Impact of a high-fat meal on assessment of clopidogrel-induced platelet inhibition in healthy subjects.

BACKGROUND: Ideal conditions for platelet reactivity testing are critical for optimal selection of a P2Y12 inhibitor. Data are inconsistent regarding the impact of high-fat meals on test assessment. METHODS: Participants included 12 healthy subjects not taking antiplatelet drugs after a 12-hour fast. After baseline assessment, subjects were given a 600 mg dose of clopidogrel. Four hours later, maximum platelet inhibition was tested in the fasting state by light transmission aggregometry (LTA), VerifyNow P2Y12, vasodilator-stimulated phosphoprotein (VASP), and whole blood aggregometry (WBA). Subjects were then provided a high-fat meal, and platelet function was evaluated two hours later. Change in measured platelet aggregation by LTA was the primary endpoint of the study. The Wilcoxon Rank Sum test was used to compare the change in platelet reactivity between fasting and non-fasting conditions. The Spearman rho (ρ) correlation coefficient was used to evaluate the association between fasting platelet reactivity and the change following a high-fat meal. RESULTS: No significant change occurred in maximal light transmission, as assessed by LTA with 5 μM ADP (p = 0.15) and with 20 μM ADP (p = 0.07). There was a significant change in the area under the curve with 5 μM ADP (p = 0.03) but not with 20 μM ADP (p = 0.18). Although there was no significant change with the VerifyNow P2Y12 assay (p = 0.16), the change was correlated with the initial fasting value (Spearman\u27s rho p = 0.008). The VASP assay and WBA varied minimally. CONCLUSION: The high-fat meal did not significantly alter platelet function assessment of commonly used platelet function tests. Greater intra-subject variability existed for the optically-dependent compared with non-optically dependent tests. TRIAL REGISTRATION: NCT01307657

Effects of Partners Together in Health (PaTH) Intervention on Physical Activity and Healthy Eating Behaviors: A Pilot Study

Background—Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. Objective—The objective of this feasibility study was to test the Partners Together in Health (PaTH) Intervention versus usual care (UC) in improving physical activity and healthy eating behaviors in coronary artery bypass graft (CABG) surgery patients and spouses. Methods—An experimental, two-group (n = 17 couples/group), repeated measures design was used. CABG patients in both groups participated in Phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients. Spouses in the control group attended educational classes with patients. It was theorized that “two persons would be better than one” at making changes and sticking with them long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), 3-months (post-CR), and 6-months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. Results—The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and UC patients or spouses at 3 or 6 months in the number of minutes/week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥ 150 min/week at \u3e 3 METs). Conclusions—The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR

Effects of Partners Together in Health (PaTH) Intervention on Physical Activity and Healthy Eating Behaviors: A Pilot Study

Background—Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. Objective—The objective of this feasibility study was to test the Partners Together in Health (PaTH) Intervention versus usual care (UC) in improving physical activity and healthy eating behaviors in coronary artery bypass graft (CABG) surgery patients and spouses. Methods—An experimental, two-group (n = 17 couples/group), repeated measures design was used. CABG patients in both groups participated in Phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients. Spouses in the control group attended educational classes with patients. It was theorized that “two persons would be better than one” at making changes and sticking with them long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), 3-months (post-CR), and 6-months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. Results—The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and UC patients or spouses at 3 or 6 months in the number of minutes/week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥ 150 min/week at \u3e 3 METs). Conclusions—The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR

Intravascular ultrasound study of angiographically mildly diseased coronary arteries

