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Rapid Formation of an Infected Coronary Artery Aneurysm With Stent Fracture. JACC Case Rep 2023; 6:101660. [PMID: 36704063 PMCID: PMC9871074 DOI: 10.1016/j.jaccas.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/29/2022] [Indexed: 06/18/2023]
Abstract
Infected coronary artery aneurysm (ICAA) is a rare but fatal disease. We describe a case of rapid formation of ICAA with fracture of an intracoronary stent observed on coronary angiography and cardiac computed tomography. Surgery with resection of the aneurysm and coronary artery bypass grafting was performed successfully. (Level of Difficulty: Intermediate.).
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Ictal chest discomfort in a patient with temporal lobe seizures and amygdala enlargement. Epilepsy Behav Rep 2022; 21:100578. [PMID: 36606273 PMCID: PMC9807991 DOI: 10.1016/j.ebr.2022.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Chest discomfort is the representative symptom of dangerous coronary artery disease (CAD), but rarely occurs in patients with seizures. We treated a 74-year-old man with right mesial temporal lobe epilepsy and amygdala enlargement, who was initially suspected of CAD and underwent repeated cardiac angiography because of recurrent episodes of paroxysmal chest discomfort starting from 68 years old. He visited an epileptologist and underwent long-term video electroencephalography monitoring (LTVEM), which confirmed right temporal seizure onset during a habitual episodes of "chest discomfort," stereotyped movement of chest rubbing with the right hand, followed by impaired conscousness. Brain magnetic resonance imaging revealed right amygdala enlargement. The present case emphasizes the importance of the wide range of symptoms, such as chest discomfort, which may associated with epielpsy and result in a delayed diagnosis. LTVEM is useful for diagnosis of epilepsy with unusual seizure semiology by recording ictal EEG changes during chest discomfort.
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Key Words
- AMPAR, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor
- Amygdala enlargement
- CAD, coronary artery disease
- CAG, coronary angiography
- CASPAR2, contactin-associated-protein-receptor-2
- Chest discomfort
- EEG, electroencephalography
- GABABR, γ-aminobutyric acid-B receptor
- LGI-1, leucine-rich glioma-inactivated ptotein-1
- LTVEM, long-term video electroencephalography monitoring
- MRI, magnetic resonance imaging
- Mesial temporal lobe epilepsy
- NMDA, N-methyl-D-aspartate receptor
- TLE, temporal lobe epilepsy
- mTLE, mesial temporal lobe epilepsy
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Stentless percutaneous coronary intervention with directional coronary atherectomy and drug-coated balloon angioplasty in worsening angina patients with metal allergies. J Cardiol Cases 2022; 27:32-35. [PMID: 36618841 PMCID: PMC9808482 DOI: 10.1016/j.jccase.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022] Open
Abstract
Metal allergy is a concern in percutaneous coronary intervention (PCI) with stent implantation because of its potential association with poor cardiovascular outcomes, such as stent thrombosis and recurrent in-stent restenosis requiring revascularization. Although stentless PCI with drug-coated balloon (DCB) angioplasty is theoretically useful for patients with metal allergies, DCB angioplasty alone for huge plaques in large vessels may yield inadequate luminal enlargement and coronary deep dissection, leading to insufficient results. Directional coronary atherectomy (DCA) is effective to reduce plaque volume. However, the efficacy of DCA followed by DCB (DCA/DCB) angioplasty in patients with metal allergies has never been described. We present two cases wherein stentless PCI with DCA/DCB angioplasty was an alternative revascularization strategy for patients with metal allergy and concomitant worsening angina pectoris involving proximal left anterior descending artery stenoses. Preoperative evaluation using coronary computed tomography angiography in Case 1 and intravascular ultrasound in Case 2 was useful to determine the possible use of the DCA/DCB procedure for huge plaques in large vessels. Learning objective Revascularization for patients with metal allergy with worsening angina pectoris due to stenoses of the proximal main arteries is often challenging because of the necessity to avoid stent implantation. As stentless percutaneous coronary intervention (PCI) is theoretically useful in such settings, PCI with directional coronary atherectomy (DCA)/drug-coated balloon angioplasty can be one of the treatable strategies. Preoperative evaluation of plaque morphology for the suitability of DCA procedure is important.
