Publications by authors named "Gilbert J Zoghbi"

37 Publications

Selective adenosine agonists and myocardial perfusion imaging.

J Nucl Cardiol 2012 Feb;19(1):126-41

Division of Cardiovascular Disease, The University of Alabama at Birmingham, FOT 920, 1960 6th Avenue South, Birmingham, AL 35294, USA.

Selective adenosine receptor agonists have several advantages for use as stress agents in conjunction with myocardial perfusion imaging compared to the non selective agents such as adenosine and dipyridamole. This review will summarize the pre-clinical and clinical data on the selective adenosine agonist stress agents regadenoson (Lexiscan(®)), binodenoson (CorVue™) and apadenoson (Stedivaze™) that have been studied so far with focus on regadenoson that has the most clinical data published so far. The article will review the adenosine receptor types and properties. It will also review the various attributes of the selective adenosine agonists including their pharmacology, pharmacokinetics and pharmacodynamics, their coronary vasodilatory and hemodynamic effects, their safety and side effects, their interactions with other drugs and their use with myocardial perfusion imaging. The landmark trials of the selective adenosine agonists will be reviewed as well as their use in special patient populations undergoing stress myocardial perfusion imaging.
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http://dx.doi.org/10.1007/s12350-011-9474-9DOI Listing
February 2012

Oral antiplatelet therapy in diabetes mellitus and the role of prasugrel: an overview.

Vasc Health Risk Manag 2011 18;7:445-59. Epub 2011 Jul 18.

Columbiana Cardiovascular Consultants, Columbiana, AL 35051, USA.

Diabetics have a prothrombotic state that includes increased platelet reactivity. This contributes to the less favorable clinical outcomes observed in diabetics experiencing acute coronary syndromes as well as stable coronary artery disease. Many diabetics are relatively resistant to or have insufficient response to several antithrombotic agents. In the setting of percutaneous coronary intervention, hyporesponsiveness to clopidogrel is particularly common among diabetics. Several strategies have been examined to further enhance the benefits of oral antiplatelet therapy in diabetics. These include increasing the dose of clopidogrel, triple antiplatelet therapy with cilostazol, and new agents such as prasugrel. The large TRITON TIMI 38 randomized trial compared clopidogrel to prasugrel in the setting of percutaneous coronary intervention for acute coronary syndromes. The diabetic subgroup (n = 3146) experienced considerable incremental benefit with a 4.8% reduction in cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke at 15-month follow-up with prasugrel treatment. Among diabetics on insulin this combined endpoint was reduced by 7.9% at 15 months. Major bleeding was not increased in the diabetic subgroup. This confirms the general hypothesis that more potent oral antiplatelet therapy can partially overcome the prothrombotic milieu and safely improve important clinical outcomes in diabetics.
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http://dx.doi.org/10.2147/VHRM.S4746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148418PMC
December 2011

The scope of coronary heart disease in patients with chronic kidney disease.

J Am Coll Cardiol 2009 Jun;53(23):2129-40

University of Alabama at Birmingham, USA.

Chronic kidney disease (CKD) affects approximately 13% of the U.S. population and is associated with increased risk of cardiovascular complications. Once renal replacement therapy became available, it became apparent that the mode of death of patients with advanced CKD was more likely than not related to cardiovascular compromise. Further observation revealed that such compromise was related to myocardial disease (related to hypertension, stiff vessels, coronary heart disease, or uremic toxins). Early on, the excess of cardiovascular events was attributed to accelerated atherosclerosis, inadequate control of blood pressure, lipids, or inflammatory cytokines, or perhaps poor glycemia control. In more recent times, outcome research has given us further information that relates even lesser degrees of renal compromise to an excess of cardiovascular events in the general population and in those with already present atherosclerotic disease. As renal function deteriorates, certain physiologic changes occur (perhaps due to hemodynamic, inflammatory, or metabolic changes) that decrease oxygen-carrying capacity of the blood by virtue of anemia, make blood vessels stiffer by altering collagen or through medial calcinosis, raise the blood pressure, increase shearing stresses, or alter the constituents of atherosclerotic plaque or the balance of thrombogenesis and thrombolysis. At further levels of renal dysfunction, tangible metabolic perturbations are recognized as requiring specific therapy to reduce complications (such as for anemia and hyperparathyroidism), although outcome research to support some of our current guidelines is sorely lacking. Understanding the process by which renal dysfunction alters the prognosis of cardiac disease might lead to further methods of treatment. This review will outline the relationship of CKD to coronary heart disease with respect to the current understanding of the traditional and nontraditional risk factors, the role of various imaging modalities, and the impact of coronary revascularization on outcome.
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http://dx.doi.org/10.1016/j.jacc.2009.02.047DOI Listing
June 2009

