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Coronary Artery Disease: HELP
Articles from Oregon
Based on 76 articles published since 2008
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These are the 76 published articles about Coronary Artery Disease that originated from Oregon during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. 2018

Truong, Quynh A / Rinehart, Sarah / Abbara, Suhny / Achenbach, Stephan / Berman, Daniel S / Bullock-Palmer, Renee / Carrascosa, Patricia / Chinnaiyan, Kavitha M / Dey, Damini / Ferencik, Maros / Fuechtner, Gudrun / Hecht, Harvey / Jacobs, Jill E / Lee, Sang-Eun / Leipsic, Jonathan / Lin, Fay / Meave, Aloha / Pugliese, Francesca / Sierra-Galán, Lilia M / Williams, Michelle C / Villines, Todd C / Shaw, Leslee J / Anonymous3891033. ·Weill Cornell Medicine, USA. Electronic address: qat9001@med.cornell.edu. · Piedmont Healthcare, USA. · UT Southwestern Medical Center, USA. · University of Erlangan, Germany. · Cedars-Sinai Medical Center, USA. · Deborah Heart and Lung Center, USA. · Maipu Diagnosis, Argentina. · William Beaumont Hospital, USA. · Oregon Health & Science University, USA. · Medical University of Innsbruck, Austria. · Mount Sinai Health System, USA. · NYU Langone Medical Center, USA. · Severance Hospital, South Korea. · Providence Healthcare, Canada. · Weill Cornell Medicine, USA. · Ignacio Chavez National Institute for Cardiology, Mexico. · William Harvey Research Institute, UK. · American British Cowdray Medical Center, Mexico. · British Heart Foundation, UK. · Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, USA. ·J Cardiovasc Comput Tomogr · Pubmed #30392926.

ABSTRACT: This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes.

2 Guideline Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors: US Preventive Services Task Force Recommendation Statement. 2018

Anonymous2681075 / Curry, Susan J / Krist, Alex H / Owens, Douglas K / Barry, Michael J / Caughey, Aaron B / Davidson, Karina W / Doubeni, Chyke A / Epling, John W / Kemper, Alex R / Kubik, Martha / Landefeld, C Seth / Mangione, Carol M / Silverstein, Michael / Simon, Melissa A / Tseng, Chien-Wen / Wong, John B. ·University of Iowa, Iowa City. · Fairfax Family Practice Residency, Fairfax, Virginia. · Virginia Commonwealth University, Richmond. · Veterans Affairs Palo Alto Health Care System, Palo Alto, California. · Stanford University, Stanford, California. · Harvard Medical School, Boston, Massachusetts. · Oregon Health & Science University, Portland. · Columbia University, New York, New York. · University of Pennsylvania, Philadelphia. · Virginia Tech Carilion School of Medicine, Roanoke. · Nationwide Children's Hospital, Columbus, Ohio. · Temple University, Philadelphia, Pennsylvania. · University of Alabama at Birmingham. · University of California, Los Angeles. · Boston University, Boston, Massachusetts. · Northwestern University, Evanston, Illinois. · University of Hawaii, Honolulu. · Pacific Health Research and Education Institute, Honolulu, Hawaii. · Tufts University, Medford, Massachusetts. ·JAMA · Pubmed #29998297.

ABSTRACT: Importance: Cardiovascular disease (CVD) is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by the Framingham Risk Score, the Pooled Cohort Equations, or similar CVD risk assessment models. If current CVD risk assessment models could be improved by adding more risk factors, treatment might be better targeted, thereby maximizing the benefits and minimizing the harms. Objective: To update the 2009 US Preventive Services Task Force (USPSTF) recommendation on using nontraditional risk factors in coronary heart disease risk assessment. Evidence Review: The USPSTF reviewed the evidence on using nontraditional risk factors in CVD risk assessment, focusing on the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score; the health benefits and harms of CVD risk assessment and treatment guided by nontraditional risk factors combined with the Framingham Risk Score or Pooled Cohort Equations compared with using either risk assessment model alone; and whether adding nontraditional risk factors to existing CVD risk assessment models improves measures of calibration, discrimination, and risk reclassification. Findings: The USPSTF found adequate evidence that adding the ABI, hsCRP level, and CAC score to existing CVD risk assessment models results in small improvements in discrimination and risk reclassification; however, the clinical meaning of these changes is largely unknown. Evidence on adding the ABI, hsCRP level, and CAC score to the Pooled Cohort Equations is limited. The USPSTF found inadequate evidence to assess whether treatment decisions guided by the ABI, hsCRP level, or CAC score, in addition to risk factors in existing CVD risk assessment models, leads to reduced incidence of CVD events or mortality. The USPSTF found adequate evidence to conceptually bound the harms of early detection and interventions as small. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the ABI, hsCRP level, or CAC score in risk assessment for CVD in asymptomatic adults to prevent CVD events. Conclusions and Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ABI, hsCRP level, or CAC score to traditional risk assessment for CVD in asymptomatic adults to prevent CVD events. (I statement).

