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Biomedical subjects

V Voudris

Publications and source records attributed to V Voudris.

34 records · Page 2Linked to original sources
PubMed1997

Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty: the DEBATE Study (Doppler Endpoints Balloon Angioplasty Trial Europe).

BACKGROUND: The aim of this prospective, multicenter study was the identification of Doppler flow velocity measurements predictive of clinical outcome of patients undergoing single-vessel balloon angioplasty with no previous Q-wave myocardial infarction. METHODS AND RESULTS: In 297 patients, a Doppler guidewire was used to measure basal and maximal hyperemic flow velocities proximal and distal to the stenosis before and after angioplasty. In 225 patients with an angiographically successful percutaneous transluminal coronary angioplasty (PTCA), postprocedural distal coronary flow reserve (CFR) and percent diameter stenosis (DS%) were correlated with symptoms and/or ischemia at 1 and 6 months, with the need for target lesion revascularization, and with angiographic restenosis (defined as DS > or = 50% at follow-up). Logistic regression and receiver operator characteristic curve analyses were applied to determine the prognostic cutoff value of CFR and DS separately and in combination. Optimal cutoff criteria for predictors of these clinical events were DS, 35%; CFR, 2.5. A distal CFR after angioplasty > 2.5 with a residual DS < or = 35% identified lesions with a low incidence of recurrence of symptoms at 1 month (10% versus 19%, P=.149) and at 6 months (23% versus 47%, P=.005), a low need for reintervention (16% versus 34%, P=.024), and a low restenosis rate (16% versus 41%, P=.002) compared with patients who did not meet these criteria. CONCLUSIONS: Measurements of distal CFR after PTCA, in combination with DS%, have a predictive value, albeit modest for the short- and long-term outcomes after PTCA, and thus may be used to identify patients who will or will not benefit from additional therapy such as stent implantation.

Aged↗
PubMed1997

Coronary vein flow velocity changes during transluminal balloon angioplasty: a study using the Doppler guide wire.

The coronary flow velocity changes in the great cardiac and middle cardiac veins, induced by intracoronary administration of nitroglycerine, adenosine, and during percutaneous transluminal coronary angioplasty, were evaluated in 12 patients with significant coronary stenoses, using the Doppler wire (Flowire). Optimal spectral signals of the time-averaged peak flow velocity were obtained in 10 patients. Nitroglycerine produced no significant flow velocity changes (P = 0.13). Adenosine caused a significant augmentation of flow velocity compared to baseline (P = 0.003). During balloon inflation, venous flow velocity decreased (P = 0.007); however, the venous outflow did not cease. A pronounced venous hyperemic response, following balloon deflation, was also documented. The utility of continuous vein flow velocity monitoring with the Flowire, during high-risk and complicated coronary interventions remains to be elucidated.

Adenosine↗
PubMed1996

Coronary flow velocity changes after intravenous dipyridamole infusion: measurements using intravascular Doppler guide wire. A documentation of flow inhomogeneity.

OBJECTIVES: This study assessed changes in coronary flow velocity measured distal to a significant stenosis of the left anterior descending coronary artery and at the adjacent normal left circumflex coronary artery, produced by intravenous administration of dipyridamole, in patients undergoing coronary angioplasty with a documented perfusion defect on dipyridamole-thallium-201 scintigraphy. BACKGROUND: Significant flow inhomogeneity is believed to develop during coronary vasodilation induced by dipyridamole, causing a defect in the thallium-201 scintigram. The recently developed intracoronary Doppler guide wire permits assessment of flow velocity variables in normal and stenotic arteries. METHODS: In 17 patients with stable angina we studied changes in time-averaged peak velocity and the diastolic/systolic velocity ratio simultaneously using two 0.014-in. (0.36-mm) Doppler guide wires at baseline and after 4 min of dipyridamole infusion (0.56 mg/kg body weight). Coronary flow velocity reserve and relative flow reserve were correlated with the degree of stenosis on coronary angiography and quantitative analysis of thallium-201 images. RESULTS: No changes in distal flow velocity was observed in the stenotic vessel (5.5 +/- 33.7% [mean +/- SD]), in contrast to a significant increase observed in the adjacent normal vessel (162.4 +/- 39.8%). Poststenotic coronary flow velocity reserve correlated with percent lumen diameter stenosis (r = -0.66, p < 0.05). A correlation was also observed between the relative flow reserve/thallium-201 relative perfusion ratio (r = 0.90, p < 0.001). CONCLUSIONS: To our knowledge, these findings represent the first direct proof of dipyridamole-induced flow inhomogeneity producing a perfusion defect on thallium-201 imaging. The degree of inhomogeneity is related to the extent of the perfusion defect.

