Cardiac Catheterization Procedures Research Articles

Prognostic relevance of thyroid disease in adults with congenital heart disease

Abstract Background Adults with congenital heart disease (ACHD) are frequently affected by thyroid diseases (TD). However, the clinical relevance of TD in ACHD remains unknown. Purpose We aimed to describe the prevalence of TD in the ACHD population and to ascertain whether TD are associated with worse outcome. Methods Clinical data on all consecutive patients aged >18 years attending our ACHD unit for a day-case between 2014 and 2019 were retrospectively collected. For statistical analysis, a composite endpoint was created combining the following events at follow-up: hospitalization for heart failure, new-onset tachyarrhythmic or bradyarrhythmic events and death. Results Four hundred ninety-five ACHD patients with a median age of 32.2 [24.5–45.6] years (46% male) were included. There was an overall prevalence of patients with moderate or complex lesions (414=84%). Compared to the group with no history of TD, patients in the TD were older, (41.9 [29.7–53.5] vs 30.2 [24.3–39] years; p<0.0001) and mainly female (77% vs 46%; p<0.0001) and more likely to have undergone at least two cardiac catheterization procedures (29 vs 13%; p<0.0001). Genetic disorders including Down syndrome were more prevalent in the group with TD (p<0.0001). Moreover, at last follow-up, those with TD had higher pro-BNP-nt values (243.5 [96.5–523] pg/ml Vs 94 [45–207] pg/ml; p<0.0001) and were in a more advanced NYHA class (27% vs 13% in class III-IV; p=0.0002). Echocardiography showed lower EF in the TD group (55 [55–60]% vs 60 [55–65]%; p=0.0002). Median follow-up was 9.4 [4.5–13.1] years. Patients with TD had a higher unadjusted mortality rate, with a trend towards statistical significance (p=0.07). Sixty-four (42%) patients in the TD group and 43 (12.5%) met our composite endpoint, leading to a 10-year survival free from events of 53.7% Vs 86.5%, respectively (p<0.0001, Figure1). Multivariate analysis showed that age, ejection fraction, previous surgical palliation, advanced physiological stage and TD were independent predictors of our composite endpoint, even after stratification for genetic disorders as reported in table1. After adjustment for baseline differences between groups with propensity matching score using age, sex, disease complexity, physiological stage, previous palliative or reparative surgery, normal or reduced systemic ventricle ejection fraction, pulmonary arterial hypertension, cyanosis and presence of systemic right ventricle as independent variables, TD remained a strong predictor of cardiac events at follow-up with an hazard ratio of 4.47 (95% CI 2.42–8.28; p<0.0001). Conclusion TD is a strong predictor of adverse outcome in the ACHD population after exclusion of potential confounding factors, being related to a fourfold increased risk of events at follow-up. Funding Acknowledgement Type of funding sources: None. Figure 1Table 1

Evaluation of the prophylactic role of pethidine in avoiding radial artery spasm during transradial cardiac interventions

Abstract Introduction Prophylactic use of benzodiazepine and opioids (fentanyl, morphine) is an established method for tackling radial artery spasm, in patients undergoing left cardiac catheterization procedures. Meperidine (Pethidine) is a synthetic opioid with elimination half life of 2–4 hours and duration of action of only 2–3 hours, making it ideal for in-lab administration. Purpose We aimed to test primarily the role of pethidine administration in preventing radial artery spasm and secondarily to assess patient discomfort during transradial coronary interventions. Methods This is a prospective, randomized, double blinded study. Patients were randomized to either pethidine 0,25mg administration (Group A) or normal saline (Group B) i.v. 10 minutes before the beginning of the procedure. As standard prophylactic measures against spasm, both groups received verapamil 5mg and nitroglycerin 100μg, after sheath introduction in the radial artery. Artery spasm was assessed clinically by the difficulty in advancing or exchanging catheters, as reported by the operator (CHUGH scale). A Visual Analog Scale (VAS) was used to estimate the patient-perceived discomfort, one hour after the end of the procedure. Results 66 patients were included, 42 in Group A and 24 in Group B. Mean age of the patients was 65.9 years, mean duration of the procedure was 27 minutes and 24% of patients proceeded to PTCA overall. Operators reported no problems in catheter manipulations (CHUGH 0) in 67% of patients from Group A vs 38% of pts from Group B. 64% Group A patients and 21% Group B patients reported no symptoms (VAS 0). Pethidine administration had a negative correlation with VAS (r: −0.418, p: 0.001) and CHUGH Scale (r: −0.295, p: 0.016) scores. Conclusion Pethidine low dose administration before radial artery catheterization, shows a positive trend in preventing spasm and reducing procedure-related patient discomfort. Larger studies are required to evaluate the role of pethidine as an alternative prophylactic measure against artery spasm in transradial cardiac interventions. Funding Acknowledgement Type of funding sources: None.

