Optical coherence tomography-verified longer balloon inflation time may provide better stent apposition and optimal index parameters.

BACKGROUND: Incomplete stent expansion and inadequate apposition predispose to stent thrombosis following percutaneous coronary intervention. Recent studies have shown that increasing the duration of balloon inflation during stent employment was beneficial. Thus, the balloon inflation time required for optimal stent expansion and apposition in patients receiving second-generation drug-eluting stents (DES) were determined using optical coherence tomography (OCT). PATIENTS AND METHODS: Between April 2014 and March 2015, 38 patients (28 men, 10 women; mean age 60.5 ± 11.4 years) with stable angina pectoris due to single significant de novo coronary artery stenosis were prospectively enrolled. All patients were administered aspirin and clopidogrel and received weight-adjusted intravenous unfractionated heparin. Images of basal lesions were obtained using the C7XR LightLab Dragonfly OCT catheter. RESULTS: Expansion and apposition parameters improved with increasing duration of balloon inflation (30 s or 60 s) with nominal pressure (12 atm). Mean lesion length was 19.8 ± 7.6 mm. Mean stent diameter and length were 2.8 ± 0.36 mm and 24.9 ± 7.6 mm, respectively. CONCLUSION: With deployment of a stent at nominal pressure with conventional duration, inadequate stent expansion and malapposition frequently occurred as detected by OCT; however, a balloon inflation duration of 60 s markedly improved stent expansion and apposition parameters without significant complications.

Outcomes of direct stenting in patients with ST-elevated myocardial infarction.

BACKGROUND: We compared direct stenting (DS) with conventional stenting (CS) - i.e., stenting after predilation - during primary percutaneous coronary intervention (P-PCI) in terms of procedural results and long-term mortality in patients with ST-elevated myocardial infarction (STEMI). METHODS: We retrospectively analyzed 2306 patients (mean age 59 years, 22% female) who underwent P­PCI within 12 h of symptom onset. Patients were then followed up prospectively for clinical events. Patients were divided into a DS group (n = 597) and a CS group (n = 1709). The CS group was further divided into a CS-1 group (baseline thrombolysis in myocardial infarction [TIMI] flow grade ≥ 1) and a CS-2 group (baseline TIMI flow grade 0). Main outcome measures were postprocedural myocardial reperfusion and all-cause mortality in long-term follow-up. RESULTS: Patients in the DS group had a higher percentage of final TIMI-3 flow, myocardial blush grade 3 and complete ST-segment resolution, better left ventricular ejection fraction, and a lower incidence of distal embolization compared with CS patients. In-hospital (1.5 vs. 4.6%, respectively, p = 0.001) and long-term all-cause mortality (8.8 vs. 17.0%, respectively, p < 0.001) were significantly lower in the DS group than in the CS group. Kaplan-Meier survival analysis showed similar survival rates in the DS and CS-1 groups (log-rank p = 0.40), but significantly worse survival in the CS-2 group than in the other groups (log-rank p < 0.001). After adjusting for risk factors, DS was not found to be a predictor of long-term mortality. CONCLUSION: DS in P­PCI was associated with better postprocedural angiographic results and long-term survival. However, the DS group had similar in-hospital and long-term mortality to matched patients in the CS group.

Terminal QRS distortion and severity of coronary artery disease in ST-elevation myocardial infarction.

