The Influence of On-pump Versus Off-pump Surgery on Short- and Medium-term Postoperative Coronary Flow Reserve After Coronary Artery Bypass Grafting.

BACKGROUND: Although several clinical trials have compared surgical outcomes between off-pump and on-pump coronary artery bypass grafting (CABG), whether there is a difference in the early- and medium-term postoperative coronary microvascular functions is not fully understood. We compared short- and medium-term coronary microvascular function after off-pump and on-pump CABG. METHODS: A prospective study of patients undergoing off-pump and on-pump CABG. Eighty-two patients scheduled for CABG were recruited: 38 underwent off-pump surgery and 44 on-pump surgery. Each participant's coronary flow reserve (CFR) and diastolic function were measured with transthoracic Doppler echocardiography six and 12 months after surgery. RESULTS: Baseline and hyperaemic diastolic peak flow velocity in the left anterior descending artery were similar in both groups, as was CFR (2.22±0.66) in the off-pump group compared with (2.13±0.61) in the on-pump group, (P=0.54). Coronary flow reserve was significantly and inversely correlated with high sensitivity C-reactive protein concentration (r=-0.416; P<0.001) and positively correlated with mitral E/A-wave velocity ratio (r=0.247; P=0.02). Stepwise linear regression analysis revealed that only high sensitivity C-reactive protein concentration was independently correlated with CFR (ß=-0.272, P=0.02). CONCLUSIONS: Heart-lung bypass technique had no medium-term influence on the coronary microcirculation, despite a possible initial unfavourable effect. Serum hs-CRP concentration was an independent predictor of medium-term coronary microvascular dysfunction.

Impaired coronary microvascular and left ventricular diastolic function in patients with inflammatory bowel disease.

BACKGROUND AND AIM: Increased incidence of coronary vascular events in patients with inflammatory bowel disease (IBD) is known. However, the association between coronary microvascular function and IBD has not been fully defined. We aimed to investigate whether coronary flow reserve (CFR) and left ventricular diastolic function were impaired in IBD patients. METHODS: Seventy-two patients with IBD (36 patients with ulcerative colitis [UC] and 36 Crohn's disease [CD]) were registered. Each subject was evaluated after a minimum 15-day attack-free period. For the control group, 36 age- and sex-matched healthy volunteers were included into the study. IBD clinical disease activity in UC was assessed by the Truelove-Witts Index (TWAS) and in CD by the Crohn's Disease Activity Index (CDAI). In each subject, CFR was measured through transthoracic Doppler echocardiography. RESULTS: Compared to the controls, the CD group and UC group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate. Baseline diastolic peak flow velocity (DPFV) of the left anterior descending artery (LAD) was significantly higher in the IBD group (24.1±3.9 vs. 22. 4±2.9, p<0.05), and hyperemic DPFV (56.1±12.5 vs. 70.6±15.3, p<0.05) and CFR (2.34±0.44 vs. 3.14±0.54, p<0.05) were significantly lower in the IBD group than in the control group. In stepwise linear regression analysis, hs-CRP and lateral Em/Am ratio were independently correlated with CFR. CONCLUSION: CFR, reflecting coronary microvascular function, is impaired in patients with IBD. CFR and left ventricular diastolic function parameters are well correlated with hs-CRP.

Does gestational diabetes history increase epicardial fat and carotid intima media thickness?

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as glucose intolerance that has begun during pregnancy. Recent studies have proven that development of atherosclerosis may be established in this population even without presence of type 2 diabetes. For assessment of atherosclerosis, epicardial fat thickness (EFT) is recently being used as a surrogate marker. In this study, we aimed to prove that women with GDM history are more inclined to have higher EFT levels than women without GDM history. METHODS: Sixty-two patients with previous GDM and 33 age- and sex-matched controls were allocated. Epicardial fat thicknesses of the subjects were measured with transthorasic echocardiography and carotid intima media thickness (c-IMT) was measured with ultrasound. Insulin resistance (IR) of each subject was assessed with Homeostasis model of assessment-insulin resistance (HOMA-IR). RESULTS: Carotid IMT and EFT were significantly higher in previous GDM group than controls. Serum gamma-glutamyl transferase (GGT), uric acid, and high-sensitivity C-reactive protein (hs-CRP) levels were also found significantly higher in the patients with previous GDM as compared to the controls. We observed that carotid IMT (ß = 310, P = 0.003), total cholesterol (ß = 315, P = 0.002), BMI (ß = 308, P = 0.002), HbA1c (ß = 227, P = 0.018), and HOMA-IR (ß = 184, P = 0.049) were independently correlated with EFT. CONCLUSIONS: Although the number of patients included in this study is limited, high EFT results may indicate presence of atherosclerosis in women with previous GDM.

