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Featuring expert guidance from Drs. James de Lemos and Torbjorn Omland, as well as other globally known leaders in cardiology, Chronic Coronary Artery Disease covers every aspect of managing and treating patients suffering from chronic coronary syndromes. This brand-new companion to Braunwald's Heart Disease was designed as a stand-alone reference for physicians treating patients who present with complex, unique challenges, offering the latest information on the use of imaging modalities in diagnosis and treatment, advances in interventional and surgical approaches to revascularization, new medications to improve symptoms and outcomes in chronic CAD, and much more. Relevant updates to the text are sourced regularly from the parent reference, Braunwald's Heart Disease and delivered on Expert Consult at no additional cost. These updates cover late-breaking clinical trials, reviews of important new articles, and the latest guidance on clinical practice, all selected and masterfully edited by Dr. Eugene Braunwald.

Coronary heart disease. --- Coronary Artery Disease

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Coronary Artery disease is one of the leading causes of death in industrialized countries and is responsible for one out of every six deaths in the United States. Remarkably, coronary artery disease is also largely preventable. The biggest challenge in the next years is to reduce the incidence of coronary artery disease worldwide. A complete knowledge of the mechanisms responsible for the development of ischaemic heart disease is an essential prerequisite to a better management of this pathology improving prevention and therapy. This book has been written with the intention of providing new concepts about coronary artery disease pathogenesis that may link various aspects of the disease, going beyond the traditional risk factors.

Coronary artery disease --- Imaging. --- Coronary arteries --- Radiography. --- Angiography --- Cardiovascular medicine

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Le respect de la compatibilité HLA en transplantation rénale est connu et appliqué depuis de nombreuses années. Il permet de diminuer l'incidence des différents rejets, aigus et chroniques, et de prolonger la survie des patients. En transplantation cardiaque en revanche, le respect de la compatibilité HLA donneur - receveur n'est pas effectué, ceci à cause du temps d'ischémie du greffon qui est trop court (4 heures). Un délai si court ne s'accorde pas avec la logistique pour permettre le typage H LA du greffon.Un nombre croissant d'études rétrospectives s'intéressent cependant à l'analyse de la compatibilité HLA en transplantation cardiaque. Cette étude fait de même en explorant les différents impacts du système HLA sur la survie à long terme des greffons cardiaques.Méthode : De 1985 à 2013, 453 transplantations cardiaques ont été réalisées aux cliniques universitaires de Saint Luc, chez 427 patients, et 26 retransplantations. Parmis ces transplantations, 289 ont répondu à nos critère de sélection, à savoir : une survie au­ delà de 30 jours et la disponibilité des informations concernant le typage HLA. Cette étude examine rétrospectivement la survie des patients, les rejets aigus, ainsi que les coronaropathies du greffon.Résultats : Nous avons trouvé une corrélation entre la compatibilité HLA-DR et l'incidence des rejets cellulaires. La survie moyenne exempte de rejet cellulaire 3a étant de 296 mois avec 0 à 1mismatch HLA-DR, contre 252 mois avec 2 mismatchs (p=0.047). De plus, le rejet cellulaire présent durant les premières années post transplantation, diminue significativement la survie des patients. Son impact ne se fait pas ressentir uniquement lors des premières années, mais au contraire se majore au fil du temps. Sa répercussion est maximale à 15 ans post transplantation. Le taux de survie à 15 ans est de 28.3% si présence de rejet cellulaire 3a la première année post transplantation contre, 59.3% sans rejet cellulaire.Les résultats concernant l'influence des anticorps anti-HLA au sein de notre cohorte sont épars et souvent non significatifs. Ceci est du à la faible représentation de certains sous­ groupes, notam ment les catégories avec anticorps « de novo » spécifiques aux donneurs.Conclusion : Les mésappariements HLA-DR augmentent l'incidence des rejets cellulaires. Les rejets cellulaires quant à eux diminuent la survie. Il est donc probable que la compatibilité HLA-DR influence la survie des patients.Quant aux anticorps anti-HLA, nous n'avons pas retrouvé d'influence globale sur la survie de patients . Ceci en raison d'un manque de recul et d'homogénéité dans la récolte et dans l'analyse des données HLA. Cependant d'autres études montrent un potentiel intérêt dans la mesure des anticorps anti HLA pour la détection précoce des rejets. HLA matching in kidney transplantation is well known and applied for years. It reduces the number and intensity of cellular rejection, both acute and chronic. It also increases the survival. However, in heart transplantation, HLA matching is not possible, because of the short ischemic time of the graft (4 hours). Such a short time does not allow the logistic to proceed these analyses. However, a growing number of studies is concerning with the HLA system and the resulting applications. This study explores the HLA domain and the impacts on long-term survival in heart transplantation.Method : From 1985 to 2013, 453 heart transplantations were performed in university hospital of Saint Luc, Bruxelles, Belgium. There were 26 retransplantations . Among these transplants, 289 met the criteria of survival beyond 30 days, whose information H LA typing were available. This study retrospectively examines patient survival, acute rejection: cellular and humoral, and cardiac allograft vasculopathy (CAV). Results : We found a correlation between the HLA-D R matching and cellular rejection. The mean freedom from cellular rejection survival is 296 months with 0 to 1HLA-DR mismatch, against 252 months with 2 mismatches (p = 0.047). In addition, the cellular rejection du ring the first years post transplantation significantly decreases the global survival of patients. The impact does not occur on the first years of survival, but increases with time. The maximum effect appears after 15 years. The percentage of survival after 15 years is 28.3% if there is at least 1cellular rejection grade 3a or more during the first year post transplantation, against 59.3% without rejection.The results on the influence of HLA antibodies in our cohort are scattered and usually not significant. This is due to the low representation of certain sub-groups, including groups presenting de novo donor specific antibodies (DSA).Conclusion : HLA-DR matching influences the incidence of cellular rejection, which in turn influences patient survival. We can extrapolate that HLA matching affects patient survival. As for H LA antibodies, we did not find an overall influence on the survival of patients. This is because of a lack of detachment and homogeneity in the collection and analysis of our data. However, other studies show a potential interest in measuring circulating antibodies for the early detection of rejection episodes.

HLA-A1 Antigen --- HLA-A2 Antigen --- Coronary Artery Disease --- Graft Survival

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Coronary Vessels --- Online Systems --- Coronary Angiography --- Coronary Disease --- Coronary Artery Disease --- ultrasonography --- radiography --- ultrasonography

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Tomography, X-Ray Computed --- Coronary Artery Disease --- Calcium --- Myocardium --- methods --- radiography --- metabolism --- pathology