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Key Words
- CABG, coronary artery bypass grafting
- CAD, coronary artery disease
- CAG, coronary angiography
- CCS, Canadian Cardiovascular Society
- CCTA, coronary computed tomography angiography
- DCA, directional coronary atherectomy
- DCB, drug-coated balloon
- Directional coronary atherectomy
- Drug-coated balloon angioplasty
- ISR, in-stent restenosis
- LAD, left anterior descending artery
- Metal allergy
- OM, obtuse marginal branch
- PCB, paclitaxel-coated balloon
- PCI, percutaneous coronary intervention
- Percutaneous coronary intervention
- RCA, right coronary artery
- Stentless
- TIMI, thrombolysis in myocardial infarction
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4
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Get Out of Jail: Managing an Entrapped Balloon Using Subintimal Plaque Modification. JACC Case Rep 2022; 4:1252-1255. [PMID: 36406910 PMCID: PMC9666741 DOI: 10.1016/j.jaccas.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 01/11/2023]
Abstract
Balloon entrapment is a potentially fatal complication of percutaneous coronary intervention. This report describes the use of subintimal plaque modification for the management of entrapped balloons. This technique, commonly done during chronic total occlusion angioplasty, was used successfully to retrieve the balloon. (Level of Difficulty: Advanced.).
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A Ruptured Coronary Artery Aneurysm Secondary to Kawasaki Disease. JACC Case Rep 2022; 4:790-793. [PMID: 35818603 PMCID: PMC9270623 DOI: 10.1016/j.jaccas.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
Coronary artery aneurysm occurs in 0.3%-0.8% of patients with Kawasaki disease, and cases of rupture are extremely rare. Only 2 cases have been reported in which the patients survived. We report a case of ruptured coronary artery aneurysm that was treated with coronary artery bypass grafting and extracorporeal membrane oxygenation. (Level of Difficulty: Advanced.).
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Wire Cutting Method Using Rotational Atherectomy for Stretched Spring Wire During Coronary Intervention. JACC Case Rep 2021; 3:1842-1848. [PMID: 34917965 PMCID: PMC8642729 DOI: 10.1016/j.jaccas.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
Abstract
During removal of an entrapped guidewire, the core wire can fracture, allowing stretching of the spring wire while the distal guidewire is still entrapped. We resolved this issue with rotational atherectomy, allowing cutting of the spring wire at the intended site, regardless of the proximal spring wire fracture. (Level of Difficulty: Advanced.)
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Cardiac Sarcoidosis Initially Diagnosed as Spontaneous Coronary Artery Dissection. JACC Case Rep 2021; 3:1656-1660. [PMID: 34766013 PMCID: PMC8571720 DOI: 10.1016/j.jaccas.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/19/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
We present the case of a woman who developed presumed spontaneous coronary artery dissection of a septal branch. She later developed high-grade atrioventricular block that led to a diagnosis of cardiac sarcoidosis involving the interventricular septum. This case illustrates a rare and challenging presentation of cardiac sarcoidosis. (Level of Difficulty: Beginner.)
