Cath Lab Digest - October 2007 - (Page 53)

53 symptomatic obstructive HCM underwent PTESC. Basal LVOT gradients measured during left heart catheterization were 70, 126 and 100 mmHg for Patients 1, 2 and 3, respectively. Using 7 Fr and 9 Fr 8mm tip CryoCath Freezor catheters (CryoCath Technologies, Inc., Montréal, Québec, Canada), cryothermal energy was applied to the interventricular septum under fluoroscopic guidance. A total of 20–32 applications of cryothermal energy were delivered, with the mean nadir temperature sustained during cryoablation being -88ºC. Two of the 3 patients had an immediate reduction in the LVOT gradient. However, at 6 months, only 1 patient had a significant sustained reduction in LVOT gradient. No adverse events relating to the procedure were experienced. Conclusion. PTESC is feasible, but did not result in a significant, sustained reduction in LVOT gradient in 2 of the 3 patients in this small series of obstructive HCM patients. The technique warrants further study to improve the consistency and duration of reduction in outflow gradient. J INVAS CARDIOL 2007;19(6):247-251. Interatrial Septal Defect Closure for Prevention of Cerebrovascular Accidents: Impact on Recurrence and Frequency of Migraine Headaches Shammas NW, Dippel EJ, Harb G, et al. Background. Recent data suggest that percutaneous closure of interatrial septal defect (IASD) is associated with a reduction in the intensity, frequency and duration of migraine headaches. In this study we review our own data to determine if we can reproduce the relationship between IASD closure in patients with a history of a central nervous system event (stroke or a transient ischemic attack [TIA]) and migraine headaches (HA). Methods. Fifty-eight consecutive patients with a history of unexplainable stroke or TIA with the exception of the presence of an IASD were included in this retrospective study. Multiple variables were collected including age, gender, history of smoking, hypertension, diabetes, hypercholesterolemia, ejection fraction, anticoagulant use pre- and postprocedure, shunt grade across the IASD pre- and post-procedure, defect size and right-sided filling pressures. All patients with a history of migraine HA answered the Migraine Disability Assessment Test (MIDAS), a standardized migraine questionnaire. Descriptive analysis was performed on all variables and compared among migraine and nonmigraine HA patients. Pre and post closure intensity and frequency of migraine HA were compared. Results. Of 58 patients, 14 (24.14%) had migraine HAs prior to percutaneous closure. There were no significant differences among the migraine and nonmigraine HA groups except that the migraine HA sufferers were younger (p = 0.016). One patient with migraine HA died on follow up from complications of cardiomyopathy. Only 5 (38.5%) of 13 patients reported still having migraine HA post closure of IASD. The frequency (41.6 ± 36.4 vs. 9.3 ± 24.8; p = 0.005) and intensity (8.0 ± 1.9 vs. 2.1 ± 3.2; p = 0.001) of the migraine HAs were markedly reduced post closure at 759 ± 545.6 days (range 89–1,433 days). There was no relationship between the shunt grade and the frequency or intensity of migraine HA. Conclusion. We conclude that IASD closure in patients with history of migraine HA and stroke or TIA have a marked improvement in the frequency and intensity of their HA. Migraine HA resolved in 61.54% patients post closure. Larger randomized studies are needed to confirm these findings, which could have significant implications for sufferers of migraine HA. J INVAS CARDIOL 2007;19(6):257-260. the mechanism of this higher risk is warranted. J INVAS CARDIOL 2007;19(6):265-268. AUGUST 2007 Short- and Long-Term Clinical Outcomes of Coronary DrugEluting Stent Recipients Presenting with Chronic Renal Disease Mishkel GJ, Varghese JJ, Moore AL, et al. Background. Randomized trials of drug-eluting stents (DES) excluded patients with severe renal insufficiency. We sought to evaluate the impact of baseline renal function on clinical outcomes in recipients of coronary DES. Methods. We retrospectively reviewed our hospital databases to identify consecutive patients who underwent DES implantations between May 2003 and December 2004, subgrouped among 4 ranges of glomerular