Pulmonary vascular resistance (PVR) and PVR index (PVRI) are key variables in a broad range of contexts, including prediction of outcomes in heart and liver transplantation, determining candidacy for closure of atrial or ventricular septal defects, and guiding treatment of pulmonary hypertension. Significant variability exists among the units used to report PVRI in current literature, making the interpretation of data and translation into clinical practice difficult. Here, we will review the measurement and derivation of PVR and PVRI and demonstrate the extent of confusion in the literature. We conducted a literature search of all published articles in PubMed using the term “PVRI.” This yielded 218 sources with defined units for PVRI, including 33 unique variants. Among all reviewed literature, 45.4% of sources reported PVRI with units ending in m 2 (meters squared), which we defined as correct, whereas 54.6% reported PVRI with units not ending in m 2 , which we defined as incorrect. This lack of uniformity has led to considerable confusion among researchers and clinicians, with potentially life‐altering consequences.
The Watchman device is a transcatheter left atrial appendage (LAA) occluding device used in patients with nonvalvular atrial fibrillation (NVAF) and a high CHADS2-VA2SC score who are poor long-term anticoagulation candidates. Pericardial effusion related to device deployment and perforation can be a life-threatening complication. While not common in hands of experienced operators, management may require surgical intervention. Here we present a rare case of LAA perforation, which was corrected by successful repositioning of the device foregoing the need for surgical management.
We looked retrospectively at the 3- to 5-year progression of mild, asymptomatic carotid artery stenosis (CAS). A random sample of 600 patients who had undergone at least two carotid artery duplex ultrasounds between 31 October 2006 and 1 November 2016 with a second duplex ⩾3 and ⩽5 years following the initial one were screened for inclusion. Internal carotid arteries (ICAs) were included if they had 20-49% stenosis on the initial duplex, with 440 carotid arteries meeting this criteria. Analyses were performed utilizing chi-squared and two-tailed t-tests. Twenty-four (5.45%) of the initial 440 carotid arteries progressed to moderate CAS. There was a statistically significant increase in the prevalence of hypertension (68% vs 47%, p=0.022) and diabetes mellitus (44% vs 22%, p=0.008) in patients with carotids that progressed to moderate CAS. There was a decrease in moderate-intensity statin use (32% vs 58%, p=0.005) and an increase in patients not on statins (36% vs 11%, p=0.001) in the group of carotids that progressed to moderate CAS. One carotid artery (0.2%) progressed from mild CAS to severe CAS. If supported by others, our data may lead to a change in the recommendations regarding appropriate follow-up of asymptomatic CAS.
Background and Aims: Physiologic measurement of myocardial perfusion in the immediate postangioplasty period may complement the angiographic assessment of the outcome of the procedure and improve our ability to identify patients at increased risk for a suboptimal late result. Immediate in-lab identification of patients at risk for late coronary restenosis would allow the interventionalist to implement alternate interventional and/or pharmacologic strategies aimed at improving the long-term outcome of angioplasty. The present single-center pilot study was undertaken to examine prospectively the value of intracoronary Doppler flow measurements immediately postangioplasty for predicting long-term patency of the dilated coronary artery. Patients and Methods: Coronary average peak flow velocity (APV) at rest and during hyperemia (6-18 µg intracoronary adenosine) and coronary flow reserve in the distal coronary segment were measured in 24 consecutive patients 10-15 min after successful elective coronary angioplasty. Volume flow (Q) was calculated as APV/2· coronary cross-sectional area •heart rate. Coronary arterial vessels and narrowings were measured by quantitative angiography using a geometric based method and automated edge detection. The present study reports the findings in the 16 patients undergoing conventional balloon angioplasty for whom hard endpoint angiographic data were available 4.9 ± 1.5 months after angioplasty. Results: A linear relation was present between angiographically measured minimal luminal dimension immediately postangioplasty and the late angiographic result of the procedure (r = 0.71, p = 0.0005). A greater acute gain during angioplasty was predictive of a larger luminal dimension at late angiographic follow-up (p = 0.006). There was no relation between the immediate postangioplasty Doppler flow measurements and the late angiographic result of the procedure. Late luminal dimension was not related to immediate postangioplasty basal or hyperemia APV, nor to immediate postangioplasty basal or hyperemic volume flow or to coronary flow reserve (all NS). Conclusions: In this single-center study, intracoronary blood flow and Doppler-derived coronary flow reserve immediately postpercutaneous transluminal coronary angioplasty were not predictive of long-term vessel patency or late coronary restenosis. The immediate angiographic result of angioplasty did correlate with the late result of the procedure.
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