Search

In many cardiovascular and infectious diseases, there are clinical and prognostic differences between men and women. The aim of this study was to compare the presentation of left-sided infective endocarditis in the two sexes. A total of 621 episodes of left-sided infective endocarditis (395 in men, 226 in women) were studied. The comparative analysis considered epidemiological, clinical, microbiological, echocardiographic and prognostic variables. Despite marked epidemiological, echocardiographic and microbiological differences between men and women, clinical characteristics, treatment approaches and outcomes (in-hospital mortality: 28% in men and 35% in women; P = .1) were similar in our patient series.

Introduction and Objectives: The development of second-generation optical coherence tomography (i.e. Fourier domain optical coherence tomography, FD-OCT) has made it possible to perform high speed pullbacks during image acquisition without the need for transient occlusion of the coronary artery. The objective of this study was to assess the reproducibility of FD-OCT systems for characterizing plaque and evaluating stent implantation in patients undergoing a percutaneous coronary intervention., Methods: The study included 45 patients scheduled for percutaneous coronary intervention who were enrolled between May and December 2008. Image acquisition was performed by FD-OCT using a non-occlusive technique and employing pullback speeds ranging from 5 to 20 mm/s. Interstudy, interobserver and intraobserver reproducibility of plaque characterization and stent analysis were assessed., Results: Fourier domain imaging was successfully performed in all patients (n=45). The average flush rate was 3+/-0.4 mL/s and the contrast volume per pullback was 16.1+/-3.5 mL. The mean pullback duration and length were 3.2+/-1.2 s and 53.3+/-12.4 mm, respectively. The interstudy reproducibility for visualizing edge dissection, tissue prolapse, intrastent dissection and malapposition was excellent (k=1). The kappa values for interstudy, interobserver and intraobserver agreement on plaque characterization were 0.92, 0.82 and 0.95, respectively., Conclusions: A second-generation OCT system (i.e. FD-OCT) involving high-speed data acquisition demonstrated good interstudy, interobserver and intraobserver reproducibility for characterizing plaque and evaluating stent implantation in patients undergoing a percutaneous coronary intervention.

Introduction and Objectives: The relationship between the lumen dimensions obtained in human coronary arteries using intravascular ultrasound (IVUS) and those obtained using optical coherence tomography (OCT) is not well understood. The objectives were to compare the lumen measurements obtained ex vivo in human coronary arteries using IVUS, OCT and histomorphometry, and in vivo in patients using IVUS and OCT with and without balloon occlusion., Methods: Ex vivo study: the lumen areas of matched anatomical sections of human coronary arteries were measured using IVUS, OCT and histology. In vivo study: the lumen areas in matched sections were measured using IVUS and OCT with and without occlusion., Results: Ex vivo: in the eight specimens studied, the lumen area obtained using OCT and IVUS was larger than that obtained using histomorphometry: mean difference 0.8+/-1 mm(2) (28%) for OCT and 1.3+/-1.1 mm(2) (40%) for IVUS. In vivo: in the five vessels analyzed, the lumen area obtained using IVUS was larger than that obtained using OCT: mean difference 1.67+/-0.54 mm(2) (33.7%) for IVUS relative to OCT with occlusion and 1.11+/-0.53 mm(2) (21.5%) relative to OCT without occlusion. The lumen area obtained using OCT without occlusion was larger than that obtained using OCT with occlusion: mean difference 0.61+/-0.23 mm(2) (13%)., Conclusions: In fixed human coronary arteries, both IVUS and OCT overestimated the lumen area compared with histomorphometry. In vivo the lumen dimensions obtained using IVUS were larger than those obtained using OCT, with or without occlusion. Moreover, the OCT image acquisition technique (i.e. with or without occlusion) also had an impact on lumen measurement.

Introduction and Objectives: At present, the effect of paclitaxel on tissue structure at the edges of Taxus(R) stents is unknown. The objective of this study was to investigate in vivo the temporal changes occurring at the edges of paclitaxel-eluting stents using intravascular ultrasound radiofrequency (IVUS-RF) data analysis., Methods: The study included 24 patients who had a total of 26 paclitaxel-eluting stented segments. In all patients, IVUS-RF imaging was performed 5 mm proximally and 5 mm distally to the stent edges 6 months after stent implantation. For subsequent analysis, proximal and distal segments were divided into five 1-mm subsegments., Results: In the first two subsegments adjacent to the proximal edge of the stent, the vessel wall had grown to compensate for plaque growth without affecting the vessel lumen, while in the remaining three subsegments there was overcompensation (i.e., the vessel wall increased to greater than the plaque size). Consequently, the lumen had increased in size. At the distal edge of the stent, overcompensation was observed in all five subsegments and the lumen had increased in size. In general, proximal and distal growth was due to an increase in fibrolipid plaque (P< .001 and P< .001, respectively) along with a decrease in the necrotic core (P=.014 and P< .001, respectively) and the presence of dense calcium (P< .001 and P< .001, respectively)., Conclusions: Serial expansive vascular remodeling was observed at proximal and distal stent edges. Remodeling occurred in response to tissue growth, which was mainly due to increased fibrofatty tissue.