Background: The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalizat...Background: The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalization for adults older than 65 years in the United States. Most available data on these patients are limited by patient selection criteria and study design of clinical trials and single- center studies. Methods: Participating hospitals identify patients with a primary or secondary discharge diagnosis of heart failure. Medical history, management, treatments, and health outcomes data are collected through review of medical records and entered into a database via secure web browser technology. Results: As of January 2004, data on 107 362 patients have been received from 282 participating hospitals. Of enrollees with available analyzable data(N=105 388 from 274 hospitals), the mean age was 72.4(± 14.0), and 52% were women. The most common comorbid conditions were hypertension(73% ), coronary artery disease(57% ), and diabetes(44% ). Evidence of mild or no impairment of systolic function was found in 46% of patients. Inhospital mortality was 4.0% and the median hospital length of stay was 4.3 days. Conclusions: The ADHERE demonstrates both the feasibility and significant implications of gathering representative data on large numbers of patients hospitalized with heart failure. Initial data provided important insights into the clinical characteristics and patterns of care of these patients. Ongoing registry work will provide the framework for improved treatment strategies for patients hospitalized with decompensated heart failure.展开更多
Experimental studies suggest that angiotensin-converting enzyme(ACE) inhibitors with high tissue affinity confer a greater degree of vascular renin-angiotensin system suppression than those with low tissue affinity de...Experimental studies suggest that angiotensin-converting enzyme(ACE) inhibitors with high tissue affinity confer a greater degree of vascular renin-angiotensin system suppression than those with low tissue affinity despite similar suppression of the circulating renin-angiotensin system. To test this hypothesis in a clinical setting, we randomized subjects with chronic heart failure to receive the low tissue affinity ACE inhibitor enalapril or the high tissue affinity ACE inhibitor trandolapril, and assessed the degree of circulating and vascular renin-angiotensin system suppression. Vascular renin-angiotensin system suppression was determined by measuring the pressor response to intravenous injections of angiotensin I. Circulating reninangiotensin system suppression was determined by measuring plasma angiotensin II. Vascular and circulating renin-angiotensin system suppression, endothelial function(flow-mediated vasodilation), and maximal exercise capacity(peak oxygen uptake) were assessed after a 4-week run-in period on open-label enalapril 40 mg/day and after 8 weeks of randomized double-blind treatment with enalapril 40 mg/day or trandolapril 4 mg/day. Twenty-six men and 4 women(mean age 52±11 years; mean left ventricular ejection fraction 25±9%; New York Heart Association class II[n=16] and III[n=14]) were studied. After a 2-month randomized treatment period, vascular renin-angiotensin system suppression, circulating renin-angiotensin system suppression, endothelial function, and exercise capacity did not differ between subjects treated with enalapril and those treated with trandolapril. Despite substantial differences in the tissue affinity of enalapril and trandolapril, the degree of vascular renin-angiotensin system suppression achievedwith these agents did not differ in subjects with chronic heart failure during long-term therapy.展开更多
Bifurcation coronary lesions are relatively frequent in today＇s interventional cardiology practice, averaging between 10%-15% of all interventions （PCIs）. Several percutaneous coronary problems inherent in the tre...Bifurcation coronary lesions are relatively frequent in today＇s interventional cardiology practice, averaging between 10%-15% of all interventions （PCIs）. Several percutaneous coronary problems inherent in the treatment of bifurcation lesions are periprocedural side branch （SB） compromise （composite of SB closure or appearance of significant ostial stenosis after main vessel （MV） stenting causing ischemia） frequently related to periprocedural myonecrosis,展开更多
The systemic nature of vascular atherosclerosis involves all vascular territories.. As interventional cardiologists, we are familiar with coronary artery bifurcation treatment. In other parts of the human body, the va...The systemic nature of vascular atherosclerosis involves all vascular territories.. As interventional cardiologists, we are familiar with coronary artery bifurcation treatment. In other parts of the human body, the vascular tree develops similar bifurcation in the carotid, renal, aortoiliac and tibio-peroneal segments. Even with some differences depending on specific vascular wall composition, the atherosclerotic process affects all such bifurcations in a similar way.展开更多
