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PubMed2005

Cerebral infarction: incidence and risk factors after diagnostic and interventional cardiac catheterization--prospective evaluation at diffusion-weighted MR imaging.

PURPOSE: To prospectively evaluate incidence of clinically silent and clinically apparent embolic cerebral infarction following diagnostic and interventional coronary angiography and associated risk factors. MATERIALS AND METHODS: Written informed consent was obtained from all patients, and the study was approved by the research ethics committee of University of Heidelberg, Germany. Fifty-two patients, including 37 men (mean age, 66.1 years +/- 11.9 [standard deviation]) and 15 women (mean age, 65.3 years +/- 10.3), undergoing elective cardiac catheterization were examined 3-26 hours (mean, 15.3 hours +/- 6) before and 12-48 hours (mean, 25.9 hours +/- 10.4) after cardiac catheterization. Magnetic resonance imaging protocol included isotropic and anisotropic diffusion-weighted single-shot echo-planar sequences. T2-weighted turbo spin-echo and T1-weighted spin-echo sequences also were performed. Apparent diffusion coefficient maps were calculated to exclude false-positive reading results on diffusion-weighted images because of T2 shine-through effect. Images were assessed by two experienced radiologists blinded to clinical data. Cardiac catheterization was performed by 11 experienced cardiologists to exclude operator-related risk. A neurologic examination according to the National Institutes of Health Stroke Scale and Barthel index was performed by a senior cardiologist before acquisition of each image. Sixteen clinical and angiographic variables were analyzed with univariate analysis for ability to predict occurrence of cerebral infarction. RESULTS: No embolic cerebral lesions could be detected at diffusion-weighted imaging before catheterization. After coronary angiography, seven (15%) of 48 patients demonstrated nine focal cerebral infarcts affecting anterior and posterior circulation. Patients remained asymptomatic. Of all tested variables, only duration of the procedure was identified as an independent predictor of occurrence of cerebral infarction (P < .05). CONCLUSION: In this prospective study, asymptomatic cerebral infarction following cardiac catheterization occurred in 15% of patients in whom duration of the procedure was significantly longer than in those without infarction (P = .017).

Aged↗
PubMed1993

Early ambulation following diagnostic 7-French cardiac catheterization: a prospective randomized trial.

There is a paucity of randomized studies concerning transfemoral cardiac catheterization and its complications, in particular that of 7F catheterization. Accordingly, we conducted a prospective, randomized trial comparing early ambulation (group A) 6 hr after diagnostic 7F cardiac catheterization versus late ambulation (group B) the following morning. A total of 273 patients were randomized in the study; 142 in group A and 131 in group B (NS). Except for a difference in the indications for catheterization, the baseline and procedure-related parameters were similar between the 2 groups. Early hematoma (formed within 6 hr) developed in 6 (4%) and 7 (5%) patients in groups A and B, respectively (NS). Similarly, there was no difference in the incidence of late hematoma formation (2% in each group). All hematomas detected were small and required no surgical intervention or extension of hospital stay. Our data showed that early ambulation following 7F left heart catheterization is feasible and safe. The access site complication rate is acceptably low and minor in nature.

Cardiac Catheterization↗
PubMed1992

Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization.

The purposes of this study were to determine the prevalence of angiographically significant renal artery stenosis in a patient population referred for diagnostic cardiac catheterization and to develop a model that predicts the highest-risk subset of patients who have significant renal artery narrowing. A prospective validation cohort study was undertaken in a referral-based university hospital. After left ventriculography, abdominal aortography was performed to screen for the presence of renal artery disease. A convenience sample of 1,302 of 1,651 consecutive patients undergoing diagnostic cardiac catheterization were enrolled in the study. Of the 1,302 abdominal aortograms performed, 1,235 (95%) were deemed of adequate quality for the evaluation of renal artery anatomy. Renal artery disease was identified in 30% of the patients. Insignificant renal artery stenosis was found in 187 (15%) and significant (greater than or equal to 50% diameter narrowing) stenosis was found in 188 (15%). Significant unilateral disease was present in 11%, and bilateral disease was present in 4%. By univariable and multivariable logistic regression analysis, the association of both clinically and catheterization-derived variables with renal artery disease was assessed. Multivariable predictors included age, severity of coronary artery disease, congestive heart failure, female gender, and peripheral vascular disease. Hypertension was not an associated variable. These data reveal the previously undetected high prevalence of renal artery disease in patients undergoing cardiac catheterization and provide clinical and angiographic features that assist in predicting its presence.