Adult↗
PubMed1994

Effects of a low-dose fish oil concentrate on angina, exercise tolerance time, serum triglycerides, and platelet function.

Fish oils have shown beneficial effects on various parameters in patients with coronary artery disease (CAD). The purpose of this study was to investigate whether the same effects can be demonstrated with a low dose of fish oil concentrate (FOC). Thirty-nine patients were studied and divided into two groups. Twenty were given 10 g fish oil (group A) and 19 were given 10 g placebo Italian olive oil (group B). Weekly anginal attacks (AA), weekly glyceryl trinitrate consumption (GTN), exercise tolerance time (ETT), serum triglycerides (ST), platelet aggregation ratio (PAR), and beta-thromboglobulin were measured at eight and twelve weeks after start of treatment. 1. The number of anginal attacks recorded by both groups decreased by 41% in group A reaching statistical significance (P < 0.05). No change was observed in group B. 2. GTN consumption decreased in group A (P < 0.05) with no significant change in group B (P:ns). 3. ETT increased significantly in group A eight and twelve weeks after start of treatment (20.6% P < 0.01, 22.6% P < 0.01). A smaller but insignificant increase was observed in group B (P: ns). 4. ST decreased significantly in group A by 22% eight weeks after start of treatment (P < 0.01) and to a lesser degree (11%) twelve weeks after start of treatment (P: ns). In group B, ST slightly increased (P: ns). 5. No statistically significant change was observed in either group in regard to PAR and beta-thromboglobulin (P: ns). These observations suggest that dietary supplementation with a low dose of FOC may have beneficial effects on the clinical status of patients with CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Intracoronary Palmaz-Schatz stent placement after complicated angioplasty: medium term follow-up.

Acute or impending coronary artery occlusion during percutaneous coronary balloon angioplasty represents a serious and potentially life-threatening complication. We studied the clinical and angiographic outcome in 21 patients who underwent emergent intracoronary Palmaz-Schatz stent implantation (11 due to persistent residual stenosis and 10 due to flow-limiting dissection) during complicated balloon angioplasty and who were followed for a mean period of 7.9 +/- 5.7 months. Excluding one patient lost to follow-up, the event-free survival rate was 70%. Six (30%) patients developed adverse clinical events. One died and 3 required elective revascularization procedures. One subacute stent thrombosis was documented. Acute Q-wave myocardial infarction occurred in 2 patients. Among 9 patients studied angiographically 5.6 +/- 2.5 months after stent placement, 2 had developed restenosis (> 50% luminal narrowing). Eleven have remained essentially symptom free. For selected patients, emergent deployment of a Palmaz-Schatz coronary stent, following complicated balloon angioplasty, offers satisfactory long-term results, thus obviating the need for a high risk emergency bypass surgery.

Angioplasty, Balloon, Coronary↗
PubMed1993

Coronary angioplasty in the elderly: immediate and long-term results.

