Study highlights:

• New software allows for 3-D images of the heart’s arteries during cardiac catheterization.
• Still in the testing phase, this technology may provide more information on the width and length of artery blockages, while exposing patients to less dye and radiation.

New technology that allows doctors to see three-dimensional images of heart arteries in the catheterization lab passed its first major testing hurdle — moving doctors closer to understanding its impact on clinical practice, researchers report in Circulation: Cardiovascular Interventions, an American Heart Association journal.

Still in the early stages of testing, the 3-D images may allow cardiologists to more accurately and quickly assess the length, branching pattern, and angles of heart arteries and any blockages.

“Coronary interventions may be improved by having a realistic, 3-D image of the coronary artery tree,” said John. D. Carroll, M.D., an investigator for the study and professor of medicine and director of interventional cardiology in the Division of Cardiology at the University of Colorado in Aurora, Colo.

Currently, doctors take multiple two-dimensional X-ray images from different views to visualize what the arteries look like inside the body. The new software, which uses existing X-ray systems, could reduce the need for multiple X-rays, thus decreasing patients’ exposure to radiation and contrast dye and cutting the time doctors spend analyzing the images.

During a cardiac catheterization procedure, doctors insert a thin tube called a catheter into a patient’s leg artery, then thread it up to the heart. The catheter is then used to inject contrast dye that temporarily fills the coronary arteries allowing x-ray visualization of the inner diameter of the artery. This allows doctors to detect plaque build up, then plan and execute, if needed, the insertion of a coronary stent to open a blocked artery and allow normal blood flow. X-rays are generated below the patient and 2-D shadow-like images of coronary arteries are created by a detector above the patient. These shadow images have been the standard method of presenting coronary angiographic images for over 50 years.

In the study, researchers compared these standard 2-D images to automatically generated, computer-reconstructed 3-D images of 23 patients’ coronary artery systems. To generate realistic 3-D images, the detector was rapidly rotated around the patient during the injection of contrast dye, a technique called rotational angiography.

“This is the first in-human use,” Carroll said about the feasibility study. “The next step is to test it in multiple centers around the world. In addition, we’ll formally test it to see the impact on clinical care. The bottom line is that this is very exciting technology that holds great promise.”

Co-authors are Anne M. Neubauer, Ph.D.; Joel A. Garcia, M.D.; John C. Messenger, M.D.; Eberhard Hansis, Ph.D.; Michael S. Kim, M.D.; Andrew J. P. Klein, M.D.; Gert A. F. Schoonenberg, M.S.; and Michael Grass, Ph.D.

Author disclosures are on the manuscript.

Philips Healthcare funded the study.

Newborns of women who smoked during pregnancy show signs of circulatory dysfunction in the first few weeks of life that get worse throughout the first year, Swedish researchers reported in Hypertension: Journal of the American Heart Association.


The blood pressure response to tilting the infants upright during sleep — a test of how the body copes with repositioning — was dramatically different in infants born to smoking mothers compared to those born to nonsmoking parents.

Infants not exposed to tobacco experienced only a 2 percent increase in blood pressure when they were tilted upright at one week of age and later a 10 percent increase in blood pressure at one year. Infants of smoking mothers had the reverse — a 10 percent increase in blood pressure during a tilt at one week and only a 4 percent increase at one year. At three months and one year, the heart rate response to tilting in the tobacco-exposed infants was abnormal and highly exaggerated, researchers reported.

“Babies of smokers have evidence of persistent problems in blood pressure regulation that start at birth and get worse over time,” said Gary Cohen, Ph.D., lead author of the study and senior research scientist in the Department of Women and Child Health at the Karolinska Institute in Stockholm, Sweden. “This study reveals for the first time that early life exposure to tobacco can lead to long-lasting reprogramming of infant blood pressure control mechanisms.”

The study included 19 infants of nonsmoking couples and 17 infants of women who smoked on average 15 cigarettes a day. Infants were normal weight at birth and breast fed. All infants had blood pressure and heart rates taken while sleeping and tilted up at a 60 degree angle during the first weeks, at three months and one year. They were then lowered back to the supine position.

Researchers also found:

• When tobacco-exposed babies were tilted semi-upright at one week, the rise in blood pressure was double that of controls, but at one year it had fallen dramatically and was only half that of age-matched controls. 
• Reversing the posture from upright to horizontal — similar to suddenly lying down — normally causes blood pressure to fall back to normal; however, in infants of smokers the maneuver resulted in a surge in blood pressure.
• When infants were sleeping undisturbed, diastolic blood pressure in the smoke-exposed infants was higher at three months and their heart rate was slower by 20 percent at one year than in infants born to nonsmoking parents.

Normally, when a person stands, the heart rate increases and the blood vessels constrict to keep blood flow to the heart and brain.

“Infants of smokers have a hyper-reactive system in the first weeks of life because the blood pressure increases too much when they are tilted up, but at one year they under-react and are less effective in adapting to an upright position,” Cohen said.

“Tobacco-exposed infants have a different profile,” Cohen said. “It’s surprising how early in life these functional abnormalities can be detected in the babies of smokers. The re-programming of the cardiovascular function is present at birth and is still present and even more dramatic at one year.”

The researchers plan to continue to follow these children further to determine whether this re-programming creates problems when they become older.

“The seeds of many diseases probably are sown very early in life,” Cohen said. “Babies of smokers may already be showing signs that they are more likely to develop high blood pressure later in life.”

Identifying early markers could have broad public health implications — possibly leading to diagnosing, treating and preventing cardiovascular disease earlier, he said.

A recent American Heart Association scientific statement provides specific guidance on limiting the consumption of added sugars and provides information about the relationship between excess sugar intake and metabolic abnormalities, adverse health conditions and shortfalls in essential nutrients. The statement, published in Circulation: Journal of the American Heart Association, for the first time, provides the association’s recommendations on specific levels and limits on the consumption of added sugars.

For more information, visit the American Heart Association page dedicated to carbohydrates and sugars at http://www.americanheart.org/nutrition/sugar

Added sugars are sugars and syrups added to foods during processing or preparation and sugars and syrups added at the table. High intake of added sugars, as opposed to naturally occurring sugars, is implicated in the rise in obesity. It’s also associated with increased risks for high blood pressure, high triglyceride levels, other risk factors for heart disease and stroke, and inflammation (a marker for heart disease), according to the statement’s lead author Rachel K. Johnson, Ph.D., M.P.H., R.D., associate provost and professor of nutrition at the University of Vermont in Burlington.

“Sugar has no nutritional value other than to provide calories,” Johnson said. “Consuming foods and beverages with excessive amounts of added sugars displaces more nutritious foods and beverages for many people.”

A report released today by the Institute of Medicine provides strong evidence that smoke-free laws reduce the risks of heart attacks and other acute cardiac events. Good news that AHA’s smoke-free laws are having an impact! Read more: http://bit.ly/4Ndll