Pretreatment with nitroprusside for microcirculatory protection in saphenous vein graft interventions.

J Invasive Cardiol 2009 Feb;21(2):34-9

Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA.

Objectives: We hypothesized that the prophylactic administration of sodium nitroprusside (NTP) during saphenous vein graft (SVG) PCI would ameliorate the detrimental effects of distal embolization and reduce the frequency and magnitude of post-procedural myonecrosis.

Methods: Sixty-four consecutive patients with normal preprocedural cardiac enzymes underwent SVG PCI without embolic protection devices and received prophylactic intragraft NTP before initial device activation. For each case, 2 control patients were selected in reverse chronologic order and were matched for stent use, thromboatherectomy device use, clinical presentation, presence of thrombus and pre-PCI thrombolysis in myocardial infarction (TIMI) flow.

Results: Mean patient age was 66 +/- 10 years, 78% of whom were males. Stent and thromboatherectomy use was 95.3% and 3.1%, respectively in both groups (p = ns). Prior to intervention, TIMI < 3 flow was present in 26.6% of cases and in 24.2% of control patients (p = ns). Thrombus was present in 20.3% of cases and in 19.5% of controls (p = ns). Post-PCI creatinine kinase (CK)-MB elevation > 3 x the upper limit of normal (ULN) occurred in 6.3% of cases vs. 16.4% of controls (p = 0.049) and > 5 x ULN in 1.6% of cases vs.10.9% of controls (p = 0.022). In a multivariate regression model that included stent use, in-stent restenosis, thrombus presence, preprocedural TIMI 3 flow, MI as procedural indication, NTP and glycoprotein IIb/IIIa use, NTP was the only independent and significant predictor of reduced post-procedural CK-MB elevation > 5 x ULN.

Conclusion: Prophylactic administration of intragraft NTP during SVG PCIs results in a lower frequency and magnitude of post-procedural cardiac enzyme elevation.
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February 2009

Hemodynamic evaluation of coronary artery bypass graft lesions using fractional flow reserve.

Catheter Cardiovasc Interv 2008 Oct;72(4):479-85

Birmingham VA Medical Center, Birmingham, AL, USA.

Background: Coronary angiography is limited by its inability to assess the hemodynamic significance of a coronary artery stenosis. The assessment of the physiological significance of saphenous vein graft (SVG) lesions with a pressure wire to determine the fractional flow reserve (FFR) is lacking.

Methods: FFR was determined in 10 SVG lesions of 10 males who had stress myocardial perfusion imaging (MPI) prior to referral for percutaneous coronary intervention for clinical indications.

Results: All SVGs had a diameter stenosis (DS) > 50% and 30% had a DS > or = 70%. A significant FFR was present in 30% of patients. Ischemia along the territory of the SVG was present in 20% of patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FFR < 0.75 for the detection of ischemia on stress MPI were 50, 75, 33, 85, and 70%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FFR < 0.75 for detecting > or = 70% DS on angiography were 33, 71, 33, 71, and 60%, respectively. There was no significant correlation between FFR and % DS (R(2) = 0.1, P = 0.35).

Conclusion: The use of FFR to assess the physiological significance of SVG lesions is feasible and provides an acceptable specificity and negative predictive value compared to stress MPI.
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http://dx.doi.org/10.1002/ccd.21675DOI Listing
October 2008

Subaortic stenosis missed by invasive hemodynamic assessment.