Aged↗
PubMed1993

[Evaluation of pulmonary arterial pressure by pulsed Doppler echocardiography compared with cardiac catheterization].

Twenty-six patients undergoing right cardiac catheterization were examined by pulsed doppler echocardiography (PDE), spectrum analysis of the shape of flow velocity curve of the pulmonary arteria during systole was made. Pulmonary arterial pressure (PAP) was qualitatively and qualitatively evaluated by right ventricular systolic time interval (RSTI) derived from pulmonary doppler blood flow velocity pattern. The correlation between PAP and the values of RSTI was evaluated, multiple stepwise regression analysis was performed. The pulmonary flow pattern and the values of RSTI measured from right ventricular outflow tract (RVOT) and main pulmonary artery (MPA) were compared. The results showed that: 1. Qualitative evaluation of PAP: (1) the triangular configuration of the pulmonary flow pattern was the feature of the pulmonary ejection flow in pulmonary hypertension (PH). (2) AT < 100ms AT/ET < 0.30 and PEP/AT > 1.1 indicated PH (PAMP > or = 2.7 kPa, AT < 100 ms, sensitivity 92.3%, specificity 100%). 2. Quantitative evaluation of PAP: (1) simple regression analysis: AT, AT/PEP especially AT showed a good inverse correlation with PAP, which was improved when a logarithmic function was applied, but not improved by the square root of heart rate. The liner regression equation and the correlation coefficient were: log PASP = -6.3617 AT +2.825 (r = -0.7925, P < 0.001); log PADP = -0.4569 AT +74.182 (r = -0.8513, P < 0.001); log PAMP = -0.0073 AT +2.198 (r = -0.8635, P < 0.001). (2) multiple stepwise regression analysis: the stepwise analysis of six parameters (PEP, ET, AT, AT/ET, AT/PEP, square root of R-R) showed that AT, PEP were the best parameters correlated with PAP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Multipolar endocardial mapping of the right atrium during cardiac catheterization: description of a new technique.

OBJECTIVES: Using a new mapping system that allows the simultaneous acquisition of data from 25 right atrial bipolar electrodes during cardiac catheterization, we mapped normal sinus rhythm and atrial reentrant tachycardia in 24 sheep (20 to 49 kg) and 7 pigs (25 to 35 kg). BACKGROUND: Rapid, high resolution mapping during cardiac catheterization may shorten ablation procedures and permit ablation of otherwise refractory arrhythmias. METHODS: A flexible, elliptic, basket-shaped recording catheter has five spokes, each with 10 electrodes arranged as 5 bipolar pairs. Catheter shape, electrode spacing and introduction technique were modified in response to the results of experiments in the first 23 animals. In the most recent eight animals, retraction of a string attached to the distal tip distended the basket, providing safe tissue contact. Filtered (30 to 250 Hz) bipolar recordings from all 25 electrode pairs, as well as a surface electrocardiogram, were recorded and digitized at 1,000 Hz using custom software. An activation map was digitally constructed and superimposed on anteroposterior and lateral fluoroscopic catheter images. Bipolar recordings were made in normal sinus rhythm (31 animals), with adequate signals recorded from > 95% of electrode pairs. Rapid burst pacing and intentional right atrial air embolus (30 to 50 ml) induced sustained atrial reentrant tachycardia in five animals, which was also adequately recorded. RESULTS: Catheter positioning and complete atrial mapping required < 10 min after venous access in the most recent eight experiments. The catheter was left in position for up to 4 h. Postmortem evaluation revealed minor superficial abrasion of the venae cavae or right atrial endocardium in six animals and moderate abrasion in two. No other damage was observed. CONCLUSIONS: This new system may ultimately assist in mapping simple or complex atrial arrhythmias during cardiac catheterization.

