Symptoms Of Ischemic Heart Disease Research Articles

Cardiac biomarkers and health-related quality of life in new hemodialysis patients without symptomatic cardiac disease.

BackgroundHealth Related Quality of Life (HRQOL) is impaired in hemodialysis patients and cardiac biomarkers are elevated, but their relationship is uncertain.ObjectivesTo determine whether the cardiac biomarkers, troponin T and N terminal pro-B type natriuretic peptide (NT-proBNP), predict deterioration in the physical domains of HRQOL.DesignA prospective cohort study of patients in a randomized controlled clinical trial of correction of anemia with erythropoietin.SettingMultiple hemodialysis centers located throughout Canada and Europe.ParticipantsPatients who started maintenance hemodialysis within the previous 3–18 months, with no clinical evidence or prior history of symptomatic cardiac failure or ischemic heart disease, and left ventricular volume < 100 ml/m2.MeasurementsPredictor: Baseline concentrations of Troponin T and NT-proBNP. Outcomes: Physical function and vitality scores using the SF-36 questionnaire and fatigue scores using the FACIT questionnaire at baseline and after 24, 48, and 96 weeks follow-up.MethodsUnivariate analysis of the association between baseline variables and baseline HRQOL scores and change in scores over time was undertaken using linear regression. Multivariate models were created using multiple linear regression, and it was pre-specified that these include the variables which were associated with the outcome at a p < 0.05 in the univariate regression.ResultsBaseline median (interquartile range) physical function score was 70 (50–85), vitality 55 (40–75), and fatigue 73 (58–86). The 75th percentile for Troponin T was 0.05 ng/mL and for NT-proBNP 652 ng/mL. High Troponin T levels were significantly associated with deterioration in the 3 physical domains, independent of other risk factors, whereas high NT-proBNP were not associated. In multivariate models baseline Troponin T > 0.05 ng/mL were significantly associated with the change from baseline to 96 weeks follow-up for SF-36 vitality and FACIT-fatigue scores, and approached statistical significance for SF-36 physical function (0.056).LimitationsNot possible to confirm whether Troponin T associations were independent of subsequent cardiac events.ConclusionsIn hemodialysis patients without prior symptomatic cardiac disease and without a dilated left ventricle at baseline, elevated baseline Troponin T levels, but not NT-pro BNP, were independently associated with deterioration in the physical domains of HRQOL.Electronic supplementary materialThe online version of this article (doi:10.1186/2054-3581-1-16) contains supplementary material, which is available to authorized users.

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Assessment of Ischemic Heart Disease and its Risk Factors among Asymptomatic Hospital Visitors

Objectives: The prevalence of Ischemic Heart Disease (IHD) and risk factors of IHD is increasing in developing countries, including India due to changes in lifestyle and dietary changes. Reports regarding asymptomatic ischemic heart disease (AIHD) among general population showed varying results. Studying the prevalence and associated risk factors of AIHD among the hospital visiting population is worthwhile. Materials and Methods: One hundred patients attending a tertiary care hospital, not known to have IHD or symptoms of IHD were included. ECG was recorded and IHD was diagnosed using Minnesota criteria. After collecting blood for lipid profile, height, weight, waist circumference (WC) and hip circumference (HC) were measured.

Atrial Fibrillation reduces the Functional REServe of the Heart by a fifth: A pilot FRESH-AF study