BACKGROUND: Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS complex on electrocardiograms (ECGs) of patients with ST-segment elevation myocardial infarction (STEMI). Although the association between G3I and short- and long-term cardiovascular events is well established, its mechanism is unclear. We assessed the association between G3I on the admission ECG and SYNTAX score (SS) in patients with STEMI undergoing primary percutaneous coronary intervention. PATIENTS AND METHODS: The study population consisted of 312 patients with STEMI. Baseline ECGs of the patients were analyzed for grade of ischemia; the online latest updated version (2.11) of the SS calculator was used to determine the SS (http://www.syntaxscore.com). Patients were divided into two groups according to their grade of ischemia: grade 2 ischemia (G2I) or G3I. Also, patients were classified according to their SS as SS < 22 (low) or SS ≥ 22 (high). RESULTS: There were 211 patients in the low SS group and 101 patients in the high SS group. G3I was present in 31.1 % (n = 97) of the study population. SS was significantly higher in patients with G3I than in patients with G2I (20.1 ± 8.8 vs. 13.7 ± 7.1, p < 0.001). G3I was significantly higher in patients with high SS (50.5 % vs. 21.8 %, p < 0.001). Multivariate logistic regression analysis revealed that G3I (p < 0.001), diabetes (p = 0.013), age (p = 0.016), and anterior MI (p = 0.011), were independent predictors of high SS. CONCLUSION: In conclusion, G3I was independently related to high SS. We suggest that elevated SS in patients with G3I may explain the relationship between G3I and the poor outcome observed in these patients. Furthermore, the prediction of high SS by means of G3I in patients with STEMI may help determine the most appropriate revascularization method and prevent procedure failure.

Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy: A 2D speckle tracking echocardiography study.

AIM: It is important to diagnose diabetic cardiomyopathy in the early stages to prevent development of evident heart failure in the future. The primary objective of this study was to evaluate the presence of subclinical left ventricular (LV) dysfunction with two-dimensional (2D) speckle tracking echocardiography (STE) and the secondary objective was to compare retinopathy-positive and -negative diabetic patients. PATIENTS AND METHODS: A total of 82 patients with type II diabetes mellitus (DM) and 90 gender-matched healthy controls were included. Retinopathy was present in 55 patients in the study group. All study participants underwent conventional 2D echocardiography and STE. RESULTS: All diabetic patients had preserved LV ejection fraction (LV-EF ≥ 50). Compared with the control group, diabetic patients had a larger left atrium (47.3 ± 19.9 mm vs. 36.9 ± 17.8 mm, p < 0.001) and a higher E/Em ratio (12.0 ± 2.9 vs. 10.5 ± 3.7, p = 0.004). The LV-EF, LV end diastolic and end systolic volumes, E/A ratios, deceleration times, and tissue Doppler parameters were compared between groups. The study group was observed to have statistically significant lower four-chamber (4C; 17.7 ± 3.0 % vs. 19.3 ± 3.5 %, p = 0.002), three-chamber (3C; 17.5 ± 3.0 % vs. 19.2 ± 3.4 %, p = 0.001), and two-chamber (2C; 18.5 ± 3.5 % vs. 20.1 ± 2.4 %, p = 0.001) peak longitudinal strain values compared with the control group. Moreover, LV global strain values were found to be significantly lower in the DM group than in the control group (17.9 ± 2.7 % vs. 21.1 ± 3.2 %, p < 0.001). By contrast, basal rotation (4.9 ± 3.3° vs.2.8 ± 4.5°, p = 0.001), apical rotation (15.3 ± 6.7° vs. 12.1 ± 5.3°, p = 0.001) and LV twist (20.2 ± 7.2° vs. 16.9 ± 6.5°, p = 0.002) in the DM group were significantly increased compared with those of controls. CONCLUSION: The STE procedure can be a useful novel technique in the determination of subclinical LV dysfunction in diabetic patients. Diabetic patients have lower longitudinal myocardial mechanics, and circumferential and rotational mechanics are impaired. There was no significant association between diabetic retinopathy and LV function.

Contrast-induced neurotoxicity after coronary angiography.

