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Find video protocols related to scientific articles indexed in Pubmed.
Fractional flow reserve and the index of microvascular resistance in patients with acute coronary syndromes.
EuroIntervention
PUBLISHED: 09-27-2014
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The aim of this article is to review what is currently known about fractional flow reserve (FFR) and related coronary physiological indices in patients with acute coronary syndrome (ACS) including non-ST-elevation (NSTEMI) and ST-elevation myocardial infarction (STEMI) with a view to making recommendations for daily practice.
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Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial.
Eur. Heart J.
PUBLISHED: 09-01-2014
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We assessed the management and outcomes of non-ST segment elevation myocardial infarction (NSTEMI) patients randomly assigned to fractional flow reserve (FFR)-guided management or angiography-guided standard care.
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Multi-embolic ST-elevation Myocardial Infarction Secondary to Aortic Valve Endocarditis.
Heart Lung Circ
PUBLISHED: 08-06-2014
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We present the case of a 42 year-old woman admitted to hospital with ST-elevation myocardial infarction involving two separate coronary territories. Angiography revealed multi-embolic occlusions of her left anterior descending (LAD) and first obtuse marginal (OM1) coronary arteries. Transoesophageal echocardiogram (TOE) showed a lesion attached to the left cusp of the aortic valve and she was treated for infective endocarditis. We discuss the management issues raised from this unique patient, including reperfusion strategies in endocarditis-associated myocardial infarction.
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Adenosine: physiology, pharmacology, and clinical applications.
JACC Cardiovasc Interv
PUBLISHED: 02-10-2014
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Adenosine is a ubiquitous extracellular signaling molecule with essential functions in human physiology. Due to the widespread expression of adenosine receptors, it has far-reaching effects across many different organ systems. With a prominent role in the cardiovascular system, it has been extensively studied for both its therapeutic and diagnostic abilities. One of the key areas of use is in the coronary circulation whereby adenosine produces a hyperemic response. An important target of adenosine is the coronary microcirculation whereby adenosine acts as a prominent vasodilator with many of the beneficial effects of adenosine reflected in its capacity to affect the microvessels. Adenosine also has an important role in the pre-conditioned state and also in the attenuation of ischemia-reperfusion injury. This review examines the physiology, pharmacology, and therapeutic applications of adenosine in the human cardiovascular system and provides a brief overview of important aspects of the adenosine-cardiac interaction. It also examines the role of adenosine in the coronary hyperemic response and discusses the use of adenosine for this purpose. After recent concerns about the use of adenosine, a discussion regarding safety of this drug is provided. A brief review of novel agents used to initiate coronary hyperemia is also provided.
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A randomized trial of deferred stenting versus immediate stenting to prevent no- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI).
J. Am. Coll. Cardiol.
PUBLISHED: 01-31-2014
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The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
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Vasodilatory capacity of the coronary microcirculation is preserved in selected patients with non-ST-segment-elevation myocardial infarction.
Circ Cardiovasc Interv
PUBLISHED: 06-11-2013
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The use of fractional flow reserve in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) is a controversial issue. We undertook a study to assess the vasodilatory capacity of the coronary microcirculation in patients with NSTEMI when compared with a model of preserved microcirculation (stable angina [SA] cohort: culprit and nonculprit vessel) and acute microcirculatory dysfunction (ST-segment-elevation myocardial infarction [STEMI] cohort). We hypothesized that the vasodilatory response of the microcirculation would be preserved in NSTEMI.
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Fractional flow reserve versus angiography in guiding management to optimize outcomes in non-ST-elevation myocardial infarction (FAMOUS-NSTEMI): rationale and design of a randomized controlled clinical trial.
Am. Heart J.
PUBLISHED: 04-17-2013
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In patients with acute non-ST-elevation myocardial infarction (NSTEMI), coronary arteriography is usually recommended; but visual interpretation of the angiogram is subjective. We hypothesized that functional assessment of coronary stenosis severity with a pressure-sensitive guide wire (fractional flow reserve [FFR]) would have additive diagnostic, clinical, and health economic utility as compared with angiography-guided standard care.