The advent of catheter ablation has reignited the controversy about whether rhythm or rate control should be the preferred mode of therapy for atrial fibrillation (AF) [1]. It is well known that compared to sinus rhythm (SR), AF is associated with increased mortality and morbidity including stroke, heart failure, and impaired quality of life. Furthermore, patients may experience adverse effects from drug treatment that may negate thebeneficial effects ofmaintaining SR [2].What is still unknown is inwhatways and by howmuch overall cardiac function is impairedwhen the atrial “kick” in SR is lost after the onset of AF. To fill this gap in knowledge, it is essential to assess cardiac functionnot onlyat rest but also during maximal stress, and not merely piecemeal aspects of cardiac function. This can be achieved by conducting full cardiopulmonary exercise testing (CPX) in combination with non-invasive evaluation of central haemodynamics [3]. Thiswouldprovide a quantitative assessment of aerobic physical exercise capacity represented by peak O2 consumption (VO2max), together with peak cardiac power output (CPOmax) which measures the overall cardiac dysfunction [4], and is by far the strongest predictor of prognosis in heart failure patients [5]. As metabolic and circulatory demands increase during severe exercise, patients with AF have lower cardiovascular reserve. Previous studies have shown that VO2max improved by 5–13% after restoration of SR in patients with AF [6], buthowmuchcardiac functional gain is achieved thereby is still unknown. We therefore measured changes in CPOmax after successful DC cardioversion (DCCv) in patients with optimally rate-controlled AF. In so doing, we tested the hypothesis that the cardiac pumping capability of patients in AF is diminished by about a fifth. Twelve unselected ambulatory patients (10 males, age: 57.5 ± 13.7 (mean ± SD) years) with symptomatic persistent AF recruited from outpatient clinics underwent full CPX with measurements of non-invasive haemodynamics before and after successful DCCv. The aetiologies (including overlaps) of their AF were ischaemic heart disease (17%), hypertension (25%), LV dysfunction (42%), valve disease (25%), lone AF (25%), and obesity (BMI N 35, 25%). None of the patients had previous catheter ablation, or any contraindication to undergomaximal exercise, such as significant outflow obstruction, haemodynamically serious structural heart disease, uncontrolled ventricular tachyarrhythmia, uncontrolled hypertension, limiting symptoms of ischaemic heart disease, inability or deemed unsafe to exercise on treadmill, contraindications to electrical cardioversion or full anticoagulation, or inability to provide full informed consent. Standardexerciseparametersweremeasuredaspartof an incremental cardiopulmonary exercise test performed on a Trackmaster TMX425 treadmill (Full Vision, Kansas, USA) using the Bruce or modified Bruce protocol, as previously described [3]. Rates of oxygen consumption (VO2) and other gaseous exchanges were recorded breath-by-breath using the Medgraphics Ultima CardiO2 analytic system (Medgraphics, Minnesota, USA). Using the CO2-rebreathing technique (indirect Fick), cardiac output were measured at rest and during peak exercise. Mean arterial pressure was calculated from the equation, MAP=DBP+ 0.412 ∗ (SBP− DBP) [7]. CPOmax in watts is the product of peak cardiac output (COmax in l.min−1)multiplied by theMAP inmm Hg at peak exercisemultiplied by a conversion factor (2.22 × 10−3) [8]. A paired sample t-test was used to assess the change in cardiac reserve variables pre and post DCCv. This study was approved by the National Research Ethics Service Committee for Yorkshire & Humber in Leeds East. After successful cardioversion, subjectively all patients claimed to feel better and more energetic and, as shown in Table 1, objectively their treadmill exercise duration increased by 19.3% (P b 0.05), coupled with an improvement in peak O2 consumption by 16.5% (P b 0.01). Their resting ventricular rate decreased from 83.1 ±20.3 to 66.9 ± 20.5 min− 1 (P b 0.05), while peak exercise HR decreased from 163 ± 42 to 128 ± 18 min−1 to (P b 0.05). Secondarily, these negative chronotropic effects led to heightened stroke volume at peak exercise by 46% (P b 0.0001), thereby raising the peak cardiac output by 16.5% (P b 0.0001). Due to a concomitantly greater

First-in-human evaluation of a sirolimus-eluting coronary stent on an integrated delivery system: the DIRECT study