3 Editorial Insights Into Coronary Plaque Microstructure Differences Between Women and Men. 2016

Ferencik, Maros. ·The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.From the Knight Cardiovascular Institute, Oregon Health and Science University, Portland; and Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston. erencik@ohsu.edu. ·Circ Cardiovasc Imaging · Pubmed #27511977.

ABSTRACT: -- No abstract --

4 Editorial How much evidence is in a case report? A road trip of scientific evidence, including skeptics, Ockham's razor, Hume's Fork, and Karl R. Popper. 2015

Achenbach, Stephan / Einstein, Andrew J / Ferencik, Maros. ·Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. Electronic address: stephan.achenbach@uk-erlangen.de. · Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA; Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA. · Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA. ·J Cardiovasc Comput Tomogr · Pubmed #26088377.

ABSTRACT: -- No abstract --

5 Editorial Revascularization choices for complex coronary artery disease: all is not what it seems. 2014

Tibayan, Yen / Cigarroa, Joaquin E. ·Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon, USA. ·Coron Artery Dis · Pubmed #24762820.

ABSTRACT: -- No abstract --

6 Review Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. 2018

Lin, Jennifer S / Evans, Corinne V / Johnson, Eric / Redmond, Nadia / Coppola, Erin L / Smith, Ning. ·Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon. ·JAMA · Pubmed #29998301.

ABSTRACT: Importance: Incorporating nontraditional risk factors may improve the performance of traditional multivariable risk assessment for cardiovascular disease (CVD). Objective: To systematically review evidence for the US Preventive Services Task Force on the benefits and harms of 3 nontraditional risk factors in cardiovascular risk assessment: the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score. Data Sources: MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for studies published through May 22, 2017. Surveillance continued through February 7, 2018. Study Selection: Studies of asymptomatic adults with no known cardiovascular disease. Data Extraction and Synthesis: Independent critical appraisal and data abstraction by 2 reviewers. Main Outcomes and Measures: Cardiovascular events, mortality, risk assessment performance measures (calibration, discrimination, or risk reclassification), and serious adverse events. Results: Forty-three studies (N = 267 244) were included. No adequately powered trials have evaluated the clinical effect of risk assessment with nontraditional risk factors on patient health outcomes. The addition of the ABI (10 studies), hsCRP level (25 studies), or CAC score (19 studies) can improve both discrimination and reclassification; the magnitude and consistency of improvement varies by nontraditional risk factor. For the ABI, improvements in performance were the greatest for women, in whom traditional risk assessment has poor discrimination (C statistic change of 0.112 and net reclassification index [NRI] of 0.096). Results were inconsistent for hsCRP level, with the largest analysis (n = 166 596) showing a minimal effect on risk prediction (C statistic change of 0.0039, NRI of 0.0152). The largest improvements in discrimination (C statistic change ranging from 0.018 to 0.144) and reclassification (NRI ranging from 0.084 to 0.35) were seen for CAC score, although CAC score may inappropriately reclassify individuals not having cardiovascular events into higher-risk categories, as determined by negative nonevent NRI. Evidence for the harms of nontraditional risk factor assessment was limited to computed tomography imaging for CAC scoring (8 studies) and showed that radiation exposure is low but may result in additional testing. Conclusions and Relevance: There are insufficient adequately powered clinical trials evaluating the incremental effect of the ABI, hsCRP level, or CAC score in risk assessment and initiation of preventive therapy. Furthermore, the clinical meaning of improvements in measures of calibration, discrimination, and reclassification risk prediction studies is uncertain.

