Coronary Artery Disease: Hillis LD

Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, Hundley WG, Manning WJ, Printz BF, Stuber M, Woodard PK. · No affiliation provided · Circulation. · Pubmed #18586979 links to  free full text

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Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, Hart JC, Herrmann HC, Hillis LD, Hutter AM, Lytle BW, Marlow RA, Nugent WC, Orszulak TA, Anonymous00214, Anonymous00215. · No affiliation provided · Circulation. · Pubmed #15466654 links to  free full text

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Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, Hart JC, Herrmann HC, Hillis LD, Hutter AM, Lytle BW, Marlow RA, Nugent WC, Orszulak TA, Antman EM, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Ornato JP, Anonymous00232, Anonymous00233, Anonymous00234. · No affiliation provided · J Am Coll Cardiol. · Pubmed #15337239 No free full text.

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Lange RA, Hillis LD. · No affiliation provided · N Engl J Med. · Pubmed #19228611 No free full text.

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Cigarroa JE, Hillis LD. · Department of Internal Medicine, Cardiovascular Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9030, USA. · Cardiol Clin. · Pubmed #16781942 No free full text.

Abstract: An ever-growing number of patients are being referred for coronary revascularization in an attempt to reduce morbidity or to reduce mortality. Multiple randomized trials comparing percutaneous and surgical coronary revascularization have been performed. The decision to proceed with percutaneous or surgical revascularization should be based ona thorough understanding of the short- and long-term risks and benefits of each procedure in conjunction with the individual patient's coronary arterial anatomy and clinical risk profile.

Trost JC, Hillis LD. · Department of Internal Medicine (Cardiology Division), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Am J Cardiol. · Pubmed #16635618 No free full text.

Abstract: Intra-aortic balloon counterpulsation (IABP) is sometimes used in critically ill patients with cardiac disease. By increasing diastolic arterial pressure and decreasing systolic pressure, it reduces left ventricular afterload. IABP may be beneficial in subjects with cardiogenic shock, mechanical complications of myocardial infarction, intractable ventricular arrhythmias, or advanced heart failure or those who undergo "high-risk" surgical or percutaneous revascularization, but the evidence to support its use in these patient groups is largely observational. Contraindications to IABP include severe peripheral vascular disease as well as aortic regurgitation, dissection, or aneurysm. The potential benefits of IABP must be weighed against its possible complications (bleeding, systemic thromboembolism, limb ischemia, and, rarely, death).

Rapp AH, Hillis LD. · Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75390-9047, USA. · Coron Artery Dis. · Pubmed #11811326 No free full text.

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Saland KE, Cigarroa JE, Lange RA, Hillis LD. · University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9047, USA. · Cardiol Rev. · Pubmed #11174891 No free full text.

Abstract: Rotational atherectomy is used most often to treat stenoses that are calcified, located at an arterial ostium or at the site of a bifurcation, or resulting from in-stent restenosis. The atherectomy device debulks soft and calcified plaque while minimizing injury to adjacent normal arterial segments. In a randomized comparison with excimer laser and balloon angioplasty, rotational atherectomy achieved a statistically higher procedural success rate without an increased incidence of major complications. Patients with lesions that were more complex derived the greatest benefit from rotational atherectomy. To date, rotational atherectomy usually is performed in conjunction with a) the intracoronary infusion of a "cocktail" containing verapamil, heparin, and nitroglycerin; b) the intravenous infusion of a glycoprotein IIb/IIIa receptor antagonist, such as abciximab; c) a stepped burr approach, leading to a burr:artery ratio of 0.8; d) burr rotations <30 seconds in duration; e) avoidance of burr deceleration; and f) low-pressure balloon angioplasty. Under these circumstances, it has a procedural success rate of 98% and a major complication rate of <2%.

Hillis LD, Cigarroa JE, Lange RA. · Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center, Dallas 75235-9047, USA. · Trans Am Clin Climatol Assoc. · Pubmed #10344010 links to  free full text

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Saland KE, Hillis LD, Lange RA, Cigarroa JE. · Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. · Am J Cardiol. · Pubmed #12356410 No free full text.

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Hundley WG, Hillis LD, Hamilton CA, Applegate RJ, Herrington DM, Clarke GD, Braden GA, Thomas MS, Lange RA, Peshock RM, Link KM. · Department of Internal Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA. · Circulation. · Pubmed #10821813 links to  free full text

