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Clayton South, Australia

Narayan O.,Monash University | Casan J.,Alfred Hospital | Szarski M.,Monash Cardiovascular Research Center | Dart A.M.,Alfred Hospital | And 2 more authors.
Journal of Hypertension | Year: 2014

BACKGROUND:: Central aortic blood pressure (cBP) is often promoted to be a superior predictor of cardiovascular risk compared to brachial blood pressure, and brachial-central pulse pressure amplification is also suggested as prognostic. Several devices and techniques, each purporting to estimate cBP, have entered commercial use. The interchangeability of cBP measurements between devices and the influence of disease states on central to brachial pulse pressure amplification remain unclear. The useful measurement of cBP in clinical trials is dependent on clarification of these issues. METHOD:: We performed a systematic meta-analysis of studies reporting cBP between 2000 and 2012. Studies were included if both central and brachial SBPs (cSBP and bSBP) were reported. Studies were categorized by technique and according to the prevalent disease state with the bSBP-cSBP difference calculated. Random-effects modeling (inverse variance weighted approach) was used to estimate the pooled mean difference associated with each technique. RESULTS:: Of the 164 eligible studies, the SphygmoCor device was most commonly reported (110 studies), with direct carotid applanation second-most utilized (31 studies). In 30 included invasive cohorts, the measured cSBP did not differ significantly from the oscillometric bSBP recorded [mean difference 4.19mmHg, 95% confidence interval (CI) -4.13 to 12.51], whereas mean differences of 12.77mmHg (95% CI 11.93, 13.60) and 8.83mmHg (95% CI 7.86, 9.79) were obtained with the SphygmoCor and carotid applanation estimates of cSBP, respectively (both P<0.05). Conversely, the reported mean cSBP-to-bSBP differences measured across various disease states with SphygmoCor did not differ significantly. CONCLUSION:: This meta-analysis suggests that noninvasive cBP estimation is device/technique-dependent. Consequently, caution is advisable in applying these devices and techniques across clinical studies. © 2014 Wolters Kluwer Health Lippincott Williams & Wilkins.

Cameron J.D.,Monash Cardiovascular Research Center
Vascular health and risk management | Year: 2013

Central arterial structure and function comprise a primary determinant of vascular health, and are integral to the important concept of ventriculo-vascular coupling or interaction. Central aortic stiffening is a major influence on central blood pressure, and directly relates to coronary perfusion. The joint session of the International Society of Vascular Health (Eastern Region) and the Ukrainian Congress of Cardiology was held in Kiev, Ukraine, on September 23, 2011; it provided an expert forum to discuss arterial evaluations, clinical applications, and progress toward translating arterial protection into cardiovascular benefits. The conclusions of the expert panel were: 1. Aortic stiffness is not presently a treatment target but may be useful for substratifying cardiovascular risk in individuals in order to better target the intensity of conventional therapy, and it may be useful in assessing response to treatment. 2. Crosstalk between macro- and microcirculation in hypertension has important implications for pharmacological treatment. An antihypertensive regimen should abolish the vicious cycle between the increased resistance in the microcirculation and the increased stiffness of the larger arteries. Such treatment should be based on drugs with multiple actions on the vascular tree, or on drug combinations that target the various segments of the arterial system. 3. Several blood pressure-independent mechanisms of large artery stiffness exist. Future considerations for clinical understanding of large artery stiffness should involve new drugs and new evaluation methods - with a focus on vascular health, for the initiation of cardiovascular prevention, for newly designed studies for treatment evaluation, and for new studies of drug combinations. 4. Arterial stiffening is a sign of cardiovascular aging and is a major factor affecting the biomechanics of large arteries. Arterial stiffness is an attractive therapeutic target in terms of vascular aging. Healthy lifestyle, physical exercise, and smoking cessation are the most effective ways of preventing and treating early vascular aging. Long-term effects of cardiovascular drugs on arterial stiffness need to be further investigated. 5. The emerging clinical data on the cardio ankle vascular index (CAVI) technique of arterial health assessment is presented, showing that the CAVI is elevated in aging, coronary artery diseases, chronic kidney disease, hypertension, diabetes mellitus, smoking, and stress. The CAVI decreased with the administration of statins, angiotensin II receptor blocking agents, and calcium channel blockers. The CAVI is suggested as an important predictor of cardiovascular diseases. Future development of a clinical understanding of large artery stiffness is important and should include consideration of new drugs and new evaluation methods, with a focus on vascular health aimed at cardiovascular prevention.

Onuma Y.,Erasmus University Rotterdam | Serruys P.W.,Erasmus University Rotterdam | Gomez J.,Erasmus University Rotterdam | De Bruyne B.,Cardiovascular Center | And 11 more authors.
Catheterization and Cardiovascular Interventions | Year: 2011

