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Asfour I, Jbara M. Living on a Thread: A Case of Critical Left Main Coronary Artery Disease With an Unusual Presentation. Cureus 2022; 14:e26942. [PMID: 35989810 PMCID: PMC9380753 DOI: 10.7759/cureus.26942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
The left main disease is significant stenosis of the left coronary artery, which is responsible of supplying blood to a major portion of the left ventricle. In this report, we describe a unique case of critical left main disease with a special clinical presentation. A 66-year-old male with insignificant past medical history presented with dyspepsia. Patient presented twice to the emergency department seeking for help for his persistent complaint. During his second visit, patient was diagnosed with type one myocardial infarction and underwent coronary angiography which showed 90% stenosis in the left main coronary artery. Patient underwent successful coronary artery bypass grafting and was sent home. This case is a unique representation of type 1 myocardial infarction as the peak troponin I level does not correlate with the extent of the myocardium being jeopardized. A big portion of the heart is at risk of injury with the 90% stenosis found in this patient’s left main coronary artery, yet the peak troponin I level is minimum. This report provides a possible explanation of the discrepancy between the peak troponin I level and the extent of the myocardium being jeopardized and describes a common yet easily missed clinical presentation of acute coronary syndrome. Left main disease is a relatively uncommon presentation of acute coronary syndrome, with potentially serious detrimental consequences. Discrepancies do occur among patients of critical left main disease, and promptly diagnosing and managing is of great importance.
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Ta N, Wei HC, Li MM. Assessment of arteriosclerosis based on multiscale cross approximate entropy of human finger pulse wave. Technol Health Care 2022; 30:1359-1369. [DOI: 10.3233/thc-220040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Arteriosclerosis is one of the diseases that endanger human health. There is a large amount of information in pulse wave signals to reflect the degree of arteriosclerosis. OBJECTIVE: The degree of arteriosclerosis is assessed by analyzing pulse wave signal and calculating multi-scale entropy values. METHODS: A method based on the multiscale cross-approximate entropy of the pulse wave of the human finger is proposed to assess the degree of arteriosclerosis. A total of 86 subjects were divided into three groups. The data of 1000 pulse cycles were selected in the experiment, and the multiscale cross-approximate entropy was calculated for the climb time and pulse wave peak interval. Independent sample t-test analysis gives the small-scale cross-approximate entropy of the two time series of climb time and pulse wave peak interval as p< 0.001 in Groups 1 and 2. The large-scale cross-approximate entropy of the two time series of climb time and pulse wave peak interval is p< 0.017 in Groups 2 and 3. RESULTS: Using the proposed algorithm, the results showed that the small-scale cross-approximate entropy of climb time and pulse wave peak interval could reflect the degree of arteriosclerosis in the human body from the perspective of autonomic nerve function. The large-scale cross-approximate entropy of climb time and pulse wave peak interval confirmed the effect of diabetes on the degree of arteriosclerosis. CONCLUSIONS: The results demonstrate the multiscale cross-approximate entropy is a comprehensive index to evaluate the degree of human arteriosclerosis.