The DIRECT study is a first-in-human evaluation of the safety and efficacy of the Svelte sirolimus-eluting coronary stent mounted on a fixed-wire, "all-in-one" integrated delivery system (IDS) in patients with de novo coronary artery lesions. The system permits easy delivery, deployment and post-dilatation of a cobalt-chromium stent eluting sirolimus from a fully bioabsorbable amino acid coating. The stent on its IDS has a very low profile, and is designed specifically to facilitate direct stenting. Patients with symptomatic ischaemic heart disease and a single de novo native coronary lesion suitable for percutaneous coronary intervention were prospectively enrolled at four New Zealand sites. The lesion length had to be <23 mm and the vessel reference diameter 2.5-3.5 mm. The primary safety and efficacy endpoints were target vessel failure (TVF) and angiographic in-stent late lumen loss (LLL) at six months, respectively. Twenty-nine of 30 enrolled patients completed six-month follow-up. TVF occurred in two patients (7%). The in-stent LLL was 0.22 ± 0.27 mm. No patient had clinically-driven target lesion revascularisation. Intravascular ultrasound neointimal volume was 3.3 ± 4.4 mm3 and volume obstruction was 2.7 ± 4.5% at six months. Optical coherence tomography showed 98 ± 4% strut coverage at a depth of 0.12 ± 0.06 mm. No patient developed stent thrombosis. Percutaneous coronary intervention using the Svelte sirolimus-eluting coronary stent mounted on an IDS appears safe and effective in de novo coronary artery lesions, with minimal in-stent proliferation and excellent stent strut coverage at six months.

Incidence of in-stent re-stenosis with CATANIA Coronary Stent

The study sought to assess safety and efficacy of implantation of CATANIA Coronary Stent. CATANIA Coronary Stent is new stents coated with an inorganic, high molecular weight polymer Polyzene F. It is a flexible cobalt chromium balloon expandable stent. Polyzine-F was claimed to have low surface thrombogenicity, anti-inflammatory, bacterial resistance, and pro healing effects which result in low rate of stent thrombosis and in-stent re-stenosis (ISR) requiring short duration of dual anti platelet therapy. Catania is neither a BMS nor a DES but somewhat in between. This is a prospective, single center, observational cohort study of 33 patients with symptomatic ischemic heart disease with de novo, obstructive lesion of native coronary arteries. The patients were followed up at 12 months after the implantation for the symptoms and any new coronary events. Of the 33 patients, one patient died due to non cardiac cause, 4 patients were admitted with unstable angina and two patients with angina and positive stress test. The entire 6 patient had significant more than 70% ISR. The target lesion revascularization (TLR) at 12 months was 18.75% At one year follow up, The Catania stent was found to be associated with a significant ISR with TLR of 18.75%.

Abstract 18255: MicroRNA Analysis in Experimental Models of Vein Graft Neointima Formation Indentifies a Critical Role For Mir-21 in Neointima Formation

Background: Coronary artery bypass grafting (CABG) is an established treatment to relieve the symptoms of ischemic heart disease. However premature graft failure, in saphenous veins is a major limitation. One of the principal etiological factors responsible for vein graft failure is activation and phenotypic modulation of smooth muscle cells (SMC), resulting in accelerated rates of proliferation and migration. MicroRNAs (miRNAs) are short, single stranded, non-coding RNAs that play important roles in modulating cell phenotypes through regulation of gene expression. Methods and results: In order to assess the expression levels of miR-21 in the progression of vein graft neointimal formation we quantified miR-21 levels in three well-established models of vein graft disease. These were the in vivo porcine model of interposition graft, the isogenic mouse model, as well as the ex vivo human sapehnous vein model of neointimal formation. MiR-21 levels were up-regulated approximately 7-fold in both the porcine and murine models at 7 and 28 days following grafting (n=6). In surgically prepared HSV which were subjected to culture ex vivo we found that miR-21 levels were elevated approximately 3-fold following 7 and 14 days of culture (n=6). In situ localization in the HSV demonstrated that miR-21 was expressed most intensely in the neointimal layer of HSV which also stained positive for SMC actin. Co-localization studies in murine vein grafts revealed that miR-21 was localised to areas of the graft that stained positive for proliferating cell nuclear antigen with substantial co-staining with SMC actin. We assessed the potential functional role of miR-21 in vein graft failure using miR-21 knockout mice. Analysis of neointimal lesion size in miR-21 knockout mice revealed an 81% reduction in neointimal area compared to wild type controls (p&lt; 0.0001, n=7-10/group). Conclusion: These findings demonstrate that miR-21 is up-regulated in multiple models of vein graft disease and that genetic abolition of miR-21 levels can attenuate neointimal formation in response to grafting. Therein, modulation of miR-21 expression represents a novel therapeutic opportunity in the setting of vein graft neoinitma formation.

