Cath Lab Digest - November 2007 - (Page 48)

CLINICAL AND INDUSTRY NEWS NOVEMBER Stress Test cont. pharmacologic stress agent as well.” To help ensure all physicians know the best strategy, a team of MCG cardiologists reviewed the literature on stress tests and wrote a comprehensive article for the October issue of Southern Medical Journal. “Coronary artery disease is a very, very prevalent condition and every physician, regardless of specialty, has to face the disease one way or the other,” says Dr. Rakesh N. Patel, MCG research assistant who will start a cardiology fellowship in July. “A lot of stress tests are available to help assess disease. To maximize the sensitivity and specificity, you have to choose the appropriate stress test.” Dr. Patel is the paper’s first author. The paper, complete with algorithms for doing just that, is followed by a quiz that offers continuing medical education credit. Pharmacologic stressors, needed by about half of patients getting stress tests, dilate healthy blood vessels but not diseased vessels, which already are maximally dilated. The addition of a radioactive contrast agent enables heart images where segments fed by healthy vessels glow and diseased areas look like black holes, says Dr. Robinson, the paper’s corresponding author. About one-third of all patients can’t exercise adequately to get good information without those pharmacologic agents. That means being able to walk for at least five minutes and reach 85 percent of maximum age-predicted heart rate: 220 minus age. “If you can exercise adequately, it increases blood flow to the heart about twofold, so you don’t need pharmacologic agents, which increase blood flow four- to fivefold,” says Dr. Robinson. “An exercise EKG is the test we should try first if it’s feasible.” However, if a patient can’t walk without pain, shortness of breath or other symptoms that led to testing in the first place, he goes right to stressing the heart with pharmacologic agents. The agents reduce the risk of the test for some patients, because their hearts don’t have to work as hard. In fact, they have been used safely in patients approximately 48 hours after a heart attack, Dr. Robinson says. Without these agents, exercise EKGs have about a 64 percent probability of picking up disease, leaving lots of room for concern if serious disease is suspected, he says. “If you perform like an athlete, walk for 12 minutes with no EKG changes, are laughing and have no symptoms, that is a great test. That means your chance of needing revascularization, of having dangerous coro- nary artery disease that could kill you, is almost zero,” Dr. Robinson says. “But if you puttered along, got to five minutes and had chest pain but your EKG was still normal, you better believe I would go on to do pharmacologic stress with the perfusion agent. The point here is, in a lethal disease, you cannot accept a 64 percent probability of picking up the disease.” In some patients, such as those with pacemakers, exercise EKGs are not even a first option; pharmacologic stress agents alone must be used to perfuse the heart. However, the physicians note that the best images are produced in patients who can also exercise, which pulls blood from the abdomen to the heart, resulting in sharper images. In fact, the MCG researchers have shown pharmacologic agents work even better when given after exercise has started. Picking the right pharmacologic agent can even be an issue. For example, the two most popular agents — adenosine and dipyridamole — can increase problems such as wheezing, says Dr. Patel. In patients with those problems, physicians opt for dobutamine, the least used agent because it creates a catecholamine surge that causes the heart to shake and blood pressure to rise and can be harmful in patients at high risk of a heart attack. ■ Hand-Held Fluid Aspiration Device FDA Cleared: New PowrSyringe Platform Added to Pinyons Medical Technology P inyons Medical Technology, Inc. announced it received U.S. Food and Drug Administration clearance to market the PowrSyringe Aspirator™. The PowrSyringe Aspirator is a disposable hand-held medical device that incorporates ergonomic and mechanical advantages for fluid aspiration during a variety of medical procedures. The use of a large syringe barrel to aspirate fluids can increase aspiration speed, suction, and volume when compared to a smaller syringe barrel. However, it takes additional user strength and force to pull plungers back when using larger barrels. Therefore, most aspiration procedures require onehand to hold the barrel and the other hand to pull the plunger back for successful aspiration. The PowrSyringe Aspirator eliminates the need for two hands to perform aspiration. The Aspirator’s design includes handles connected to an integrated syringe barrel and plunger that pull the plunger back when the handles are squeezed. The PowrSyringe Aspirator platform is open-ended with universal connectors in a variety of barrel sizes that are compatible with multiple catheters, needles, and related medical devices. Pinyons is developing a family of PowrSyringe devices for angiography, balloon catheter inflation, spinal discography & vertebroplasty, biopsy, aspiration, and other general applications where fluids are injected or aspirated through small devices to diagnose, treat, or enable other medical devices. The PowrSyringe Monitor is expected to be available for commercial sale in early 2008. U.S. and foreign patents are issued and pending on the PowrSyringe Injector, Monitor, and Aspirator. The PowrSyringe Aspirator is licensed to Pinyons Medical Technology, Inc. by Aspiration Medical Technologies, LLC in Park City, Utah. Pinyons Medical Technology, Inc., www.pinyonsmedical. com has offices in Park City, Utah and Hallandale Beach, Florida. ■ Frost & Sullivan Select Guerbet, Manufacturer of X-ray Contrast Agent Oxilan, for Product Quality Award rost & Sullivan have selected Guerbet as the recipient of the 2007 North American Frost & Sullivan Product Quality Leadership Award for the superiority of its contrast media products. The company’s flagship product is Oxilan® (ioxilan) Injection, a non-ionic low viscous and low osmolar monomer x-ray contrast agent. “Contrast media products in the medical imaging industry encounter several technical and regulatory hurdles, developmental costs, clinical testing, and FDA approval to reach a sellable stage and finally, gain acceptance by end users,” says Frost & Sullivan Research Analyst AJ Ajibade. “Guerbet has implemented a product development strategy that emphasizes quality and customer satisfaction, with the high quality technical characteristics of its contrast media products embodying the extent of its commitment.” Guerbet has Oxilan to thank for its sustained success. Despite the possibility of side effects in injection of x-ray contrast media, Oxilan has achieved remarkably positive usage feedback, confirming it to be a safe product. Based on differences in structure, ionicity, osmolality and viscosity, contrast media are categorized under either monomers or dimers, ionic or nonionic, low osmolar contrast media (LOCM) or high osmolar contrast media (HOCM) and low viscous contrast media (LVCM) or high viscous contrast media (HVCM). As an LOCM and LVCM, Oxilan shows fewer adverse side effects. “Oxilan’s unique molecular structure has a hydrophobic region within its hydrophilic side chain, which leads to molecular aggregation and a reduction in the number of osmotically active particles in solution,” explains Ajibade. “This results in the lowest osmolality (695mOsm/kg H2O) and viscosity (16.3 mPa.s at 20°C) of all non-ionic monomer contrast media.” Each year, Frost & Sullivan presents this Award to the company that has demonstrated superior quality control over their existing competitors in product manufacturing. For more information, visit www.awards.frost.com. ■ http://www.awards.frost.com

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

Henry Ford Heart and Vascular Institute Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach Improving Patient Compliance with Antiplatelet Medications Clinical Editor’s Corner Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device The Clinical and Economic Impact of Measuring Fractional Flow Reserve FFR and Choosing an Optimal Revascularization Strategy Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential Use of a Mobile Lab to ‘Test the Waters’ at a Rural Hospital Remembering a Cardiac Cath Lab History ACVP• Membership Page What Do You Think? The Ten-Minute Interview with… Ernie Livingston, RN, BSN SICP* Chapter Updates Who’s in Charge? Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction Preserving Left Ventricular Function during Percutaneous Coronary Intervention Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Making the Most of Your First Impression: Interviewing Tips and Techniques CEU Education Center Clinical & Industry News Meetings Calendar

Cath Lab Digest - November 2007

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