Echocardiography 2008 Oct 2;25(9):1007-10. Epub 2008 Sep 2.

University of Alabama and Birmingham, Veterans Affairs Medical Center, Division of Cardiology, Birmingham, Alabama, USA.

We present a case of 61-year-old man that was evaluated for possible aortic stenosis but did not show a left ventricular outflow gradient on invasive assessment in the catheterization laboratory. Transthoracic echocardiography showed subaortic stenosis secondary to a discrete membranous structure in the left ventricular outflow tract. This is the first case in the literature of a patient with discrete subaortic stenosis missed by invasive hemodynamic assessment.
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http://dx.doi.org/10.1111/j.1540-8175.2008.00732.xDOI Listing
October 2008

The effects of medications on myocardial perfusion.

J Am Coll Cardiol 2008 Aug;52(6):401-16

Division of Cardiovascular Diseases, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.

Antianginal and lipid-lowering medications may modify the results of stress myocardial perfusion imaging. Several studies have shown the beneficial potential of these agents in suppressing myocardial ischemia in patients with known coronary artery disease. The effects of nitrates, calcium-channel blockers, beta-blockers, and statins on myocardial perfusion imaging are likely attributable to changes in myocardial blood flow and myocardial oxygen supply-demand ratio. This comprehensive review examines relevant experimental and clinical published data. Technical issues in image interpretation specific to myocardial perfusion imaging and implications of use of cardiac medications to results of myocardial perfusion imaging are discussed.
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http://dx.doi.org/10.1016/j.jacc.2008.04.035DOI Listing
August 2008

The safety of bivalirudin during elective percutaneous coronary interventions in heart transplant patients.

Cardiol J 2007 ;14(5):458-62

Background: Bivalirudin has been shown to be safe and effective during percutaneous coronary interventions (PCI) of native coronary arteries in the REPLACE 2 trial. The safety of bivalirudin during PCIs in heart transplant patients is not known.

Methods: Heart transplant patients who had undergone PCI of de novo lesions and received bivalirudin during the procedure were included in the study. Medical records were reviewed for the occurrence of death, myocardial infarction, target vessel revascularization or major bleeding up to 30 days after discharge. The results were compared with the REPLACE 2 trial and with a control group of heart transplant recipients who received heparin during their procedures.

Results: There were 51 separate PCIs performed in 30 patients in the study group. The mean age was 56 +/- 12 years and 6 (20%) were women. The control group consisted of 24 patients who had undergone 35 PCIs. There were no deaths, myocardial infarctions or target vessel revascularization during the follow-up period in the study group. The combined endpoint of death, myocardial infarctions, target vessel revascularization and major bleeding requiring two or more units of packed red blood cells occurred in 2 (3.9%) patients compared to 275 (9.2%) patients in the REPLACE 2 trial (p = 0.195) and 5 (14.3%) in the control group (p = 0.115).

Conclusion: Bivalirudin is a safe antithrombotic medication to use during elective PCI in heart transplant patients with cardiac allograft vasculopathy. (Cardiol J 2007; 14: 458-462).
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October 2012

Hypertrophic obstructive cardiomyopathy in liver transplant patients.

Cardiol J 2008 ;15(1):74-9

University of Alabama at Birmingham, Birmingham, AL, USA.

The optimal treatment strategy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) and end-stage liver disease (ESLD) is not well defined. Although medical management is the accepted first line treatment, patients who are unresponsive to medication require further interventions. Since ESLD patients have a high operative risk for surgical myomectomy, alcohol septal ablation (ASA) emerges as a good alternative in these cases. The timing of ASA in relation to liver transplantation is still unclear. We report here on the first case of an orthotopic liver transplant-recipient undergoing ASA and the second of a cirrhotic patient requiring ASA as a bridge to liver transplantation. Both patients had a good clinical outcome and we argue that ASA in HOCM patients should be driven by symptom onset, and that in the asymptomatic patient it can be safely deferred until after liver transplantation.
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October 2008

Three-dimensional balloon catheter sizing identifies significant underdeployed stents using conventional methods in renal artery interventions.

J Invasive Cardiol 2008 Jun;20(6):270-6

Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.