Does mild preeclampsia cause arterial stiffness and ventricular remodeling through inflammation?

BACKGROUND: A link between preeclampsia (PE) and excessive maternal morbidity and mortality is a commonly recognized fact. Moreover it has been suggested that chronic inflammatory state connected with PE contributes to accelerated atherosclerosis. There is also an association between PE and maternal cardiac remodeling and biventricular diastolic dysfunction. The aim of the study was to investigate the presence of impaired myocardial performance and increased arterial stiffness in patients who experienced a mild case of PE five years previously. METHODS: The study included forty PE patients (40 women; mean age 33.75 +/- 7.95) and 27 healthy volunteers (27 women; mean age 36.44 +/- 10.45)Transthoracic echocardiography including Doppler echocardiography combined with tissue Doppler imaging (TDI), and aortic stiffness index (AoSI), aortic distensibility (AoD), and aortic elastic modulus (AoEM) values were measured in each study participant. RESULTS: There was a statistically significant increase in hsCRR aortic stiffness index, and aortic elastic modulus in PE patients as compared to controls (2.43 +/- 1.91 vs. 3.80 +/- 2.06, p=0.007; 3.09 +/- 2.41 vs. 7.32 +/- 6.89, p=0.001; 2.89 +/- 2.11 vs. 7.00 +/- 6.83, p=0.001), while a significant decrease was observed in the aortic strain and distensibility (respectively 22.35 +/- 15.99 vs. 12.24 +/- 9.22, p=0.005; 11.17 +/- 9.68 vs. 6.13 +/- 4.99, p=0.018). No differences between the two groups were observed with regard to the left ventricular myocardial performance index (MPI) (0.55 +/- 0.16 vs. 0.53 +/-0.19, p=0.630). CONCLUSIONS: To the best of our knowledge, this has been the first study to demonstrate impaired aortic elasticity and unaffected myocardial performance index in patients with mild PE. Moreover, these effects turned out to be significantly correlated with inflammation.

Impaired coronary microvascular function and its association with disease duration and inflammation in patients with psoriasis.

SUBJECTS: Thirty-six patients with psoriasis and 56 healthy volunteers were included in this study. METHODS: Echocardiographic examination included transmitral peak flow velocities of the early phase (E) and late phase (A) of the mitral inflow, left ventricular myocardial velocity measurements, and coronary flow reserve (CFR) measurement. RESULTS: Baseline coronary diastolic peak flow velocity (DPFV) of left anterior descending artery (LAD) was significantly higher in the psoriasis group. However, hyperemic DPFV was slightly lower and CFR (2.19 ± 0.39 vs. 2.60 ± 0.31, P < 0.0001) was significantly lower in the psoriasis group than in the control group. CFR was significantly and inversely correlated with disease duration, Psoriasis Area and Severity Index (PASI) score, and hsCRP. CONCLUSION: CFR is decreased in patients with psoriasis, and it correlates to disease duration, PASI score, and inflammation.

Effect of masked, white-coat, and sustained hypertension on coronary flow reserve and peripheral endothelial functions.

In this study, we have measured coronary flow reserve (CFR) using transthoracic echocardiography and brachial artery flow-mediated dilatation using vascular ultrasound in 36 subjects with masked hypertension (MH), 62 patients with sustained hypertension (SH), 40 patients with white-coat hypertension (WCH), and 39 healthy volunteers. CFR was significantly lower in the MH and SH groups (2.30 ± 0.39 and 2.28 ± 0.52, respectively) than in the control and WCH groups (2.85 ± 0.39 and 2.77 ± 0.41, respectively; P < .05). CFR was significantly impaired in patients with MH and SH compared with WCH and normotensive subjects. MH and SH groups are comparable with regard to cardiovascular risks and target organ damage.