Role of a hospital pharmacist in cardiac day procedure ward: a prospective observational study

Abstract Background The cardiac day procedure ward provides peri-procedural care to elective patients attending hospital for a broad range of diagnostic and interventional cardiac catheterisation procedures. In this acute setting, changes to patients' medication regimen can often occur, however patient-completed questionnaires are often inaccurate.1,2 Australian standards recommend that an accurate medication history be obtained, and medication reconciliation performed for all patients.3 A plan for cessation and restarting of relevant medications should also be documented.1 However, the role of a pharmacist in this setting has not been widely studied. Purpose The aim of this study is to evaluate the role of a pharmacist in a cardiac day procedure ward and identify patient groups who may benefit from a pharmacist medication review. Methods A prospective, observational study was conducted over 5 weeks (24/2/20–27/3/20) in a cardiac day procedure ward at a major tertiary referral centre, in a multi-site Australian metropolitan hospital network. An 8-hour per day clinical pharmacy service was provided to the ward, which is open approximately 12 hours per day. Results In the study period, 297 patients presented to the ward, and 79% (234/297) received a pharmacist medication review (a systematic assessment of a patient's medication management to optimise treatment outcomes). Elective day procedures were planned for 247 patients, and in 74% (182/247) a pharmacist documented a best possible medication history (comprehensive list of a patient's prescription and non-prescription medicines using two or more information sources). Medication-related problems were identified in 51 patients, with the majority (79%, 70/89) in patients presenting for coronary angiography. 93% (83/89) of interventions were accepted after discussion with the hospital resident medical officer or interventionalist. The remainder (7%, 6/89) were not enacted as further monitoring of vital signs or cardiologist follow-up was needed. Following their procedure, 155 patients returned to the ward for recovery. A specific plan for continuation, cessation or restarting of medications post-procedure was initially documented for 16% (25/155) of patients by catheterisation laboratory staff, and increased to 90% (140/155) with pharmacist medication review. Prescriptions for medications changes were required in 25% (38/155) of patients, and prescription medication counselling was provided by the pharmacist for all patients. Conclusion Pharmacists can optimise medication management of patients in cardiac day procedure wards by obtaining an accurate medication history, identifying medication related problems, and documenting a post-procedure medication plan; particularly for patients presenting for coronary angiography. While this study supports the embedding of a clinical pharmacy service in cardiac day procedure wards, more research is needed to fully elucidate the impact on patient outcomes. Funding Acknowledgement Type of funding sources: None.

424 - Cardiac Healthcare Disparities in Schizophrenia at the End-of-Life

Background:Schizophrenia is a serious mental illness associated an early mortality of 15 to 20 years. Eighty percent of deaths are due to cardiovascular disease, and the risk of sudden cardiac death is three- times greater than the general population. Both modifiable and non-modifiable risk factors like lifestyle, medication side-effects, genetics, and healthcare disparities have been identified, but this relationship is not fully understood.Research Objective:To examine cardiac-related healthcare utilization of individuals with schizophrenia at the end-of-life.Method:As a retrospective cohort study the Mayo Clinic Unified Data Platform (UDP) was used to identify a schizophrenia group (SG) (n = 610) 50 years or older with a death date between 1/1/1999 – 1/1/2019 and control group (n = 610) matched by gender (53% women) and age of death (72.8 ± 12.4 years). Measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Pearson’s chi-square (χ2), analysis of variance was used (ANOVA), and logistic regression were used for statistical analysis.Results:SG was more likely than controls to be unmarried, unemployed, or from racial minority groups (all p<0.001) and was more likely to have diabetes mellitus (p<0.001) or cardiovascular disease (p=0.004). SG was less likely to receive an electrocardiogram (ECG) (p<0.001), echocardiogram (p=0.003), or cardiac catheterization procedure (p<0.001), and more likely to receive hemoglobin A1C testing (p<0.001). Of those receiving an ECG, SG had a greater mean QTc interval (453.8 ms vs. 438.0 ms; p<0.001) and were twice as likely to have an ECG result interpreted as “prolonged QTc” (p<0.001).Between group differences for utilization of troponin or low-density lipoprotein testing, or pacemaker- related procedures were not statistically significant.Conclusion:Individuals with schizophrenia in this cohort were less likely to receive cardiovascular evaluations and interventions during their last year of life. Despite the higher likelihood for prolonged QTc, a recognized biomarker of cardiac risk, SG was less likely to receive an ECG. Given the greater cardiac comorbidity and higher risk of sudden cardiac death in schizophrenia, interventions are needed to address these disparities in care.