BACKGROUND: Contrast-induced neurotoxicity (CIN) is a very rare complication of coronary angiography. Clinical presentations include encephalopathy, seizures, cortical blindness, and focal neurological deficits. An inherent difficulty in understanding the natural history of the condition as well as its risk factors and prognosis is the rarity of its occurrence. To date, there are only case reports published on this complication. PATIENTS AND METHODS: This was a retrospective analysis of 9 patients with CIN (8 men, 1 woman; mean age, 64.6 ± 7.8 years; range, 47-72 years) and coronary artery disease who were administered iopromide contrast agent. RESULTS: In the last 3 years, we diagnosed 9 patients with CIN. Of these, 8 patients (89 %) had hypertension. The clinical presentations of the patients were different on admission: 6 patients had acute coronary syndrome and 3 patients had stable angina pectoris. One patient had history of previous contrast agent exposure. All patients underwent coronary angiography with a low-osmolar nonionic monomer contrast agent (iopromide; Ultravist®-300, Bayer Healthcare). The mean volume of contrast injected was 177 ± 58 ml. The mean time between contrast agent administration and clinical symptoms was 100 ± 71 min (range, 30-240 min). While in 5 of the patients (56 %) the clinical sign of CIN was confusion, 2 had ophthalmoplegia, 1 had cerebellar dysfunction, and 1 had monoplegia. In 8 of 9 patients (89 %), neurological symptoms resolved after giving supportive medication and hydration. Only 1 female patient, who had bilateral ophthalmoplegia, did not recover. Neurological recovery occurred at a mean time of 14.2 ± 6.7 h (range, 8-30 h). CONCLUSION: CIN is a very rare condition. Advanced age, male gender, and hypertension are the greatest risk factors for CIN. Although the prognosis of CIN is benign, it can potentially cause permanent neurological deficits or death. We found that patients with ophthalmic involvement had a higher propensity for persistent deficit. On the basis of the current data, we propose 170 ml as the maximal recommended dose for coronary procedures.

Spontaneous coronary artery dissection associated with Leriche syndrome.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. SCAD has been observed in three groups of patients; those with coronary atherosclerosis, women in the peripartum period, and those with an idiopathic cause. SCAD may also be associated with other conditions. Herein, we present a 44-year-old man who developed SCAD concomitant with Leriche syndrome.

A mysterious case of fatal embolism after the repair of tetralogy of Fallot: secondary to arrhythmia?

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. The most important late complications observed after repair of TOF are atrio-ventricular arrhythmias and sudden cardiac death. We present a rare case of fatal embolism and sudden cardiac death in a 36-year-old patient, 30 years after the operation for TOF.

The role of oxidative stress in diabetic cardiomyopathy: an experimental study.

BACKGROUND: Diabetes mellitus (DM) has a negative effect on cardiovascular functions. Little, however, is known of the overall effect of DM on the cardiac histology or the pathophysiological basis of this. AIM: We aimed to investigate the role of oxidative stress on the pathogenesis of diabetic cardiomyopathy in an experimental model. MATERIALS AND METHODS: 12 week-old female Sprague Dawley rats were randomly allocated into a healthy control group (n=6) and an DM group (n=6). After 12 weeks of alloxan induced DM, the groups' cardiac tissues were histopathologically analyzed and examined for determination of oxidant and antioxidant enzymes [activities of catalase (CAT), superoxide dismutase (SOD), and myeloperoxidase (MPO) and amount of reduced glutathione (GSH) and lipid peroxidation (LPO)]. RESULTS: When compared to the control group, the DM group showed cardiomyopathic changes. In the DM group, activities of CAT (144 +/- 0.9 vs. 112 +/- 1.4, p < 0.05) and LPO amount (27.0 +/- 0.74 vs. 14.4 +/- 0, 20, p < 0.05) were significantly increased whereas activities of SOD (142 +/- 0.2 vs. 146 +/- 0.7, p < 0.05) and amount of GSH (3.48 +/- 0.01 vs. 3.73 +/- 0.01, p < 0.05) were significantly decreased when compared to the control group. Besides, activities of MPO (7.3 +/- 0.02 vs. 8.6 +/- 0.11, p < 0.05) were comparable between groups. CONCLUSIONS: Using the experimental animal model, we were able to demonstrate that DM causes cardiomyopathic changes, and we propose that these changes could be mediated by an oxidative stress.