Effect of Tai Chi on Cardiac Autonomic Function and Salivary Cortisol Level in Healthy Adults.

Introduction: An estimated 8.2 million American adults (1 in 3) have 1 or more types of cardiovascular disease. Heart rate variability (HRV) analysis is considered a non-invasive procedure for analyzing cardiovascular autonomic influence. Depressed HRV has been linked to stress and abnormal cardiovascular autonomic modulation. Purpose: This study evaluated the acute effects of tai chi on cardiac autonomic function and cortisol level in healthy adults. Design: 10 healthy adults, 7 females and 3 males, with an average age of 54 ± 2.04 were included in this study. They were asked not to consume any alcoholic or caffeinated beverages at least 24 hours before the study. Each subject practiced tai chi for 1 hour. HRV measurements were obtained at supine rest using Nexus biofeedback device before and after 10 min, 20 min and 30 min post tai chi exercise. Saliva samples were collected before tai chi and after 45 min post tai chi practice. Results: The cardiac autonomic function was assessed using frequency domain HRV analyses. Repeated measures ANOVA revealed that there is significant difference in means of HR, SDNN, nLF and nHF between the pre tai chi and post tai chi groups. Using student’s T-test, we found that the nHF increased significantly from 42.79 ± 4.12 to 52.82 ± 4.39 after 30 min post tai chi exercise (p<0.05). In contrast, nLF decreased significantly from 57.21 ± 4.12 to 52.82 ± 4.39 after 30 min post tai chi exercise (p<0.05). HR significantly decreased from 73 ± 2 to 67.79 ± 2.94 after 30 min post tai chi exercise. Also, SDNN increased significantly from 34 ± 5.26 to 41.38 ± 6.42 after 30 min post tai chi exercise. No significant changes in cortisol level were observed between pre tai chi and post tai chi groups. Conclusion: Tai chi exercise can modulate cardiac autonomic tone by enhancing the vagal activity and reducing the sympathetic activity. Long-term beneficial effects of tai chi on cardiac autonomic function need further investigation.Pratik KalsariaGeib, Roy WMoga, Margaret MWaite, GabiMaster of ScienceDepartment of BiologyCunningham Memorial library, Terre Haute,Indiana State UniversityILL-ETD-090MastersTitle from document title page. Document formatted into pages: contains 51 p.: ill. Includes abstract and appendi

Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

Background: Intravascular imaging can facilitate chronic total occlusion (CTO) percutaneous coronary intervention. Methods and Results: We examined the frequency of use and outcomes of intravascular imaging among 619 CTO percutaneous coronary interventions performed between 2012 and 2015 at 7 US centers. Mean age was 65.4±10 years and 85% of the patients were men. Intravascular imaging was used in 38%: intravascular ultrasound in 36%, optical coherence tomography in 3%, and both in 1.45%. Intravascular imaging was used for stent sizing (26.3%), stent optimization (38.0%), and CTO crossing (35.7%, antegrade in 27.9%, and retrograde in 7.8%). Intravascular imaging to facilitate crossing was used more frequently in lesions with proximal cap ambiguity (49% versus 26%, P<0.0001) and with retrograde as compared with antegrade‐only cases (67% versus 31%, P<0.0001). Despite higher complexity (Japanese CTO score: 2.86±1.19 versus 2.43±1.19, P=0.001), cases in which imaging was used for crossing had similar technical and procedural success (92.8% versus 89.6%, P=0.302 and 90.1% versus 88.3%, P=0.588, respectively) and similar incidence of major cardiac adverse events (2.7% versus 3.2%, P=0.772). Use of intravascular imaging was associated with longer procedure (192 minutes [interquartile range 130, 255] versus 131 minutes [90, 192], P<0.0001) and fluoroscopy (71 minutes [44, 93] versus 39 minutes [25, 69], P<0.0001) time. Conclusions: Intravascular imaging is frequently performed during CTO percutaneous coronary intervention both for crossing and for stent selection/optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO percutaneous coronary intervention. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436