CHALLENGING OUR ASSUMPTIONS AS WE PLAN FOR ACCESS TO MAJOR CARDIAC PROCEDURES DURING RECOVERY FROM THE COVID-19 PANDEMIC

BACKGROUNDAt the onset of the COVID-19 pandemic in March 2020, there was an initial considerable decline in the number of major cardiac procedures (interventional cardiology, cardiac surgery, TAVI, and electrophysiology) in Ontario. Cardiac programs were concerned about managing the anticipated exponential growth of the wait list for these services throughout the pandemic and into post-pandemic recovery planning. The purpose of this project is to highlight the notable trends in wait list and procedure volumes for the major cardiac procedures from the initial ramp down of services in March 2020 to April 2021 in Ontario.METHODS AND RESULTSTo support system level planning and coordination for major cardiac procedures in Ontario, CorHealth collects prospective data from the 20 cardiac centres across the 5 regions in Ontario for each of the major cardiac procedures, otherwise known as the CorHealth Cardiac Registry. This Registry was used to identify changes in cardiac activity and the number of people waiting for each major cardiac procedures per facility and across regions. The pre-pandemic time period (January 2019-February 2020) was used as baseline data for calculation of changes during the pandemic (March 15, 2020-April 2021) for these analyses. While all cardiac procedures were dramatically reduced in the initial months of the pandemic, by April 2021, annual activity compared to pre-pandemic baseline volumes ranged from a 23% reduction (standard ablation) to a 6% increase in activity (TAVI) (Table 1). There was regional variation whereby the change in CABG volumes ranged from a 5% increase (North) to a 25% reduction in the Central and Toronto Regions. Referrals for diagnostic cardiac catheterization, cardiac surgery and electrophysiology procedures followed a similar pattern as procedure volumes. As such, the wait list for these cardiac procedures did not increase over the first 12 months of the pandemic (Figure 1).CONCLUSIONWhile there was a dramatic reduction in the number of cardiac procedures and surgeries during peak periods of the COVID-19 pandemic in Ontario, this was accompanied by a dramatic, and unanticipated reduction in referrals for these services. There was also evidence of regional variation within Ontario for reduction in procedure volumes compared to baseline. As the healthcare system recovers post-pandemic, a systems approach is needed to fully understand the multiple factors contributing to the reduction in referrals and regional variation during the pandemic. This information is critical for informing recovery plans while identifying opportunities to reform and improve access to care moving forward.

Exposure to low-dose ionizing radiation from cardiac catheterization and risk of cancer: the COCCINELLE study

The COCCINELLE study is a nationwide retrospective French cohort set up to evaluate the risk of radiation associated cancer in patients who undergone cardiac catheterization (CC) procedures for diagnosis or treatment of congenital heart disease during childhood [1] . Children who undergone CC procedures from 01/01/2000 to 31/12/2013 before the age of 16 in one of the 15 pediatric cardiology departments which perform pediatric CC in mainland France were included. The follow-up started at the date of the first recorded CC procedure until the exit date, i.e. the date of death, the date of first cancer diagnosis, the date of the 18 th birthday, or the 31/12/2015, whichever occurred first. The cohort was linked to the National Childhood Cancer Registry to identify patients diagnosed with cancer and with the French National Directory for the Identification of Natural Persons to retrieve the patients’ vital status. An external comparison was conducted using standardized incidence ratios (SIR). Breslow and Day's approximation was used to estimate 95% confidence intervals (CI) for the SIRs [2] . A total of 17,104 children were included in the cohort and followed for 110,335 person-years, with 22,227 CC procedures collected. Among the patients, 81.6% received only one procedure. Fifty-nine cancer cases were observed in the cohort. SIRs were increased for all-cancer (SIR = 3.8, 95% CI 2.9, 4.9), leukemia (SIR = 3.3, 95% CI 2.0, 5.4), lymphoma (SIR = 14.9, 95% CI 9.9, 22.5) and solid cancers excluding central nervous system tumors (SIR = 3.3, 95% CI 2.0, 5.5) compared with the general population. Increased risks of cancer were observed. Potential explanations include shared genetic or environmental factors, immunosuppression drugs, and exposure to medical ionizing radiation procedures. The dose-response analysis between ionizing radiation doses received during CCs and cancer occurrence will allow to address this question.