Light cigarette smoking and vascular function.

OBJECTIVE: The present study was undertaken to test the hypothesis that smoking induces peripheral endothelial dysfunction and altered function in central conduit arteries. METHODS: A total of 22 healthy volunteers (10 women and 12 men; mean age 25.3 +/- 5.8 years) were included. At baseline, brachial artery flowmediated dilatation (FMD), aortic stiffness index (ASI), aortic distensibility (AoD), and aortic elastic modulus (AoEM) of all subjects were measured. On the 2nd day, the subjects were assigned to smoke either 1 light (0.6 mg of nicotine, 8 mg of tar, and 9 mg of carbon monoxide) or 1 regular cigarette (0.9 mg of nicotine, 12 mg of tar, and 12 mg of carbon monoxide) and the measurements were repeated for all subjects 20 minutes following smoking. After 15 days, the subjects were assigned to smoke 1 cigarette of the type that was not smoked on the 2nd day, and the same measurements were performed 20 minutes after smoking. RESULTS: In response to smoking 1 light cigarette, FMD values declined from 15.0 +/- 6.8% to 9.1 +/- 2.9% (P = 0.002). After smoking 1 regular cigarette, FMD values declined from 15.0 +/- 6.8% to 9.4 +/- 4.8% (P= 0.002). Aortic elasticity and left ventricular diastolic functions (LVDF) were significantly impaired by both types of cigarettes. CONCLUSION: Smoking light cigarettes has similar acute detrimental effects on FMD, LVDF, ASI, AoD, and AoEM as regular cigarettes.

Mild carbon monoxide poisoning impairs left ventricular diastolic function.

RATIONALE: Carbon monoxide (CO) poisoning is associated with direct cardiovascular toxicity. In mild CO poisoning in which cardiovascular life support is not required, the effects of CO on left and right ventricular functions are unknown in patients without cardiac failure. OBJECTIVES: Echocardiography was used to determine whether or not mild CO poisoning impairs ventricular function. Twenty otherwise healthy patients with CO poisoning and 20 age- and gender-matched controls were studied. Echocardiographic examinations were performed at the time of admission and 1 week after poisoning. RESULTS: The impairment observed in the left and right ventricular diastolic function at the time of admission was greater than the impairment 1 week after poisoning. Mild CO poisoning did not have a significant effect on systolic function. Carboxyhemoglobin levels were positively correlated with left ventricular diastolic dysfunction, whereas the levels were not correlated with right ventricular diastolic function. CONCLUSIONS: In CO intoxication, the development of left and right ventricular diastolic dysfunction precedes systolic abnormality. Patients with mild CO poisoning do not manifest cardiovascular symptoms; however, it should be borne in mind that most of these patients have myocardial involvement.

Association between serum total antioxidant status and coronary microvascular functions in patients with SLE.

Mortality from cardiovascular disease has been found to be increased in patients with systemic lupus erythematosus (SLE). Coronary flow reserve (CFR) measurement is used both to assess epicardial coronary arteries and to examine the integrity of coronary microvascular circulation. Oxidative stress, enhancing modification of plasma lipids, is also associated with atherosclerotic events in lupus patients. Impairment of CFR and TAS has been shown to be an early manifestation of coronary atherosclerosis. Forty patients with SLE and 33 healthy volunteers were included in this study. Echocardiographic examination included left ventricular myocardial velocity measurements and coronary flow reserve (CFR) measurement. Serum total antioxidant status levels (TAS) also were measured using TAS kit. Lateral myocardial early peak velocity (Em) and lateral Em/Am ratio did not differ between the groups, but lateral myocardial atrial peak velocity (Am) was significantly higher in SLE group than the control group. Baseline coronary diastolic peak flow velocity (DPFV) of left anterior descending was similar in both the groups. However, hyperemic DPFV and CFR (2.50 ± 0.42 vs. 3.09 ± 0.45, P < 0.0001) were significantly lower in the SLE group than in the control group. CFR significantly and inversely correlated with CRP and significantly correlated with TAS. Subclinical coronary microvascular dysfunction can occur in SLE patients without traditional cardiovascular risk factors, probably associated with underlying inflammation and impairment of TAS.

