| 1. |
- Ahmad, Yousif, et al.
(författare)
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Coronary Hemodynamics in Patients With Severe Aortic Stenosis and Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement : Implications for Clinical Indices of Coronary Stenosis Severity
- 2018
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Ingår i: JACC: Cardiovascular Interventions. - : Elsevier BV. - 1876-7605 .- 1936-8798. ; 11:20, s. 2019-2031
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In this study, a systematic analysis was conducted of phasic intracoronary pressure and flow velocity in patients with severe aortic stenosis (AS) and coronary artery disease, undergoing transcatheter aortic valve replacement (TAVR), to determine how AS affects: 1) phasic coronary flow; 2) hyperemic coronary flow; and 3) the most common clinically used indices of coronary stenosis severity, instantaneous wave-free ratio and fractional flow reserve.BACKGROUND: A significant proportion of patients with severe aortic stenosis (AS) have concomitant coronary artery disease. The effect of the valve on coronary pressure, flow, and the established invasive clinical indices of stenosis severity have not been studied.METHODS: Twenty-eight patients (30 lesions, 50.0% men, mean age 82.1 ± 6.5 years) with severe AS and coronary artery disease were included. Intracoronary pressure and flow assessments were performed at rest and during hyperemia immediately before and after TAVR.RESULTS: Flow during the wave-free period of diastole did not change post-TAVR (29.78 ± 14.9 cm/s vs. 30.81 ± 19.6 cm/s; p = 0.64). Whole-cycle hyperemic flow increased significantly post-TAVR (33.44 ± 13.4 cm/s pre-TAVR vs. 40.33 ± 17.4 cm/s post-TAVR; p = 0.006); this was secondary to significant increases in systolic hyperemic flow post-TAVR (27.67 ± 12.1 cm/s pre-TAVR vs. 34.15 ± 17.5 cm/s post-TAVR; p = 0.02). Instantaneous wave-free ratio values did not change post-TAVR (0.88 ± 0.09 pre-TAVR vs. 0.88 ± 0.09 post-TAVR; p = 0.73), whereas fractional flow reserve decreased significantly post-TAVR (0.87 ± 0.08 pre-TAVR vs. 0.85 ± 0.09 post-TAVR; p = 0.001).CONCLUSIONS: Systolic and hyperemic coronary flow increased significantly post-TAVR; consequently, hyperemic indices that include systole underestimated coronary stenosis severity in patients with severe AS. Flow during the wave-free period of diastole did not change post-TAVR, suggesting that indices calculated during this period are not vulnerable to the confounding effect of the stenotic aortic valve.
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| 2. |
- Ahmad, Yousif, et al.
(författare)
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Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses : A Multicenter Study Using Intracoronary Pressure and Flow
- 2019
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Ingår i: Circulation. Cardiovascular Interventions. - 1941-7632. ; 12:12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation. METHODS: Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2). RESULTS: Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71±1.4 mm Hg·cm·s-1 versus post-TAVI 3.04±1.6 mm Hg·cm·s-1 [P=0.03]). Microvascular reserve over the wave-free period of diastole significantly improved post-TAVI (pre-TAVI 1.88±1.0 versus post-TAVI 2.09±0.8 [P=0.003]); this was independent of the severity of the underlying coronary stenosis. The change in microvascular resistance post-TAVI was equivalent to that produced by stenting a coronary lesion with an instantaneous wave-free ratio of ≤0.74. CONCLUSIONS: TAVI improves microcirculatory function regardless of the severity of underlying coronary disease. TAVI for severe AS produces a coronary hemodynamic improvement equivalent to the hemodynamic benefit of stenting coronary stenoses with instantaneous wave-free ratio values <0.74. Future trials of physiology-guided revascularization in severe AS may consider using this value to guide treatment of concomitant coronary artery disease.
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| 3. |
- Harrington, Charlene, et al.
(författare)
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Marketization in Long-Term Care : A Cross-Country Comparison of Large For-Profit Nursing Home Chains
- 2017
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Ingår i: Health Services Insights. - : SAGE Publications. - 1178-6329. ; 10, s. 1-23
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Tidskriftsartikel (refereegranskat)abstract
- This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability.
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| 4. |
- Roy, Rupak, et al.
(författare)
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SN 2012aa : A transient between Type Ibc core-collapse and superluminous supernovae
- 2016
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Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 596
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Tidskriftsartikel (refereegranskat)abstract
- Context. Research on supernovae (SNe) over the past decade has confirmed that there is a distinct class of events which are much more luminous (by similar to 2 mag) than canonical core-collapse SNe (CCSNe). These events with visual peak magnitudes less than or similar to-21 are called superluminous SNe (SLSNe). The mechanism that powers the light curves of SLSNe is still not well understood. The proposed scenarios are circumstellar interaction, the emergence of a magnetar after core collapse, or disruption of a massive star through pair production. Aims. There are a few intermediate events which have luminosities between these two classes. They are important for constraining the nature of the progenitors of these two different populations and their environments and powering mechanisms. Here we study one such object, SN 2012aa. Methods. We observed and analysed the evolution of the luminous Type Ic SN 2012aa. The event was discovered by the Lick Observatory Supernova Search in an anonymous galaxy (z approximate to 0.08). The optical photometric and spectroscopic follow-up observations were conducted over a time span of about 120 days. Results. With an absolute V-band peak of similar to-20 mag, the SN is an intermediate-luminosity transient between regular SNe Ibc and SLSNe. SN 2012aa also exhibits an unusual secondary bump after the maximum in its light curve. For SN 2012aa, we interpret this as a manifestation of SN-shock interaction with the circumstellar medium (CSM). If we assume a Ni-56-powered ejecta, the quasi-bolometric light curve requires roughly 1.3 M-circle dot of Ni-56 and an ejected mass of similar to 14 M-circle dot. This also implies a high kinetic energy of the explosion, similar to 5.4 x 10(51) erg. On the other hand, the unusually broad light curve along with the secondary peak indicate the possibility of interaction with CSM. The third alternative is the presence of a central engine releasing spin energy that eventually powers the light curve over a long time. The host of SN 2012aa is a star-forming Sa/Sb/Sbc galaxy. Conclusions. Although the spectral properties of SN 2012aa and its velocity evolution are comparable to those of normal SNe Ibc, its broad light curve along with a large peak luminosity distinguish it from canonical CCSNe, suggesting that the event is an intermediate-luminosity transient between CCSNe and SLSNe at least in terms of peak luminosity. In comparison to other SNe, we argue that SN 2012aa belongs to a subclass where CSM interaction plays a significant role in powering the SN, at least during the initial stages of evolution.
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