Abstract: BACKGROUND: After successful percutaneous coronary arterial revascularization, 25% to 60% of subjects have restenosis, a recurrent coronary arterial narrowing at the site of the intervention. At present, restenosis is usually detected invasively with contrast coronary angiography. This study was performed to determine if phase-contrast MRI (PC-MRI) could be used to detect restenosis noninvasively in patients with recurrent chest pain after percutaneous revascularization. METHODS AND RESULTS: Seventeen patients (15 men, 2 women, age 36 to 77 years) with recurrent chest pain >3 months after successful percutaneous intervention underwent PC-MRI measurements of coronary artery flow reserve followed by assessments of stenosis severity with computer-assisted quantitative coronary angiography. The intervention was performed in the left anterior descending coronary artery in 15 patients, one of its diagonal branches in 2 patients, and the right coronary artery in 1 patient. A PC-MRI coronary flow reserve value </=2.0 was 100% and 82% sensitive and 89% and 100% specific for detecting a luminal diameter narrowing of >/=70% and >/=50%, respectively. CONCLUSIONS: Assessments of coronary flow reserve with PC-MRI can be used to identify flow-limiting stenoses (luminal diameter narrowings >70%) in patients with recurrent chest pain in the months after a successful percutaneous intervention.

Lee TH, Hillis LD, Nabel EG. · No affiliation provided · N Engl J Med. · Pubmed #19228613 No free full text.

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Arbab-Zadeh A, Levine BD, Trost JC, Lange RA, Keeley EC, Hillis LD, Cigarroa JE. · Cardiology Division, Johns Hopkins University, 600 N. Wolfe St/Blalock 524, Baltimore, MD 21287-0409, USA. · Cardiology. · Pubmed #19092242 No free full text.

Abstract: OBJECTIVES: To assess the influence of acute hypoxemia on the dimensions of diseased and nondiseased coronary arterial segments in humans. METHODS: In 18 subjects (age 53 +/- 8 years) with known or suspected coronary artery disease, quantitative coronary angiography was performed before and after being randomly assigned to breathing (1) an inspired oxygen concentration (fraction of inspired oxygen, FIO2) of 21% (room air, RA) for 20 min (n = 4, controls) or (2) an FIO2 of 15 and 10% for 10 min each (corresponding to altitudes of 2,500 and 5,500 m, respectively; n = 14). RESULTS: In the control subjects, no hemodynamic, oximetric or angiographic variable changed. In the 14 study subjects, the arterial partial pressure of oxygen averaged 85 +/- 13 mm Hg on RA, 65 +/- 15 mm Hg on 15% FIO2 and 44 +/- 13 mm Hg on 10% FIO2. Average arterial segment diameter was 2.52 +/- 0.63 mm on RA, 2.55 +/- 0.62 mm on 15% FIO2 (not significant vs. RA) and 2.66 +/- 0.66 mm on 10% FIO2 (p < 0.001 vs. RA). The increase in coronary arterial diameter with 10% FIO2 occurred only in normal segments (2.74 +/- 0.64 vs. 2.97 +/- 0.64 mm; p < 0.001), but not in diseased segments (2.34 +/- 0.57 vs. 2.38 +/- 0.55 mm; not significant). CONCLUSIONS: In humans, severe hypoxemia induces vasodilation of angiographically normal coronary arterial segments, whereas it causes no change in diseased segments.

Abrol R, Trost JC, Nguyen K, Cigarroa JE, Murphy SA, McGuire DK, Hillis LD, Keeley EC. · Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. · Am J Cardiol. · Pubmed #17134619 No free full text.

Abstract: Patients with left bundle branch block (LBBB) and concomitant coronary artery disease (CAD) have a worse prognosis than those with LBBB without CAD. In addition, subjects with CAD and concomitant LBBB have a higher cardiovascular mortality than those with a similar extent of CAD but without LBBB. Because the presence of LBBB makes the noninvasive identification of CAD problematic, patients with LBBB often are referred for coronary angiography to assess the presence and severity of CAD. To determine the clinical and demographic variables that might help identify those with CAD, we analyzed data from 336 consecutive patients with LBBB referred for coronary angiography. Of the 336, 54% had CAD. In conclusion, those with CAD were likely to be older, Caucasian, and men; they were more likely to have angina pectoris, myocardial infarction, and diabetes mellitus; and they were more likely to have a left ventricular ejection fraction <0.50. In contrast, patients with heart failure were less likely to have CAD.

Robinson CR, Martin JL, Zhang L, Canham RM, Abdullah SM, Cigarroa JE, Hillis LD, Murphy SA, McGuire DK, de Lemos JA, Keeley EC. · The Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. · Am J Cardiol. · Pubmed #16377273 No free full text.

Abstract: In patients who have ST-segment elevation myocardial infarction (STEMI), a patent infarct-related artery on the initial angiogram is associated with improved clinical outcomes, including decreased mortality. The present study assessed the influence of administering aspirin, beta blockers, statins, and angiotensin-converting enzyme inhibitors before STEMI on infarct-related artery patency. Our data demonstrate that patients who have STEMI and receive these medications on an outpatient basis before the event have a higher likelihood of having a patent infarct-related artery compared with patients who do not receive these medications. Further, our data demonstrate a graded association according to the number of such medications being administered: the likelihood of a patent infarct-related artery increased to >50% as the number of these medications increased.