Indications and outcomes of cardiac catheterization following congenital heart surgery in children

To evaluate indications of post-operative cardiac catheterization procedures (POCCPs) after pediatric cardiac surgery and their impact on outcomes. POCCP is proposed in a variety of situations. Clinical impact of diagnostic POCCPs and transcatheter interventions (TCIs) remain scarcely described. Non-planned POCCPs performed after congenital heart surgeries and before hospital discharge between January 2013 and July 2019 were reviewed. Hybrid procedures were excluded. Heart defects, illness course, surgeries, and POCCPs were classified. Indications and findings were comprehensively regrouped. Outcomes were analyzed. Two hundred and seventeen POCCPs were performed on 192 patients (median age 2.3months, weight 4.2 kg) on median postoperative-day 8 (IQR 2-20days). Patients had defects of great complexity (79.9%) and a high disease severity index (46.4%). Aristotle's complexity level of surgeries was III (27.6%) and IV (47.4%). POCCPs CRISP category was 4 (39.6%) and 5 (22.6%). POCCPs identified 70 (32.3%) new diagnostic information. POCCPs confirmed 67.1% of suspected diagnoses: anatomical lesions were less likely to be confirmed when compared to physiological anomalies (55.6% < 81.7%, P < 0.01). Surgically-acquired lesions were less likely confirmed when compared to residual lesions ( P < 0.01). In confirmed diagnoses, POCCP indicated interventions (74.1%), and changes in medical management (25.9%). Interventions (133 TCIs, 16 redo-surgeries) were successful (97%) and immediate (92.6%). TCIs were unplanned (38.3%) and performed across fresh suture lines (30.1%). Eight significant adverse events were recorded and survival to discharge was 87.5%. POCCP provides adequate answers for both anatomical and physiological questions in high-risk patients with complicated courses. POCCP guides appropriately subsequent treatment with high efficiency and satisfactory outcomes.

The VE/VCO2 slope: A useful tool to evaluate the physiological status of children with congenital heart disease

Cardio-pulmonary exercise test (CPET) is becoming a key examination to assess physical capacity and disease severity in paediatric cardiology. The VE/VCO2 slope has been increasingly used as a surrogate marker for morbidity and mortality in adult heart failure, pulmonary arterial hypertension and for adult patients with CHD. Nevertheless, the use of the VE/VCO2 slope in children remains limited in the absence of reference values and clearly identified clinical determinants. This study aimed to compare the VE/VCO2 slope in a paediatric cohort with CHD to that of age- and gender-adjusted healthy controls. We also intended to identify the clinical and CPET variables associated with VE/VCO2 slope in this population. This cross-sectional study was carried out between November 2010 and September 2015 in two tertiary care paediatric cardiology reference centres. A total of 700 children were enrolled (399 CHD and 301 healthy controls). The mean VE/VCO2 slope was significantly higher in CHD than in healthy subjects (31.6 ± 4.8 vs. 29.3 ± 4.8; P < 0.001). When considering CHD sub-groups, the VE/VCO2 slope was impaired in single ventricle, complex anomalies of ventriculo-arterial connections, anomalies of the atrioventricular junctions and valves. The VE/VCO2 slope according to the CHD physiological status was illustrated in the Fig. 1, it was higher in children with significant pulmonary regurgitation, tricuspid regurgitation, right ventricular hypertension and right ventricle outflow tract (RVOT) obstacle. In the CHD group, VE/VCO2 slope increase was associated with BMI, the presence of a RVOT obstacle, the number of cardiac catheter procedures, as well as low age, FVC, tidal volume, and PetCO2 (Fig. 1). Increased VE/VCO2 slope was predominantly in children with single ventricle and/or residual right heart abnormalities suggesting that maldistribution of pulmonary blood flow during exercise is an important CHD-unique determinant of VE/VCO2 slope.