Interpretation of electrocardiogram images sent through the mobile phone multimedia messaging service.

OBJECTIVE: In this study, the diagnostic accuracy of interpretations of electrocardiogram (ECG) images taken by a mobile phone and sent as multimedia message was investigated. MATERIALS AND METHODS: The ECGs of 305 patients who were admitted to the emergency department with cardiac complaints were photographed with the camera of a Nokia (Espoo, Finland) N93 mobile phone. The images were sent via a multimedia messaging system to an identical mobile phone carried by a cardiologist and were interpreted on the screen of that mobile phone. Another cardiologist and an emergency physician interpreted ECG paper printouts separately. The findings of the core laboratory were used as the gold standard. The interpretation errors were scaled from 1 to 4 with respect to the significance of findings. RESULTS: The total ratio of Grade 4 errors, which consisted of significant errors, did not show any significant difference (p=0.76) between the interpretations by the emergency medicine specialist and the cardiologist who interpreted the ECGs on the mobile phone; the cardiologist who interpreted the ECG paper printouts made significantly fewer mistakes than the other two specialists (p=0.025 and p=0.023, respectively). The separate assessment of the findings showed that in the diagnostic process of ST-segment elevation, depression, and supraventricular tachycardia, the consistency of the interpretations (κ=0.81, κ=0.81, and κ=1.0, respectively) made on the mobile phone screen was slightly better than that of the emergency medicine specialist (κ=0.73, κ=0.77, and κ=0.80, respectively) and was similar to that of the cardiologist (κ=0.91, κ=0.91, and κ=1.0, respectively) who interpreted ECG paper printouts. CONCLUSIONS: Our findings suggest that sending the ECG images via a multimedia message service may be a practical and inexpensive telecardiology procedure.

Successful closure of the ventricular septal defect;A rare complication after transcatheter aortic valve replacement.

In this report, we present a patient with ventricular septal defect (VSD) that was detected at follow-up one month after transcatheter aortic valve implantation (TAVI) and successfully closed percutaneously. Before the procedure, a 29 mm Portico self-expanding aortic valve prosthesis was placed in the heavy calcific aortic valve position, and then the balloon was dilated due to aortic insufficiency and excellent results were obtained. One month after TAVI, the patient complained of shortness of breath at rest, and on physical examination a pansystolic murmur was detected. Transthoracic echocardiography (TTE) revealed a well-functioning prosthetic aortic valve; however, a VSD was detected causing left-to-right shunt in the interventricular septum. Later, we performed the interventional treatment of the defect using the Amplatzer muscular VSD occluder device with the transfemoral approach. Currently, five months after the combined procedure, the patient showed a significant improvement in symptoms and no significant shunt was observed.

A Combination of Heart Rate-Corrected QT Interval and GRACE Risk Score Better Predict Early Mortality in Patients with Non-ST Segment Elevation Acute Coronary Syndrome.

OBJECTIVE: This study aimed to evaluate whether the addition of heart rate-corrected QT inter- val prolongation to the Global Registry of Acute Coronary Events risk score improves the pre- dictive value for early mortality in patients with non-ST segment elevation acute coronary syndrome. METHODS: We retrospectively screened our database for consecutive non-ST-segment eleva- tion acute coronary syndrome patients between January 2017 and July 2019. The demographic and clinical parameters were acquired via chart review. All electrocardiograms were reviewed by 2 physicians. QT interval was measured using the tangent method. Early mortality was defined as all-cause death observed during the hospital stay or within 30 days after discharge. RESULTS: The final study population consisted of 283 patients, there were 17 early deaths. Ten of 59 patients with prolonged corrected QT intervals died (16.9%, P < .001). Both the Global Registry of Acute Coronary Events risk score (odds ratio: 1.032; 95% CI: 1.012-1.053; P = .002) and corrected QT interval (odds ratio: 1.026; 95% CI: 1.007-1.045; P = 0.007) independently predicted early mortality. The area under value was 0.769 (95% CI: 0.674-0.863, P < .001) for the corrected QT interval and 0.780 (95% CI:0.681-0.878; P < .001) for the Global Registry of Acute Coronary Events risk score alone. However, when the corrected QT interval and the Global Registry of Acute Coronary Events risk score were combined, it was found to be 0.808 (95% CI: 0.713-0.904, P < .001). CONCLUSION: This study is the first to report that prolonged corrected QT and the Global Registry of Acute Coronary Events risk score independently predict early mortality and a combina- tion of these 2 factors may improve the predictive value for early mortality in patients with ST-segment elevation acute coronary syndrome.