7 Review The State of the Absorb Bioresorbable Scaffold: Consensus From an Expert Panel. 2017

Bangalore, Sripal / Bezerra, Hiram G / Rizik, David G / Armstrong, Ehrin J / Samuels, Bruce / Naidu, Srihari S / Grines, Cindy L / Foster, Malcolm T / Choi, James W / Bertolet, Barry D / Shah, Atman P / Torguson, Rebecca / Avula, Surendra B / Wang, John C / Zidar, James P / Maksoud, Aziz / Kalyanasundaram, Arun / Yakubov, Steven J / Chehab, Bassem M / Spaedy, Anthony J / Potluri, Srini P / Caputo, Ronald P / Kondur, Ashok / Merritt, Robert F / Kaki, Amir / Quesada, Ramon / Parikh, Manish A / Toma, Catalin / Matar, Fadi / DeGregorio, Joseph / Nicholson, William / Batchelor, Wayne / Gollapudi, Raghava / Korngold, Ethan / Sumar, Riyaz / Chrysant, George S / Li, Jun / Gordon, John B / Dave, Rajesh M / Attizzani, Guilherme F / Stys, Tom P / Gigliotti, Osvaldo S / Murphy, Bruce E / Ellis, Stephen G / Waksman, Ron. ·Department of Medicine, New York University School of Medicine, New York, New York. Electronic address: sripalbangalore@gmail.com. · Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Department of Medicine, HonorHealth and the HonorHealth Heart Group, Scottsdale, Arizona. · Department of Medicine, University of Colorado, Denver, Colorado. · Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California. · Department of Medicine, Westchester Medical Center, Valhalla, New York. · Department of Medicine, North Shore University Hospital, Manhasset, New York. · Department of Medicine, Tennova Healthcare, Knoxville, Tennessee. · Department of Medicine, Baylor Heart and Vascular Hospital, Dallas, Texas. · Department of Medicine, North Mississippi Medical Center, Tupelo, Mississippi. · Department of Medicine, University of Chicago, Chicago, Illinois. · Department of Medicine, MedStar Washington Hospital Center, Washington, DC. · Department of Medicine, Advocate Christ Hospital and Medical Center, Oak Lawn, Illinois. · Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland. · Department of Medicine, UNC/Rex Healthcare, Raleigh, North Carolina. · Department of Medicine, Cardiovascular Research Institute of Kansas, Kansas City, Kansas. · Department of Medicine, Seattle Heart and Vascular Institute, Seattle, Washington. · Department of Medicine, OhioHealth, Columbus, Ohio. · Department of Medicine, University of Kansas, Kansas City, Kansas. · Department of Medicine, Missouri Heart Center, Columbia, Missouri. · Department of Medicine, The Heart Hospital Baylor Plano, Plano, Texas. · Department of Medicine, St. Joseph's/Trinity Hospital, Syracuse, New York. · Department of Medicine, DMC Heart Hospital/Wayne State University, Detroit, Michigan. · Department of Medicine, Mercy Hospital and Clinic, Springfield, Missouri. · Department of Medicine, Heart & Vascular Institute, Detroit, Michigan. · Department of Medicine, Miami Cardiac & Vascular Institute, Baptist Health, Miami, Florida. · Department of Medicine, Columbia University Medical Center, New York, New York. · Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · Department of Medicine, University of South Florida, Tampa, Florida. · Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey. · Department of Medicine, York Hospital, York, Pennsylvania. · Department of Medicine, Tallahassee Memorial Hospital/Florida State University, Tallahassee, Florida. · Department of Medicine, San Diego Cardiac Center, San Diego, California. · Department of Medicine, Providence St. Vincent Medical Center, Portland, Oregon. · Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. · Department of Medicine, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma. · Department of Medicine, Geisinger Holy Spirit, Harrisburg, Pennsylvania. · Department of Medicine, Sanford Health, Sioux Falls, South Dakota. · Department of Medicine, Seton Heart Institute, Austin, Texas. · Department of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas. · Department of Medicine, Cleveland Clinic, Cleveland, Ohio. ·JACC Cardiovasc Interv · Pubmed #29216997.

ABSTRACT: Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late. This is not too dissimilar to the challenges seen with first-generation DES in which refinement of deployment technique, prolongation of dual antiplatelet therapy, and technical iteration mitigated excess risk of very late stent thrombosis, making DES the treatment of choice for coronary artery disease. This white paper discusses the factors potentially implicated in the excess risks, including the scaffold consideration and deployment technique, and outlines patient and lesion selection, implantation technique, and dual antiplatelet therapy considerations to potentially mitigate this excess risk with the first-generation thick strut Absorb scaffold (Abbott Vascular, Abbott Park, Illinois). It remains to be seen whether these considerations together with technical iterations will ultimately close the gap between scaffolds and metal stents for short-term events while at the same time preserving options for future revascularization once the scaffold bioresorbs.

8 Review Nonobstructive Coronary Artery Disease by Coronary CT Angiography Improves Risk Stratification and Allocation of Statin Therapy. 2017

Emami, Hamed / Takx, Richard A P / Mayrhofer, Thomas / Janjua, Sumbal / Park, Jakob / Pursnani, Amit / Tawakol, Ahmed / Lu, Michael T / Ferencik, Maros / Hoffmann, Udo. ·Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine, Yale-New Haven Hospital, Yale Medical School, New Haven, Connecticut. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: uhoffmann@partners.org. ·JACC Cardiovasc Imaging · Pubmed #28330658.

ABSTRACT: OBJECTIVES: This study sought to determine prognostic value of nonobstructive coronary artery disease (CAD) for atherosclerotic cardiovascular disease (ASCVD) events and to determine whether incorporation of this information into the pooled cohort equation reclassifies recommendations for statin therapy as defined by the 2013 guidelines for cholesterol management of the American College of Cardiology and American Heart Association (ACC/AHA). BACKGROUND: Detection of nonobstructive CAD by coronary computed tomography angiography may improve risk stratification and permit individualized and more appropriate allocation of statin therapy. METHODS: This study determined the pooled hazard ratio of nonobstructive CAD for ASCVD events from published studies and incorporated this information into the ACC/AHA pooled cohort equation. The study calculated revised sex- and ethnicity-based 10-year ASCVD risk and determined boundaries corresponding to the original 7.5% risk for ASCVD events. It also assessed reclassification for statin eligibility by incorporating the results from meta-analysis to individual patients from a separate cohort. RESULTS: This study included 2 studies (2,295 subjects; 66% male; prevalence of nonobstructive CAD, 47%; median follow-up, 49 months; 67 ASCVD events). The hazard ratio of nonobstructive CAD for ASCVD events was 3.2 (95% confidence interval: 1.5 to 6.7). Incorporation of this information into the pooled cohort equation resulted in reclassification toward statin eligibility in individuals with nonobstructive CAD, with an original ASCVD score of 3.0% and 5.9% or higher in African-American women and men and a score of 4.4% and 4.6% or higher in Caucasian women and men, respectively. The absence of nonobstructive CAD resulted in reclassification toward statin ineligibility if the original ASCVD score was as 10.0% and 17.9% or lower in African-American women and men and 13.7% and 14.3% or lower in Caucasian women and men, respectively. Reclassification is observed in 14% of patients. CONCLUSIONS: Detection of nonobstructive CAD by coronary computed tomography angiography improves risk stratification and permits individualized and more appropriate allocation of statin therapy across sex and ethnicity groups.