Exposure to low-dose ionising radiation from cardiac catheterisation and risk of cancer: the COCCINELLE study cohort profile

PurposeThe COCCINELLE study is a nationwide retrospective French cohort set up to evaluate the risk of cancer in patients who undergone cardiac catheterisation (CC) procedures for diagnosis or treatment of...

Gender-Based Disparities in Rural Versus Urban Patients Undergoing Cardiac Procedures.

IntroductionRural populations have higher rates of diabetes and hypertension (HTN) with disparities in outcomes among patients presenting to the emergency room with heart attack and stroke. However, it is unclear whether there are any sex differences among patients presenting for cardiac procedures from rural versus urban areas. Our study aimed to investigate gender-based differences in baseline characteristics and procedural outcomes among rural and urban residents presenting for cardiac catheterization and percutaneous interventional procedures.MethodsWe assessed baseline conditions and outcomes in 1775 patients who underwent cardiac catheterization and or Percutaneous Coronary Intervention at the University of Tennessee Medical Center between July 2018 to October 2019 from rural as well as urban areas. Baseline conditions assessed were diabetes, HTN, stroke, peripheral vascular disease, heart failure, and prior bypass surgery. Outcomes assessed were vascular/bleeding complications, duration of the procedure, and mortality.ResultsThere were significant gender-based inter-group differences in outcomes between rural versus urban residents. In general, both rural and urban males had significantly longer procedure times and higher mortality than rural or urban females (P=0.01). Among females, rural women had longer procedure times than urban women. Bleeding complications were greater among rural residents than urban residents (p≤0.001), with rural females having the highest bleeding complication rate. Mortality was also higher among rural females compared to their urban counterparts (p=0.01).Significant gender-based inter-group differences were noted between rural versus urban residents. While the incidence of stroke was higher among rural and urban females compared to males, the peripheral vascular disease was more common among males. The history of coronary artery bypass graft (CABG) was more commonly seen among rural males than females. Rural and urban males had significantly longer procedure times than females, particularly urban females (P=0.01). Among women, rural females had longer procedure times, higher vascular/bleeding complications, and greater mortality than urban females. Mortality was higher among rural men and women compared to urban men or women (p=0.01). Rural women had the highest bleeding/vascular complications.ConclusionsWe found significant gender-based differences between rural versus urban patients. While rural females had a higher incidence of stroke, peripheral vascular disease and a history of CABG were more commonly seen among rural males. Overall, rural males had higher mortality than females (P=0.01). Among women, rural females had longer procedure times, higher bleeding complications, and greater mortality than urban females. Being aware of such gender-based differences may help physicians take steps to improve outcomes. Information derived from our study may also be useful for policymakers in directing healthcare funding to lower gaps in the care of patients such as those with peripheral vascular disease, ultimately leading to better health outcomes.

EVALUATION OF ANNUAL RADIATION EXPOSURE OF STAFF IN A CARDIAC CATHETERIZATION DEPARTMENT IN SAUDI ARABIA

The objective of this study is to estimate the annual effective dose for cardiologists and nurses by measuring Hp(10) and Hp(0.07) during cardiac catheterization procedures. A total of 16 staffs members were working in interventional cardiology during 1year at a tertiary hospital. The occupational dose was measured using calibrated thermo-luminescent dosemeters (TLD-100, LiF:Mg,Ti). The overall mean and range of the annual Hp(10) and Hp(0.07) (mSv) for cardiologists were 3.7 (0.13-14.5) and 3.2 (0.21-14.7), respectively. Cardiologists were frequently exposed to higher doses compared with nurses and technologists. The exposure showed wide variations, which depend on occupation and workload. Staff is adhered to radiation protection guidelines regarding shielding the trunk, thyroid shield, thus appropriately protected. Lens dose measurement is recommended to ensure that dose limit is not exceeded.

Radiation Dose Reduction in Congenital Heart Disease Patients During Cardiac Catheterization by a Novel Protocol.