Background: Renal artery stent restenosis remains a significant impediment that in part is attributed to suboptimal stent deployment. We tested the hypothesis that optimal stent deployment during renal artery interventions can be achieved using the Metricath (MC) system, a balloon-catheter sizing device.

Methods: The MC low-pressure balloon derives accurate vessel lumen dimensions from the three-dimensional reconstruction of volume of fluid and pressure within the inflated balloon. We systematically compared the final visual assessment of renal artery intervention with a subsequent MC minimal lumen diameter (MLD) in patients undergoing renal artery stenting.

Results: Sixteen patients underwent angioplasty and stenting of 20 renal artery lesions. MC guidance resulted in adjunctive intervention in 90% of lesions, increasing MLD from 4.40 +/- 0.77 mm before to 5.17 +/- 0.82 mm (p < 0.001) after adjunctive intervention. The MC MLD to the angiographic reference vessel diameter improved from 77.4 +/- 15.2% to 91.2 +/- 17.5% (p < 0.001), and the MC MLD to the nominal stent diameter improved from 76.2 +/- 7.1% to 90.0 +/- 9.4% (p < 0.001) after adjunctive intervention. Stent expansion was more pronounced at its distal site compared to the lesion site where the postinterventional distal stent MLD was 5.52 +/- 0.93 mm (p = 0.23), and the lesion MLD was 5.17 +/- 0.82 (p = 0.001) compared to a nominal stent diameter of 5.78 +/- 0.88 mm. An MC MLD-to- nominal stent diameter ratio greater than or equal to 85% occurred in 10% of lesions before adjunctive dilatation and in 65% of lesions after adjunctive balloon post dilatation.

Conclusions: MC guidance during renal interventions revealed a large proportion of underdeployed stents that were further optimized by adjunctive intervention.
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June 2008

Saphenous vein graft-to-left atrium fistula treated with percutaneous transcatheter embolization with coils.

J Invasive Cardiol 2007 Nov;19(11):E331-4

Section of Interventional Cardiology, University of Alabama at Birmingham, Birmingham 35294, Alabama, USA.

Coronary artery fistulae are rare anomalies that are most commonly congenital and rarely acquired. We present a first case of a vein graft to the left atrium fistula that occurred post coronary artery bypass grafting and was treated with percutaneous transcatheter embolization with coiling. The coil was initially lost in the left atrium, but was successfully retrieved and the fistula was closed. We review the pertinent literature on acquired coronary artery fistulae and their management.
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November 2007

Transthoracic echocardiography guided procedures in the catheterization laboratory.

Echocardiography 2007 Oct;24(9):1000-7

Division of Cardiovascular Disease, University of Alabama at Birmingham, 1530 3rd Avenue S., Birmingham, AL 35294, USA.

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http://dx.doi.org/10.1111/j.1540-8175.2007.00497.xDOI Listing
October 2007

Predictors of survival in patients with end-stage renal disease evaluated for kidney transplantation.

Am J Cardiol 2007 Sep 5;100(6):1020-5. Epub 2007 Jul 5.

Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Cardiovascular disease is the major cause of mortality in patients with end-stage renal disease (ESRD). This study examined the all-cause mortality in 3,698 patients with ESRD evaluated for kidney transplantation at our institution from 2001 to 2004. Mean age for the cohort was 48+/-12 years, and 42% were women. Stress myocardial perfusion imaging was done in 2,207 patients (60%) and coronary angiography in 260 patients (7%). There were 622 deaths (17%) during a mean follow-up period of 30+/-15 months. The presence and severity of coronary disease on angiography was not predictive of survival. Coronary revascularization did not impact survival (p=0.6) except in patients with 3-vessel disease (p=0.05). The best predictor of death was left ventricular ejection fraction, measured by gated myocardial perfusion imaging, with 2.7% mortality increase for each 1% ejection fraction decrease. In conclusion, left ventricular ejection fraction is a strong predictor of survival in patients with ESRD awaiting renal transplantation. Strategies to improve cardiac function or earlier renal transplantation deserve further studies.
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http://dx.doi.org/10.1016/j.amjcard.2007.04.045DOI Listing
September 2007

Percutaneous aortic valvuloplasty as a bridge to a high-risk percutaneous coronary intervention.