Coronary flow velocity reserve is reduced in patients with an exaggerated blood pressure response to exercise.

Coronary artery disease and cardiovascular mortality are increased in patients with an exaggerated blood pressure response to exercise. The exact cause of this increase remains unknown, but previous studies have indicated the presence of endothelial dysfunction in peripheral arteries and subclinical atherosclerosis in these patients. The present study aimed to clarify whether coronary microvascular dysfunction is also present in patients with exaggerated blood pressure response to exercise. A total of 95 patients undergoing exercise testing were consecutively enrolled. Flow-mediated vasodilatation and carotid intima-media thickness were measured using standardized methods. A transthoracic echocardiography examination was performed to measure coronary flow velocity reserve. Patients with an exaggerated blood pressure response to exercise had significantly lower coronary flow velocity reserve than the controls (2.06 (1.91-2.36) vs. 2.27 (2.08-2.72), p = 0.004), and this difference was caused by a reduction in hyperemic flow velocity (57.5 (51.3-61.5) vs. 62.0 (56.0-73.0), p = 0.004) rather than a difference in basal flow (26.5 (22.3-29.8) vs. 26.0 (24.0-28.8), p = 0.95). Patients with an exaggerated blood pressure response to exercise also had a significantly greater carotid intima-media thickness and significantly lower flow-mediated vasodilatation than controls. However, an exaggerated blood pressure response to exercise remained a significant predictor of coronary microvascular dysfunction after adjusting for confounders (OR: 3.60, 95% CI: 1.23-10.54, p = 0.02). Patients with an exaggerated blood pressure response to exercise show signs of coronary microvascular dysfunction, in addition to endothelial dysfunction and subclinical atherosclerosis. This finding might explain the increased risk of coronary artery disease and cardiovascular mortality in these patients.

Acute effects of smoking light cigarettes on coronary microvascular functions.

BACKGROUND: To date, there has been no study comparing the possible acute effects on coronary microvascular functions of smoking light cigarettes (those with low tar and nicotine yield) and regular cigarettes. METHODS: Twenty healthy volunteers (8 women and 12 men; mean age, 25.8 +/- 5.8 years) were included in a single-blind, open-label, cross-over study to compare the effects of smoking light cigarettes (containing 0.6 mg nicotine, 8 mg tar, 9 mg carbon monoxide) and smoking regular cigarettes (containing 0.9 mg nicotine, 12 mg tar, 12 mg carbon monoxide) on coronary flow reserve (CFR). For each participant, CFR values were measured at baseline, after smoking 2 regular or light cigarettes, and 15 days later after smoking 2 cigarettes of the other kind. RESULTS: After smoking 2 cigarettes, CFR values declined from 2.8 +/- 0.56 (baseline) to 2.31 +/- 0.51 after smoking light cigarettes (P = .003), and from 2.8 +/- 0.56 (baseline) to 2.21 +/- 0.45 after smoking regular cigarettes (P < .001). After smoking light and regular cigarettes, CFR values were similar (P = .678). CONCLUSIONS: Light cigarette smoking has similar acute detrimental effects on coronary microvascular function and CFR as does regular cigarette smoking.

Anomalous right coronary artery from the left sinus of Valsalva presenting a challenge for percutaneous coronary intervention.