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Affiliation(s)
- Na Ta
- School of Electrical and Information Engineering, North Minzu University, Yinchuan, Ningxia, China
| | - Hai-Cheng Wei
- Basic Experimental Teaching and Engineering Training Center, North Minzu University, Yinchuan, Ningxia, China
| | - Miao-Miao Li
- School of Electrical and Information Engineering, North Minzu University, Yinchuan, Ningxia, China
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Senior R, Reynolds HR, Min JK, Berman DS, Picard MH, Chaitman BR, Shaw LJ, Page CB, Govindan SC, Lopez-Sendon J, Peteiro J, Wander GS, Drozdz J, Marin-Neto J, Selvanayagam JB, Newman JD, Thuaire C, Christopher J, Jang JJ, Kwong RY, Bangalore S, Stone GW, O’Brien SM, Boden WE, Maron DJ, Hochman JS. Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial. J Am Coll Cardiol 2022; 79:651-661. [PMID: 35177194 PMCID: PMC8875308 DOI: 10.1016/j.jacc.2021.11.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Detection of ≥50% diameter stenosis left main coronary artery disease (LMD) has prognostic and therapeutic implications. Noninvasive stress imaging or an exercise tolerance test (ETT) are the most common methods to detect obstructive coronary artery disease, though stress test markers of LMD remain ill-defined. OBJECTIVES The authors sought to identify markers of LMD as detected on coronary computed tomography angiography (CTA), using clinical and stress testing parameters. METHODS This was a post hoc analysis of ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), including randomized and nonrandomized participants who had locally determined moderate or severe ischemia on nonimaging ETT, stress nuclear myocardial perfusion imaging, or stress echocardiography followed by CTA to exclude LMD. Stress tests were read by core laboratories. Prior coronary artery bypass grafting was an exclusion. In a stepped multivariate model, the authors identified predictors of LMD, first without and then with stress testing parameters. RESULTS Among 5,146 participants (mean age 63 years, 74% male), 414 (8%) had LMD. Predictors of LMD were older age (P < 0.001), male sex (P < 0.01), absence of prior myocardial infarction (P < 0.009), transient ischemic dilation of the left ventricle on stress echocardiography (P = 0.05), magnitude of ST-segment depression on ETT (P = 0.004), and peak metabolic equivalents achieved on ETT (P = 0.001). The models were weakly predictive of LMD (C-index 0.643 and 0.684). CONCLUSIONS In patients with moderate or severe ischemia, clinical and stress testing parameters were weakly predictive of LMD on CTA. For most patients with moderate or severe ischemia, anatomical imaging is needed to rule out LMD. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
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Affiliation(s)
- Roxy Senior
- Northwick Park Hospital-Royal Brompton Hospital, London, United Kingdom.
| | | | | | | | - Michael H. Picard
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bernard R. Chaitman
- St Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St. Louis, MO, USA
| | | | | | | | | | - Jesus Peteiro
- CHUAC, Universidad de A Coruña, CIBER-CV, A Coruna, Spain
| | | | | | - Jose Marin-Neto
- Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | - James J. Jang
- Kaiser Permanente/ San Jose Medical Center, San Jose, CA, USA
| | | | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, NY, USA
| | - Gregg W. Stone
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Foundation, New York, NY, USA
| | | | - William E. Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - David J. Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Ullah H, Elakabawi K, Ke H, Ullah N, Ullah H, Shah SA, Khan HH, Khan MA, Guo N, Yuan Z. Predictors and 3-year outcomes of compromised left circumflex coronary artery after left main crossover stenting. Clin Cardiol 2021; 44:1377-1385. [PMID: 34269478 PMCID: PMC8495093 DOI: 10.1002/clc.23693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are few predictors of decreased fractional flow reserve (FFR) in the left circumflex coronary artery (LCx) after left main (LM) crossover stenting. OBJECTIVES We aimed to determine the predictors for low FFR at LCx and possible treatment strategies for compromised LCx, together with their long-term outcomes. METHODS Altogether, 563 patients who met the inclusion criteria were admitted to our hospital from February 2015 to November 2020 with significant distal LM bifurcation lesions. They underwent single-stent crossover percutaneous coronary intervention (PCI) under intravascular ultrasound (IVUS) guidance with further LCx intervention based on the measured FFR. RESULTS The patients showed significant angiographic LCx ostial affection post-LM stenting, but only 116 (20.6%) patients had FFR < 0.8. The three-year composite major adverse cardiac events (MACE) rates were comparable between the high and low FFR groups (16.8% vs. 15.5; p = 0.744). In a multivariate analysis, low FFR at the LCx was associated with post-stenting minimal luminal area (MLA) of LCx (odds ratio [OR]: 0.032, p < .001), post-stenting LCx plaque burden (OR: 1.166, p < .001), poststenting LM MLA (OR: 0.821, p = .038), and prestenting LCx MLA (OR: 0.371, p = .044). In the low FFR group, those with compromised LCx managed with drug-eluting balloon had the lowest three-year MACE rate (8.1%), as compared to either those undergoing kissing balloon inflation (KBI) (17.5%) or stenting (20.5%) (p = 0.299). CONCLUSION Unnecessary LCx interventions can be avoided with FFR-guided LCx intervention. Poststenting MLA and plaque burden of the LCx, and main vessel stent length are poststenting predictors of low FFR.
