- Email: [email protected]
Low Coronary Arterial Wall Shear Stress is Associated with Endothelial Dysfunction and Expansive Arterial Remodeling In Vivo: Implications for Plaque Vulnerability
study additionally demonstrates the value of echocardiographic evaluation of diastolic function post STEMI. http://dx.doi.org/10.1016/j.hlc.2012.05.111 102 Low Coronary Arterial Wall Shear Stress is Associated with Endothelial Dysfunction and Expansive Arterial Remodeling In Vivo: Implications for Plaque Vulnerability R. Puri 1 , D. Leong 1 , S. Nicholls 2 , G. Liew 1 , A. Nelson 1 , A. Carbone 1 , B. Copus 1 , D. Wong 1 , J. Beltrame 1 , S. Worthley 1 , M. Worthley 1,∗ 1 University
of Adelaide, and Royal Adelaide Hospital, Australia 2 Cleveland Clinic, United States Objectives: To investigate in vivo relationships between segmental wall shear stress (WSS), endotheliumdependent vasoreactivity and arterial remodeling in patients with stable coronary disease. Background: Low WSS has been implicated in the development and progression of coronary atherosclerosis. Endothelial dysfunction predicts incident coronary events. The interplay between these entities, coupled with plaque morphology in humans in vivo has yet to be explored. Methods: Twenty-four patients with minor angiographic coronary arterial disease (<30% stenosis severity) underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound (IVUS)-upon-Doppler guide wire imaging. Macrovascular response [change in segmental lumen volume (SLV) at baseline and following IC salbutamol], plaque burden [percent atheroma volume (PAV)], remodeling indices (RI), eccentricity indices (EI) and WSS were evaluated in 172 consecutive 5-mm coronary segments. Results: Baseline WSS was directly related to endothelium-dependent epicardial coronary vasomotion (% change SLV, coefficient 17.2, p = 0.004), and inversely related to RI (coefficient −0.23, p = 0.02) and EI (coefficient −10.0, p = 0.001). Baseline WSS was lower in segments displaying endothelial dysfunction (defined as any change in SLV ≤ 0) compared with preserved function (0.66 ± 0.33 vs 0.71 ± 0.22 N/m2 , p = 0.05). Independent of plaque burden, segments with the lowest tertile of WSS displayed lower endothelial function. High plaque burden segments harbouring the lowest tertiles of WSS were associated with vasoconstriction, expansive arterial remodeling and greater plaque eccentricity. Conclusions: In patients with stable coronary syndromes and minor angiographic coronary disease, coronary segments with low in vivo WSS values display functional and morphological features of plaque vulnerability. http://dx.doi.org/10.1016/j.hlc.2012.05.112
CSANZ 2012 Abstracts
S43
103 Low Level Troponin Release in Day-case PCI Patients is Common and Does Not Preclude Same-day Discharge I. Webb 1,2,∗ , M. Simmonds 1,2 , P. Larsen 1,3 , S. Harding 1,2 1 Wellington Cardiovascular Research Group, Wellington, New Zealand 2 Cardiology Department, Wellington Hospital, Wellington, New Zealand 3 Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
Introduction: Same-day discharge following PCI reduces bed occupancy, is cost effective and popular with patients. Low-level elevations of troponin T (TnT) following PCI are common. Outcomes following same-day discharge of PCI patients with low-level TnT elevation are currently unknown. Methods: We prospectively studied a cohort of 885 patients undergoing elective PCI between 2006 and 2010. All patients routinely had TnT levels measured 6–8 h post-intervention. Decisions regarding the suitability of same-day discharge were made 6 h post procedure. Patients with a suboptimal angiographic result, evidence of peri-procedural ischaemia/infarction (prolonged chest pain, ECG changes or TnT > 0.15 ng/mL) or access site complications were admitted. Demographic, procedural and outcomes data at 24-h and 30-days were recorded. Results: Of 774 TnT negative patients, 698 (90.2%) were discharged home on the same day (group 1). Postprocedural TnT elevation (>0.03 g/mL) was observed in 101 (11.4%) patients, of whom 52 were discharged home same day (group 2). The mean TnT level in this group was 0.07 g/mL. There was no MACE (death, MI, stent thrombosis or TVR) within 24 h of discharge in either group 1 or group 2. Readmission for any reason within 24 h was uncommon and did not differ between group 1 and group 2 (0.7% vs 1.9%, p = 0.23). Similarly, 30-day outcomes were comparable between groups, with no MACE events in group 2. Conclusion: Peri-procedural TnT elevation is common following day-case PCI. Where appropriate clinical guidelines are in position, same-day discharge of patients with low-level TnT release is safe and not associated with adverse events. http://dx.doi.org/10.1016/j.hlc.2012.05.113