Objective:Cardiac catheterization remains a major source of radiation exposure for patients with congenital heart disease. This study reports the magnitude of radiation with a 3.75 frame per second (fps) pulse fluoroscopy rate and compares the reduction with the previous 15 fps protocol during cardiac catheterization for pediatric and adult congenital heart disease.Material and Methods:All diagnostic and interventional cardiac catheterization procedures from a single tertiary center were analyzed from January 1, 2014 to December 31, 2015, one year before and after implementing lower starting pulse fluoroscopy rates. The radiation dose was quantified as air kerma dose (mGy) and dose-area product (DAP; µGy/m2). Radiation exposure was analyzed for diagnostic and interventional procedures; the diagnostic group was subdivided into cyanotic and acyanotic patients, whereas the interventional group was subdivided according to the most common indications.Results:A total of 786 procedures were analyzed. The median fluoroscopy times and contrast amounts did not show a statistically significant difference between both periods (487 vs. 456 seconds and 42.5 vs. 45.3 cm3). The median air kerma for all procedures showed an 88% reduction after implementing lower pulse fluoroscopy rates (340-41 mGy). The doses were reduced significantly for diagnostic and interventional angiograms from 470 mGy and 162 mGy to 40 mGy and154 mGy. Among all patient groups, the most striking decrease was observed in the diagnostic procedures we use, of which fluoroscopy is more prominent than cine angiography.Conclusion:We claim that novel radiation dose reduction protocols could be easily applied without increasing fluoroscopy time or losing image quality.

Evidence-Based Practices in the Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Association.

Cardiac catheterization procedures have rapidly evolved and expanded in scope and techniques over the past few decades. However, although some practices have emerged based on evidence, many traditions have persisted based on beliefs and theoretical concerns. The aim of this review is to highlight common preprocedure, intraprocedure, and postprocedure catheterization laboratory practices where evidence has accumulated over the past few decades to support or discount traditionally held practices.

Case Report: Transient cortical blindness following coronary angiography

Temporary blindness, also known as transient cortical blindness, is an uncommon impediment of contrast agent usage during angiography procedures. The occurrence of blindness after a cardiac catheterization procedure is rare and its pathophysiology remains largely speculative. The most probable mechanism seems to be contrast agent-related disruption of the blood-brain barrier, possibly initiated by several predisposing factors. This case reports a 52-year-old man with transient vision loss that occurred following coronary angiography. Brain magnetic resonance imaging (MRI) showed no acute pathology and his vision spontaneously returned within approximately 15 hours post-procedure without any requirement of specific therapy. Suggesting that transient cortical blindness may have occurred following coronary angiography which subsequently self-resolved.

Preprocedural Anxiety in the Transradial Cardiac Catheterization Era.

Transradial cardiac catheterization is increasingly being used for the management of coronary artery disease given the low risk of procedural discomfort and complications with this approach. However, the evidence relating to preprocedural anxiety levels in these patients is scarce. The aim of this study was to evaluate the anxiety levels and the predictors of anxiety in patients undergoing transradial cardiac catheterization procedures. Data were collected using a self-administered survey. Anxiety was measured using the Spielberg's State-Trait Anxiety Inventory questionnaire. Multiple regression analysis was used to identify whether gender, age, family history of heart disease, smoking status, history of depression, and trait anxiety scores were predictors of preprocedural anxiety. A total of 198 patients participated in this study. More than half of the patients (53.5%) were classified as having a high state anxiety level. The mean (SD) preprocedural trait and state anxiety scores were 35.34 (9.8) and 36.43 (11.4), respectively. Female patients, those younger than 65 years, current smokers, and those with a family history of heart disease, a history of depression, and a history of anxiety had significantly higher anxiety scores. Having high trait anxiety scores was the only predictor of preprocedural anxiety. Although the transradial approach has a low procedural risk and causes less discomfort to the patient, anxiety persists in more than 50% of patients, with trait anxiety being the best predictor. Nurses should therefore try to decrease anxiety levels in the preprocedural phase to minimize postprocedural adverse outcomes in this group of patients.