Should We Do Cardiac Stress Tests in Asymptomatic Renal Transplant Candidates?

Background: Although the high burden of coronary artery disease in the dialysis population, the expected benefit of screening tests in asymptomatic renal transplant candidates is a controversial topic. Recently, we found that the rates of noninvasive stress testing(stress echocardiogram, or nuclear stress test) range from 20 to 100% depending on which renal specific transplant guidelines(KDOQI, AST, and Lisbon) were applied. Interestingly the positive predictive value of ischemia on noninvasive stress test is about 5% -10% in KDOQI, AST, and Lisbon guidelines. Noninvasive stress tests are more expensive and able to trigger ischemia, and arrhythmia than conventional trans thoracic echocardiography(TTE). We compared episodes of patient death with heart disease, and ischemic heart disease Methods: Kidney transplant candidates who recommended stress test according to the guidelines (KDOQI and AST) were enrolled. Although they had multiple risk factors, they had a good ordinary activity and no symptoms. All of patients were performed TTE and selected that did not show any regional wall motion abnormality, severe valvular disease, and abnormal ejection fraction. 165 paitents were enrolled and divided into two groups. A group underwent only TTE (N=124) and B group underwent TTE with noninvasive stress test (n=41). We measured incidence of patient death with heart disease, and symptomatic ischemic heart disease within 3 years after kidney transplantation. Results: The mean age of group A was 39 ±7 years, and B group was 40 ±5 years. Diabetes patients of group A and B were consisted of 8.8%(11/124) and 9.7% (4/41), respectively. Only 4 patients of group B had a positive result on noninvasive stress test but they had no obstructive coronary disease on coronary angiograms. The total incidence of ischemic heart disease of group A and B were 6.4% (8/124) and 7.3% (3/41), respectively. There was no patient in both groups who death with primary heart problems within 3 years after kidney transplantation. Conclusion: Conventional TTE has a similar effect to predict ischemic heart disease in asymptomatic candidates who are relatively young, and have a good physical functional copacity. Renal transplant specific guidelines recommend widespread pretransplant cardiac test. Therefore we need prospective studies that compare screening tests and their associated clinical outcomes to find proper application of diagnostic strategies in kidney transplant candidates.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

The ‘all comer’ Coroflex Please drug-eluting stent registry in Europe and Asia – An overall and transcontinental assessment of the 10-month major adverse cardiac events

BackgroundRandomized trials assess the potential of a medical device in well defined indications while “all comer studies” reveal the device performance in the real clinical environment. AimsThis ‘all comers’ registry assessed the 10-month outcome of the Coroflex® Please drug-eluting stent in Europe and Asia by clinically driven major adverse cardiac events. MethodsThe Coroflex® Please Registry was an international, prospective, multicenter registry enrolling patients with symptomatic ischemic heart disease. The primary endpoint was clinically driven target lesion revascularization (TLR) at 9 months. Secondary endpoints were technical success, in-hospital outcomes, definite stent thrombosis and major adverse cardiac events (death, myocardial infarction, or TLR) for subgroup analyses. ResultsOf the enrolled 1230 patients (63.6 ± 11.2 years, 33.9% diabetics), 339 (27.6%) had an acute coronary syndrome, 148 (12.1%) STEMI and 191 (15.6%) NSTEMI. After 10.5 ± 3.8 months (follow-up rate 92.8%), the target lesion revascularization rate (TLR) was 7.8% overall, 8.3% in STEMI, and 11.3% in NSTEMI patients. Total MACE was 11.1% and significantly higher in ACS with either diabetes mellitus (22.9%, p = 0.017) or age ≥75 years (25.4%, p = 0.026). In European and Asian patients MI rates (5.2% vs 3.1%, p = 0.135) and cardiac death rates (1.6% vs 0.9%, p = 0.414) were similar. The MACE rate was higher in Europe (13.6% vs 4.7%, p < 0.001) driven by a six times higher TLR rate. ConclusionsTLR and MACE occurred within the range of previously published data. The incidence of MI and cardiac death were not different between Europe and Asia. MACE were higher in Europe driven by target lesion revascularization.

