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C Richard Conti

Publications and source records attributed to C Richard Conti.

At least 37 records · Page 2Linked to original sources
PubMed2005

An update on enhanced external counterpulsation.

The development of advanced revascularization techniques has resulted in the growth of a subset of patients with coronary artery disease who are nonrevascularizable and are considered to have refractory angina. Enhanced external counterpulsation (EECP) has been developed for the management of these patients with chronic, refractory disease. Evidence has shown that through improvement of vascular endothelial function and recruitment of collateral vessels, EECP provides many clinical benefits. These patients experience sustained decreases in angina, improvement in exercise time, improved myocardial perfusion, and enhanced quality of life. Furthermore, EECP appears to be safe and effective in the treatment of angina in patients with impaired systolic function and has similar potential in patients with congestive heart failure.

Angina Pectoris↗
PubMed2005

Cardiovascular risk profiles around the world.

In summary, the world is in trouble, but simple lifestyle modifications and drugs available to modify risk can change the picture dramatically. Unfortunately, if obesity persists, as it seems to be doing in our young people, there may come a time when our children's children and their children die at an earlier age than their parents.

Adult↗
PubMed2005

One-stop cardiovascular diagnostic imaging (and radiation dose).

Kefer et al. indicate that "MSCT and MR are useful for the noninvasive detection of coronary artery stenoses on both a segmental and per vessel basis. Because neither technique is 100% accurate, these techniques are not ready yet to replace conventional coronary angiography." In summary, all things considered, a properly done cardiac catheterization with contrast angiography can really be a one-stop shop for diagnostic imaging and therapy of the cardiovascular system, and the radiation dose is acceptable.

Cardiac Catheterization↗
PubMed2005

Current Nonpharmacologic Management of Coronary Artery Disease: Focus on External Counterpulsation.

The basic principle of enhanced external counterpulsation (EECP) is diastolic augmentation of arterial pressure, lowering of systolic arterial pressure along with increasing venous return. EECP is a noninvasive procedure involving sequential inflation and rapid deflation of compressive cuffs wrapped around the patient's calves, thighs, and lower abdomen, timed to the cardiac cycle using the electrocardiogram. Theoretically, this should result in decreased myocardial oxygen demand and an increased coronary blood flow. Long-term benefits may be the result of the opening of dormant coronary collateral circulation, but this is theory and not proven. Extracardiac factors, such as peripheral arterial stiffness, endothelial dysfunction, and elevated myocardial oxygen demand, are also the therapeutic targets for EECP. There is some evidence that long-term benefits may be the result of a training effect due to 35 1-hour diastolic inflations at 300 mm Hg and systolic deflations of the compressive cuffs. To date, the extracardiac effects of EECP have received little attention and peripheral vascular adaptations to EECP have not been investigated. EECP, by promoting lower-extremity arterial "run-off" and intermittent reactive hyperemia in the legs with each inflation/deflation cycle of the compressive cuffs, may improve peripheral vascular function, thus inducing changes in peripheral vascular biology that will reduce ventricular work and myocardial oxygen demand in patients with coronary artery disease similar to that of exercise. At the University of Florida, this therapy is used for patients with chronic stable angina who are refractory to medical therapy and are not candidates for a revascularization procedure. The treatment does take time (35 once-a-day 1-hour treatments), and not all patients are candidates for the procedure. For example, patients with severe peripheral vascular disease, severe hypertension, thrombophlebitis, markedly irregular heart rhythm, and severe aorta insufficiency are excluded. Approximately 75% of patients report improvement (ie, a decrease in symptoms and an increase in exercise duration). Our results are such that this management strategy does deserve consideration in patients with persistent chronic stable angina on maximum medical therapy who are not candidates for revascularization and are unhappy with their lifestyle.

Journal Article↗
PubMed2005

The effects of enhanced external counterpulsation on myocardial perfusion in patients with stable angina: a multicenter radionuclide study.

BACKGROUND: Enhanced external counterpulsation (EECP) reduces angina and extends time to exercise-induced ischemia in patients with symptomatic coronary disease. One- and two-center studies and a retrospective case series reported that EECP improves myocardial perfusion in stable angina pectoris. We sought to critically evaluate and quantify the effect of EECP on myocardial perfusion. METHODS: In 6 US university hospitals, EECP was performed for 35 hours in patients with class II to IV angina who had exercise-induced myocardial ischemia. Symptom-limited quantitative gated technetium Tc 99m sestamibi single photon emission computed tomography exercise perfusion imaging was performed at baseline and 1 month post-EECP. Sestamibi was injected at the same heart rate in both stress tests. Single photon emission computed tomography images were read at a blinded core laboratory. RESULTS: Thirty-seven patients were enrolled, 34 of whom completed pre- and post-EECP stress testing. The mean age was 61 +/- 10 years, 81% were male, 78% had prior revascularization, and 68% had 3-vessel disease. The mean angina class decreased from 2.7 +/- 0.7 at baseline to 1.7 +/- 0.7 after EECP (P < .001). Exercise duration increased from 9.1 +/- 3.7 minutes at baseline to 10.2 +/- 3.6 minutes post-EECP (P = .03). The average percentage of tracer uptake, magnitude of reversibility, average thickening fraction, and the left ventricular ejection fraction remained unchanged after EECP. CONCLUSIONS: We confirm previous report that EECP reduces angina and improves exercise capacity. There were no significant changes in mean defect magnitude, amount of reversibility, thickening fraction, and ejection fraction measured using myocardial quantitative single photon emission computed tomography imaging when compared at identical pre- and post-EECP heart rates.

Angina Pectoris↗
PubMed2004

When should patients with chest pain be referred for coronary angiography?

When evaluating patients with possible coronary artery disease, it is necessary to combine physiologic assessment (measurements of ischemia) with anatomic pathologic assessment (coronary angiography). Coronary angiography currently is the only way to assess the anatomic pathology of the coronary circulation with precision. When it is combined with ventriculography and tests for myocardial ischemia, one can make clinical decisions related to the significance of the coronary artery disease observed. Common sense really demands that coronary angiography is only indicated when the information derived from this diagnostic procedure will facilitate therapeutic decisions in the individual patient.

Chest Pain↗