Occupational dose measurement for radiographers during cardiac catheterization procedures

Occupational dose measurement for radiographers during cardiac catheterization procedures

COMPARISON OF TWO HAEMODYNAMIC MONITORING SYSTEMS IN THE CARDIAC CATHETERIZATION LABORATORY: THE MANIFOLD (MANUAL) VS. AUTOMATED ACIST CVI®

Objective: Hemodynamic monitoring is an integral part of any cardiac catheterization procedure and can be potentially prone to many distortions, including damping and resonance. The optimum damping ratio recommended for accurate haemodynamic monitoring ranges between 0.4 to 0.8. The most common systems used include Manifold, the manual system and the automated, ACICT CVi® device, which is claimed to be as accurate as the manual system and easier to use. The aim of this prospective study was to compare damping ratio, ascending aortic pressure waveform and invasive blood pressures (BP) between manifold and ACIST CVi®, in patients undergoing cardiac catheterization. Design and method: This study was conducted at the cardiac catheterization Laboratory at King Abdul-Aziz Cardiac Center, National Guard Health Affairs, Riyadh in adult patients undergoing elective cardiac catheterization procedures. The fast-flush test was performed at the beginning of the procedure using manifold and ACIST in a cross-over fashion. The square wave was analysed to calculate the damping coefficient for each device. Data was analyzed by JMP Pro (SAS for Windows, Version 13) p &lt; 0.05 considered significant. The patients gave informed consent and the study was approved by the Institutional Ethics Committee. Results: We compared the two systems in a randomised cross-over fashion in 54 subjects (mean age 58.1 ± 12, 24% females). The mean damping ratio was 0.61 ± 0.11 (range 0.34–0.95) with manifold vs. 0.95 ± 0.27 (range 0.53–2.1) with ACIST, mean difference 0.33, p &lt; 0.0001. The over-damped ACIST yielded lower BP measurements compared with manifold; mean difference 6 mm Hg systolic and 5 mm Hg diastolic with almost 30% of the subjects showing a discrepancy of &gt; 10 mm Hg between the two systems. Conclusions: To the best of our knowledge, this is the first study comparing a manual haemdynamic monitoring system to an automated one used widely in cardiac catheterization laboratories. In our study, while the mannifold met the international recommendations for accurate haemodynamic monitoring, ACIST device was overdamped, resulting in significant underestimation of invasive pressures. We recommend using the manifold system for studies involving haemodynamically compromised patients and in patients depending upon accurate haemodynamics for diagnostic purposes.

ANATOMICAL VARIATIONS OF THE ORIGIN OF PROFUNDA FEMORIS ARTERY – A CADAVERIC STUDY

INTRODUCTION: The Profunda Femoris Artery (PFA) is a large branch arises from the lateral or posterolateral part of the Femoral Artery (FA), about 3 to 5cm below the inguinal ligament. The PFA is in close proximity to femoral vessels in the femoral triangle the precise anatomical knowledge of PFA and its branches is of great signicance in preventing profuse haemorrhage, pseudo aneurysms and traumatic AV stulae while doing any procedures or surgeries in that area. AIM &amp; OBJECTIVES: To study the anatomical variations in source of origin, site of origin and distance of origin from midpoint of inguinal ligament of PFA. MATERIALS AND METHODS: The present observational study was conducted on the dissection of 70 lower limbs of 35 adult cadavers (27 male &amp; 8 female) in the Department of Anatomy S.V.S Medical College, Mahabubnagar over a period of 2 years. Contents of the femoral triangle were dissected as per Cunningham's manual. The source of origin, site, distance of origin from mid points of inguinal ligament and course of PFA were noted. Collected data was analysed statistically. RESULTS: In the present study the PFA was arising from the femoral artery in all these 70 Lower Limbs. The commonest site of origin of PFA was postero lateral side of femoral artery in 17 (48.6%) Limbs on right side, 16(45.8%) limbs on left side, followed by lateral side of FA in14(40%) limbs on right side, 12(34.3%) limbs on left side ,followed by posterior in 4(11.4%) limbs on each side. The PFA was originating from medial side of FA only in 3 (4.29%) left limbs The PFA was taking origin below the inguinal ligament most commonly at the distance of 3-4cm in 10(29) limbs on right side, 15(43%) limbs on left side and at 4-5cm in 8(23%) limbs on right side, 5(14%) limbs on left side, at 2-3cm in 8 (23%) limbs on right side, 6(17%) limbs on left side, at 5-7cm in 3(8.5%) limbs on right in 1 (3%) limbs on left side. The PFA was taking origin higher level with in 2cm below the midpoint of inguinal ligament in 6 (17%) limbs on right side, 8(23%) limbs on left side. CONCLUSIONS: The knowledge of site and level of origin of Profundafemoris artery helps in avoiding the formation of iatrogenic femoral arteriovenous stula (0.1-1.5%) while performing femoral artery puncture during femoral puncture, cardiac catheterisation and radiological procedures

Cardiac Catheterization Procedures in Patients with HIV: A Retrospective Analysis.

