PracticeUpdate: Cardiology - Winter 2018

EDITOR’S PICKS 11

Nitroglycerin Injection at the Radial Artery Puncture Site Reduces Occlusion After Transradial Coronary

Catheterization Circulation: Cardiovascular Interventions

Take-home message • In this randomized study of patients undergoing transradial coronary catheter- ization (n=188), the authors evaluated the efficacy of a subcutaneous injection of 0.5 mL 0.1% nitroglycerin at the radial artery puncture site for reducing risk of radial artery occlusion. In the nitroglycerin-treated group, the incidence of radial artery occlusion was significantly lower compared with the placebo group (5.4% vs 14.4%, respectively). • Dilating the radial artery with a subcutaneous nitroglycerin injection reduced the risk of post-catheterization artery occlusion. Abstract

Controlled Trial) trial. All patients had cardiac magnetic resonance imaging scans (including myocardial T1 time), serum B-type natriuretic peptide, 6-min walk tests, and Short Form- 36 questionnaires performed at baseline and 6 months. Sixteen patients with no history of AF or left ventricular systolic dysfunction were enrolled as normal controls for T1 time. RESULTS Thirty-six patients (18 in each treatment arm) were included in this substudy. Demograph- ics, comorbidities, and myocardial T1 times were well matched at baseline. At 6 months, patients in the CA group had a significant reduction in myocardial T1 time from baseline compared with the medical rate control group (−124 ms; 95% confidence interval [CI]: −23 to −225 ms; p = 0.0176), although it remained higher than that of normal controls at 6 months (p = 0.0017). Improvements in myocardial T1 time with CA were associated with significant improvements in absolute LVEF (+12.5%; 95% CI: 5.9% to 19.0%; p = 0.0004), left ventricular end-systolic volume (p = 0.0019), and serum B-type natriuretic pep- tide (−216 ng/l; 95% CI: −23 to −225 ng/l; p = 0.0125). CONCLUSIONS The improvement in LVEF and reverse ventricular remodeling following suc- cessful CA of AF-mediated cardiomyopathy is accompanied by a regression of diffuse fibrosis. This suggests timely treatment of arrhythmia-mediated cardiomyopathy may mini- mize irreversible ventricular remodeling. Regression of Diffuse Ventricular Fibrosis Following Restoration of Sinus Rhythm With Catheter Ablation in Patients With Atrial Fibril- lation and Systolic Dysfunction: A Substudy of the CAMERA MRI Trial. JACC Clin Electrophys- iol 2018 Jun 27;[EPub Ahead of Print], S Prabhu, may be able to reverse this process and enjoy improved function with successful CA… " " This study provides hope that even individuals with advanced LV fibrosis in the setting of AF

BACKGROUND Transradial coronary cathe- terization is widely used as a diagnostic or interventional procedure for coronary disease. However, it can lead to adverse complications, such as radial artery occlusion. We sought to determine whether preprocedural injection of nitroglycerin at the radial artery puncture site reduces radial artery occlusion.

" In the nitroglycerin-treated group, the incidence of

METHODS AND RESULTS A total of 188 patients undergoing transradial coronary catheteriza- tion were randomized in a single-blind fashion to receive subcutaneous injection of 0.5 mL 0.1% nitroglycerin or a placebo at the radial artery puncture site. The participants under- went ultrasound examinations of the radial artery before and at 24 hours after the pro- cedure. Of the 188 patients enrolled, 182 completed the study, as the procedure failed in 2 participants in the nitroglycerin-treated group and 4 in the placebo group. Baseline demo- graphic and clinical characteristics were similar between 2 groups. Comparing the radial artery diameters before and after the operation, there was a statistically significant increase in the nitroglycerin-treated group (2.48±0.45 ver- sus 2.45±0.46 mm; P=0.003) but a decrease in the placebo control group (2.41±0.50 ver- sus 2.46±0.49 mm; P<0.001). Importantly, the radial artery occlusion was significantly lower compared with the placebo group (5.4% vs 14.4%, respectively). "

incidence of radial arterial occlusion was sub- stantially lower in the nitroglycerin-treated group than in the placebo control group (5.4% versus 14.4%; P=0.04). There was not signifi- cant difference in other complications (forearm hematoma and radial artery pseudoaneurysm, respectively), and there was no incidence of cause hypotension or an intolerable headache. CONCLUSIONS Subcutaneous injection of nitroglycerin at the radial artery puncture site dilates the radial artery and reduces the incidence of early radial artery occlusion post-catheterization. Subcutaneous Injection of Nitroglycerin at the Radial Artery Puncture Site Reduces the Risk of Early Radial Artery Occlusion After Transra- dial Coronary Catheterization: A Randomized, Placebo-Controlled Clinical Trial. Circ Cardi- ovasc Interv 2018 Jul 01;11(7)e006571, Y Chen, Z Ke, J Xiao, et al. www.practiceupdate.com/c/70868

BT Costello, AJ Taylor, et al. www.practiceupdate.com/c/70274

VOL. 3 • NO. 3 • 2018