Animals↗
PubMed1997

[Treatment of femoral false aneurysms following cardiac catheterization with compression and color Doppler echocardiography monitoring].

PURPOSE: To evaluate the efficiency of a non-surgical treatment of the femoral false aneurysm following cardiac catheterization using the color Doppler echocardiography monitorization. METHODS: From August 1993 to October 1996, 17 patients were evaluated by the color Doppler echocardiography, 7 women and 10 men, between 58 and 77 years of age, with the diagnosis of femoral false aneurysms after cardiac catheterization. All the cases were selected for therapy with this new technique, that consisted of the compression of the false aneurysm with the transducer of the ultrasound device and monitorization of the evolution of the false aneurysm thrombosis, through image observation in real time, on the equipment monitor. RESULTS: There were 17 selected patients, 16 were successfully treated, requiring an average of 30 minutes of compression with consequent thrombosis of the false aneurysm, without recurrence in 30 days of follow-up. No complications with the use of this technique were noted and the hospitalization period was, on average, 1 day. CONCLUSION: This technique is efficient, safe and should be the first choice for the therapy of patients with femoral aneurysm following cardiac catheterization.

Aged↗
PubMed1989

The future looks bright for cardiac catheterization.

With heart disease the leading killer in the United States and all Western countries, cardiology continues to be one of the most important services a hospital can offer. Cardiac catheterization laboratories can be one of the top revenue-producing programs if a hospital offers a competitive, comprehensive program that attracts respected cardiologists. Cardiac catheterization remains the best diagnostic tool for cardiovascular disorders and an important therapeutic method for treating heart disease through procedures such as PTCA. If a hospital doesn't offer these services, it is losing patients to hospitals that do. Cardiac catheterizations laboratories are key to a hospital's success and will remain so for years to come.

Cardiac Care Facilities↗
PubMed1986

Comparison of Doppler-derived pressure gradient to that determined at cardiac catheterization in adults with aortic valve stenosis: implications for management.

Over a 1-year period cardiac catheterization was performed in 58 patients, mean age 66 years, who had elevated aortic blood flow velocity (more than 1.7 m/s) by continuous-wave Doppler echocardiography. Doppler echo signals were initially judged acceptable for quantitative analysis in 95% of patients, usually from the apical transducer position. Cardiac catheterization was performed within a mean of 8 days (60% within 1 day) of the Doppler echo study. The aortic valve mean pressure gradients at catheterization ranged from 0 to 93 mm Hg. The linear correlation coefficient (r value) between the mean pressure gradient determined by Doppler echocardiography and catheterization was 0.87. The correlation was maintained in 15 patients with aortic regurgitation (r = 0.91) and in 16 patients with significant coronary artery disease (r = 0.93). In the 16 patients with reduced cardiac output (mean 3.2 liters/min, range 2.2 to 3.9) the correlation was 0.81. A strategy for using the Doppler echo-calculated pressure gradient to manage patients with valvular aortic stenosis (AS) was derived by investigating the relation of the Doppler echo gradient to the aortic valve area in 35 patients with no aortic regurgitation detected at catheterization. All 12 patients with a Doppler echo mean gradient of less than 30 mm Hg had an aortic valve area of more than 0.75 cm2 and all 11 patients with a Doppler echo mean gradient of more than 50 mm Hg had an aortic valve area of less than 0.75 cm2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Cancer following cardiac catheterization in childhood.