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142
of Adelaide, and Royal Adelaide Hospital, Australia 2 Cleveland Clinic, United States Objectives: To investigate in vivo relationships between segmental wall shear stress (WSS), endotheliumdependent vasoreactivity and arterial remodeling in patients with stable coronary disease. Background: Low WSS has been implicated in the development and progression of coronary atherosclerosis. Endothelial dysfunction predicts incident coronary events. The interplay between these entities, coupled with plaque morphology in humans in vivo has yet to be explored. Methods: Twenty-four patients with minor angiographic coronary arterial disease (<30% stenosis severity) underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound (IVUS)-upon-Doppler guide wire imaging. Macrovascular response [change in segmental lumen volume (SLV) at baseline and following IC salbutamol], plaque burden [percent atheroma volume (PAV)], remodeling indices (RI), eccentricity indices (EI) and WSS were evaluated in 172 consecutive 5-mm coronary segments. Results: Baseline WSS was directly related to endothelium-dependent epicardial coronary vasomotion (% change SLV, coefficient 17.2, p = 0.004), and inversely related to RI (coefficient −0.23, p = 0.02) and EI (coefficient −10.0, p = 0.001). Baseline WSS was lower in segments displaying endothelial dysfunction (defined as any change in SLV ≤ 0) compared with preserved function (0.66 ± 0.33 vs 0.71 ± 0.22 N/m2 , p = 0.05). Independent of plaque burden, segments with the lowest tertile of WSS displayed lower endothelial function. High plaque burden segments harbouring the lowest tertiles of WSS were associated with vasoconstriction, expansive arterial remodeling and greater plaque eccentricity. Conclusions: In patients with stable coronary syndromes and minor angiographic coronary disease, coronary segments with low in vivo WSS values display functional and morphological features of plaque vulnerability. http://dx.doi.org/10.1016/j.hlc.2012.05.112
CSANZ 2012 Abstracts
S43
103 Low Level Troponin Release in Day-case PCI Patients is Common and Does Not Preclude Same-day Discharge I. Webb 1,2,∗ , M. Simmonds 1,2 , P. Larsen 1,3 , S. Harding 1,2 1 Wellington Cardiovascular Research Group, Wellington, New Zealand 2 Cardiology Department, Wellington Hospital, Wellington, New Zealand 3 Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
Introduction: Same-day discharge following PCI reduces bed occupancy, is cost effective and popular with patients. Low-level elevations of troponin T (TnT) following PCI are common. Outcomes following same-day discharge of PCI patients with low-level TnT elevation are currently unknown. Methods: We prospectively studied a cohort of 885 patients undergoing elective PCI between 2006 and 2010. All patients routinely had TnT levels measured 6–8 h post-intervention. Decisions regarding the suitability of same-day discharge were made 6 h post procedure. Patients with a suboptimal angiographic result, evidence of peri-procedural ischaemia/infarction (prolonged chest pain, ECG changes or TnT > 0.15 ng/mL) or access site complications were admitted. Demographic, procedural and outcomes data at 24-h and 30-days were recorded. Results: Of 774 TnT negative patients, 698 (90.2%) were discharged home on the same day (group 1). Postprocedural TnT elevation (>0.03 g/mL) was observed in 101 (11.4%) patients, of whom 52 were discharged home same day (group 2). The mean TnT level in this group was 0.07 g/mL. There was no MACE (death, MI, stent thrombosis or TVR) within 24 h of discharge in either group 1 or group 2. Readmission for any reason within 24 h was uncommon and did not differ between group 1 and group 2 (0.7% vs 1.9%, p = 0.23). Similarly, 30-day outcomes were comparable between groups, with no MACE events in group 2. Conclusion: Peri-procedural TnT elevation is common following day-case PCI. Where appropriate clinical guidelines are in position, same-day discharge of patients with low-level TnT release is safe and not associated with adverse events. http://dx.doi.org/10.1016/j.hlc.2012.05.113
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142