9 Review Is there still a role for cardiac CT in the emergency department in the era of highly-sensitive troponins? 2017

Dedic, Admir / Nieman, Koen / Hoffmann, Udo / Ferencik, Maros. ·Departments of Cardiology and Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands. · Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA - ferencik@ohsu.edu. · Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA. ·Minerva Cardioangiol · Pubmed #27886161.

ABSTRACT: Physicians practicing cardiovascular medicine are every day confronted with patients presenting with symptoms suggestive of an acute coronary syndrome (ACS). Over the years, there have been substantial technical advances, such as the introduction of new non-invasive imaging techniques and the introduction of new highly sensitive cardiac biomarkers. Physicians have adopted these new assets and have become more experienced with them thus improving medical care. Nevertheless, the search for an efficient, yet safe diagnostic work-up for patients presenting with symptoms suggestive of ACS is ongoing. A large proportion of patients will require some form of non-invasive testing and the choice for the diagnostic modality as well as its timing are important steps in this process. Cardiac computed tomography (CT), a non-invasive imaging technique that rapidly provides visualization of the coronary artery tree, is an attractive option, with its unparalleled negative predictive value for obstructive coronary artery disease (CAD). With the introduction of highly-sensitive troponins (hsTn), the role of non-invasive testing, including cardiac CT, has changed. This review will provide an oversight on what is known about cardiac CT in acute chest presentations. Furthermore, we will discuss the changing role of cardiac CT in the era of hsTn and the possibility of their combined use in the work-up of suspected ACS patients. hsTn is currently an established tool for the diagnosis and triage of patients with suspected ACS. The role of cardiac CT has shifted now to a secondary, comprehensive rule-out test in patients with inconclusive biomarker status, providing information on stenosis severity, plaque burden, high-risk features and the presence of other serious conditions that can also give rise to hsTn.

10 Review The Role of Imaging with Cardiac Computed Tomography in Cardio-Oncology Patients. 2016

Pitekova, Barbora / Ravi, Sriram / Shah, Shimoli V / Mladosievicova, Beata / Heitner, Stephen / Ferencik, Maros. ·Knight Cardiovascular Institute, Oregon Health and Science University, 3180 Sam Jackson Park Rd., Mail Code UHN62, Portland, OR, 97239, USA. · Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Spitalska 24, 813 72, Bratislava, Slovakia. · Knight Cardiovascular Institute, Oregon Health and Science University, 3180 Sam Jackson Park Rd., Mail Code UHN62, Portland, OR, 97239, USA. ferencik@ohsu.edu. ·Curr Cardiol Rep · Pubmed #27443383.

ABSTRACT: Cardiovascular diseases and cancer represent the two most common causes of morbidity and mortality in industrialized countries. With the increase in long-term survival of cancer patients, cardiovascular diseases are the leading cause of mortality for many cancer survivors. In this article, we will review the most common cardiovascular toxicities of cancer therapies and will describe the role of cardiac CT in the detection and monitoring of cardiovascular disease. While there is limited evidence for the use of CT imaging in cancer patients, we will discuss the utility of cardiac CT in the detection and management of coronary artery disease, pericardial and valvular heart disease.

11 Review Antispastic Management in Arterial Grafts in Coronary Artery Bypass Grafting Surgery. 2016

He, Guo-Wei / Taggart, David P. ·Department of Cardiovascular Surgery and Center for Basic Medical Research, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin and Zhejiang University and The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China, and Department of Surgery, Oregon Health and Science University, Portland, Oregon. Electronic address: gwhezj@163.com. · Department of Cardiothoracic Surgery, Oxford University, United Kingdom. ·Ann Thorac Surg · Pubmed #27319987.

ABSTRACT: Arterial grafts have long-term patency superior to vein grafts but have a tendency to develop spasm that can lead to potentially life-threatening complications. A perfect antispastic protocol should include advanced surgical technique and adequate pharmacologic methods. All pharmacologic vasodilator drugs relax the vessel through specific mechanisms, and therefore, there is no perfect, single best vasodilator to prevent or treat spasm of the arterial graft against all mechanisms of contraction. One of the choices is to use a combination of pharmacologic vasodilators targeting different mechanisms of spasm to obtain the reliable and best effect.