filtration rate (GFR) between ≥ 90 ml/min and < 30 ml/min, in 30 ml/min decrements, and 1 group treated with long-term dialysis. Clinical follow up was obtained at 6 months, 1 year and annually thereafter. Results. Our study group included 2,758 patients with long-term outcomes recorded over a mean follow up of 706 ± 273 days. The rates of in-hospital adverse events increased significantly as GFR decreased, though no major adverse event occurred among the dialyzed patients. Actuarial survival analyses up to 2 years revealed significant between-groups differences in rates of major adverse cardiac events (MACE) and death (both p < 0.001), while the differences in target vessel revascularization (TVR) rates did not reach statistical significance (p = 0.069). By Cox regression analysis, a GFR < 60 ml/min remained a significant predictor of 2-year mortality (p < 0.001) and MACE (p < 0.001), but not TVR (p = 0.839). Conclusions. In conclusion, low rates of TVR were observed over 2 years in DES recipients with a wide range of renal function. Low rates of TVR were countered by high rates of death and MACE among renally insufficient patients over the long term. J INVAS CARDIOL 2007;19(8):331-337. Persistent Sex Difference in Hospital Outcome following Percutaneous Coronary Intervention: Results from the New York State Reporting System Srinivas VS, Garg S, Negassa A, et al. Background. Although sex-related differences in early outcomes have been observed in young women following acute myocardial infarction (AMI) and coronary bypass surgery, evidence for similar differences following percutaneous coronary intervention (PCI) is lacking. Methods. Using the 1999–2002 New York State PCI reporting system, we identified 11,162 men and 2,561 women aged 50 years or younger undergoing a first PCI procedure. In-hospital outcomes were compared by gender after multivariable adjustment for baseline, clinical and procedural characteristics. Results. Young women undergoing an initial PCI procedure were more likely to belong to racial or ethnic minorities and exhibit more comorbidities than young men. However, they had better ejection fraction (52.9% + 11.3 vs. 51.9 + 11; p = 0.0002) and presented more often with single-vessel disease (75% vs. 67%; p < 0.0001). Despite women receiving glycoprotein IIb/IIIa inhibitors (58.6% vs. 65.1%; p < 0.0001) and stents (92.5 % vs. 94.9%; p < 0.0001) less often, procedural success was achieved equally (97% vs. 96%). Young women experienced higher rates of in-hospital mortality (0.70% vs. 0.22%; p < 0.0001), and vascular damage (0.82% vs. 0.24%; p < 0.0001) compared to men. In multivariable analysis, female sex independently predicted in-hospital mortality (OR 4.0, 95% CI: 1.9–8.1) after adjustment for urgency of PCI, clinical and procedural characteristics. Conclusion. A gender-based difference in early survival exists in young women undergoing a first PCI procedure. Further investigation into Analysis of Left and Right Ventricular Doppler Tissue Imaging in Patients undergoing Percutaneous Closure of Patent Foramen Ovale Yalonetsky S, Schwartz Y, Lorber A. Percutaneous patent foramen ovale (PFO) closure is performed for the prevention of paradoxical emboli. Doppler tissue imaging (DTI) was performed before and following transcatheter PFO closure in patients with an otherwise structurally normal heart to detect alterations in regional myocardial motion. The analysis revealed a mild, but statistically significant, reduction in the systolic motion of the basal interventricular septum. Other DTI parameters, including diastolic motion of the basal interventricular septum, systolic and diastolic motion of the left ventricular free-wall mitral annulus junction and the right ventricular free-wall tricuspid annulus junction, and the left ventricular cardiac performance (Tei) index remained unchanged. We found, thus, that transcatheter PFO closure does not cause major alteration in regional myocardial motion or cardiac performance. J INVAS CARDIOL 2007;19(6):252-254. Full article text can be obtained at www.invasivecardiology.com. All abstracts are reprinted with permission. http://www.invasivecardiology.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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