateral blood flow at balloon inflation (Qc/QN) was calculated according to the third pressure-flow equation and correlated to the presence or absence of ischemia. It could be demonstrated that QC/QN exceeds 22% in all 23 patients without ischemia, whereas Qc/QN was less than 22% in 34 out of 37 patients who experienced ischemia during balloon inflation. This margin value of 22% is very close to the theoretically expected value of 20%. based upon a coronary flow reserve of 5 under standard physiologic conditions. It can be concluded that the concept of fractional flow reserve provides a rapid, accurate, and elegant way for quantitative assessment of maximum coronary and myocardial blood flow before and after PTCA. Moreover, this is the first method that enables quantitative calculation of collateral blood flow in clinical practice. (J Interven Cardiol 1993; 6:331–344)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1993.tb00877.x
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  • 3
    Electronic Resource
    Electronic Resource
    Exercise gated planar myocardial perfusion imaging using technetium-99m sestamibi for the diagnosis of coronary artery disease: an alternative to exercise tomographic imaging (1995)
    Springer
    European journal of nuclear medicine 22 (1995), S. 40-48 
    Details
    ISSN: 1619-7089
    Keywords: Multi-gated planar imaging ; Single-photon emission tomography ; Sestamibi ; Technetium-99m ; Coronary artery disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Single-photon emission tomography (SPET) using technetium-99m labelled myocardial tracers (e.g.99mTc-sestamibi) has become one of the most popular myocardial imaging methods for the diagnosis of coronary artery disease (CAD). This prospective study was designed to evaluate the diagnostic performance of99mTc-sestamibi exercise gated planar myocardial imaging by comparison with both visual and quantitative analyses of SPET. The study was conducted in 115 consecutive patients with known or suspected CAD, including 54 patients with a previous myocardial infarction (MI), referred for exercise testing prior to coronary angiography. Multi-gated planar imaging and SPET were performed after bicycle exercise. The end-diastolic (ED) and SPET images were visually scored (SVi). Myocardial uptake was quantitated on SPET slices using maximum count circumferential profiles (SQu) and defect extent was measured by comparison with gender-matched data sets obtained from 27 controls (〈5% likelihood of CAD). CAD was defined as coronary artery stenosis 〉50% and/or regional wall motion abnormality. The cut-off criteria for positivity of the three procedures were determined from receiver operating characteristic (ROC) curves derived from the data of patients without previous MI. The area under the ROC curves was similar for ED, SVi and SQu. This was confirmed by the analysis of sensitivity performed using the ROC curve-derived cut-off criteria, in patients with or without previous MI. SVi was more sensitive than ED in identifying the diseased vessel(s) (ED: 41% vs SVi: 80%;P〈0.0005) but ED was more specific in this respect (ED: 79% vs SVi: 61%;P〈0.0005). We conclude that visual analysis of ED images obtained from gated99mTc-sestamibi stress planar imaging is a valuable alternative to SPET imaging for the diagnosis of CAD. SPET is, however, more accurate for the evaluation of the disease extent and localization and therefore remains the method of choice for the assessment of myocardial perfusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00997246
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  • 4
    Electronic Resource
    Electronic Resource
    Radionuclide absolute left ventricular volumes during upright exercise: validation in normal subjects by simultaneous hemodynamic measurements (1985)
    Springer
    European journal of nuclear medicine 10 (1985), S. 111-117 
    Details
    ISSN: 1619-7089
    Keywords: Radionuclide angiography ; left ventricular volumes ; upright exercise
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A nongeometric radionuclide technique for the determination of absolute left ventricular volumes was validated during exercise in nine normal subjects. Simultaneous reference stroke volume and cardiac output measurements were obtained by the Fick method. The reference left ventricular volumes were calculated by combining the Fick stroke volume and the isotopic ejection fraction. Data were collected at rest in the supine and upright positions and during 60° upright exercise, at three levels of increasing severity. At rest, from supine to upright position, the reference end-diastolic volume decreased significantly from 182±24 ml to 154±21 ml (mean±SD, P〈0.005); during upright exercise of low intensity, end-diastolic volume increased to 176±24 ml (P〈0.05); at