Coronary angioplasty was performed in 37 elderly patients (> sixty-eight years) with unstable or stable angina, refractory to medical treatment. History of myocardial infarction was present in 38% and of previous bypass surgery in 5% of patients. Coronary angiography revealed single-vessel disease in 22 (59%) and multivessel disease in 15 (41%) of patients. The mean left ventricular ejection fraction was 53 +/- 17%. Percutaneous transluminal coronary angioplasty (PTCA) was successful in 92% of patients; there were two angioplasty failures and 1 acute occlusion leading to Q wave myocardial infarction. In patients with multivessel disease complete revascularization was achieved in 33%. Follow-up data (21.29 +/- 9.23 months) are available in all patients with primary angiographic success. There was 1 death. Seventy-nine percent of patients had an improved anginal status, and repeat PTCA was performed in 2 patients because of clinical recurrence. Thus, coronary angioplasty is a safe and efficacious method of revascularization in symptomatic patients over the age of sixty-eight years.

Aged↗
PubMed1990

"High-risk" percutaneous transluminal coronary angioplasty with preventive intra-aortic balloon counterpulsation.

Between January 1987 and February 1988, 1,385 patients underwent percutaneous transluminal coronary angioplasty; 27 procedures were performed using prophylactic intraaortic balloon counterpulsation. Twenty-four patients had poor left ventricular function (EF less than 40%), and coronary dilatation was performed in arteries opposite to an occluded myocardial necrosis related vessel. In three patients of advanced age with distal stenoses and normal left ventricular function a multivessel dilatation was performed. Primary success rate was achieved in all patients. There were no deaths, myocardial infarctions or emergency bypass operations in the hospitalization period. During the follow-up (9 to 21 months) there were 2 deaths, 1 cardiac transplantation, and 6 restenosis with repeated dilatation. If revascularization is warranted, in high-risk patients, coronary angioplasty can be performed safely and successfully with protection by intraaortic balloon counterpulsation. However the long-term prognosis of these patients is complicated by the presence of other high-risk variables, such as advanced age or poor left ventricular function.

Age Factors↗
PubMed1989

Results of percutaneous valvuloplasty for calcific aortic stenosis with different balloon catheters.

Percutaneous aortic valvuloplasty is a palliative treatment for patients with calcific aortic stenosis who would be poor candidates for surgical treatment. The results and associated complications of this procedure were analysed in a series of 47 patients in which different types of dilating catheters were used. In 25 patients a single balloon (19 mm) was used (group A), in 13 patients a bifoil balloon (2 x 15mm) (group B), and in the remaining nine patients (group C) a trefoil balloon (3 x 10mm) was used. An increase in aortic valve area was achieved in all patients. The results obtained with the bifoil balloon were better than with the other types of balloon catheter, with an increase in aortic area of + 118% vs. + 74% (monofoil) and + 76% (trefoil) (P less than 0.05). The tolerance of the inflation procedure was also better with this type of balloon, as it allowed for shorter inflation and deflation times. These results show that balloon aortic valvuloplasty, when indicated, is best performed with a bifoil balloon dilating catheter, and undue complications usually do not occur.

Aged↗
PubMed1989

Right heart failure due to an inter-atrial shunt after percutaneous mitral balloon dilatation.

Percutaneous mitral valve dilatation was performed in a 61-year-old female patient with severe mitral valve stenosis. The valve could be dilated, but a moderate left to right atrial shunt was present after the procedure. Although the mitral valve area had increased from 1 cm2 to 1.7 cm2, the patient presented 1 week later with right heart failure, explained by right heart volume overload resulting from the persistent shunt. Clinical status quickly improved with diuretics. Although this evolution has not been previously reported, it may be expected in older patients with decreased compliance of pulmonary arteries and right heart chambers.

Cardiac Volume↗
PubMed1989

[Course of aortic valve insufficiency in percutaneous aortic valvuloplasty].