12 Review A Practical Approach to Mechanical Circulatory Support in Patients Undergoing Percutaneous Coronary Intervention: An Interventional Perspective. 2016

Atkinson, Tamara M / Ohman, E Magnus / O'Neill, William W / Rab, Tanveer / Cigarroa, Joaquin E / Anonymous1150867. ·Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon. · Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. · Division of Cardiology, Henry Ford Hospital, Detroit, Michigan. · Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. · Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon. Electronic address: cigarroa@ohsu.edu. ·JACC Cardiovasc Interv · Pubmed #27151604.

ABSTRACT: Percutaneous mechanical circulatory support has been used to stabilize patients in cardiogenic shock and provide hemodynamic support during high-risk percutaneous coronary interventions for several decades. The goal of this paper is to provide a practical approach to percutaneous mechanical circulatory support in patients undergoing percutaneous coronary intervention with cardiogenic shock and/or high risk features to aid in decision making for interventional cardiologists.

13 Review Non-invasive and invasive imaging of vulnerable coronary plaque. 2016

Celeng, Csilla / Takx, Richard A P / Ferencik, Maros / Maurovich-Horvat, Pál. ·MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. · Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR. · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: p.maurovich-horvat@cirg.hu. ·Trends Cardiovasc Med · Pubmed #27079893.

ABSTRACT: Vulnerable plaque is characterized by a large necrotic core and an overlying thin fibrous cap. Non-invasive imaging modalities such as computed tomography angiography (CTA) and magnetic resonance imaging (MRI) allow for the assessment of morphological plaque characteristics, while positron emission tomography (PET) enables the detection of metabolic activity within the atherosclerotic lesions. Invasive imaging modalities such as intravascular ultrasound (IVUS), optical-coherence tomography (OCT), and intravascular MRI (IV-MRI) display plaques at a high spatial resolution. Near-infrared spectroscopy (NIRS) allows for the detection of chemical components of atherosclerotic plaques. In this review, we describe state-of-the-art non-invasive and invasive imaging modalities and stress the combination of their advantages to identify vulnerable plaque features.

14 Review Spasm in Arterial Grafts in Coronary Artery Bypass Grafting Surgery. 2016

He, Guo-Wei / Taggart, David P. ·Department of Cardiovascular Surgery and Center for Basic Medical Research, TEDA International Cardiovascular Hospital, Tianjin, and the Affiliated Hospital of Hangzhou Normal University and Zhejiang University, Hangzhou, China; Department of Surgery, Oregon Health and Science University, Portland, Oregon. Electronic address: gwhezj@163.com. · Department of Cardiothoracic Surgery, Oxford University, Oxford, United Kingdom. ·Ann Thorac Surg · Pubmed #26588865.

ABSTRACT: Spasm of arterial grafts in coronary artery bypass grafting surgery is still a clinical problem, and refractory spasm can occasionally be lethal. Perioperative spasm in bypass grafts and coronary arteries has been reported in 0.43% of all coronary artery bypass grafting surgery, but this may be an underestimate. Spasm can develop not only in the internal mammary artery but more frequently in the right gastroepiploic and radial artery. The mechanism of spasm can involve many pathways, particularly those involving regulation of the intracellular calcium concentration. Endothelial dysfunction also plays a role in spasm. Depending on the clinical scenario, the possibility of spasm during and after coronary artery bypass grafting should be confirmed by angiography. If present, immediate intraluminal injection of vasodilators is often effective, although other procedures such as an intraaortic balloon pump or extracorporeal membrane oxygenation may also become necessary to salvage the patient. Prevention of spasm involves many considerations, and the principles are discussed in this review article.

15 Review Levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and risk of coronary artery disease: A meta-analysis based on 4713 participants. 2016

Xuan, Chao / Tian, Qing-Wu / Li, Hui / Zhang, Bei-Bei / He, Guo-Wei / Lun, Li-Min. ·Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, China. · Department of Molecular Microbiology, Oslo University Hospital, Norway. · TEDA International Cardiovascular Hospital, Tianjin; The Affiliated Hospital of Hangzhou Normal University, China Department of Surgery, Oregon Health and Science University, Portland, USA. · Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, China lunlmqd@163.com. ·Eur J Prev Cardiol · Pubmed #25956428.

ABSTRACT: BACKGROUND: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase by competing with L-arginine. As a result, the expression of nitric oxide decreases and endothelial dysfunction occurs. Studies have evaluated the association between the serum ADMA level and risk of coronary artery disease. However, conflicting results have been obtained. METHODS: Pubmed, Web of Science, Embase, Ovid, Cochrane databases were searched to identify eligible studies published in English until December 2014. Association was assessed on the basis of weighted mean differences (WMD) with 95% confidence intervals (CIs). Publication bias was analysed using Begg's and Egger's tests. Sensitivity analysis was performed to evaluate result stability. RESULTS: A total of 16 case-control studies with 2939 patients and 1774 controls were included in the meta-analysis. Pooled result indicated that patients with coronary artery disease yielded a higher ADMA level than healthy controls (WMD: 0.248, 95% CI: 0.156-0.340; p = 1.16 e-7). Sensitivity analysis suggested that our meta-analysis result was stable. Subgroup analysis found a similar pattern in patients with myocardial infarction (WMD: 0.397, 95% CI: 0.112-0.683; p = 0.0106), stable angina pectoris (WMD: 0.197, 95% CI: 0.031-0.364; p = 0.02) and unstable angina pectoris (WMD: 0.857, 95% CI: 0.293-1.420; p = 0.003). CONCLUSIONS: Meta-analysis results indicated that an increased ADMA level is associated with an increased risk of coronary artery disease.