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The resting status of the coronary microcirculation is a predictor of microcirculatory function following elective PCI for stable angina.
Int. J. Cardiol.
PUBLISHED: 03-26-2013
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We performed a prospective study to investigate markers of percutaneous coronary intervention (PCI) related microvascular injury.
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Calculation of the index of microcirculatory resistance without coronary wedge pressure measurement in the presence of epicardial stenosis.
JACC Cardiovasc Interv
PUBLISHED: 01-26-2013
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This study sought to investigate a novel method to calculate the index of microcirculatory resistance (IMR) in the presence of significant epicardial stenosis without the need for balloon dilation to measure the coronary wedge pressure (P(w)).
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Focused clinical review: periprocedural management of antiplatelet therapy in patients with coronary stents.
Heart Lung Circ
PUBLISHED: 02-25-2011
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Coronary stent implantation, particularly drug eluting stents, is now the major method of coronary revascularisation. Following drug-eluting stent implantation dual antiplatelet therapy with aspirin and thienopyridine is recommended for at least 12 months. Premature discontinuation, often at the time of noncardiac surgery, has been associated with stent thrombosis which has a significant risk of death and myocardial infarction. Late (>30 days) and very late (>365 days) stent thrombosis appears to more common with DES and poses the questions of when is it safe to stop antiplatelet therapy post coronary stenting and how to manage patients who need non-cardiac surgery. This article reviews the evidence for stent thrombosis and the peri-operative management of patients with coronary stents and provides an algorithm for patient management based on multidisciplinary assessment of bleeding risk, perioperative cardiac event and stent thrombosis risk.
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Looks can be deceiving: dissociation between angiographic severity and hemodynamic significance of a lesion. The importance of microvascular resistance.
Cardiovasc Revasc Med
PUBLISHED: 10-11-2010
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We present a case of an intermediate right coronary artery lesion with a fractional flow reserve (FFR) of 0.93 despite a myocardial perfusion scan demonstrating reversible ischemia in the inferior wall. An assessment of microvascular resistance was performed using the index of microcirculatory resistance (IMR). This was consistent with elevated resistance and may explain the discordance between the high FFR result, the positive perfusion study, and the lesion appearance on angiography. FFR assumes stable and minimal resistance at hyperemia; however, there may be situations where this does not occur, contributing to discrepant values. An understanding of the underlying physiological principles that underpin FFR is required for all physicians using this increasingly utilized technique.
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Percutaneous management of aortic stenosis in high-risk patients.
Med. J. Aust.
PUBLISHED: 05-05-2010
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As the population ages, the prevalence of aortic stenosis is increasing. There is an unmet clinical need for the treatment of aortic stenosis in high-risk patients, who are often older, frail and have multiple comorbidities. Percutaneous aortic valve replacement (PAVR) is a new and innovative technique for the management of high-risk patients with aortic stenosis. There are currently two devices under evaluation in clinical trials in Australia: the CoreValve ReValving System and the Edwards SAPIEN valve. These devices are generally deployed retrogradely, mainly transfemorally or via the subclavian artery or, less commonly, transapically. Initial experience has been encouraging, with good short-term outcomes. However, there is a lack of long-term data. PAVR is presently only advocated for high-risk older patients with symptomatic aortic stenosis. Where PAVR lies in the treatment algorithm for aortic stenosis will be determined by randomised controlled trials, but for now it offers a genuine treatment alternative for high-risk patients.
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Clozapine-induced cardiotoxicity: a clinical update.
Med. J. Aust.
