The clinical benefits of using the left internal mammary artery (LIMA) to bypass the left anterior descending artery are well established making it the most frequently used conduit for coronary artery bypass surgery (CABG). Coronary subclavian steal syndrome (CSSS) occurs during left arm exertion when (1) the LIMA is used during bypass surgery and (2) there is a high grade (≥75%) left subclavian artery stenosis or occlusion proximal to the ostia of the LIMA resulting in "stealing" of the myocardial blood supply via retrograde flow up the LIMA graft to maintain left upper extremity perfusion. Although CSSS was once thought to be a rare phenomenon, its prevalence has been underestimated and is becoming increasingly recognized as a serious threat to the success of CABG. Current guidelines are lacking on recommendations for screening of subclavian artery stenosis (SAS) pre- and post-CABG. We hope to provide an algorithm for SAS screening to prevent CSSS in internal mammary artery bypass recipients and review treatment options in the percutaneous era.
The aim of this study was to investigate whether intake of dietary sodium or potassium is related to changes in left ventricular (LV) diastolic functioning and LV mass index in young individuals with normal or elevated blood pressure. We prospectively analyzed echocardiographic data in 1,065 young adults (18–39 years) enrolled in the Strong Heart Family Study who were free from cardiovascular disease at baseline: 501 (47%) participants were normotensive and 564 (53%) were pre-hypertensive or hypertensive. Dietary sodium and potassium intake was ascertained by using a Block food-frequency questionnaire at baseline. Cardiac geometry and functioning was assessed at baseline and 4 years later. Marginal models were used to assess the associations of average intakes of sodium and potassium with echocardiographic measures. Participants with pre-hypertension or hypertension were older, had higher body mass index and reported higher intakes of sodium than normotensive individuals at baseline. In prospective analyses, potassium intake was found to be negatively related to mitral E-velocity (p=0.029) in normotensive individuals whereas sodium/potassium ratio was positively associated with atrial filling fraction (p=0.017). In pre-hypertensive or hypertensive participants sodium consumption was positively associated with atrial filling fraction (p=0.034) and an increase in sodium/potassium ratio was related to higher LV mass index (p=0.046). In conclusion, an increase in dietary sodium/potassium ratio was related to an accentuation of atrial-phase LV diastolic filling in normotensive young individuals while in pre-hypertensive or hypertensive individuals it was associated with higher LV mass index.
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