16 Review Coronary artery disease in offender populations: incarceration as a risk factor and a point of intervention. 2014

Donahue, John. ·VISN 20 Northwest Mental Illness Research, Education and Clinical Center, Portland VA Medical Center, Portland, OR, USA jdonahue81@gmail.com. ·J Correct Health Care · Pubmed #25038141.

ABSTRACT: Coronary artery disease (CAD) is a significant health problem and global burden. Research on antisocial behaviors has identified some groups of offenders as vulnerable to the development of cardiovascular disorders. This article reviews the relationship between criminal offending and CAD, with a particular emphasis on incarcerated populations. Existing research supports this link, with incarceration demonstrating substantial associations with numerous cardiac risk factors, development of cardiac problems, and cardiovascular disease mortality. Comprehensive multicomponent prevention programs, while often available in the community, have received little research attention in prison settings. In addition to clarifying the relationship between incarceration and heart disease, this article reviews various treatment and management responses made by prison officials.

17 Review Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. 2012

Inaba, Yoichi / Chen, Jennifer A / Bergmann, Steven R. ·Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR 97239, USA. yoichiinaba@yahoo.com ·Atherosclerosis · Pubmed #21764060.

ABSTRACT: OBJECTIVES: We conducted the meta-analysis to compare the diagnostic accuracies of carotid plaque and carotid intima-media thickness (CIMT) measured by B-mode ultrasonography for the prediction of coronary artery disease (CAD) events. METHODS: Two reviewers independently searched electronic databases to identify relevant studies through April 2011. Both population-based longitudinal studies with the outcome measure of myocardial infarction (MI) events and diagnostic cohort studies for the detection of CAD were identified and analyzed separately. Weighted summary receiver-operating characteristic (SROC) plots, with pertinent areas under the curves (AUCs), were constructed using the Moses-Shapiro-Littenberg model. Meta-regression analyses, using parameters of relative diagnostic odds ratio (DOR), were conducted to compare the diagnostic performance after adjusting other study-specific covariates. RESULTS: The meta-analysis of 11 population-based studies (54,336 patients) showed that carotid plaque, compared with CIMT, had a significantly higher diagnostic accuracy for the prediction of future MI events (AUC 0.64 vs. 0.61, relative DOR 1.35; 95%CI 1.1-1.82, p=0.04). The 10-year event rates of MI after negative results were lower with carotid plaque (4.0%; 95% CI 3.6-4.7%) than with CIMT (4.7%; 95% CI 4.2-5.5%). The meta-analysis of 27 diagnostic cohort studies (4.878 patients) also showed a higher, but non-significant, diagnostic accuracy of carotid plaque compared with CIMT for the detection of CAD (AUC 0.76 vs. 0.74, p=0.21 for relative DOR). CONCLUSIONS: The present meta-analysis showed that the ultrasound assessment of carotid plaque, compared with that of CIMT, had a higher diagnostic accuracy for the prediction of future CAD events.

18 Review What combination therapy with a statin, if any, would you recommend? 2011

Dujovne, Carlos A / Williams, Craig D / Ito, Matthew K. ·Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA. dujovnec@ohsu.edu ·Curr Atheroscler Rep · Pubmed #21107758.

ABSTRACT: The latest recommended goals for blood lipid levels may require multiple lipid drugs. Lower doses in combination may render more efficacy and safety than highest doses of single agents. Except for isolated hypoalphalipoproteinemia (a low level of high-density lipoprotein cholesterol), therapies will start with a statin. All marketed statins are acceptable. The choice may be based on dose- efficacy and patient's tolerability. High-potency statins (eg, atorvastatin, simvastatin, or rosuvastatin) are often chosen. Currently, generic statins, such as simvastatin, lovastatin, pravastatin, and fluvastatin, offer cost benefits. The choice of added agent depends on the "residual lipoprotein abnormalities" after statin therapy, efficacy, compliance issues, and cost. Approved "combined" preparations improve cost and compliance. To further lower low-density lipoprotein cholesterol, ezetimibe is a safe, efficacious choice, pending resolution of a controversial trial's results. Colesevelam is moderately effective and the best tolerated bile acids sequestrant. In combined dyslipidemias, extended-release niacin is the best tolerated niacin preparation; other quality-controlled immediate-release preparations have similar safety and efficacy but produce more flushing of the skin. Niacin or fenofibrate is effective in normalizing high-density lipoprotein and triglyceride levels persisting after statin therapy. Agents approved by the US Food and Drug Administration and the latest guidelines of the National Cholesterol Education Program, American Heart Association/American College of Cardiology provide choices and indications of drug combinations.

19 Review Prognostic value of myocardial metabolic imaging with BMIPP in the spectrum of coronary artery disease: a systematic review. 2010

Inaba, Yoichi / Bergmann, Steven R. ·Division of Cardiovascular Medicine, Oregon Health and Science University, UHN62, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. inaba@ohsu.edu ·J Nucl Cardiol · Pubmed #19851821.