PUBLISHED: 02-18-2009
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Clozapine is a valuable drug for patients with treatment-resistant schizophrenia. Myocarditis is the most publicised cardiac complication of clozapine treatment, but cardiomyopathy and pericarditis have also been reported. Myocarditis has heterogeneous and non-specific presenting features, making it difficult to identify patients with clozapine-related myocarditis clinically. A high index of suspicion is required. The gold standard for diagnosis of myocarditis is an endomyocardial biopsy, but this is not a practical initial approach. Transthoracic echocardiography is a valuable, reproducible and widely available tool to assist in diagnosis of clozapine-induced cardiotoxicity. The level of B-type natriuretic peptide, a hormone secreted in response to ventricular wall stress, may be useful for evaluating patients with clozapine-induced cardiac dysfunction and may in the future be useful for screening asymptomatic patients. The mainstay of treatment of clozapine-induced cardiotoxicity is cessation of clozapine and provision of supportive care.
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Extremely late drug-eluting stent thrombosis: 2037 days after deployment.
Cardiovasc Revasc Med
PUBLISHED: 01-23-2009
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Thrombosis of drug eluting stents has been documented up to four years after stent implantation, often in the setting of cessation of antiplatelet therapy. We present a case of drug-eluting stent thrombosis, 2037 days after initial implantation, which we believe is the latest reported case. Late stent thrombosis remains a rare but catastrophic complication of coronary intervention. We hypothesize that the procoagulant milieu of surgery, coupled with cessation of one or both antiplatelet agents preoperatively, compounds the risk of perioperative stent thrombosis.
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The role of cardiac magnetic resonance imaging (MRI) in acute myocardial infarction (AMI).
Heart Lung Circ
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Acute myocardial infarction (AMI) is a leading cause of mortality and morbidity in the world, despite the rate having significantly declined over the past decade. The aim of this review is to consider the emerging diagnostic and clinical utility of cardiac MRI in patients with recent AMI. Cardiac MRI has high reproducibility and accuracy, allowing detailed functional assessment and characterisation of myocardial tissue. In addition to traditional measures including infarct size (IS), transmural extent of necrosis and microvascular obstruction (MVO), other infarct characteristics can now be identified using innovative MRI techniques. These novel pathologies include myocardial oedema and myocardial haemorrhage which also have functional and prognostic implications for patients. In addition to its diagnostic utility in ordinary clinical practice, cardiac MRI has been increasingly used to provide information on surrogate outcome measures, such as left ventricular ejection fraction (LVEF) and volumes, in clinical trials. MRI is becoming more available in secondary care, however, the potential clinical utility and cost effectiveness of MRI in post-MI patients remains uncertain. Cardiac MRI is most likely to be useful in high risk patients with risk factors for heart failure (HF). This includes individuals with early signs of pump failure and risk factors for adverse remodelling, such as MVO. This review focuses on the role of cardiac MRI in the assessment of patients with AMI.
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Novel method of rescuing kinked guide catheter from axillary artery in transradial coronary intervention: the balloon retrieval technique.
J Invasive Cardiol
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This case illustrates a novel and innovative method of retrieving a kinked guiding catheter in transradial intervention without the need for vascular snare.
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The index of microvascular resistance identifies patients with periprocedural myocardial infarction in elective percutaneous coronary intervention.
Heart
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This study was designed to assess whether measurement of the index of microvascular resistance (IMR) could help prospectively identify patients who develop periprocedural myocardial infarction (PPMI).
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Impact of right atrial pressure on decision-making using fractional flow reserve (FFR) in elective percutaneous intervention.
Int. J. Cardiol.
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We undertook a prospective study to assess the impact of routine incorporation of right atrial pressure into the calculation of FFR in a real world elective PCI cohort.
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When collateral supply is accounted for epicardial stenosis does not increase microvascular resistance.
Circ Cardiovasc Interv
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The relationship between epicardial stenosis and microvascular resistance remains controversial. Exploring the relationship is critical, as many tools used in interventional cardiology imply minimal and constant resistance. However, variable collateralization may impact well on these measures. We hypothesized that when collateral supply was accounted for, microvascular resistance would be independent of epicardial stenosis.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.