Stauffenberg MT, Lange RA, Hillis LD, Cigarroa J, Hsu RM, Devaraj S, Jialal I. · Department of Pathology, The University of Texas Southwestern Medical Center at Dallas, USA. · Arch Pathol Lab Med. · Pubmed #15504061 No free full text.

Abstract: CONTEXT: Homocysteine is emerging as a novel marker of atherothrombosis. Its role as an independent risk factor for cardiovascular disease is generally accepted. There is scanty data correlating homocysteine levels measured by immunoassay with cardiovascular disease. We previously validated a fluorescence polarization immunoassay for measuring homocysteine, which compared favorably with high performance liquid chromatography. OBJECTIVE: To determine if homocysteine levels measured by immunoassay correlate with extent of atherosclerotic burden, as represented by degree of coronary artery stenosis determined by coronary angiography. DESIGN: Fasting plasma samples were obtained from patients undergoing coronary angiography (N = 165). Homocysteine levels were measured by immunoassay and coronary artery stenosis was determined by coronary angiography. RESULTS: Median coronary artery stenosis for the 3 homocysteine subgroups, less than 1.35, 1.35 to 6.75, and greater than 6.75 mg/L (<10, 10-15, and >15 micromol/L), was 75%, 90%, and 99%, respectively (P = .01 for trend). Also, folate and vitamin B12 levels decreased with increasing homocysteine levels (P = .01 and .04, respectively, for trend). Spearman's correlation showed a significant association between homocysteine level and coronary artery stenosis (r = 0.20; P = .009). When men and women were examined separately, the correlation was significant only for women (r = 0.30; P = .01). CONCLUSION: Homocysteine levels, as measured by immunoassay, show a positive correlation with cardiovascular disease in women. Thus, this is a valid measure of atherosclerotic burden and, therefore, a reliable addition to the established laboratory repertoire for the assessment of cardiovascular disease.

Nguyen K, Cigarroa JE, Lange RA, Hillis LD, Keeley EC. · Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8837, USA. · Am J Cardiol. · Pubmed #15165932 No free full text.

Abstract: Patients with coronary artery disease (CAD) and concomitant left bundle branch block have increased mortality compared with those with CAD but without left bundle branch block. We retrospectively analyzed the extent of CAD in 200 patients with left bundle branch block referred for coronary angiography. Only 13% had left main or 3-vessel CAD. These findings were irrespective of left ventricular (LV) function. Of the 65 patients with normal LV function, only 5 (8%) had left main or 3-vessel disease, and of the 135 patients with depressed LV function, only 21 (16%) had left main or 3-vessel disease.

Rapp AH, Hillis LD, Lange RA, Cigarroa JE. · Department of Internal Medicine (Cardiovascular Division), the University of Texas Southwestern Medical Center, Dallas 75390-9047, USA. · Am J Cardiol. · Pubmed #11356405 No free full text.

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Hundley WG, Hamilton CA, Clarke GD, Hillis LD, Herrington DM, Lange RA, Applegate RJ, Thomas MS, Payne J, Link KM, Peshock RM. · Department of Internal Medicine, The Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA. · Circulation. · Pubmed #10385498 links to  free full text

Abstract: BACKGROUND: Coronary artery bypass grafting improves survival in patients with >70% luminal diameter narrowing of the 3 major epicardial coronary arteries, particularly if there is involvement of the proximal portion of the left anterior descending (LAD) coronary artery. Measurement of coronary flow reserve can be used to identify functionally important luminal narrowing of the LAD artery. Although magnetic resonance imaging (MRI) has been used to visualize coronary arteries and to measure flow reserve noninvasively, the utility of MRI for detecting significant LAD stenoses is unknown. METHODS AND RESULTS: Thirty subjects (23 men, 7 women, age 36 to 77 years) underwent MRI visualization of the left main and LAD coronary arteries as well as measurement of flow in the proximal, middle, or distal LAD both at rest and after intravenous adenosine (140 microgram/kg per minute). Immediately thereafter, contrast coronary angiography and when feasible, intracoronary Doppler assessments of coronary flow reserve, were performed. There was a statistically significant correlation between MRI assessments of coronary flow reserve and (a) assessments of coronary arterial stenosis severity by quantitative coronary angiography and (b) invasive measurements of coronary flow reserve (P<0.0001 for both). In comparison to computer-assisted quantitative coronary angiography, the sensitivity and specificity of MRI for identifying a stenosis >70% in the distal left main or proximal/middle LAD arteries was 100% and 83%, respectively. CONCLUSIONS: Noninvasive MRI measures of coronary flow reserve correlated well with similar measures obtained with the use of intracoronary Doppler flow wires and predicted significant coronary stenoses (>70%) with a high degree of sensitivity and specificity. MRI-based measurement of coronary flow reserve may prove useful for identification of patients likely to obtain a survival benefit from coronary artery bypass grafting.