Coronary microvascular function in patients with Cushing’s syndrome

The aim of the study was to evaluate patients with Cushing's syndrome the coronary flow reserve (CFR), an index of coronary microvascular function. Fifteen newly diagnosed patients with Cushing's syndrome (1 male/14 females; mean age 45 ± 11 years), were selected for having no clinical evidence of ischemic heart disease. Twelve patients had pituitary-dependent Cushing's disease and three had an adrenal adenoma. Fifteen subjects matched for age, sex, and major cardiovascular risk factors were used as controls. Coronary flow velocity in the left anterior descending coronary artery was investigated by transthoracic Doppler echocardiography at rest and during adenosine infusion. CFR was obtained as the ratio hyperemic/resting diastolic flow velocity. A reduced coronary reserve (hyperemic/resting ratio ≤ 2.5) was found in 5/15 Cushing patients and 4/15 controls. In all patients with abnormal CFR, epicardial coronary stenosis was excluded by multi-slice computed tomographic coronary angiography. CFR was inversely related to urinary cortisol in patients with endogenous hypercortisolism (Spearman's rho = -0.57, P = 0.03), while no correlation was found in controls. Coronary microvascular function, as assessed by CFR, is pathologically reduced in a considerable number of patients with Cushing's syndrome without clinical symptoms of ischemic heart disease and in the absence of epicardial coronary artery lesions, as well as in controls matched for cardiovascular risk factors. The presence of comorbidities can explain this early coronary abnormality in both patients and controls. Whether urinary cortisol may be a predictor of coronary microvascular function in the setting of patients with Cushing's syndrome, needs further investigation.

Heat shock protein concentrations in chronic generalized periodontitis of elderly patients

The present article summarizes data on the content of antibodies targeting heat shock proteins and the concentration of IL-1α, IL-8, IL-4, IgG, IgM, IgA, and sIgA in blood and saliva of elderly patients suffering from chronic generalized periodontitis before and after treatment of periodontal inflammation and clinical symptoms of ischemic heart disease.

Apolipoprotein E polymorphism is associated with both number of diseased vessels and extent of coronary artery disease in Czech patients with CAD

The impact of ApoE polymorphism on angiographic parameters was assessed in patients referred for coronary angiography. Elective coronary angiography was performed in 671 subjects (525 men, 146 women, mean age 60 ± 10 years) with symptoms of ischemic heart disease. The patients were divided into: no CAD group (smooth coronary vessels, n=83), one-vessel (n=155), two-vessel (n=170) and three-vessel disease (n=196). Patients with stenoses 0-50% were excluded. Within patients with CAD, we evaluated overall extent of CAD measured by the number of stenotic segments according to AHA (1 segment vs. 2-3 vs. ≥4), and the severity of the most serious stenosis (in percent). ApoE genotype was determined using real-time PCR. The frequency of ε2/ε3 genotype (n=56) was lower in the three-vessel disease group compared to one-vessel disease (OR=0.25, P=0.0019), two-vessel disease (OR=0.31, P=0.0114) or no CAD group (OR=0.24, P=0.0057). Frequency of ε2/ε3 decreased with the number of affected segments (1 vs. ≥4: OR=0.35, P=0.0143). The ε3/ε4+ε4/ε4 genotypes (n=123) were more frequent in CAD patients altogether compared with no CAD group (OR=2.30, P=0.019), while no impact of the ε4 allele on angiographic parameters within the CAD patients was detected. In ε2/ε3 carriers with CAD, lower LDL-cholesterol, total cholesterol and lower use of lipid-lowering drugs were observed. The results show predominantly focal form of CAD in patients with ε2/ε3 genotype. Lower LDL-cholesterol and total cholesterol may play the key role, although other contributing factors are discussed.