ABSTRACT: BACKGROUND: We conducted a systematic review to summarize the current literature on the prognostic value of BMIPP imaging, fatty-acid metabolic imaging, for the prediction of cardiovascular events in coronary artery disease. METHODS AND RESULTS: Electronic databases (including Japanese medical literature search engines) were searched by a Japanese investigator using a predefined search strategy. Eleven studies, all conducted in Japan, were included in the meta-analysis. In three studies involving 541 patients with suspected acute coronary syndrome who were excluded for acute myocardial infarction (AMI), an abnormal finding on BMIPP imaging was significantly associated with future hard events (cardiac death or non-fatal myocardial infarction). The negative predictive value of BMIPP imaging for future hard events was 98.9% (96.8-99.7%) over 3.5 years. In six studies involving 542 patients with AMI, a larger defect on BMIPP imaging was significantly associated with future hard events. The prognostic value of perfusion-metabolism mismatch compared with myocardial perfusion imaging was dependent upon the relative timing of BMIPP imaging, revascularization, and myocardial perfusion damage. CONCLUSIONS: BMIPP imaging is useful for the risk stratification of patients with coronary artery disease, particularly patients with acute chest pain.

20 Review Is the "triple rule-out" study an appropriate indication for cardiovascular CT? 2009

Shapiro, Michael D. ·Department of Cardiovascular Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN62, Portland, OR 97239, USA. shapirmi@ohsu.edu ·J Cardiovasc Comput Tomogr · Pubmed #19201674.

ABSTRACT: There is interest in using the fast volume coverage of 64-slice cardiovascular CT angiography (CCTA) in patients presenting with undifferentiated acute chest pain to simultaneously evaluate the coronary arteries, thoracic aorta, and pulmonary arteries during a single breathhold, the so-called "triple rule-out." However, it is not clear whether the triple rule-out study is an appropriate indication for cardiovascular CCTA. Initial studies suggest that performing a triple rule-out protocol to comprehensively evaluate patients with acute chest pain presenting to the emergency department (ED) is feasible and that quantitative parameters of image quality may be comparable to the conventional, dedicated coronary and pulmonary CTA protocols. Recent data also suggest that a triple rule-out protocol has the potential to identify a subset of patients presenting with acute chest pain who can safely be discharged from the ED. In addition, new scanner technology has also reduced the contrast and radiation doses necessary for such an examination. However, despite these early encouraging results, randomized control trials designed to determine whether this protocol is safe, cost-effective, and improves clinical decision making are necessary before routine implementation of such an examination can be justified.

21 Review Epidemiology of sudden cardiac death: clinical and research implications. 2008

Chugh, Sumeet S / Reinier, Kyndaron / Teodorescu, Carmen / Evanado, Audrey / Kehr, Elizabeth / Al Samara, Mershed / Mariani, Ronald / Gunson, Karen / Jui, Jonathan. ·Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR 97239, USA. chughs@ohsu.edu ·Prog Cardiovasc Dis · Pubmed #19026856.

ABSTRACT: The current annual incidence of sudden cardiac death in the United States is likely to be in the range of 180,000 to 250,000 per year. Coinciding with the decreased mortality from coronary artery disease, there is evidence pointing toward a significant decrease in rates of sudden cardiac death in the United States during the second half of the 20th century. However, the alarming rise in prevalence of obesity and diabetes in the first decade of the new millennium both in the United States and worldwide, would indicate that this favorable trend is unlikely to persist. We are likely to witness a resurgence of coronary artery disease and heart failure, as a result of which sudden cardiac death will have to be confronted as a shared and indiscriminate, worldwide public health problem. There is also increasing recognition of the fact that discovery of meaningful and relevant risk stratification and prevention methodologies will require careful prospective community-wide analyses, with access to large archives of DNA, serum, and tissue that link with well-phenotyped databases. The purpose of this review is to summarize current knowledge of sudden cardiac death epidemiology. We will discuss the significance and strengths of community-wide evaluations of sudden cardiac death, summarize recent observations from such studies, and finally highlight specific potential predictors that warrant further evaluation as determinants of sudden cardiac death in the general population.

22 Review Toll-like receptors: new therapeutic targets for the treatment of atherosclerosis, acute coronary syndromes, and myocardial failure. 2008

Erickson, Benjamin / Sperber, Kirk / Frishman, William H. ·Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA. ·Cardiol Rev · Pubmed #18923230.

ABSTRACT: The toll-like receptors (TLRs) are a class of transmembrane molecules that have important functions in both innate and acquired immunity. As part of the body's normal immune defense against microbial pathogens, stimulation of these receptors will trigger the inflammatory response cascade and the release of cytokines. Activation of these receptors also plays a role in a variety of systemic inflammatory diseases such as asthma, sepsis, atherosclerosis, acute coronary artery disease, and left ventricular remodeling. Pharmacologic approaches to modify the actions of TLRs are now under consideration as potential treatments for inflammatory systemic diseases that include atherosclerosis. At the same time, it is essential to characterize the benefits and risks of modifying such an important part of the body's innate immune system.