J Invasive Cardiol 2007 Aug;19(8):E238-41

Birmingham VA Medical Center, Birmingham, AL, USA.

We describe a novel approach of using percutaneous aortic valvuloplasty as a bridge to percutaneous coronary intervention in a patient with refractory congestive heart failure, severe aortic stenosis, severe left ventricular dysfunction and severe 3-vessel coronary artery disease who was not a surgical candidate for aortic valve replacement and coronary artery bypass grafting.
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August 2007

A novel method of clot extraction using a FilterWire EX in acute myocardial infarction.

J Invasive Cardiol 2007 Apr;19(4):E104-6

Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294, USA.

We describe a novel approach for the use of a FilterWire EX distal protection device as a snaring device for clot extraction in a patient who sustained acute ST-elevation myocardial infarction due to occlusion of the right coronary artery.
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April 2007

Myocardial perfusion imaging after transient balloon occlusion during percutaneous coronary interventions.

J Nucl Cardiol 2007 Apr;14(2):221-8

Birmingham VA Medical Center, University of Alabama at Birmingham, Birmingham, Ala 35294, USA.

Background: Myocardial perfusion imaging (MPI) is highly sensitive in detecting rest ischemia when the radiotracer is injected during the episode of ischemia. The frequency of abnormal MPI results after resolution of ischemia is not well defined. The aim of this study was to determine how long MPI results remain abnormal after transient coronary artery occlusion.

Methods And Results: Patients undergoing single-vessel percutaneous coronary intervention were injected with technetium 99m sestamibi at 30 to 60 minutes (group 1) (n = 20) or 90 to 120 minutes (group 2) (n = 10) after the last balloon inflation and 24 hours later. There were 30 men aged 59 +/- 8 years. The culprit vessel was the left anterior descending artery in 14 patients and the right coronary artery in 13. The diameter stenosis was reduced from 76.1% +/- 8.7% to 3.0% +/- 6.4% (P < .001). The duration of balloon inflation was 40.3 +/- 12.5 seconds. Chest pain or ST shifts occurred in 66% of patients. A perfusion defect in the territory of the culprit artery was detected in 3 of 20 patients (15%) in group 1 and in 0 of 10 patients (0%) in group 2 (P = .3). One of those three patients had a perfusion defect on MPI done 24 hours later, along with a regional wall motion abnormality on the 2 sets of images.

Conclusions: Abnormal perfusion is seen in a small percentage of patients at 30 to 60 minutes and in none at 90 to 120 minutes after a brief transient balloon occlusion. These results might have important implications in patient care.
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http://dx.doi.org/10.1016/j.nuclcard.2006.11.012DOI Listing
April 2007

Origin of all three major coronary arteries from the right sinus of Valsalva: clinical, angiographic, and magnetic resonance imaging findings and incidence in a select referral population.

Catheter Cardiovasc Interv 2007 Apr;69(5):711-8

Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.

Objective: We sought to determine the incidence and imaging features by coronary angiography and cardiac magnetic resonance imaging (MRI) of anomalies in which the right, circumflex, and left anterior descending coronary arteries arise separately from the right sinus of Valsalva.

Background: The anomalous origin of all major coronary arteries from separate ostia in the right sinus of Valsalva has been reported as exceedingly rare, with mainly isolated cases reported. A knowledge of the origin and proximal courses of aberrant arteries is critical for patient management.

Methods: 42 consecutive patients without other congenital heart disease referred to our institution for MRI evaluation of anomalous coronary artery over a six year period were evaluated. Analysis of angiograms and MRI was done to determine the anatomic origin and proximal pathway of coronary arteries (determined by conventional angiography and MRI) and degree of any stenosis (by angiography).

Results: Seven of the 42 patients (17%) in this referral population had the described anatomy. Both conventional angiography and MRI depicted the origin and proximal courses of these arteries. In all patients, the circumflex passed behind the aorta. In three, the left anterior descending passed through the ventricular septum; in four, it passed anterior to the pulmonary trunk.