Left ventricular myocardium segmentation on delayed phase of multi-detector row computed tomography

Advanced ischemic heart disease is usually accompanied by left ventricular (LV) myocardial volume loss and an abnormal enhancing pattern on delayed phase of multi-detector row computed tomography (MDCT). To assist radiologists and physicians in estimating the LV myocardial volume on delayed phase, this paper proposes an adaptive segmentation method for contouring the myocardial region in the delayed-phase MDCT and for computing the volume. The proposed method uses an anisotropic diffusion filter as a preprocessing procedure to enhance contrast and reduce specks in MDCT imaging. This work picks the middle of mid-ventricular level image slices as the lead slice. The proposed method develops two contouring modes to sketch the myocardium contour on the lead slice. By establishing the obtained contours as the initial contours, the region-growing method is employed to identify the contour of the myocardial region for each slice. The convex-hull finding algorithm is then used to refine the extracted contour. Finally, the width properties of the myocardial region and the morphological operators are used to obtain the entire LV myocardial volume. Twenty-seven healthy patients who had no symptoms of ischemic heart disease are examined to evaluate the performance of the proposed method. Compared with manual contours delineated by two experienced experts, the contouring results using computer simulation reveal that the proposed method reliably identifies contours similar to those obtained using manual sketching. The proposed method provides robust contouring for the LV myocardium on delayed-phase MDCT. The potential role of this technique may substantially reduce the time required to sketch manually a precise contour with high stability.

Safety and effectiveness of the Catania Polyzene-F coated stent in real world clinical practice: 12-month results from the ATLANTA 2 registry

The pivotal ATLANTA first-in-man study showed the promising safety and efficacy profile of the novel Catania™ stent in a population with ~20% American College of Cardiology/American Heart Association (ACC/AHA) type C coronary lesions. The ATLANTA 2 registry was designed to evaluate the 12-month safety and efficacy of the Catania stent in a broader real world scenario. The ATLANTA 2 registry was a prospective, non-randomised, single-arm study of patients with symptomatic ischaemic heart disease and de novo lesions of native coronary arteries. A total of 300 patients (396 lesions) were recruited and 482 Catania stents were implanted. At 12 months, major adverse cardiac events were 8.8%, mainly driven by target lesion revascularisation (6.5%). Cardiac death and non-fatal myocardial infarction occurred in 2.5% and 0.7% of patients, respectively. Subacute definite or probable stent thrombosis was 0.7%. No late stent thrombosis was recorded. Compared with patients treated with drug-eluting stents or bare metal stents in the study period, those treated with Catania stents experienced similar outcomes at one year. The 12-month results of the ATLANTA 2 registry confirmed the positive results of the ATLANTA first-in-man trial in a more complex population. A randomised trial is needed to assess the comparative value of the Catania stent over currently-used drug-eluting stents or bare metal stents.

Collaborative Care Intervention for Stable Ischemic Heart Disease

Accumulating evidence suggests that collaborative models of care enhance communication among primary care providers, improving quality of care and outcomes for patients with chronic conditions. We sought to determine whether a multifaceted intervention that used a collaborative care model and was directed through primary care providers would improve symptoms of angina, self-perceived health, and concordance with practice guidelines for managing chronic stable angina. We conducted a prospective trial, cluster randomized by provider, involving patients with symptomatic ischemic heart disease recruited from primary care clinics at 4 academically affiliated Department of Veterans Affairs health care systems. Primary end points were changes over 12 months in symptoms on the Seattle Angina Questionnaire, self-perceived health, and concordance with practice guidelines. In total, 183 primary care providers and 703 patients participated in the study. Providers accepted and implemented 91.6% of 701 recommendations made by collaborative care teams. Almost half were related to medications, including adjustments to β-blockers, long-acting nitrates, and statins. The intervention did not significantly improve symptoms of angina or self-perceived health, although end points favored collaborative care for 10 of 13 prespecified measures. While concordance with practice guidelines improved 4.5% more among patients receiving collaborative care than among those receiving usual care (P < .01), this was mainly because of increased use of diagnostic testing rather than increased use of recommended medications. A collaborative care intervention was well accepted by primary care providers and modestly improved receipt of guideline-concordant care but not symptoms or self-perceived health in patients with stable angina.

