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  1. Role of adrenergic receptors in human coronary vasomotion
    Autor*in: BARBATO, EMANUELE
    Erschienen: 2009

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  2. Drug-Eluting Stent Implantation. Technique Matters, More Than Ever**Editorials published in JACC: Cardiovascular Interventions reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Interventions or the American College of Cardiology
    Autor*in: De Bruyne, B ; BARBATO, EMANUELE
    Erschienen: 2008

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  3. Relation of Low Response to Clopidogrel Assessed With Point-of-Care Assay to Periprocedural Myonecrosis in Patients Undergoing Elective Coronary Stenting for Stable Angina Pectoris
    Autor*in: Cuisset, T ; Hamilos, M ; Sarma, J ; Sarno, G ; Wyffels, E ; Vanderheyden, M ; Bartunek, J ; De Bruyne, B ; Wijns, W. ; BARBATO, EMANUELE
    Erschienen: 2008

    Impaired responses to antiplatelet therapy assessed by laboratory tests are associated with an increased risk of recurrent ischemic events after percutaneous coronary intervention (PCI). This study was designed to determine the relation between... mehr

     

    Impaired responses to antiplatelet therapy assessed by laboratory tests are associated with an increased risk of recurrent ischemic events after percutaneous coronary intervention (PCI). This study was designed to determine the relation between responses to aspirin and clopidogrel as assessed by a point-of-care assay (Verify Now, Accumetrics, San Diego, California) and periprocedural myocardial infarction (PMI) in patients undergoing elective PCI for stable angina. One hundred twenty-two consecutive patients undergoing elective coronary stenting prospectively received aspirin 500 mg and clopidogrel 600 mg ≥12 hours before PCI. Clopidogrel response was measured with P2Y12 reaction units (PRUs) and percent inhibition P2Y12 from baseline (percent inhibition P2Y12) and aspirin response with aspirin reaction units (ARUs). Troponin T level was considered positive if it was >0.03 ng/ml. Responses to aspirin and clopidogrel were correlated (r = 0.42, p <0.0001). PMI occurred in 27 patients (22%) who showed significantly lower percent inhibition P2Y12 (25.3 ± 26 vs 38.3 ± 25, p = 0.01) and a trend toward higher PRU values (221 ± 87 vs 193 ± 94, p = 0.21). We did not find any difference for aspirin response as assessed by ARUs in patients with or without PMI (460 ± 82 vs 454 ± 73, p = 0.82). Stratification of percent inhibition P2Y12 isolated a quartile of clopidogrel nonresponders (inhibition P2Y12 <15%) with significantly higher incidence of PMI (44% vs 15%, odds ratio 4.6, 95% confidence interval 1.9 to 11.5, p = 0.001). In conclusion, point-of-care assessment of clopidogrel response reliably predicted PMI after low- to medium-risk elective PCI for stable angina. © 2008 Elsevier Inc. All rights reserved.

     
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  4. Assessment of renal flow and flow reserve in humans
    Autor*in: Manoharan, G ; Pijls, NHJ ; Lameire, N ; Verhamme, K ; Heyndrickx, GR ; Wijns, W ; Madaric, J ; Tielbeele, X ; Bartunek, J ; De Bruyne, B. ; BARBATO, EMANUELE
    Erschienen: 2006

    OBJECTIVES: The purpose of this work was to establish the normal range of maximal renal hyperemic response in humans and to identify the ideal renal vasodilatory stimuli. BACKGROUND: Stenotic renovascular atherosclerosis is increasingly treated by... mehr

     

    OBJECTIVES: The purpose of this work was to establish the normal range of maximal renal hyperemic response in humans and to identify the ideal renal vasodilatory stimuli. BACKGROUND: Stenotic renovascular atherosclerosis is increasingly treated by percutaneous transluminal renal intervention but with an unpredictable outcome. This may be due to hemodynamically non-significant stenosis or the presence of irreversible damage to the glomerular circulation. We propose that the renovascular hyperemic response may help identify appropriate patients. METHODS: In 28 normotensive patients, quantitative angiographic measurements of the renal artery were obtained, and renal artery pressure and flow velocity were continuously recorded after various hyperemic agents. RESULTS: In a first group of 11 patients, a significant increase in renal artery average peak velocity (APV) was observed after intrarenal (IR) bolus injection of 600 μg isosorbide dinitrate (41 ± 19%), 30 mg papaverine (50 ± 34%), 50 μg dopamine (94 ± 54%), 0.8 μg·kg-1 fenoldopam (80 ± 25%), and during IR infusion of 1 μg·kg-1·min-1 fenoldopam (86 ± 28%). A second group of 17 patients received intravenous infusion of dopamine (3, 5, 10, 20, 30, and 40 μg·kg -1·min-1). The 3 and 5 μg·kg -1·min-1 of dopamine modestly reduced renal resistance index (RI) (-13 ± 15% and -25 ± 20%, respectively). At higher dosages, no further decline in RI was observed. No significant change in vessel diameter was observed before and after the administration of the pharmacological stimuli suggesting that changes in APV corresponded with changes in absolute renal blood flow. CONCLUSIONS: The normal renal flow reserve averages approximately 2 in humans with normal renal function. An IR bolus injection of 50 μg·kg-1 of dopamine is the most convenient means to elicit maximal renal hyperemia. © 2006 by the American College of Cardiology Foundation.

     
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  5. Pressure-derived measurement of coronary flow reserve
    Autor*in: MacCarthy, P ; Berger, A ; Manoharan, G ; Bartunek, J ; Wijns, W ; Heyndrickx, GR ; Pijls NHJ ; De Bruyne, B. ; BARBATO, EMANUELE
    Erschienen: 2005

    We aimed to validate the technique of measuring the coronary flow reserve (CFR) with coronary pressure measurements against an established thermodilution technique. The CFR has traditionally required measurement of coronary blood flow velocity with... mehr

     

    We aimed to validate the technique of measuring the coronary flow reserve (CFR) with coronary pressure measurements against an established thermodilution technique. The CFR has traditionally required measurement of coronary blood flow velocity with the Doppler wire and, more recently, using a thermodilution technique with the coronary pressure wire. However, recent work has suggested that the CFR may be derived from pressure measurements alone (the ratio of the square root of the pressure drop across an epicardial stenosis during hyperemia to that value at rest). This depends on the assumption that friction losses across a coronary stenosis are negligible. We compared pressure-derived CFR values with those obtained by the thermodilution technique using the intracoronary pressure wire in 38 stenoses in 34 patients with significant coronary stenoses undergoing percutaneous intervention. We also compared these two techniques of measuring CFR in 25 stenoses (6 vessels) artificially created by inflating small balloons within a stented coronary artery after percutaneous intervention. There is a close linear relationship between pressure-derived and thermodilution CFR in native (r 2 = 0.52; p < 0.001) and artificial stenoses (r 2 = 0.54; p < 0.05), although the pressure-derived technique appears to systematically underestimate CFR values in both situations. This applies to native and artificial stenoses. Coronary flow reserve cannot be measured merely with pressure alone, and it cannot be safely assumed that friction losses are negligible across a native coronary stenosis. These data suggest that friction loss is an important determinant of the pressure gradient along an atherosclerotic coronary artery. © 2005 by the American College of Cardiology Foundation.

     
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