Conclusions: This series is the largest ever reported on this complex anatomical variant and the first to give a systematic analysis of the anatomy by angiography and MRI. This constellation of multiple anomalous coronary arterial origins and proximal courses may not be as rare as previously reported.
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http://dx.doi.org/10.1002/ccd.21078DOI Listing
April 2007

Transjugular biopsy of a right atrial mass under intracardiac echocardiographic guidance.

J Am Soc Echocardiogr 2006 Aug;19(8):1072.e5-8

Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.

Biopsy of cardiac tumors to obtain a tissue diagnosis has been performed under echocardiographic (transthoracic or transesophageal) or fluoroscopic guidance. We report successful transjugular biopsy of a right atrial mass using intracardiac echocardiographic guidance.
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http://dx.doi.org/10.1016/j.echo.2006.03.005DOI Listing
August 2006

Three-vessel coronary artery disease, aortic stenosis, and constrictive pericarditis 27 years after chest radiation therapy: a case report.

Heart Surg Forum 2006 ;9(4):E728-30

Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama, Birmingham 35233 , USA.

A patient with a history of Hodgkin's lymphoma presented with recurrent left pleural effusions and dyspnea on exertion 27 years after radiation therapy. Further evaluation disclosed suspected radiation-induced constrictive pericarditis, aortic stenosis and regurgitation, and severe coronary artery disease. He underwent successful 3-vessel coronary artery bypass grafting, aortic valve replacement, and pericardiectomy.
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http://dx.doi.org/10.1532/HSF98.20061031DOI Listing
December 2006

Percutaneous balloon pericardiotomy for the treatment of infected pericardial effusion with tamponade.

J Invasive Cardiol 2006 Jul;18(7):E194-7

Birmingham VA Medical Center and University of Alabama at Birmingham, Birmingham, Alabama, USA.

Percutaneous balloon pericardiotomy has been used as an alternative for surgically created pericardial window mainly for the management of malignant pericardial effusions in critically ill patients. We describe a patient with purulent pericardial effusion and cardiac tamponade who was treated successfully and without complications with percutaneous balloon pericardiotomy.
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July 2006

Effect of caffeine on ischemia detection by adenosine single-photon emission computed tomography perfusion imaging.

J Am Coll Cardiol 2006 Jun;47(11):2296-302

Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294 , USA.

Objectives: The purpose of this research was to study the effect of one cup of coffee taken 1 h before adenosine stress on the results of myocardial perfusion imaging.

Background: Caffeine is believed to attenuate the coronary hyperemic response to adenosine by competitive blockade of the A2a receptor. Caffeine is commonly withheld before adenosine single-photon emission computed tomography (SPECT) perfusion imaging so as not to mask ischemia detection.

Methods: We studied the effect of one 8-oz cup of coffee taken 1 h before adenosine stress in patients who had demonstrable reversible defects on adenosine SPECT perfusion imaging performed while off caffeine.

Results: There were 22 men and 8 women, age 64 +/- 9 years. The blood level of caffeine 1 h after intake was 3.1 +/- 1.6 mg/l. There were two patients with ST-segment depression before and one after caffeine intake (p = NS). The summed stress score (SSS) based on 17 segments (scale of 0 to 3, 3 being normal) was 44 +/- 5 before and 45 +/- 5 after caffeine (p = NS). The summed difference score was 3.8 +/- 1.9 before and. 3.9 +/- 2.3 after caffeine (p = NS), reflecting that around 50% of the perfusion abnormality was reversible before and after caffeine. Using polar maps, the perfusion abnormality was 12 +/- 10% at baseline and 12 +/- 10% after caffeine (p = NS) in agreement with SSS. The left ventricular ejection fraction by gated SPECT was 50 +/- 13% at baseline and 51 +/- 13 % after caffeine (p = NS).

Conclusions: A cup of coffee does not mask the presence or severity of reversible defects induced by adenosine SPECT imaging.
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http://dx.doi.org/10.1016/j.jacc.2005.11.088DOI Listing
June 2006

Radiation therapy-related cardiovascular disease.