23 Review Myocardial perfusion imaging with contrast echocardiography. 2008

Carr, Chad L / Lindner, Jonathan R. ·Cardiovascular Division UHN-62, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. ·Curr Cardiol Rep · Pubmed #18489868.

ABSTRACT: Advances in myocardial perfusion imaging have firmly established the use of noninvasive techniques capable of providing useful information over a broad range of diagnostic and therapeutic cardiovascular problems. Evaluating regional myocardial perfusion abnormalities is a cornerstone for the diagnosis of coronary artery disease, risk assessment in those with known disease, and determination of myocardial viability. The clinical use of myocardial perfusion imaging and the current limitations of existing techniques continue to promote the development of new technologies capable of assessing microvascular and capillary perfusion abnormalities on a global myocardial level. Myocardial contrast echocardiography is an emerging technique capable of rapidly assessing myocardial perfusion at the capillary level in many different clinical settings. This article focuses on myocardial contrast-enhanced ultrasound perfusion techniques, emphasizing the unique information this modality provides compared with other noninvasive perfusion imaging techniques.

24 Clinical Trial Susceptibility Loci for Clinical Coronary Artery Disease and Subclinical Coronary Atherosclerosis Throughout the Life-Course. 2015

Salfati, Elias / Nandkeolyar, Shuktika / Fortmann, Stephen P / Sidney, Stephen / Hlatky, Mark A / Quertermous, Thomas / Go, Alan S / Iribarren, Carlos / Herrington, David M / Goldstein, Benjamin A / Assimes, Themistocles L. ·From the Department of Medicine, Stanford University School of Medicine, CA (E.S., S.P.F., M.A.H., T.Q., B.A.G., T.L.A.) · Ecole Doctorale B2T, IUH, Université Paris 7, Paris, France (E.S.) · Medical College of Wisconsin, Milwaukee (S.N.) · Kaiser Permanente Center for Health Research, Portland, OR (S.P.F.) · Kaiser Permanente Division of Research, Oakland, CA (S.S., A.S.G., C.I.) · Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC (D.M.H.) · and Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (B.A.G.). ·Circ Cardiovasc Genet · Pubmed #26417035.

ABSTRACT: BACKGROUND: Recent genome-wide association studies have identified 49 single nucleotide polymorphisms associated with clinical coronary artery disease. The mechanism by which these loci influence risk remains largely unclear. METHODS AND RESULTS: We examined the association between a genetic risk score composed of high-risk alleles at the 49 single nucleotide polymorphisms and the degree of subclinical coronary atherosclerosis in 7798 participants from 6 studies stratified into 4 age groups at the time of assessment (15-34, 35-54, 55-74, and >75 years). Atherosclerosis was quantified by staining and direct visual inspection of the right coronary artery in the youngest group and by scanning for coronary artery calcification in the remaining groups. We defined cases as subjects within the top quartile of degree of atherosclerosis in 3 groups and as subjects with a coronary artery calcium score >0 in the fourth (35-54 years) where less than one quarter had any coronary artery calcium. In our meta-analysis of all strata, we found 1-SD increase in the genetic risk score increased the risk of advanced subclinical coronary atherosclerosis by 36% (P=8.3×10(-25)). This increase in risk was significant in all 4 age groups including the youngest group where atherosclerosis consisted primarily of raised lesions without macroscopic evidence of plaque rupture or thrombosis. Results were similar when we restricted the genetic risk score to 32 single nucleotide polymorphisms not associated with traditional risk factors or when we adjusted for traditional risk factors. CONCLUSIONS: A genetic risk score for clinical coronary artery disease is associated with advanced subclinical coronary atherosclerosis throughout the life-course. This association is apparent even at the earliest, uncomplicated stages of atherosclerosis.

25 Article Serum Uric Acid as an Independent Risk Factor for the Presence and Severity of Early-Onset Coronary Artery Disease: A Case-Control Study. 2018

Tian, Ting-Ting / Li, Hui / Chen, Sheng-Jie / Wang, Qing / Tian, Qing-Wu / Zhang, Bei-Bei / Zhu, Jie / He, Guo-Wei / Lun, Li-Min / Xuan, Chao. ·Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, China. · Department of Molecular Microbiology, Oslo University Hospital, Oslo, Norway. · Department Scientific Research Management, The Affiliated Hospital of Qingdao University, Qingdao, China. · Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Academy of Medical Sciences & Peking Union Medical College, Tianjin, China. · Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA. ·Dis Markers · Pubmed #30425752.

ABSTRACT: Serum uric acid (UA) is the final product of purine metabolism in humans. The present study is aimed at identifying the potential association between serum UA and early-onset coronary artery disease (EOCAD). The study population consisted of 1093 EOCAD patients aged ≤50 years, and 1117 age- and sex-matched apparently healthy people served as controls. The concentrations of UA were measured by uricase method. The severity of CAD was evaluated by Gensini score. The mean serum level of UA was 5.843 ± 1.479 mg/dl in EOCAD patients and 5.433 ± 1.529 mg/dl in controls. Serum UA levels were significantly higher in the EOCAD group than those in the control group (

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