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Key Words
- AVB, atrioventricular block
- CAD, coronary artery disease
- CAG, coronary angiography
- CS, cardiac sarcoidosis
- CT, computed tomography
- ECG, electrocardiogram
- FDG, 18F-fluorodeoxyglucose
- IVS, interventricular septum
- PET, positron emission tomography
- SCAD, spontaneous coronary artery dissection
- TTE, transthoracic echocardiogram
- bradycardia
- cardiomyopathy
- imaging
- palpitations
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8
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Aspiration After Sealing the Entrance by Stenting Is a Promising Method to Treat Subintimal Hematoma. JACC Case Rep 2021; 3:380-384. [PMID: 34317541 PMCID: PMC8311015 DOI: 10.1016/j.jaccas.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
Creation of a distal re-entry site is widely performed to treat subintimal hematoma. However, this method has a risk of further vessel damage. The present aspiration technique after sealing the entry site by stenting is more promising because the hematoma can be reduced without additional vessel damage. (Level of Difficulty: Advanced.)
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Coexistence of Spontaneous Coronary Artery Dissection, Takotsubo Cardiomyopathy, and Myocardial Bridge. JACC Case Rep 2021; 3:250-254. [PMID: 34317512 PMCID: PMC8310971 DOI: 10.1016/j.jaccas.2020.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/25/2020] [Accepted: 11/25/2020] [Indexed: 12/26/2022]
Abstract
We report a case of spontaneous coronary artery dissection located next to a myocardial bridge in a patient with concomitant takotsubo cardiomyopathy. A fusion image with multidetector-row computed tomography and single-photon emission computed tomography played an important role in the diagnosis of these lesions. (Level of Difficulty: Advanced.)
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Key Words
- 123I-BMIPP, iodine-123 beta-methyl iodophenyl pentadecanoic acid
- CAG, coronary angiography
- ECG, electrocardiogram
- IVUS, intravascular ultrasonography
- LAD, left anterior descending artery
- MB, myocardial bridge
- MDCT, multidetector-row computed tomography
- SCAD, spontaneous coronary artery dissection
- SPECT, single-photon emission computed tomography
- TC, takotsubo cardiomyopathy
- apical ballooning
- myocardial bridge
- spontaneous coronary artery dissection
- takotsubo cardiomyopathy
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Oncostatin M is a novel biomarker for coronary artery disease - A possibility as a screening tool of silent myocardial ischemia for diabetes mellitus. IJC HEART & VASCULATURE 2021; 35:100829. [PMID: 34235245 PMCID: PMC8250159 DOI: 10.1016/j.ijcha.2021.100829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
Objective Oncostatin M (OSM) is an inflammatory cytokine of the interleukin-6 family which plays a crucial role in the pathogenesis of atherosclerosis. Therefore, we tested our hypothesis that serum OSM levels are increased in patients with coronary artery diseases (CAD). Methods and results Serum OSM level was measured by sandwich technique immunoassay in 315 consecutive patients and who underwent coronary angiography at the International University of Health and Welfare Hospital from April 2019 to March 2021. A diagnosis of CAD was made in 169 patients. Serum OSM levels were significantly higher in patients with significant coronary stenosis compared to those without it. [123.0 ± 46.7 pg/mL (n = 169) vs. 98.3 ± 47.9 pg/mL (n = 146), p < 0.001]. A positive correlation was noted between serum OSM levels and severity and complexity of coronary stenosis. Importantly, the coronary revascularization significantly decreased the serum OSM levels. We furthermore detected a positive correlation between serum OSM levels and HbA1c levels. Finally, our data suggested that 120 pg/mL of serum OSM was the potential cutoff value for screening of silent myocardial ischemia related with diabetic mellitus (DM). Conclusion Serum OSM can be a novel biomarker for CAD and may be useful for the screening of asymptomatic CAD in patients with DM.