Off-pump coronary artery bypass in poland syndrome with dextrocardia: case report

Poland Syndrome is a congenital disorder characterised by hypoplasia of the pectoral muscles along with upper extremity deformities. We encountered a patient with Poland syndrome associated with dextrocardia and also failed pectus excavatum repairs who presented to us with symptomatic ischaemic heart disease requiring intervention. He underwent successful off-pump coronary artery bypass surgery (OPCABG). As far as we are aware, this is the first case report of OPCABG in a case of Poland syndrome with dextrocardia. We describe here the management of this complex patient and wish to emphasise that the off-pump option is feasible in dextrocardia with some technical modifications.

Left ventricular myocardium segmentation on arterial phase of multi-detector row computed tomography

Rationale and objectives Variation of left ventricular myocardial volumes correlates closely with ischemic heart diseases. In clinical practice, because physicians and radiologists rely much on myocardial contour to diagnose many different cardiac diseases, automatic segmentation of left ventricular myocardium and quantifying myocardium characteristics is clinically beneficial. This paper presents a hybrid segmentation method for left ventricular myocardium on arterial phase of multi-detector row computed tomography (MDCT) imaging. Materials and methods The proposed method utilizes an intensity transformation equation as a preprocessing procedure to enhance contrast and reduce noise in MDCT imaging. By setting the centroid of left ventricle (LV) as an initial seed, the conventional region growing method is employed to identify the endocardial contour of LV cavity for each slice. Then the level-set method (LSM) utilizes the extracted endocardial contour as initial contour to delineate the epicardium of LV. The two extracted contours are integrated to form the region of interest (ROI) of the LV. Finally, the ROIs from all slices are combined to obtain the volume of the whole LV myocardium. Results Twenty-two healthy patients who had no symptoms of ischemic heart disease are applied to evaluate the performance of the proposed method. Compared with manual contours delineated by two experienced experts, the contouring results from computer simulation reveal that the proposed method always identifies similar contours as that obtained by the manual sketching. Conclusion The proposed method provides a robust and fast automatic contouring for LV myocardium on arterial phase of MDCT. The potential role of this technique may save much of the time required to manually sketch a precise contour with high stability.

Coronary Revascularization: 2011

Coronary revascularization is a proven method to alleviate the symptoms of ischemic heart disease and improve survival. There have been many improvements in surgical revascularization since its advent > 40 years ago and in balloon angioplasty since its first usage > 30 years ago. Patients will continue to benefit as these surgical techniques continue to undergo further improvements. This article is a testament to the many physicians, surgeons, scientists, industry leaders, and insurers who continue to reinvent how we provide cutting-edge procedures in the most cost-effective manner for our patients.

Ischemic Heart Disease in Women: A Review for Primary Care Physicians

Ischemic heart disease (IHD) is the leading cause of death among women in the Western world, and its prevalence is growing. The pathophysiology of heart disease in women differs from that in men. Women with chest pain and abnormal stress tests are less likely than men to have critical stenosis of coronary arteries, a phenomenon attributed to endothelial dysfunction. Hypertension, intimal injury, and cholesterol are among the various factors that contribute to endothelial dysfunction. The presenting symptoms of IHD also differ in women. Women are more likely to describe neck and throat pain and to characterize the pain as intense, sharp, or burning. A history of coronary or other vascular disease, diabetes, or chronic kidney disease places patients at high risk for IHD. Risk factor modification can be tailored based on each patient's risk. Hormone replacement therapy, antioxidants, folic acid, and aspirin in healthy women under 65 years of age have recently been shown to be ineffective in the prevention of IHD.