maximal exercise, end-diastolic volume was not different from the resting value in upright position. The end-systolic volume gradually decreased at rest from 67±11 ml in the supine position to 54±8 ml in the upright position (P〈0.05) and to 32±7 ml at maximal exercise (P〈0.005). Compared with these reference data, the scintigraphic measurements were significantly lower on average by 23% for stroke volume, 21% for cardiac output, 22% for end-diastolic volume, and 23% for end-systolic volume. The overall changes in stroke volume (P〈0.05) and end-systolic volume (P〈0.001) occurring at rest and during exercise were correctly detected by the scintigraphic method but the smaller changes in end-diastolic volume (less than 15%) were not (P〈0.15) because they were within the range of the precision of the technique. If subtle changes in left ventricular volume are to be quantitated, attempts should be made to reduce the random variability of the scintigraphic method.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00252716
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  • 5
    Electronic Resource
    Electronic Resource
    Assessment of left ventricular dysfunction by nuclear cardiology (1994)
    Springer
    Cardiovascular drugs and therapy 8 (1994), S. 381-392 
    Details
    ISSN: 1573-7241
    Keywords: ventricular dysfunction ; viable myocardium ; radioisotopes ; nuclear medicine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Nuclear cardiology techniques may be of help in evaluating the patient with symptoms of congestive heart failure and ventricular dysfunction in two respects: quantification of functional parameters by radionuclide angiography, and differentiation of viable from nonviable myocardium by perfusion and metabolic imaging. Left ventricular ejection fraction and volumes can be accurately assessed by equilibrium radionuclide angiography with a count-based method without any geometric assumptions. Indeed, because of its high reproducibility, this method is particularly suited for making sequential measurements in the same patient. The distinction between viable or reversible and scarred or irreversible dysfunctional myocardium can be made on the basis of myocardial perfusion, cell membrane integrity, and metabolic activity. Thallium myocardial imaging is used clinically to assess the first two parameters based on experimental data. Two clinical methods may be applied to the detection of viability: stress-redistribution-reinjection imaging or rest-redistribution imaging. In both of these, the severity of the reduction in thallium activity should be assessed to discriminate viable from nonviable myocardium. Stress-redistribution-reinjection thallium imaging should be the first approach, if possible, because inducible ischemia is a much more significant clinical variable in a patient with ventricular dysfunction in terms of management and risk assessment than is knowledge of myocardial viability. Positron emmission tomography (PET) provides enhanced image resolution and correction for body attenuation, thereby overcoming the two major limitations of thallium imaging. In addition, it provides the capacity to quantitate regional blood flow and to assess regional metabolic activity independent of flow. Overall, the accuracies of thallium imaging (around 70%) and PET imaging (around 82%) are similar for the prediction of segmental changes after revascularization. However, in patients with poor global left ventricular function, the accuracy of PET seems to be better. Further studies are needed in a large number of patients evaluated for regional and global function to establish algorithms using thallium and PET imaging in dysfunctional myocardium. Dobutamine echocardiography should also be evaluated in these algorithms.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00877323
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  • 6
    Electronic Resource
    Electronic Resource
    Myocardial viability (1995)
    Springer
    The international journal of cardiovascular imaging 11 (1995), S. 85-88 
    Details
    ISSN: 1573-0743
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion The contribution of PET ‘viability’ studies to the understanding of recoverable ischemic left ventricular dysfunction cannot be overemphasized. However, it is uncertain whether FDG used with PET will continue to play a pivotal role in the clinical evaluation of all patients with poor function. Several competitive approaches became available over the recent years, perhaps equally effective. Currently, no data from appropriate prospective studies comparing cost, effectiveness and impact on patient prognosis of the different approaches are available.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01142229
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