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Key Words
- BMI, body mass index
- BNP, brain natriuretic peptide
- Biomarker
- CACS, coronary computed tomography calcium score
- CAD, coronary artery disease
- CAG, coronary angiography
- Coronary artery diseases
- DM, diabetes mellitus
- Diabetes mellitus
- EF, ejection fraction
- FFR, fractional flow reserve
- HDL-C, high-density lipoprotein-cholesterol
- HF, heart failure
- LDL-C, low-density lipoprotein-cholesterol
- LVEF, left ventricular ejection fraction
- OSM
- OSM, oncostatin M
- PCI, percutaneous coronary intervention
- Silent myocardial ischemia
- YAP, yes-associated protein
- iFR, instantaneous wave-free ratio
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Siblings With Familial Dwarfism Presenting With Acute Myocardial Infarction at Adolescence. JACC Case Rep 2021; 3:795-800. [PMID: 34317628 PMCID: PMC8311190 DOI: 10.1016/j.jaccas.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 12/02/2022]
Abstract
We encountered siblings with familial Majewski osteodysplastic primordial dwarfism type II (MOPD II) with acute myocardial infarction in adolescence and in their early 20s. We successfully performed percutaneous and surgical coronary interventions. From these cases, we were able to better understand coronary artery disease of MOPD II and provide better management. (Level of Difficulty: Intermediate.)
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Key Words
- AMI, acute myocardial infarction
- CABG, coronary artery bypass grafting
- CAD, coronary artery disease
- CAG, coronary angiography
- ECG, electrocardiogram
- HOMA-IR, homeostatic model assessment for insulin resistance
- LAD, left anterior descending artery
- LCX, left circumflex artery
- MOPD II, Majewski osteodysplastic primordial dwarfism type II
- PCNT, pericentrin gene
- coronary artery disease
- insulin resistance
- pediatric
- primordial dwarfism
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A Continuous Murmur as the Only Clinical Sign for Complex Coronary Artery Fistulas Diagnosis. JACC Case Rep 2021; 3:740-744. [PMID: 34317617 PMCID: PMC8311187 DOI: 10.1016/j.jaccas.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/08/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
An asymptomatic patient presented at our hospital exhibiting a Brugada electrocardiography pattern with coronary artery fistulas. Coronary artery fistula is a congenital or acquired rare abnormal condition with increased symptoms and complications over time. In the absence of the therapeutic consensus, we discuss the association and management for this condition. (Level of Difficulty: Advanced.).
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Key Words
- BA, bronchial artery
- BrP, Brugada phenocopy
- BrS, Brugada syndrome
- CAF, coronary artery fistula
- CAG, coronary angiography
- CBF, coronary artery–to–bronchial artery fistula
- CCTA, cardiac computed tomography angiography
- ECG, electrocardiography
- IE, infectious endocarditis
- LAD, left anterior descending artery
- LMT, left main trunk
- PT, pulmonary trunk
- TTE, transthoracic echocardiography
- coronary vessel anomaly
- electrocardiogram
- murmur
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Symptomatic Presentation of Acute Myocardial Infarction in Heart Transplantation Patients. JACC Case Rep 2021; 3:400-406. [PMID: 34317545 PMCID: PMC8311041 DOI: 10.1016/j.jaccas.2020.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022]
Abstract
Patients with acute myocardial infarction with a history of an orthotopic heart transplantation rarely present with classic anginal symptoms, secondary to cardiac denervation. We present 2 cases, the first of a patient with a ST-segment elevation myocardial infarction and the second who presented with a non-ST-segment elevation myocardial infarction. Both patients presented with typical symptoms and were treated with percutaneous coronary intervention. (Level of Difficulty: Intermediate.).
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Coronary Artery Embolism Caused by BioGlue Surgical Adhesive After Type A Acute Aortic Dissection Repair. JACC Case Rep 2021; 3:53-57. [PMID: 34317468 PMCID: PMC8305680 DOI: 10.1016/j.jaccas.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
Coronary artery embolism due to BioGlue surgical adhesive after repair of type A acute aortic dissection is a rare condition. We report a case of BioGlue coronary artery embolism after type A acute aortic dissection repair confirmed using intravascular ultrasound imaging and pathological examination. It was successfully treated with percutaneous coronary intervention. (Level of Difficulty: Advanced.)