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Affiliation(s)
- Hameed Ullah
- Department of CardiologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Karim Elakabawi
- Department of CardiologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Department of CardiologyBenha UniversityEgypt
| | - Han Ke
- Department of CardiologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Najeeb Ullah
- Department of Data Science (FIT)University of MonashMolbourneAustralia
| | - Habib Ullah
- Department of CardiologyDow University of health sciencesKarachiPakistan
| | - Sardar Ali Shah
- Department of CardiologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | | | | | - Ning Guo
- Department of CardiologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Zuyi Yuan
- Department of CardiologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
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Nudi F, Nudi A, Neri G, Procaccini E, Schillaci O, Versaci F, Frati G, Biondi-Zoccai G. Myocardial perfusion imaging in patients with unprotected left main disease. Minerva Cardiol Angiol 2020; 69:485-490. [PMID: 32472987 DOI: 10.23736/s2724-5683.20.05180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The management of patients with unprotected left main (LM) coronary artery disease remains challenging, with recent data casting a shadow of doubt on the safety of percutaneous coronary intervention. We aimed at describing the features of patients undergoing myocardial perfusion imaging (MPI) subsequently found to have LM disease. METHODS We queried our institutional database for subjects without prior revascularization or myocardial infarction (MI), who had undergone MPI followed by invasive coronary angiography within 6 months, comparing those with evidence of angiographically significant LM disease (i.e. diameter stenosis ≥50%) to those without significant coronary artery disease (CAD), or those with CAD not involving LM. Baseline, stress and imaging features were systematically collected and analyzed, and clinical outcomes (death, myocardial infarction, revascularization) sought. RESULTS We included a total of 74 patients with LM disease, which were compared with 70 without CAD, and 920 with significant CAD not involving LM. MPI was remarkably safe in all subjects, and significant differences were found for several features, but particularly so for ST change, rate pressure product, and left ventricular ejection fraction (all P<0.05). Most patients with LM disease had moderate or severe ischemia, and the apical, lateral and inferior regions were the most sensitive ones. Clinical outcomes after an average of 35 months were worse in patients with LM disease than in subjects with significant CAD not involving LM, albeit non-significantly, possibly in light of the higher use of coronary artery bypass grafting. CONCLUSIONS MPI is safe and informative in patients with LM disease, and multidimensional appraisal of MPI results may guide decision-making on top of providing prognostic detail and warranty period.
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Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardiac Imaging, Madonna della Fiducia Clinic, Rome, Italy.,Replycare, Rome, Italy
| | - Alessandro Nudi
- Service of Hybrid Cardiac Imaging, Madonna della Fiducia Clinic, Rome, Italy
| | | | | | - Orazio Schillaci
- Institute of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Francesco Versaci
- UOC UTIC Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
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Aaty A, Al Fattah AA, Allam AH. Each Nuclear Cardiology lab should have its own lower limit of normal for functional parameters: True or False? J Nucl Cardiol 2018; 25:661-664. [PMID: 28236216 DOI: 10.1007/s12350-017-0830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Ahmed Aaty
- Cardiology, Alexandria University, Alexandria, Egypt
| | - Alia Abd Al Fattah
- Faculty of Medicine, Critical Care Medicine, Cairo University Kasr Alainy, Cairo, Egypt
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