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Articles by H. E Botker
Total Records ( 3 ) for H. E Botker
  T Thim , M. K Hagensen , D Wallace Bradley , J. F Granada , G. L Kaluza , L Drouet , W. P Paaske , H. E Botker and E. Falk
  Background—

Intravascular ultrasound–derived virtual histology (VH IVUS) is used increasingly in clinical research to assess composition and vulnerability of coronary atherosclerotic lesions. However, the ability of VH IVUS to quantify individual plaque components, in particular the size of the destabilizing necrotic core, has never been validated. We tested for correlation between VH IVUS necrotic core size and necrotic core size by histology in porcine coronary arteries with human-like coronary disease.

Methods and Results—

In adult atherosclerosis-prone minipigs, 18 advanced coronary lesions were assessed by VH IVUS in vivo followed by postmortem microscopic examination (histology). We found no correlation between the size of the necrotic core determined by VH IVUS and histology. VH IVUS displayed necrotic cores in lesions lacking cores by histology.

Conclusions—

We found no correlation between necrotic core size determined by VH IVUS and real histology, questioning the ability of VH IVUS to detect rupture-prone plaques, so-called thin-cap fibroatheromas.

  K Munk , N. H Andersen , M. R Schmidt , S. S Nielsen , C. J Terkelsen , E Sloth , H. E Botker , T. T Nielsen and S. H. Poulsen
  Background—

We have found that remote ischemic conditioning (rIC), adjunctive to primary angioplasty, increases myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) and extensive myocardial area at risk (AAR). The present substudy aimed to evaluate the short-term effects of rIC on left ventricular (LV) function.

Methods and Results—

Patients with a first STEMI were randomized to rIC (4 cycles of 5 minutes upper-limb ischemia) during transfer to primary percutaneous coronary intervention (pPCI) (n=123) versus pPCI alone (n=119). Ejection fraction (EF), LV volumes, (2D and 3D echocardiography and myocardial perfusion imaging), and speckle-tracking global longitudinal strain were compared between treatment groups. There was no significant difference in LV function at day 1 (EF-2D, 0.51±0.10 versus 0.49±0.10; P=0.22) and after 30 days (EF-2D, 0.54±0.08 versus 0.53±0.10) between the rIC and the pPCI-alone groups. In patients with extensive AAR ≥35% of LV (n=53), EF after 30 days was higher after rIC than after pPCI alone (EF-2D, 0.51±0.07 versus 0.46±0.09; P=0.05). In patients with anterior infarction (n=97), rIC preserved LV function on day 1 (EF-2D, 0.51±0.11 versus 0.46±0.11; P=0.03) and persistently after 30 days (EF-2D, 0.55±0.08 versus 0.50±0.11; P=0.04; EF-myocardial perfusion imaging, 0.55±0.10 versus 0.49±0.12; P=0.02). These patients had similar AAR, whereas rIC reduced infarct size from 16% to 7% of LV (P=0.01).

Conclusions—

Although no significant overall effect was observed, rIC seemed to result in modest improvement in LV function in high-risk patients prone to develop large myocardial infarcts. These results need to be confirmed in larger trials.

Clinical Trial Registration—

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00435266.

  M Busk , A Kaltoft , S. S Nielsen , M Bottcher , M Rehling , L Thuesen , H. E Botker , J. F Lassen , E. H Christiansen , L. R Krusell , H. R Andersen , T. T Nielsen and S. D. Kristensen
  Aims

Primary angioplasty for ST-segment elevation myocardial infarction (STEMI) is recommended only if symptom duration is <12 h. We evaluated final infarct size (FIS) and myocardial salvage in early presenters (<12 h) vs. late presenters (12–72 h) undergoing primary angioplasty.

Methods and results

Myocardial perfusion imaging (MPI) was performed acutely to assess area at risk (AAR) before angioplasty and repeated after 30 days to assess FIS (% of LV myocardium), salvage index (% non-infarcted AAR), and left ventricular ejection fraction (LVEF). Late presenters (n = 55) compared with early presenters (n = 341) had larger median FIS [14% (inter-quartile range 3–30) vs. 7% (2–18), P = 0.005], lower salvage index [53% (27–89) vs. 69% (45–91), P = 0.05], and lower LVEF [48% (44–58%) vs. 53% (47–59), P = 0.04]. However, FIS, salvage index, and LVEF correlated weakly with symptom duration (R2-values <0.10). In patients with TIMI-flow 0 (n = 247), late presenters had lower salvage index than early presenters [44% (23–73) vs. 57% (42–86), P = 0.03], but substantial salvage (>50% of AAR) was observed in 41% of late presenters despite total infarct-artery occlusion.

Conclusion

FIS is larger in late presenters (>12 h) than early presenters after primary angioplasty for STEMI. However, substantial myocardial salvage can be obtained beyond the 12 h limit, even when the infarct-related artery is totally occluded.

 
 
 
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