Background—
Reducing digital pulse rates (PR) are known to reduce total energy during invasive cardiovascular procedures, which likely has benefits for patients and staff. Physicians may be reluctant to reduce these parameters because they fear a decline in image quality that could affect procedural outcomes. We sought to assess the effect of default rates of fluoroscopy (Fluoro) and CINE-acquisition (CINE) on total x-ray dose and image quality during invasive cardiovascular procedures.
Methods and Results—
We retrospectively reviewed procedures done with 2 default PRs: a standard dose cohort (PR, 15 for Fluoro and CINE), and a reduced dose cohort (PR, 10 for Fluoro and CINE). Total x-ray dose, Fluoro time, and contrast use were compared between groups. A blinded angiographic image quality assessment was then performed using an objective 10-point angiographic quality score. There were no significant differences between cohorts for fluoroscopy time or contrast use. The reduced dose cohort has a significant reduction in mean total x-ray dose (PR 15, 1763.1 mGy; PR 10, 1179.1 mGy;
P
<0.0001). When adjusted for potential confounders, a 38% reduction in total x-ray dose was identified (
P
<0.0001). There was no difference in adjusted angiographic quality score between the cohorts (PR 15, 7.90; PR 10, 8.00;
P
=0.67), indicating no decline in image quality with PR reduction.
Conclusions—
Reducing default PRs during invasive cardiovascular procedures yields large and significant reductions in total x-ray energy with no decline in angiographic image quality.
Abstract-The molecular mechanisms that regulate the proliferation of smooth muscle cells (SMCs) of the vasculature in response to injury are poorly understood. Members of the inhibitor of DNA binding (Id) class of helix-loop-helix transcription factors are known to regulate the growth of a variety of cell types; however, the expression of the various Id genes in SMCs and in vascular lesions has not been examined. In the present study, the yeast 2-hybrid system was used to clone Id genes from a cultured rat aortic SMC library. By use of ubiquitous E proteins as bait, Id3 and a novel isoform of Id3 (Id3a) were cloned. Id3a is the product of alternative splicing of the Id3 gene, resulting in inclusion of a 115-bp "coding intron," which encodes a unique 29 -amino acid carboxyl terminus for the Id3a protein. Unlike Id3, Id3a mRNA was not detected in the normal rat carotid artery. However, after balloon injury, Id3a was abundantly expressed throughout the neointimal layer. In addition, mRNA of the human homologue of Id3a (Id3L) Key Words: smooth muscle cells Ⅲ helix-loop-helix factors Ⅲ atherosclerosis Ⅲ vascular injury Ⅲ alternative splicing T he phenotype of smooth muscle cells (SMCs) within atherosclerotic and restenotic lesions in humans 1,2 and lesions generated after vascular injury in experimental animals 3-5 is modulated relative to normal medial SMCs. This modulation is characterized by loss of myofilaments, formation of a large endoplasmic reticulum and the Golgi complex, migration into the neointima, and extracellular matrix secretion. 4 In addition, this phenotypic modulation is accompanied by alterations in growth factor receptor expression and growth responsiveness, resulting in enhanced proliferation. The proliferation of intimal SMCs leads to encroachment on the vessel lumen. Thus, the identification of factors that enhance and inhibit the growth of SMCs is important for understanding and potentially intervening in the SMC response that leads to vascular lesion formation.
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RHC via the AVA is a feasible and safe alternative to PVA. Our experience and rapid adoption support the use AVA as the access site of choice for RHC in uncomplicated patients.
Left and right trans-radial approach for primary PCI have similar in room procedural times, success rates, and comparable safety. Trans-radial PCI through either arm is a feasible and safe approach in patients with STEMI.
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