Atherosclerotic process has a predilection for .bifurcation due to the complex hemodynamics and resultant altered shear stress that contributes to the localization and progression of atheromatous plaques. Coronary int...Atherosclerotic process has a predilection for .bifurcation due to the complex hemodynamics and resultant altered shear stress that contributes to the localization and progression of atheromatous plaques. Coronary intervention, especially the placement of stents further alters the hemodynamics and shear forces. These factors may account for the increased incidences of in-stent restenosis, stent thrombosis, side-branch （SB） restenosis, etc, that continue to plague bifurcation intervention.展开更多
文摘Background: The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalization for adults older than 65 years in the United States. Most available data on these patients are limited by patient selection criteria and study design of clinical trials and single- center studies. Methods: Participating hospitals identify patients with a primary or secondary discharge diagnosis of heart failure. Medical history, management, treatments, and health outcomes data are collected through review of medical records and entered into a database via secure web browser technology. Results: As of January 2004, data on 107 362 patients have been received from 282 participating hospitals. Of enrollees with available analyzable data(N=105 388 from 274 hospitals), the mean age was 72.4(± 14.0), and 52% were women. The most common comorbid conditions were hypertension(73% ), coronary artery disease(57% ), and diabetes(44% ). Evidence of mild or no impairment of systolic function was found in 46% of patients. Inhospital mortality was 4.0% and the median hospital length of stay was 4.3 days. Conclusions: The ADHERE demonstrates both the feasibility and significant implications of gathering representative data on large numbers of patients hospitalized with heart failure. Initial data provided important insights into the clinical characteristics and patterns of care of these patients. Ongoing registry work will provide the framework for improved treatment strategies for patients hospitalized with decompensated heart failure.
文摘Experimental studies suggest that angiotensin-converting enzyme(ACE) inhibitors with high tissue affinity confer a greater degree of vascular renin-angiotensin system suppression than those with low tissue affinity despite similar suppression of the circulating renin-angiotensin system. To test this hypothesis in a clinical setting, we randomized subjects with chronic heart failure to receive the low tissue affinity ACE inhibitor enalapril or the high tissue affinity ACE inhibitor trandolapril, and assessed the degree of circulating and vascular renin-angiotensin system suppression. Vascular renin-angiotensin system suppression was determined by measuring the pressor response to intravenous injections of angiotensin I. Circulating reninangiotensin system suppression was determined by measuring plasma angiotensin II. Vascular and circulating renin-angiotensin system suppression, endothelial function(flow-mediated vasodilation), and maximal exercise capacity(peak oxygen uptake) were assessed after a 4-week run-in period on open-label enalapril 40 mg/day and after 8 weeks of randomized double-blind treatment with enalapril 40 mg/day or trandolapril 4 mg/day. Twenty-six men and 4 women(mean age 52±11 years; mean left ventricular ejection fraction 25±9%; New York Heart Association class II[n=16] and III[n=14]) were studied. After a 2-month randomized treatment period, vascular renin-angiotensin system suppression, circulating renin-angiotensin system suppression, endothelial function, and exercise capacity did not differ between subjects treated with enalapril and those treated with trandolapril. Despite substantial differences in the tissue affinity of enalapril and trandolapril, the degree of vascular renin-angiotensin system suppression achievedwith these agents did not differ in subjects with chronic heart failure during long-term therapy.
文摘Bifurcation coronary lesions are relatively frequent in today＇s interventional cardiology practice, averaging between 10%-15% of all interventions （PCIs）. Several percutaneous coronary problems inherent in the treatment of bifurcation lesions are periprocedural side branch （SB） compromise （composite of SB closure or appearance of significant ostial stenosis after main vessel （MV） stenting causing ischemia） frequently related to periprocedural myonecrosis,
文摘The systemic nature of vascular atherosclerosis involves all vascular territories.. As interventional cardiologists, we are familiar with coronary artery bifurcation treatment. In other parts of the human body, the vascular tree develops similar bifurcation in the carotid, renal, aortoiliac and tibio-peroneal segments. Even with some differences depending on specific vascular wall composition, the atherosclerotic process affects all such bifurcations in a similar way.
文摘Atherosclerotic process has a predilection for .bifurcation due to the complex hemodynamics and resultant altered shear stress that contributes to the localization and progression of atheromatous plaques. Coronary intervention, especially the placement of stents further alters the hemodynamics and shear forces. These factors may account for the increased incidences of in-stent restenosis, stent thrombosis, side-branch （SB） restenosis, etc, that continue to plague bifurcation intervention.
