A novel framework for fluid/structure interaction in rapid subjectspecific simulations of blood flow in coronary artery bifurcations

Background/Aim. Practical difficulties, particularly long model development time, have limited the types and applicability of computational fluid dynamics simulations in numerical modeling of blood flow in serial manner. In these simulations, the most revealing flow parameters are the endothelial shear stress distribution and oscillatory shear index. The aim of this study was analyze their role in the diagnosis of the occurrence and prognosis of plaque development in coronary artery bifurcations. Methods. We developed a novel modeling technique for rapid cardiovascular hemodynamic simulations taking into account interactions between fluid domain (blood) and solid domain (artery wall). Two numerical models that represent the observed subdomains of an arbitrary patient-specific coronary artery bifurcation were created using multi-slice computed tomography (MSCT) coronagraphy and ultrasound measurements of blood velocity. Coronary flow using an in-house finite element solver PAK-FS was solved. Results. Overall behavior of coronary artery bifurcation during one cardiac cycle is described by: velocity, pressure, endothelial shear stress, oscillatory shear index, stress in arterial wall and nodal displacements. The places where (a) endothelial shear stress is less than 1.5, and (b) oscillatory shear index is very small (close or equal to 0) are prone to plaque genesis. Conclusion. Finite element simulation of fluid-structure interaction was used to investigate patient-specific flow dynamics and wall mechanics at coronary artery bifurcations. Simulation model revealed that lateral walls of the main branch and lateral walls distal to the carina are exposed to low endothelial shear stress which is a predilection site for development of atherosclerosis. This conclusion is confirmed by the low values of oscillatory shear index in those places

Antimicrobial treatment of Erysipelatoclostridium ramosum invasive infections: a systematic review

The aim of this systematic review was to determine the causal role of Erysipelatoclostridium ramosum in specific invasive infections in humans, and to assess the clinical outcome of antibiotic therapy used to treat them. Several electronic databases were systematically searched for clinical trials, observational studies or individual cases on patients of any age and gender with a systemic inflammatory response syndrome (SIRS) due to E. ramosum isolated from body fluids or tissues in which it is not normally present. Only reports identifying E. ramosum as the only microorganism isolated from a patient with SIRS were included. This systematic review included 15 studies reporting 19 individual cases in which E. ramosum caused invasive infections in various tissues, mainly in immunocompromised patients. E. ramosum was most often isolated by blood cultures and identified by specific biochemical tests. Severe infections caused by E. ramosum were in most cases effectively treated with antibiotics, except in two patients, one of whom died. More than one isolate of E. ramosum exhibited 100% susceptibility to metronidazole, amoxicillin/clavulanate and piperacillin/tazobactam. On the other hand, individual resistance of this bacterium to penicillin, ciprofloxacin, clindamycin, imipenem and ertapenem was reported. This systematic review confirmed the clinical relevance of E. ramosum as a cause of a number of severe infections mainly in immunocompromised inpatients. Metronidazole and meropenem appear to be the antibiotics of choice that should be used in combination or as monotherapy to treat E. ramosum infections, depending on the type and severity of the infection

Coronary Microcirculation: The Next Frontier in the Management of STEMI

Although the widespread adoption of timely invasive reperfusion strategies over the last two decades has significantly improved the prognosis of patients with ST-segment elevation myocardial infarction (STEMI), up to half of patients after angiographically successful primary percutaneous coronary intervention (PCI) still have signs of inadequate reperfusion at the level of coronary microcirculation. This phenomenon, termed coronary microvascular dysfunction (CMD), has been associated with impaired prognosis. The aim of the present review is to describe the collected evidence on the occurrence of CMD following primary PCI, means of assessment and its association with the infarct size and clinical outcomes. Therefore, the practical role of invasive assessment of CMD in the catheterization laboratory, at the end of primary PCI, is emphasized, with an overview of available technologies including thermodilution- and Doppler-based methods, as well as recently developing functional coronary angiography. In this regard, we review the conceptual background and the prognostic value of coronary flow reserve (CFR), index of microcirculatory resistance (IMR), hyperemic microvascular resistance (HMR), pressure at zero flow (PzF) and angiography-derived IMR. Finally, the so-far investigated therapeutic strategies targeting coronary microcirculation after STEMI are revisited

Improved propensity-score matched long-term clinical outcomes in patients with successful percutaneous coronary interventions of coronary chronic total occlusion

© 2018, International Heart Journal Association. All rights reserved. The objective of the study was to evaluate major adverse cardiovascular events (MACE) after successful versus failed percutaneous coronary intervention for chronic total occlusion (PCI-CTO). Limited data are available on long-term clinical follow-up in the treatment of chronic total occlusion (CTO). Between January 2009 and December 2010 PCI-CTO was attempted in 283 consecutive patients with 289 CTO lesions. Procedural success was 62.3% and clinical follow-up covered 83% (235/283) of the study population with a median follow-up of 66 months (range, 59-74). The total incidence of MACE was 57/235 (24.3%), and was significantly higher in the procedural failure group than in the procedural success group (33/87 (37.9%) versus 24/148 (16.2%), P < 0.001). All-cause mortality was significantly lower in patients with successful PCI-CTO compared to failed PCI-CTO (10.8% versus 20.7%, P < 0.05). Also, the rate of cardiovascular death in the procedural failure group (14.9%) was slightly higher than that in the procedural success group (7.4%, P = 0.066). The rate of TVR was statistically higher in the procedural failure group (P < 0.009). Propensity score-adjusted Cox regression showed that procedural success remained a significant predictor of MACE (adjusted HR 0.402; 95% CI 0.196-0.824; P = 0.013). Our study emphasizes the importance of CTO recanalization in improving long-term outcome including all-cause mortality with a borderline effect on cardiovascular mortality