The risk of occurrence or aggravation of aortic valve regurgitation after percutaneous aortic valvuloplasty was evaluated by angiography in 50 consecutive patients: 17 men, 33 women, mean age 77.6 years. In all cases angiography was performed with a pigtail catheter, trying to get the catheter in the same position for injections before and after dilatation. Forty-one patients showed no changes from the predilatation situation: aortic regurgitation was absent in 10 cases, minimal in 30 cases and moderate in 1 case. Minute leakage developed in a patient who had no aortic valve regurgitation prior to dilatation. Regurgitation decreased or subsided in 8 patients, i.e.: moderate leakage became minimal in 6 cases and minimal leakage completely disappeared in 2 cases. In the last 8 patients (3 men, 5 women, mean age 76 years) heart rate and transaortic diastolic pressure gradient were identical before and after dilatation, which means that the angiographic reduction of leakage was due to better closure of the valve. Aortic valve dilatation seems to carry a low risk of major aortic regurgitation. In patients who require percutaneous valvuloplasty for tight aortic valve stenosis, the presence of a small or moderate aortic leakage should not preclude the procedure from being performed.

Aged↗
PubMed1988

[Reproducibility of myocardial ischemia induced by atrial stimulation].

Reproducibility of myocardial ischemia induced by atrial pacing (P) was investigated in 25 patients (pts) without previous anterior myocardial infarction and showing a positive exercise stress test. The second period of atrial pacing (P2) was exerted 20 minutes after the first (P1). During P2, a reduction in the parameters reflecting myocardial oxygen requirements (maximal left ventricular pressure, dp/dt max, TTI*HR values) was noted, while the signs of ischemia were less pronounced (ST depression decreasing from 2.3 +/- 1 mm to 1.6 +/- 1.0 mm; % of lactate extraction (%L) decreasing from - 6.4 +/- 25.5 to + 8.5 +/- 19.2; p less than 0.5). The 25 pts were divided into 2 groups according to the ejection fraction (EF greater than .55 16 pts Gr.F+; EF less than .55 9 pts Gr.F-). The distribution of coronary lesions was the same for the 2 groups. During P1 GR.F+ registered a negative % L as opposed to Gr.F-. During P2, the difference in the % L between the 2 groups was also significant (2.6 +/- 19.9% F+ vs 18.9 +/- 14.3% F-; p less than .05). Collateral circulation had no effect upon the results, neither for P1 or P2. This study shows that a second period of atrial pacing, 20 minutes after the first, induced lesser ischemia than the first period of atrial pacing. This phenomenon could explain the paradoxical improvement observed in certain patients after a first episode of angina. These results have implications as regards the necessity of double blind studies compared to placebo when using this technique in the evaluation of the effects of anti-ischemic drugs.

Coronary Disease↗
PubMed1986

Anomalous origin of the right coronary artery arising from the circumflex artery.

A case of anomalous origin of the right coronary artery discovered among 3100 selective coronary arteriograms is described. This artery was arising from the circumflex artery. The position, distribution, and configuration of this coronary artery was as a normal right coronary artery, except that its origin was in the peripheral segment of the circumflex artery. This anomalous origin is very rare and seems not to give rise to any clinical significance.

Angina Pectoris↗
PubMedDate not supplied

Additional salutary hemodynamic effects of the combined use of the paraaortic counterpulsation device and intraaortic balloon pump versus a paraaortic counterpulsation device alone.

The hemodynamic effects of the combined use of the paraaortic counterpulsation device (PACD) (stroke volume 65 ml) implanted on the ascending aorta, and a 20 ml intraaortic balloon pump (IABP) placed in the descending aorta, were compared with the PACD working alone in 12 dogs after the induction of heart failure. Heart failure was characterized by left ventricular end-diastolic pressure (LVEDP) greater than 18 mmHg and systolic aortic pressure (SAP) in stage A: 116 mmHg greater than or equal to SAP greater than 70 mmHg; in stage B: 70 mmHg greater than or equal to SAP greater than 30 mmHg; and in stage C: SAP less than or equal to 30 mmHg. Both modalities of mechanical assistance produced significant salutary hemodynamic effects in stages A and B. No difference was observed in stage C. In conclusion, the combined use of PACD and IABP is more effective than the use of either of these devices alone. This modality of mechanical assistance may easily be applied in patients that cannot be weaned from extracorporeal circulation, and in whom IABP was unsuccessfully applied.

Animals↗