BACKGROUND: Low-dose ionizing radiation is one of the definitive risk factors for cancer development. Nevertheless, only a few follow-up studies of children subjected to cardiac catheterization have been performed, yielding inconsistent results. METHODS: Our study group included 674 children who underwent cardiac catheterization due to congenital anomalies, between the years 1950-1970 in three major medical centres in Israel. A registered nurse conducted a review of the children's medical files in each hospital. Demographic data and vital status were ascertained from the Israeli National Registry, using a unique identity number. Subsequently, the study cohort was linked with the Israeli National Cancer Registry, in order to identify cancer cases that had been diagnosed through December 1996, the last follow-up date of the study. RESULTS: Over 75% of the study participants were native-born; 56.2% were males. Approximately 78% of the cohort subjects were alive at the end of follow-up; 28.6% of the participants underwent more than one procedure. All of the diagnosed cases occurred in males. Expected number of malignancies for all sites was 4.75, while the observed number was 11.0 (standardized incidence ratio [SIR] = 2. 3; 95% CI : 1.2-4.1). Of the 11 cancer cases, 4 lymphomas were observed (0.63 were expected, SIR = 6.3; 95% CI : 1.7-16.2). One of these was Hodgkin's Disease. There were also three cases of melanoma as opposed to 0.62 expected (SIR = 4.9; 95% CI : 1.0-14.2). CONCLUSIONS: This finding is compatible with current knowledge about the carcinogenic effect of low-dose irradiation but differs in the occurrence of an excess of lymphoma in the absence of an excess of leukaemia, which has not been reported before. The dissonance between males and females is yet to be resolved. IMPLICATIONS: Radiation doses that are used currently during cardiac catheterization are lower than in the past. Yet, the procedure is more common and frequently involves longer duration due to therapeutic interventions. The possible long-term results of such an exposure should be kept in mind.

Adolescent↗
PubMed1993

Prediction of cardiovascular death by means of clinical and exercise test variables in patients selected for cardiac catheterization.

The objective of this report is the development of a population-specific prediction rule based on clinical and exercise test data that would estimate the risk of cardiovascular death in patients selected for cardiac catheterization. Prospective data and follow-up information were obtained from patients who underwent cardiac catheterization soon after clinical assessment and exercise testing. Males (n = 588) referred for evaluation of coronary heart disease from 1984 to 1990 were selected after exclusion of patients with significant valvular heart disease and patients with prior cardiac surgery. Half had a prior myocardial infarction and half complained of typical angina pectoris. All patients performed a treadmill test and were selected for clinical reasons to undergo coronary angiography within 3 months. Over a mean follow-up period of 2.5 years (+/- 1.4 years), there were 39 cardiovascular deaths and 45 nonfatal myocardial infarctions. The Cox proportional hazards model demonstrated the following characteristics to be statistically significant independent predictors of time until cardiovascular death: history of congestive heart failure (hazards ratio of 4), ST depression on the resting ECG (hazards ratio of 3), and a drop in systolic blood pressure below the resting value during exercise (hazards ratio of 5). Exercise-induced ST depression was not associated with either death or nonfatal myocardial infarction. A simple score based on one item of clinical information (history of congestive heart failure), a resting ECG finding (ST depression), and an exercise test response (exertional hypotension) stratified our patients for 4 years after testing from 75% with a low risk (annual cardiac mortality rate of 1%), 17% with a moderate risk (annual mortality rate of 7%), and 1% with a high risk (annual cardiac mortality rate of 12%, with a hazards ratio of 20 and 95% confidence interval from 6 to 70X). It was concluded that the variables available from the usual noninvasive workup of patients with known or suspected coronary artery disease enable prediction of risk of cardiovascular death. Three quarters of those usually undergoing cardiac catheterization can be identified by simple noninvasive variables as being at such low risk that invasive intervention is unlikely to improve prognosis.

Aged↗
PubMed2004

[Prevalence of renal artery stenosis in patients undergoing cardiac catheterization: when should abdominal aortography be performed? Results in 467 patients].