Coronary artery spatial distribution of chronic total occlusions: Insights from a large US registry

ObjectiveTo assess the spatial distribution of chronic total occlusions (CTOs) within the coronary arteries and describe procedural strategies and outcomes during CTO percutaneous coronary intervention (PCI).BackgroundAcute occlusions due to plaque rupture tend to cluster within the proximal third of the coronary artery.MethodsWe examined the clinical and procedural characteristics of 1,348 patients according to lesion location within the coronary tree.ResultsA total of 1,369 lesions in 1,348 patients (mean age 66 ± 10 years, 85% male) were included. CTO PCI of proximal segments (n = 633, 46%) was more common than of mid (n = 557, 41%) and distal segments (n = 179, 13%). Patients undergoing CTO PCI of proximal segments were more likely to be smokers (P &lt; 0.01), have prior coronary artery bypass graft surgery (P = 0.03) and lower ejection fraction (P = 0.04). CTOs occurring in proximal segments had longer length (P &lt;0.01), proximal cap ambiguity (P &lt; 0.01), and moderate/severe calcification (P &lt; 0.01) compared to mid or distally located CTOs. Interventional collaterals were more often present in CTO PCI of proximal segments (64%, 53%, 56%, P &lt; 0.01) consistent with the higher use of retrograde approach (47%, 33%, 37%, P &lt; 0.01) relative to antegrade wire escalation (67%, 82%, 82%, P &lt; 0.01). Procedural complexity was higher in CTO PCI of proximal segments (vs. mid and distal): contrast volume= 275 ml (200-375), 260 ml (200-350), 250 ml (175-350), P = 0.01; fluoroscopy time 53 minutes (32-83), 39 minutes (24-65), 40 minutes (22-72), P &lt; 0.01. However, procedural success (87%, 90%, 85%, P = 0.1), technical success (89%, 91%, 88%, P = 0.24), and complications rates (2.8%, 2.5%, 2.2%, P = 0.88) were not different.ConclusionsThe most common target vessel location for CTO PCI is the proximal coronary segment. PCI of proximal occlusions is associated with adverse clinical and angiographic characteristics and often requires use of the retrograde approach, but can be accomplished with high procedural and technical success and low complication rates. © 2016 Wiley Periodicals, Inc

Impact of Calcium on Chronic Total Occlusion Percutaneous Coronary Interventions

We sought to examine the impact of calcific deposits on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The outcomes of 1,476 consecutive CTO PCIs performed in 1,453 patients (65.5 ± 10 years, 85% male) between 2012 and 2016 at 11 US centers were evaluated. Moderate or severe quantity of calcium was present in 58% of target lesions. Calcified lesions were more tortuous and more likely to have proximal cap ambiguity and interventional collaterals. PCI of moderately/severely calcified CTOs more often required use of the retrograde approach (54% vs 30%,

Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention

BACKGROUND: Various scoring systems have been developed to predict the technical outcome and procedural efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We examined the predictive capacity of 3 CTO PCI scores (Clinical and Lesion-related [CL], Multicenter CTO registry in Japan [J-CTO] and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO] scores) in 664 CTO PCIs performed between 2012 and 2016 at 13 US centers. RESULTS: Technical success was 88% and the retrograde approach was utilized in 41%. Mean CL, J-CTO and PROGRESS CTO scores were 3.9±1.9, 2.6±1.2 and 1.4±1.0, respectively. All scores were inversely associated with technical success (p CONCLUSIONS: CL, J-CTO and PROGRESS CTO scores perform moderately in predicting technical outcome of CTO PCI, with better performance for antegrade-only procedures. All scores correlate with procedure time and fluoroscopy dose, and the CL score also correlates with contrast utilization

Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry

BACKGROUND: We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres. RESULTS: Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and \u3e 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; P \u3c 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions. CONCLUSIONS: Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success