J Heart Lung Transplant 2006 Feb;25(2):257-8

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http://dx.doi.org/10.1016/j.healun.2005.04.010DOI Listing
February 2006

Re-stenosis of a sirolimus-coated stent in a heart transplant recipient with allograft vasculopathy.

J Heart Lung Transplant 2005 Sep;24(9):1444

Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

We report the first case of in-stent re-stenosis in a sirolimus-coated stent in a heart transplant recipient with allograft vasculopathy. A 54-year-old male transplant recipient with new lesions in the left anterior descending artery detected during a routine surveillance catheterization was treated with two sirolimus-coated stents. Three months later he presented with dyspnea on exertion, and a repeat left heart catheterization demonstrated a focal area of in-stent stenosis in the proximal stent, which was treated with a cutting balloon.
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http://dx.doi.org/10.1016/j.healun.2004.11.315DOI Listing
September 2005

Relation between effects of adenosine on brachial artery reactivity and perfusion pattern in patients with known or suspected coronary artery disease.

Am J Cardiol 2005 Jan;95(2):304-7

Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, AL 35294, USA.

This study examined the changes in brachial artery diameter and flow velocity in response to intravenous adenosine and compared the results to cuff occlusion and single-photon emission computed tomographic (SPECT) images. The change in diameter was less with adenosine than with cuff occlusion. There was no correlation between the presence of abnormal SPECT images and the responses to adenosine or cuff occlusion in either diameter or flow velocity.
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http://dx.doi.org/10.1016/j.amjcard.2004.08.100DOI Listing
January 2005

Palliation of allograft vasculopathy with transluminal angioplasty: a decade of experience.

J Am Coll Cardiol 2004 Jun;43(11):1973-81

Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA.

Objectives: The goal of this study was to examine the outcomes of percutaneous coronary interventions (PCI) and the predictors for restenosis after cardiac transplantation.

Background: The role of PCI as definitive therapy for allograft coronary disease (ACD) remains contentious.

Methods: Between January 1, 1990 and December 31, 2000, 62 patients (1.5 to 15.5 years after transplant) underwent 151 procedures resulting in PCIs of 219 lesions. Follow-up after PCI angiography was usually obtained at three and six months, then yearly. Repeat PCI was routinely done to lesions with >60% restenosis.

Results: The primary procedural success was 97%. Repeat PCI occurred in 74 of 219 lesions (34%); PCI-related mortality was 2.6% (4 of 151). The freedom from re-PCI (of same vessel site) was 75% at six months, 65% at one year, and 57% at four years. The freedom from restenosis was 95% at one month, 81% at three months, and 57% at six months. Multivariate predictors of freedom from restenosis were the use of stents, higher anti-proliferative immunosuppressant dose, and an era effect. In the setting of one-vessel disease at first PCI, the two-year freedom for ACD death or graft loss was 74%, compared with 75% for two-vessel and 27% for three-vessel disease (p = 0.009).

Conclusions: Despite the increasing effectiveness of PCI for localized ACD, the survival after development of advanced ACD remains poor. Stents appear to increase effectiveness of PCI for ACD, but other factors in the current era contribute to improved outcomes.
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http://dx.doi.org/10.1016/j.jacc.2004.02.045DOI Listing
June 2004

Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review.

Echocardiography 2004 Feb;21(2):175-82

Birmingham's Veterans Affairs Medical Center, Division of Cardiovascular Disease, Alabama 35233, USA.

Spontaneous coronary artery dissection is a rare cause of myocardial ischemia and sudden death. Coronary aneurysms and pseudoaneurysms, which may occur after percutaneous coronary interventions, rarely occur spontaneously. We review the pertinent medical literature and describe the intravascular findings of spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms.
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http://dx.doi.org/10.1111/j.0742-2822.2004.03050.xDOI Listing
February 2004

Spontaneous coronary artery dissection with pseudoaneurysm formation diagnosed by intravascular ultrasound: a case report.

Echocardiography 2004 Feb;21(2):153-7

Division of Cardiovascular Disease, Birmingham's Veterans Affairs Medical Center Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.