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Clinical characteristics and management of iodine contrast media-related anaphylactic shock during cardiac catheterization. World Allergy Organ J 2020; 13:100459. [PMID: 32952847 PMCID: PMC7486688 DOI: 10.1016/j.waojou.2020.100459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 11/21/2022] Open
Abstract
Objective This study aimed to investigate the clinical characteristics and impact of intra-aortic balloon pump (IABP) implantation on the prognosis of patients with anaphylactic shock (AS) during cardiac catheterization. Methods We analyzed the medical records of 34 patients who had AS caused by iodine contrast media (ICM) between January 2009 and December 2019. Clinical features and treatments were analyzed, and patients were categorized into survival and dead groups. In addition, the patients were further divided into IABP and non-IABP (NIABP) groups to assess the impact on AS according to whether a IABP was used or not. Results Of the 417,938 patients in whom ICM was used, 34 with AS were monitored. The prevalence of AS was 0.008%. Among the 34 patients, 6 (0.001%) died from fatal anaphylactic reactions accompanying shock, 26 (76.5%) had hypotension as the first presentation of AS in the survival and dead groups (78.6% and 66.7%, respectively), and 5 (14.7%) had unconsciousness at the initial onset of AS. The subgroup analysis revealed a higher mortality in the IABP group than in the NIABP (4/9, 44.4% vs. 2/25, 8%; P = 0.031). Conclusions The present study suggests a low prevalence of ICM-related AS. Hypotension was more frequent in AS related to ICM, and unconsciousness at the initial onset of AS implied a poor prognosis. The use of an IABP did not improve the outcome of the patients with AS. IABP implantation should not be used as a routine treatment for patients with AS.
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Key Words
- ADR, adverse drug reaction
- AS, anaphylactic shock
- Anaphylactic shock
- BMI, body mass index
- CAD, coronary arterial disease
- CAG, coronary angiography
- Contrast media
- Coronary angiography
- IABP, intra-aortic balloon pump
- ICM, iodine contrast media
- IRB, institutional review board
- Intra-aortic balloon pumping
- LDL-C, low-density lipoprotein cholesterol
- eGFR, estimated glomerular filtration rate
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de Winter Electrocardiographic Pattern Caused by Diagonal Branch Lesion. JACC Case Rep 2020; 2:1451-1453. [PMID: 34316994 PMCID: PMC8302171 DOI: 10.1016/j.jaccas.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022]
Abstract
A woman in her 50s developed acute coronary syndrome with de Winter pattern electrocardiogram (ECG). A coronary angiography revealed diagonal branch lesion caused by spontaneous coronary artery dissection, whereas the left-anterior descending artery was intact. The ECG change was transient and returned to normal without treatment 2 h later. (Level of Difficulty: Beginner.)
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Key Words
- AV, atrioventricular
- CAG, coronary angiography
- ECG, electrocardiogram
- LAD, left anterior descending
- LAO, left anterior oblique
- MI, myocardial infarction
- RAO, right anterior oblique
- RCA, right coronary artery
- SCAD, spontaneous coronary artery dissection
- TIMI, Thrombolysis In Myocardial Infarction
- acute myocardial infarction
- de Winter pattern
- spontaneous coronary artery dissection
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Percutaneous Coil Embolization of Confluent Bilateral Coronary Artery Fistulas. JACC Case Rep 2020; 2:991-995. [PMID: 34317400 PMCID: PMC8302086 DOI: 10.1016/j.jaccas.2020.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 10/29/2022]
Abstract
A 52-year-old woman presented with a continuous heart murmur at an annual health examination. Coronary computed tomography angiography showed confluent coronary artery fistulas meeting to form a large aneurysm fistulizing to the pulmonary artery. Percutaneous coil embolization was performed, resulting in the disappearance of the coronary artery fistulas and aneurysms. (Level of Difficulty: Intermediate.).
