Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

OBJECTIVE:

Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques.

METHODS:

A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified.

RESULTS:

An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001). The global longitudinal strain showed a significant increase after successful revascularization (p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction ≥50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement.

CONCLUSIONS:

Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.     

Human Neutrophil Defensins and Their Effect on Epithelial Cells

Background: The aims of the present study include: 1) to localize human neutrophil defensin‐1 (HNP‐1) through HNP‐3 in gingiva and in neutrophil extract‐treated epithelial cell monolayers; 2) to determine the effects of HNP‐1 on the epithelial cell viability, attachment, and spreading; and 3) to analyze the effect of HNP‐1 on the bacterial adherence to epithelial cells. Methods: For localization of HNP‐1 through HNP‐3 in gingival tissue and in preincubated cell monolayers, immunohistochemical and immunocytochemical methods were used. Viability and proliferation of epithelial cells were determined with commercial kits after incubating the keratinocytes with different HNP‐1 concentrations (low, 1 to 5 μg/mL; moderate, 10 μg/mL; high, 20 to 50 μg/mL). Attachment and spreading of keratinocytes on fibronectin‐coated surfaces in the presence of HNP‐1 were evaluated under microscope. Attachment of Fusobacterium nucleatum ATCC25586 and Prevotella intermedia ATCC25611 on keratinocytes preincubated with HNP‐1 were determined with a standard antibiotic test. Results: HNP‐1 through HNP‐3 localized in the junctional epithelium of clinically healthy gingiva and in the pocket epithelium of gingiva with periodontitis. When keratinocyte monolayers were incubated with neutrophil extracts, HNP‐1 through HNP‐3 were bound to the periphery of the growing cell colonies. In low HNP‐1 concentrations, the keratinocyte proliferation enhanced. Moderate and high concentrations of HNP‐1 increased the cellular death significantly. HNP‐1 increased the attachment and spreading of keratinocytes on fibronectin‐coated surfaces and bacterial attachment to keratinocytes in a concentration‐dependent manner. Conclusion: HNP‐1 plays a role in the integrity of keratinocytes by stimulating their proliferation, attachment, and spreading, whereas higher doses increase the bacterial attachment and keratinocyte death.     

Pharmacologic Preconditioning Therapy Prior to Atrial Septal Defect Closure in Patients at High Risk for Acute Pulmonary Edema

Objectives: The aim of this study was to assess whether transient atrial septal defect (ASD) occlusion and, if required, vasodilator therapy would improve the safety of percutaneous ASD closure in high-risk subsets. Background: While percutaneous ASD closure is generally considered a low risk intervention, hypertensive and elderly patients may develop pulmonary edema following the procedure because of underlying left ventricular (LV) diastolic dysfunction. Methods: Fifty-two consecutive patients who underwent successful percutaneous ASD closures were enrolled into a single-center prospective registry. Patients with arterial hypertension and/or >60 years of age (n = 15) were considered at risk for periprocedural pulmonary edema. Those patients were tested for an increase of LV filling pressures during transient ASD occlusion and, if this was the case, treated according to a prespecified algorithm. Clinical and echocardiography data were collected in-hospital and at 6 months follow-up. Results: Shunt size was comparable in high and standard-risk patients (Qp:Qs 2.1 ± 0.8 vs. 2.1 ± 0.7, P = 0.82). High-risk patients had more often pulmonary hypertension (58% vs. 14%, P < 0.05) and were more frequently symptomatic. Among them, 4/15 (27%) demonstrated a significant rise of left-sided filling pressures during transient ASD balloon occlusion and underwent pharmacologic preconditioning prior to ASD closure. None of them developed periprocedural pulmonary edema. At follow-up, patients were less symptomatic (Pre: NYHA II n = 15, NYHA III n = 9; Post: NYHA II n = 15, NYHA III n = 0; P = 0.02) and right ventricular size decreased from 23 ± 5 cm(2) to 17 ± 5 cm(2) , P < 0.05. Conclusion: Transient ASD occlusion and, if required, pharmacologic preconditioning prior to percutaneous closure may prevent periprocedural pulmonary edema in high-risk patients. (J Interven Cardiol 2012;25:505-512).     

Treatment regimen with bevacizumab decreases mean platelet volume in patients with metastatic colon cancer

The risk of thromboemboli is increased in patients with cancer, and this is precipitated by the chemotherapeutic agents. Bevacizumab is an anti-vascular endothelial growth factor monoclonal antibody and has an importance in the treatment of metastatic colon cancer. The association between bevacizumab, which is demonstrated to increase the risk of thromboemboli, and mean platelet volume (MPV), which is a marker of thrombocyte function, has been investigated within study. A total of 74 patients with metastatic colon cancer were included in the study and the levels of platelets (PLTs), MPV, and platecrit (PCT) values were recorded in SPSS 16.0 program both at baseline and at the >third month. There were significant decreases in 3 parameters (PLT, MPV, and PCT) during the treatment period with bevacizumab (P = .009, P = .001, and P = .000, respectively). Unlike cases with thrombosis, there is a significant decrease in MPV in combination treatments with bevacizumab.     

Dehiscence and fenestration in patients with different vertical growth patterns assessed with cone-beam computed tomography

Abstract Objective: To test the null hypothesis that the presence of alveolar defects (dehiscence and fenestration) was not different among patients with different vertical growth patterns. Materials and Methods: A total of 1872 teeth in 26 hyper-divergent (mean age: 24.4 ± 4.8?years), 27 hypo-divergent (mean age: 25.1 ± 4.5?years), and 25 normo-divergent (mean age: 23.6 ± 4.1?years) patients with no previous orthodontic treatment were evaluated using cone-beam computed tomography. Axial and cross-sectional views were evaluated with regard to whether dehiscence and/or fenestration on buccal and lingual surfaces existed or not. For statistical analysis, the Pearson chi-square test was used at a P < .05 significance level. Results: According to the statistical analysis, the hypo-divergent group (6.56%) had lower dehiscence prevalence than the hyper-divergent (8.35%) and normo-divergent (8.18%) groups (P = .004). Higher prevalences of dehiscence and fenestration were found on buccal sides in all vertical growth patterns. While fenestration was a common finding for the maxillary alveolar region, dehiscence was a common finding in the mandible in all groups. Conclusion: The null hypothesis was rejected. Although the prevalence of fenestrations was not different, significant differences for dehiscences were found in patients with different vertical growth patterns.