Objectives: The ABSORB cohort A trial using the bioresorbable everolimus-eluting scaffold (BVS revision 1.0, Abbott Vascular) demonstrated a slightly higher acute recoil with BVS than with metallic stents. To reinforce the mechanical strength of the scaffold, the new BVS scaffold (revision 1.1) with modified strut design was developed and tested in the ABSORB cohort B trial. This study sought to evaluate and compare the in vivo acute scaffold recoil of the BVS revision 1.0 in ABSORB cohort A and the BVS revision 1.1 in ABSORB cohort B with the historical recoil of the XIENCE V® everolimus-eluting metal stent (EES, SPIRIT I and II). Methods: In the ABSORB cohort B trial, 101 patients with one or two de-novo lesions were enrolled at 10 sites. In ABSORB cohort A, 27 patients treated with a BVS 1.0 were analyzed and compared with EES. Acute absolute recoil, assessed by quantitative coronary angiography, was defined as the difference between mean diameter of the last inflated balloon at the highest pressure (X) and mean lumen diameter of the stent immediately after the last balloon deflation (Y). Acute percent recoil was defined as (X - Y)/X and expressed as a percentage. Results: Out of 101 patients enrolled in the ABSORB cohort B trial, 88 patients are available for complete analysis of acute recoil. Absolute recoil of BVS 1.1 (0.19 ± 0.18 mm) was numerically higher than metallic EES (vs. 0.13 ± 0.21 mm) and similar to BVS 1.0 (0.20 ± 0.21 mm) but the differences did not reach statistical significance (P = 0.40). The acute percent recoil demonstrated the same trend (EES: 4.3% ± 7.1%, BVS 1.0: 6.9% ± 7.0%, BVS 1.1: 6.7% ± 6.4%, P = 0.22). In the multivariate regression model, high balloon/artery ratio (>1.1) (OR 1.91 [1.34-2.71]) was the predictive for high absolute recoil (>0.27 mm) while (larger) preprocedural MLD was protective (OR 0.84 [0.72-0.99]). The stent/scaffold type was not a predictor of acute recoil. Conclusions: The average in vivo acute scaffold recoil of the BVS 1.1 is slightly higher than the metallic EES. However, the scaffold/stent type was not predictive of high acute recoil, while implantation in undersized vessels or usage of oversized devices might confound the results. Copyright © 2011 Wiley-Liss, Inc.

Nasis A.,Monash Cardiovascular Research Center | Meredith I.T.,Monash Cardiovascular Research Center | Nerlekar N.,Monash Cardiovascular Research Center | Cameron J.D.,Monash Cardiovascular Research Center | And 10 more authors.
Radiology | Year: 2011

Purpose: To assess the impact on length of stay and rate of major adverse cardiovascular events of a cardiac computed tomographic (CT) angiography-guided algorithm to examine patients who present to the emergency department (ED) with low- to intermediate-risk chest pain. Materials and Methods: The study was approved by the institutional review board, and all patients gave written informed consent. Two hundred three consecutive patients (mean age, 55 years ± 11 [standard deviation]; 123 men) with low- to intermediate-risk ischemic-type chest pain were prospectively enrolled. Patients underwent initial cardiac CT angiography with subsequent treatment determined by reference to findings at cardiac CT angiography; patients without overt plaque were immediately discharged from the hospital, patients with nonobstructive plaque and mild-to-moderate stenoses were discharged after a negative 6-hour troponin level, and patients with severe stenoses were admitted to the hospital. Discharged patients were followed up for a mean of 14.2 months. Additionally, length of stay and safety outcomes among these patients were compared with those in 102 consecutive patients with low- to intermediate-risk chest pain who presented to the ED and underwent a standard of care (SOC) work-up without cardiac CT angiography. One-way analysis of variance with Bonferroni correction was used to compare length of stay between groups. Results: Cardiac CT angiography findings in the 203 patients who underwent cardiac CT angiography were as follows: Sixty-five (32%) patients had no plaque, 107 (53%) had nonobstructive plaque, and 31 (15%) had severe stenoses. At follow-up, there were no deaths or cases of acute coronary syndrome (cardiac CT angiography, 0%, 95% confidence interval [CI]: 0%, 1.85%; SOC, 0%, 95% CI: 0%, 3.63%), and the rate of readmission to the hospital because of chest pain was higher with the SOC approach (9% vs 1%, P =.01). Mean ED length of stay was lower with cardiac CT angiography (6.62 hours 6 0.38 after a single troponin level and 9.15 hours ± 0.30 after serial troponin levels) than with the SOC approach (11.62 hours ± 0.47, P < .001). Conclusion: Tailoring troponin measurement to cardiac CT angiography findings is safe and allows early discharge of patients with low- to intermediate-risk chest pain, resulting in reduced length of stay. © RSNA, 2011.

Ormiston J.A.,Auckland City Hospital | Serruys P.W.,Erasmus Medical Center | Onuma Y.,Erasmus Medical Center | Van Geuns R.-J.,Erasmus Medical Center | And 15 more authors.
Circulation: Cardiovascular Interventions | Year: 2012

Background: Nonserial observations have shown this bioresorbable scaffold to have no signs of area reduction at 6 months and recovery of vasomotion at 1 year. Serial observations at 6 months and 2 years have to confrm the absence of late restenosis or unfavorable imaging outcomes. Methods and Results: The ABSORB trial is a multicenter single-Arm trial assessing the safety and performance of an everolimus-eluting bioresorbable vascular scaffold. Forty-five patients underwent serial invasive imaging, such as quantitative coronary angiography, intravascular ultrasound, and optical coherence tomography at 6 and 24 months of follow-up. From 6 to 24 months, late luminal loss increased from 0.16±0.18 to 0.27±0.20 mm on quantitative coronary angiography, with an increase in neointima of 0.68±0.43 mm2 on optical coherence tomography and 0.17±0.26 mm2 on intravascular ultrasound. Struts still recognizable on optical coherence tomography at 2 years showed 99% of neointimal coverage with optical and ultrasonic signs of bioresorption accompanied by increase in mean scaffold area compared with baseline (0.54±1.09 mm2 on intravascular ultrasound, P=0.003 and 0.77±1.33 m2 on optical coherence tomography, P=0.016). Two-year major adverse cardiac event rate was 6.8% without any scaffold thrombosis. Conclusions: This serial analysis of the second generation of the everolimus-eluting bioresorbable vascular scaffold confrmed, at medium term, the safety and efficacy of the new device. © 2012 American Heart Association, Inc.

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