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Prognostic value of proximal left coronary artery flow velocity detected by transthoracic Doppler echocardiography. IJC HEART & VASCULATURE 2018; 19:52-57. [PMID: 29946565 PMCID: PMC6016069 DOI: 10.1016/j.ijcha.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/17/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lesions in the proximal left coronary artery (LCA) are associated with a poor prognosis compared with other lesional sites. Transthoracic Doppler echocardiography (TTDE) can help to detect proximal LCA flow, and an accelerated coronary flow velocity (CFV) indicates the presence of proximal LCA lesions. This study aimed to investigate the prognostic value of CFV in the proximal LCA measured by TTDE. METHODS We enrolled 1472 consecutive hemodynamically stable patients with known or suspected heart disease whose CFV was successfully detected using TTDE accompanied by routine echocardiography between 2008 and 2011. The primary outcome was cardiac death (acute myocardial infarction, heart failure, or sudden cardiac death) and patients were followed up over a median of 6.3 years. RESULTS Overall, 42 cardiac deaths (3%) were observed. An increased CFV was significantly associated with the outcome in several models based on potential confounders (age, rate pressure product, Framingham Risk Score, diabetes, coronary artery disease, hemoglobin, brain natriuretic peptide, estimated glomerular filtration rate, left ventricular mass, left ventricular ejection fraction, and E/e'). Using a receiver operating characteristic curve analysis, the optimal cut-off value for the CFV to the association of the outcome was 37 cm/s (area under the curve, 0.70; sensitivity, 82%; specificity, 62%). In sequential Cox proportional hazards models, the CFV added incremental prognostic information to the clinical and basic echocardiographic parameters (chi-squared: 110.7 to 146.6, P < 0.01). CONCLUSIONS An increased CFV in the proximal LCA was associated with cardiac death, incremental to the clinical and basic echocardiographic parameters.
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Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis: Results From the VIRTU-Fast Study. JACC Basic Transl Sci 2017; 2:434-446. [PMID: 28920099 PMCID: PMC5582193 DOI: 10.1016/j.jacbts.2017.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 04/02/2017] [Accepted: 04/04/2017] [Indexed: 11/28/2022]
Abstract
Fractional flow reserve (FFR)-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel "pseudotransient" analysis protocol for computing virtual fractional flow reserve (vFFR) based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis) using a desktop PC, with <1% error relative to that of full-transient computational fluid dynamics analysis. Sensitivity analysis demonstrated that physiological lesion significance was influenced less by coronary or lesion anatomy (33%) and more by microvascular physiology (59%). If coronary microvascular resistance can be estimated, vFFR can be accurately computed in less time than it takes to make invasive measurements.
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Key Words
- CAD, coronary artery disease
- CAG, coronary angiography
- CFD, computational fluid dynamics
- CMV, coronary microvasculature
- FFR, fractional flow reserve
- PCI, percutaneous coronary intervention
- RoCA, rotational coronary angiography
- computational fluid dynamics
- coronary artery disease
- coronary microvascular physiology
- coronary modelling
- coronary physiology
- fractional flow reserve
- mFFR, invasively measured fractional flow reserve
- vFFR, virtual fractional flow reserve
- vFFRps-trns, virtual fractional flow reserve computed with the pseudotransient steady-state method
- vFFRsteady, virtual fractional flow reserve computed with steady-state CFD analysis and cycle mean values
- vFFRtrns, virtual fractional flow reserve computed with full transient CFD
- virtual fractional flow reserve
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Lactated Ringer's solution for preventing myocardial reperfusion injury. IJC HEART & VASCULATURE 2017; 15:1-8. [PMID: 28616565 PMCID: PMC5458128 DOI: 10.1016/j.ijcha.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/31/2017] [Indexed: 11/30/2022]
Abstract
Reperfusion of ischemic myocardium is crucial for salvaging myocardial cells from ischemic cell death. However, reperfusion itself induces various deleterious effects on the ischemic myocardium. These effects, known collectively as reperfusion injury, comprise stunned myocardium, reperfusion-induced arrhythmia, microvascular reperfusion injury, and lethal reperfusion injury. No approach has proven successful in preventing any of these injuries in the clinical setting. My colleagues and I recently proposed a new postconditioning protocol, postconditioning with lactate-enriched blood (PCLeB), for the prevention of reperfusion injury. This new approach consists of intermittent reperfusion and timely coronary injections of lactated Ringer's solution, aiming to achieve controlled reperfusion with cellular oxygenation and minimal lactate washout from the cells. This approach appeared to be effective in preventing all types of reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI), and we have already reported excellent in-hospital outcomes of patients with STEMI treated using PCLeB. In this review article, I discuss a possible mechanism of reperfusion injury, which we believe to be valid and which we targeted using this new approach, and I report how the approach worked in preventing each type of reperfusion injury.