PURPOSE: To define a subgroup of patients at increased risk of renal artery stenosis (RAS) in a population of patients undergoing cardiac catheterization. MATERIALS AND METHODS: A total of 467 patients (mean age of 64 Years +/-11) underwent cardiac catheterization and aortography Results were evaluated to detect correlations between the presence or absence of RAS and clinical and biological parameters. RESULTS: A total of 42 (9%) patients had a renal artery stenosis. Univariate analysis defined parameters correlated with the presence of RAS: systolic blood pressure (p=0.03), pulse pressure (p=0.005), age (p<0.0001), creatinine clearance (p<0.0001), 2-vessel (p=0.028) and 3-vessel (p=0.037) coronary artery diseases. Multivariate analysis showed that the presence of RAS correlated to creatinine clearance (p=0.02) and 2-vessel coronary artery disease. A creatinine clearance between 30 and 60 ml/min and multi-vessel coronary artery disease defined a subgroup at increased risk of RAS with sensitivity, specificity, positive and negative predictive values of: 47.6, 90.1, 32.3 and 94.6%. The prevalence of renal artery stenosis was 5.2% when both parameters were absent. CONCLUSION: Patients with mild renal insufficiency and multi-vessel coronary artery disease defined a subgroup of patients at increased risk of RAS (32.5%) that may benefit from abdominal aortography performed at the time of cardiac catheterization.

Aged↗
PubMed1982

Use of videotape in the preparation of children for cardiac catheterization.

To help children with congenital heart disease, and their parents, cope with the stress of hospitalization for cardiac catheterization, a videotape was developed entitled "Leonard Z. Lion Presents ... Learning About Your Heart Catheterization." Fifty-three patients with congenital heart disease, 3 to 12 years of age, were randomly assigned to experimental (N = 31) or control (N = 22) groups. Each viewed the catheterization videotape or an unrelated control videotape before cardiac catheterization. The child's knowledge, anxiety, and adjustment during and after hospitalization for catheterization were evaluated. The experimental group displayed a significantly greater knowledge of events and sensations experienced during hospitalization than controls (P less than .0001). Children in the experimental group tended to sleep more during the catheterization procedure (P = .05) and when awake to ask more questions (P = .02). After discharge, the experimental group also tended to demonstrate more independent behavior. We conclude that viewing this videotape on heart catheterization helped children with congenital heart disease to cope with the stress of hospitalization for the procedure.

Cardiac Catheterization↗
PubMed1998

Cerebral blood flow velocities monitored by transcranial Doppler during cardiac catheterizations in children.

Transcranial Doppler (TCD) was used to evaluate brain circulation during cardiac catheterizations in 32 children requiring pulmonary (n=10) or aortic balloon dilatations (n=2), ductus arteriosus coil insertions (n=5), or angiography (n=15). Cerebral blood flow velocity (CBFV) in the middle cerebral artery was measured before (baseline), during, and after each procedure (mean+/-95%ci). High-intensity transient signals (HITS) were also detected during these maneuvers. Balloon angioplasty decreased CBFV by 63+/-11% from baseline (P < 0.01). Shorter durations of the inflation cycle resulted in earlier CBFV recovery (r=0.78). During angiography, CBFV increased by 11+/-4% (P < 0.01) in all except one case that showed retrograde diastolic flow. Mean total HITS count was 44 (95%ci.limits: 27,74). These signals were more frequently found in septal defects or systemic arterial manipulations. Pediatric cardiac catheterization may impose transient fluctuations in brain perfusion as indicated by TCD, but their clinical implications are uncertain. CBFV changes during balloon angioplasty emphasize the importance of rapid inflation/deflation cycles. TCD can monitor such changes and evaluate preventive measures.

Adolescent↗
PubMed1993

Evaluation of two oximeters for use in cardiac catheterization laboratories.

We evaluated two whole-blood oximeters designed for use in the cardiac catheterization laboratory: the Oxicom 3000 and the AVOXimeter 1000. Unlike the larger CO-Oximeters, which hemolyze a blood sample before analysis, these simple instruments use disposable cuvettes to allow determination of oxyhemoglobin saturation of whole blood. Thus they eliminate the need for cleaning solutions and considerable maintenance. We evaluated the accuracy of these instruments in comparison with a Radiometer OSM3 and found them both to work well on routine samples. Of note, the AVOXimeter performed better than the Oxicom when the sample was hemolyzed and when green dye was present. In addition, the AVOXimeter measures the total hemoglobin concentration and the oxygen content of each sample, eliminating errors that hemodilution introduces into the determination of cardiac output by the Fick principle. We conclude that whole-blood oximeters are accurate and useful instruments for use in the cardiac catheterization laboratory.

