Immunogenetic Studies of Respiratory Anaphylaxis in Selectively Bred Guinea Pigs

The genetic and immunological basis of respiratory anaphylaxis was studied in two strains of guinea pigs selectively bred for either high or low respiratory anaphylactic response to inhalation of ovalbumin. Individuals of the parental strains, Fl-hybrids and backcross offspring were examined for class II MHC type and asthmatic response to ovalbumin. Analysis of the results revealed an association of asthma phenotype and MHC class II type. Apart from the gene(s) in the MHC several other genes seem to be involved in the control of guinea pig asthma.     

Percutaneous Access of the Epicardial Space for Mapping Ventricular and Supraventricular Arrhythmias in Patients With and Without Prior Cardiac Surgery

Percutaneous Epicardial Access . Introduction: There is a paucity of data on the success rates of achieving percutaneous epicardial access in different groups of patients. Methods and Results: Percutaneous epicardial access was attempted in 137 patients having 149 procedures; 19 patients had supraventricular tachycardia (SVT), 25 patients had idiopathic VT and 93 patients had scar‐related ventricular tachycardia (VT). Ten patients had prior cardiac surgery. Successful epicardial access was achieved in 133 of 149 (89.3%) procedures. Access was achieved in 17 of 19 (89.5%) patients with SVT, all patients with idiopathic VT, 80 of 93 (86.0%) patients with scar‐related VT and in 2 (20%) patients with prior cardiac surgery. Attempted access failed in 16 patients; 8 had prior cardiac surgery and 3 had prior pericarditis. After an initial procedure, repeat access was attempted in 15 patients, 5.1 ± 5.4 months after initial epicardial mapping and ablation. Access was successful in 13 (86.7%) and failed in 2 patients who had pericarditis after their first procedure. Only 4 patients were given intrapericardial glucocorticoid at their first epicardial procedure. Prior cardiac surgery and a history of pericarditis predicted unsuccessful access (P < 0.01). Complications (9 patients) included pericardial bleeding (80–250 mL) and intraabdominal bleeding. Conclusions: In patients without prior cardiac surgery, percutaneous epicardial access can be obtained in the majority of patients. Prior cardiac surgery precludes access in the most patients and when possible adhesions may limit catheter movement. Repeat access is possible in the majority of patients without the installation of intrapericardial glucocorticoid at the first procedure. (J Cardiovasc Electrophysiol, Vol. 21, pp. 406–411, April 2010)     

Risk Stratification Following Complex PCI: Clinical Versus Anatomical Risk Stratification Including “Post PCI Residual SYNTAX‐Score” as Quantification of Incomplete Revascularization

Background

EuroSCORE and completeness of revascularization predicts long‐term survival after multivessel PCI (MV‐PCI). The SYNTAX‐Score has also been proposed to predict clinical outcome. The prognostic impact of these scores to predict long‐term survival after PCI has not yet been compared.

Methods and Results

Long‐term survival was assessed in 740 patients undergoing MV‐PCI. We calculated EuroSCORE, SYNTAX‐Score, STS‐Score, the clinical SYNTAX‐Score (CSS), and the “post‐PCI residual SYNTAX‐Score.” Mean follow‐up time was 4.5 ± 2.5 years. 341 patients (46%) were treated for ACS (STEMI N = 191; NSTEMI N = 150). 113 patients (15%) underwent PCI of left main coronary artery. The EuroSCORE was significantly lower for stable patients compared to patients with ACS (stable 4.1 ± 4.5, NSTEMI 13.9 ± 13.3, STEMI 18.1 ± 18.7, p < 0.001). The differences in the SYNTAX‐Score were less obvious but even significant (stable 14.9 ± 8.6, NSTEMI 17.8 ± 9.9, STEMI 18.3 ± 9.0; p < 0.001). Patients in the highest tertiles of each risk score experienced a dramatically elevated mortality rate compared to the extremely low mortality rate in the lower tertiles (p log‐rank <0.001). This comparison remained significant for the EuroSCORE and STS‐Score but not for the SYNTAX‐Score, when analysis was restricted to stable patients. The multivariate Cox‐regression‐analysis confirmed the logistic EuroSCORE, EuroSCORE II, and the STS‐Score as independent predictors of long‐term mortality, whereas the SYNTAX‐Score (including residual form) and the CSS had no predictive value.

Conclusion

The EuroSCORE and the STS‐Score outperforms the SYNTAX‐Score and the CSS in predicting long‐term survival following MV‐PCI. In addition, the residual SYNTAX‐Score predicts long‐term survival not independently.