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Key Words
- CAG, coronary angiography
- CK, creatine kinase
- CRP, C-reactive protein
- ECG, electrocardiography
- Lactate
- MI, myocardial infarction
- MPT, mitochondrial permeability transition
- No-reflow phenomenon
- PCI, percutaneous coronary intervention
- PCLeB, postconditioning with lactate-enriched blood
- PVC, premature ventricular contraction
- Postconditioning
- Reperfusion arrhythmia
- ST-segment elevation myocardial infarction
- STEMI, ST-segment elevation myocardial infarction
- Stunning
- TIMI, thrombolysis in myocardial infarction
- VF, ventricular fibrillation
- VT, ventricular tachycardia
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Right coronary artery ostial stenosis associated with idiopathic ventricular tachycardia ablation. HeartRhythm Case Rep 2015; 1:13-17. [PMID: 28491501 PMCID: PMC5420054 DOI: 10.1016/j.hrcr.2014.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Endothelial progenitor cells regenerate infracted myocardium with neovascularisation development. J Adv Res 2013; 6:133-44. [PMID: 25750747 PMCID: PMC4348451 DOI: 10.1016/j.jare.2013.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 01/12/2023] Open
Abstract
We achieved possibility of isolation, characterization human umbilical cord blood endothelial progenitor cells (EPCs), examination potency of EPCs to form new blood vessels and differentiation into cardiomyoctes in canines with acute myocardial infarction (AMI). EPCs were separated and cultured from umbilical cord blood. Their phenotypes were confirmed by uptake of double stains dioctadecyl tetramethylindocarbocyanine-labeled acetylated LDL and FITC-labeled Ulex europaeus agglutinin 1 (DILDL-UEA-1). EPCs of cord blood were counted. Human VEGFR-2 and eNOS from the cultured EPCs were assessed by qPCR. Human EPCs was transplanted intramyocardially in canines with AMI. ECG and cardiac enzymes (CK-MB and Troponin I) were measured to assess severity of cellular damage. Histopathology was done to assess neovascularisation. Immunostaining was done to detect EPCs transdifferentiation into cardiomyocytes in peri-infarct cardiac tissue. qPCR for human genes (hVEGFR-2, and eNOS) was done to assess homing and angiogenic function of transplanted EPCs. Cultured human cord blood exhibited an increased number of EPCs and significant high expression of hVEGFR-2 and eNOS genes in the culture cells. Histopathology showed increased neovascularization and immunostaining showed presence of EPCs newly differentiated into cardiomyocyte-like cells. Our findings suggested that hEPCs can mediate angiogenesis and differentiate into cardiomyoctes in canines with AMI.
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Key Words
- AMI, acute myocardial infarction
- Acute myocardial infarction
- CAG, coronary angiography
- CFU, colony forming unit
- CTO, chronic total occlusion
- Canine
- DILDL-FITC labeled UEA-11, 1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine-labeled acetylated LDL (DiLDL,) and FITC-labeled Ulex europaeus agglutinin-1
- Human EPCs
- MVD, multivessel disease
- Neovascularization
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