Calibration↗
PubMed1991

Cardiac catheterization laboratories: should every hospital have one?

It is obvious that times have changed. Cardiac catheterization laboratories are everywhere. The concerns that must be addressed continually are: 1. Patient safety and quality of patient care. 2. Access to emergency hospitalization. 3. The overseeing of these laboratories. 4. Physician conflict of interest. 5. Need for the laboratory in the region In order to add a new cardiac catheterization laboratory to any region, patient need must be documented. Patient need is the only justification for the development of a new laboratory. I fail to understand how the continuing development of new laboratories will decrease costs, and am concerned that more catheterization laboratories will mean more studies of patients with borderline indications for the procedure.

Cardiac Catheterization↗
PubMed1990

Patient satisfaction with diagnostic cardiac catheterization: ambulatory vs. inpatient performance.

In a combined retrospective and historical cohort analysis, 72 patients at The Mount Sinai Hospital were studied to assess satisfaction with diagnostic cardiac catheterization and coronary arteriography performed as an ambulatory procedure (40 patients) and as an inpatient procedure (32 patients). A composite questionnaire designed to measure patient satisfaction was generated by the method of summed ranks, a common method of pooling aspects from several sources. Ten psychosocial dimensions of patient satisfaction were explored to determine if any difference existed between the ambulatory-patient population and the inpatient population. The ambulatory-patient group had a higher total mean satisfaction score than the inpatient group (4.01 vs. 3.60, p less than .001). Analysis of the specific dimensions showed that the ambulatory group had mean satisfaction scores higher than those of the inpatient group in convenience of procedure (4.12 vs. 3.13), continuity of care (3.83 vs. 3.42), technical quality (4.85 vs. 4.05), interpersonal aspects of communication (4.53 vs. 4.01), physical environment (4.14 vs. 3.18), and global satisfaction (4.71 vs. 4.25). These differences were statistically significant using the two-tailed t test (t greater than t.05,70 = 1.994). These data suggest that cardiac catheterization performed as an ambulatory procedure yields greater satisfaction than when performed as an inpatient procedure. This fact, in combination with prior published conclusions that ambulatory cardiac catheterization is more cost effective and has a statistically similar complication rate, supports the recommendation that this procedure be performed as an ambulatory procedure.

Adult↗
PubMed1975

Serum CPK isoenzymes after cardiac catheterization.

Exclusion of acute myocardial infarction preoperatively, particularly in patients undergoing cardiac catheterization, is an important requirement for optimal results following coronary revascularization. Unfortunately, activity of conventionally measured serum enzymes (AST, LDH, total CPK) is frequently raised because of enzyme released from non-cardiac sources during the catheterization procedure. however, serum activity of the MB CPK isoenzyme, an isoenzyme found primarily in heart muscle, appears to be more specific. Accordingly, in the present study, total CPK and MB CPK activities were determined in serum samples from 53 patients undergoing diagnostic catheterization, immediately before study and serially for 24 hours afterwards. A comprehensive range of catheterization procedures included selective coronary arteriography in 39 patients by brachial (17) or femoral (22) artery approaches. Myocardial infarction was excluded by clinical and electrocardiographic criteria in all patients before and after the procedure. MB CPK isoenzyme activity was also measured in serum samples from 50 patients with actue myocardial infarction documented electrocardiographically, and in 20 controls admitted to hospital but without cardiovascular disease. In patients with acute myocardial infarction, both total CPK and MB CPK isoenzyme levels were significantly raised (0.78 +/- 0.087 and 0.086 +/- 0.037 IU/ml, respectively), exceeding the upper limit of normal in all cases. MB CPK activity remained within normal limits (less than 0.004 IU/ml) in all 20 subjects without cardiovascular disease. Peak total serum CPK activity exceeded control levels in all patients undergoing catheterization (0.260 +/- 0.033). However, in each case, MB CPK isoenzyme activity remained within normal limits (less than .004). Thus, in contrast to an increase of activity of conventionally used serum enzymes, increased MB CPK isoenzyme activity is a reliable indicator of myocardial infarction, even in patients undergoing cardiac catheterization.

Adolescent↗