AbstractObjectives. We hypothesized that intravascular ultrasound may identify significant coronary artery narrowing in the mildly diseases artery of patients with or one- or two-vessel coronary artery disease.Bacground. Necropsy studies have revealed that coronary angiography may underestimate stenosis severity in vessels that appear mildly diseased. Intravascular ultratound has been shown to detect atherosclerotic changs in a angiographically normal coronary arteries and to correlate better with histologic findings.Methods. In 20 patients, we performed intravascular ultrasound imaging (3.5F catheter, 30-MHz transducer) in 37 coronary arteries that were considered mildly diseased (<50% diameter narrowing) by qualitative angiography. The angiographic diagnosis was no significant coronary artery in eight patients, one-vessel disease to seven and two-vessel disease in five. Each vessel, except for the left main coronary artery, was divided into proximal, mid and distal segments. Percent area narrowing and minimal lumen diameter were subsequently quantified by both ultrasound and quantitative angiography.Results. Mean maximal arterial area narrowing by ultrasound in the 67 segments studied was 36 ± 20% (range 0% to 80.2%) and 19 ± 23% (range 0% to 82%) by quantitative angiography of these same (p < 0.001, paired ttest). Mean minimal lumen diameter of the segments was 3.3 ± 0.9 mm by ultrasound and 2.7 ± 0.8 mm by quantitative angiography. In 10 patients there were 19 angiographically mildly diseased segments where the percent arterial area narrowing by ultrasound was ≥50%. Intravascular ultrasound revealed that the more proximal (reference) segmnt had >25% intimal thickening in 12 of the 19 underestimated segments. In six stenosed segments (32%), total vessel area increased compared with that of the adjacent proximal vessel segment because of compensatory dilation.Conclusions. Intravascular ultrasound identified potentially significant coronary artery disease in vessels that appear to be only mildly diseased by angiography

Pneumopericarditis: A Case of Acute Chest Pain with ST Segment Elevation

Pneumopericarditis describes a clinical scenario where fluid and air are found within the pericardial space. Although infrequent, pneumopericarditis should be considered in patients presenting with acute chest pain as a differential diagnosis. This is relevant in patients with history of upper gastrointestinal (GI) surgery, as this may lead to a fistula communicating the GI tract and the pericardium. We report a 42-year-old man with history of numerous surgical interventions related to a Nissen fundoplication that presented with acute chest pain and inferior lead ST segment elevations. Emergent coronary angiography was negative for coronary vascular disease but fluoroscopy revealed air in the pericardial space. Subsequent radiographic studies helped confirm air in the pericardial space with a fistulous communication to the stomach. Ultimate treatment for this defect was surgical closure

Hemostatic Assessment of Patients Undergoing lntraaortic Balloon Pump Therapy

Patients undergoing intraaortic balloon pump (IABP) therapy are at risk for developing coagulopathies due to the adverse effects of prolonged exposure of the synthetic surface of the polyurethane balloon to blood components. Hemorrhagic risk has been attributed to a number of factors including thrombocytopenia, vascular injury, and/or platelet degranulation which increase the potential of receiving autogeneic blood transfusions. The present study is a prospective evaluation of coagulation using a viscoelastic monitor (Thrombelastograph- TEG) that measures functional aspects of clot development and stabilization in patients being treated with IABP therapy. Following Institutional Review Board approval, six patients undergoing IABP therapy for hemodynamic instability were enrolled in this study. Blood samples were taken prior to balloon insertion, at 8, 16, 24, 48, 72, and 96 hours on IABP therapy, and 24 hours following the removal of the balloon when applicable. Samples were incubated with heparinase to degrade heparin and TEG profiles were subsequently determined in duplicate. Measured parameters on the TEG included Rtime, K-time, maximum amplitude, alpha angle, and lysis at 30 and 60 minutes with calculation of the TEG index. Mortality was 33% following IABP discontinuation. Transfusion of packed red blood cells occurred in 50% of the patients during their balloon pump therapy. Patients demonstrated a significant deviance in fibrinolytic potential from pre-IABP lysis (1.6% ± 1.8) at both 24 hours (18.8% ± 22.9) and 48 hours (21.9% ± 28.5) of therapy (p<0.05) which returned to baseline shortly after balloon removal. Activation of coagulation factors appeared evident by a steadily increasing alpha angle from pre-IABP data (31.1 ± 9.2) throughout the duration of therapy and 24 hour recovery (53 ± 14; p<.005), and by a steadily trending increase in the TEG index pre-IABP (.251 ± 1.4) to post-IABP (2.6 ± 1.7; p<0.05). The results indicate that IABP therapy induces an increase in fibrinolytic potential at 24 to 48 hours of balloon pump therapy with a paradoxical trend toward increased coagulability, potentially predisposing the patient to hemorrhagic risk