Spontaneous coronary artery dissection is a rare cause of myocardial ischemia. Coronary artery pseudoaneurysm may occur after percutaneous coronary interventions and rarely spontaneously. We present a patient who had spontaneous coronary artery dissection with formation of a pseudoaneurysm diagnosed by intravascular ultrasound.
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http://dx.doi.org/10.1111/j.0742-2822.2004.02160.xDOI Listing
February 2004

Optimizing risk stratification in cardiac rehabilitation with inclusion of a comorbidity index.

J Cardiopulm Rehabil 2004 Jan-Feb;24(1):8-13; quiz 14-5

Division of Cardiovascular Disease, University of Alabama at Birmingham, 35294-0007, USA.

Purpose: The risk stratification criteria of the American Association of Cardiovascular and Pulmonary Rehabilitation include guidelines to be used in stratifying cardiac rehabilitation (CR) patients for risk of disease progression (long term) and clinical events (short term). Noncardiac comorbidities are not included as indicators in these criteria. This study was designed to ascertain the prevalence of noncardiac comorbidities among CR patients, and to assess their relation to the current risk stratification algorithm for clinical events.

Methods: Patients were stratified into high-, intermediate-, and low-risk groups according to the American Association of Cardiovascular and Pulmonary Rehabilitation risk stratification criteria for clinical events (ARSE) at program entry. Within each risk group, age, gender, race, and noncardiac comorbidities were ascertained. Comorbidities were summarized in a comorbidity index (CMI). The relation between clinical events and risk status by ARSE and CMI was evaluated by logistic regression.

Results: Among 490 patients (age, 60 +/- 12 years; 35% women; 30% nonwhite) enrolled in CR with ischemic heart disease, the number of comorbidities ranged from 0 to 7 (median, 2; 75th percentile, 3). The patients categorized in the three ARSE groups differed significantly in age and comorbidities. Although ARSE tended to identify patients with a greater comorbidity burden, 38% of the patients with a comorbidity index exceeding the 75th percentile were not classified in the highest ARSE group. Clinical events increased across ARSE and CMI risk strata. Both ARSE and CMI were independent predictors of events in an age-, gender-, and race-adjusted logistic regression analysis (ARSE odds ratio [OR], 1.56; 95% confidence interval [CI], 1.14-2.12; CMI OR, 1.23, 95% CI, 1.03a-1.47). Events were predicted best when both classifications were combined. Exploratory gender-specific analyses suggested that ARSE performed better among men than among women, whereas CMI was a more important predictor among women.

Conclusions: To appreciate more fully the overall complexity of disease among CR patients, ARSE should be supplemented not only with the inclusion of cardiac risk factors, as suggested in the current guidelines, but also with an assessment of noncardiac comorbidities.
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http://dx.doi.org/10.1097/00008483-200401000-00002DOI Listing
May 2004

Effect of caffeine administered intravenously on intracoronary-administered adenosine-induced coronary hemodynamics in patients with coronary artery disease.

Am J Cardiol 2004 Feb;93(3):343-6

Division of Cardiovascular Disease, Birmingham's Veterans Affair Medical Center, and Department of Medicine, University of Alabama at Birmingham, 35233, USA.

It is believed that caffeine attenuates the coronary hyperemic response to adenosine by blocking the A2a receptors. We studied the effect of caffeine on adenosine-induced myocardial hyperemia measured by fractional flow reserve after intracoronary adenosine administration. Fractional flow reserve was not affected by intravenous caffeine infusion at a dose that was comparable to oral consumption.
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http://dx.doi.org/10.1016/j.amjcard.2003.10.017DOI Listing
February 2004

Long-term follow-up of brachytherapy for treatment of allograft in-stent restenosis.

Catheter Cardiovasc Interv 2004 Feb;61(2):217-21

Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.

The experience of brachytherapy in the treatment of in-stent restenosis of allograft arteries is limited. We present two cases of in-stent restenosis treated with brachytherapy with favorable angiographic follow-up at 10 months in one patient and at 17 months in the other.
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http://dx.doi.org/10.1002/ccd.10689DOI Listing
February 2004
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