With the advent of effective antiretroviral therapies, there has been a decrease in HIV-related mortality, but an increase in non-AIDS-related comorbidities including cardiovascular disease (CVD). We sought to investigate current status of cardiac catheterization (CC) procedures in people with HIV (PWH). This is a retrospective study done at a University Hospital in South Florida between 2017 and 2019. Medical records from 985 PWH indicated that CC was performed in 1.9% of the cases. Of the PWH who underwent CC, 68% were found to have obstructive coronary artery disease (CAD). Among obstructive CAD cases, PCI was performed in 77% and CABG in 21% of cases; 26% had a repeat procedure and 11% died from non-cardiac causes. When comparing PWH who had CC to those who did not, there was a significantly higher rate of statin use (63% vs. 25%, p < 0.015) and a higher prevalence of low ejection fraction (38% vs. 11%, p = 0.004) among those patients who underwent CC. However, there was no significant difference in the prevalence of hypertension (p = 0.13), HbA1c levels (p = 0.32), CD4 count (p = 0.45) nor in undetectable viral load status (p = 0.75) after controlling for age, sex and BMI. Despite the finding of traditional CVD risk factors among PWH, there were no differences in HIV-related factors among patients requiring CC, supporting the importance of optimization of traditional CVD risk factors in this population.

Routine surveillance of patients post Fontan palliation: lessons learnt from cardiac catheterisation

BackgroundThere is no consensus on the clinical utility of ‘routine’ diagnostic cardiac catheterisation in patients with Fontan palliation in the absence of symptoms or haemodynamic lesions.ObjectiveWe sought to evaluate whether diagnostic cardiac catheterisation for a variety of indications led to a change in the clinical management of patients with a Fontan circulation.MethodsAll adult patients (≥16 years) with Fontan palliation undergoing diagnostic cardiac catheterisation at our institution from 2016 to 2019 were included retrospectively. Patients undergoing electrophysiological studies were excluded as haemodynamic measurements were not taken. Routine cardiac catheterisation at our institution is considered in adult patients who have not had a diagnostic cardiac catheter for more than 5 years.ResultsThirty-eight patients, mean age 27 ± 7 years, 60% NYHA I, 31% NYHA II, 8% NYHA III, at mean duration post Fontan of 20 ± 6 years, lateral tunnel (LT) n = 20, extracardiac (EC) n = 14 and atriopulmonary (AP) n = 4, underwent 41 diagnostic cardiac catheterisation procedures. Indication for cardiac catheterisation was as follows: haemodynamic lesion identified on cross-sectional imaging in 12; routine catheterisation in 9; cyanosis in 8; dyspnoea in 8; significant liver stiffness on ultrasound hepatic elastography in 2; and arrhythmia in 2. Of the 9 patients undergoing routine diagnostic catheterisation, 3 had not had any diagnostic catheterisation since their Fontan completion and, in the remaining six, the mean time lapsed since the last diagnostic catheter was 8 ± 3 years. The diagnostic catheterisation led to a recommended change in clinical management on 24 occasions (59%): catheter intervention in 17 (40%); surgery in 4 (10%); medication change in 3 (17%); and transplant referral in 2 (5%). The clinical indications that led to changes in clinical management were: cyanosis (8/8), dyspnoea (7/8), haemodynamic lesions on cross-sectional imaging (8/11) and arrhythmia (1/2). None of the 9 patients listed for routine diagnostic catheterisation or as a result of findings on ultrasound hepatic elastography had a recommended change in clinical management.ConclusionDiagnostic cardiac catheterisation frequently leads to changes in the clinical management of patients with Fontan palliation presenting with dyspnoea, cyanosis, and for further evaluation of potential haemodynamic lesions identified on cross-sectional imaging. Routine cardiac catheterisation in the absence of the above indications had limited impact on clinical management in our cohort.