A 41-year-old man presented with worsening angina. Coronary angiography showed 70% narrowing in the middle segment of the left anterior descending (LAD) coronary artery. Selective cannulation of the right coronary artery (RCA) could not be achieved with Judkins right 3.5- and 4.0-cm curve diagnostic catheters. Nonselective injection into the aortic root revealed an anomalous RCA originating from the left sinus of Valsalva and 80% narrowing just proximal to the right ventricle branch. Initial percutaneous coronary intervention (PCI) was directed to the LAD and an adequate angiographic result was achieved. One week later, PCI was performed for the RCA. Cannulation of the RCA was not possible with Judkins curve guiding catheters (right 4 and 5 cm; left 4, 5, and 6 cm). Eventually, selective cannulation was achieved with a 7-F multipurpose Hockey Stick guiding catheter and stent placement was accomplished. The patient had an uneventful recovery. The use of a multipurpose Hockey Stick catheter may be considered when the usual techniques fail to cannulate an anomalous RCA.

Mentholated cigarette smoking and brachial artery, carotid artery, and aortic vascular function.

OBJECTIVES: We investigated possible acute effects of mentholated versus nonmentholated cigarette smoking on vascular functions and left ventricular diastolic functions in otherwise healthy young smokers. STUDY DESIGN: The study included 20 otherwise healthy smokers (6 women, 14 men; mean age 25.6 years) and 22 healthy nonsmokers (12 women, 10 men; mean age 25.1 years). Ultrasound and echocardiographic examinations were performed to determine baseline characteristics for the brachial artery, aorta, and carotid artery, including brachial flow-mediated dilation (FMD), aortic and carotid stiffness index (SI), distensibility, and elastic modulus (EM). On day 2, each subject smoked either two mentholated or nonmentholated cigarettes and ultrasound and echocardiographic examinations were repeated. The procedure was repeated 15 days later with each subject smoking the other type of cigarette. RESULTS: From the baseline level of 14.0+/-9.0%, FMD decreased significantly to 8.3+/-3.2% (p=0.012) and to 9.8+/-5.5% (p=0.025) after smoking mentholated and nonmentholated cigarettes, respectively. Increase in systolic blood pressure was significant only with mentholated cigarettes (p=0.003). Increases in heart rate and rate-pressure product were significant in both groups, being more prominent with mentholated cigarettes. Both types of cigarettes resulted in significant prolongation of mitral E deceleration time and decrease in mitral E/A ratio. Changes in aortic SI and EM were significant only with mentholated cigarettes, while changes in carotid SI and EM were significant in both groups. Menthol-associated changes in systolic blood pressure, heart rate, rate-pressure product, carotid strain, and carotid SI parameters differed significantly from those seen after nonmentholated cigarette smoking (p=0.027, p<0.001, p<0.001, p=0.037, and p<0.001, respectively). CONCLUSION: Our findings show that mentholated cigarettes are not safer than nonmentholated cigarettes and that menthol-associated acute impairment is more severe in many parameters of elasticity and stiffness.

Effects of normal blood pressure, prehypertension, and hypertension on coronary microvascular function.

BACKGROUND: The assessment of coronary flow reserve (CFR) by transthoracic Doppler echocardiography has recently been introduced into clinical practice, and reduced CFR has been suggested to be a sensitive indicator of hypertensive end-organ damage; however, to date, this methodology has not been used to evaluate CFR in subjects with prehypertension. Accordingly, the present study was designed to evaluate CFR in subjects with prehypertension. METHODS AND RESULTS: We measured CFR of 40 subjects with prehypertension, 60 patients with hypertension, and 50 normotensive healthy volunteers using transthoracic Doppler echocardiography. None of the subjects had any systemic disease. Age, gender, body mass index, heart rate, lipid profiles, fasting glucose levels, and hemoglobin were similar among the 3 groups. CFR was significantly lower in the hypertension group than in the prehypertension and control groups; in addition, it was significantly lower in subjects with prehypertension than in control subjects (2.23+/-0.47, 2.54+/-0.48, and 2.91+/-0.53, respectively). Furthermore, we found that prehypertension (beta=-0.31, P<0.01) and hypertension (beta=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.20, P=0.01), systolic blood pressure (r=-0.51, P<0.01), diastolic blood pressure (r=-0.47, P<0.01), high-sensitivity C-reactive protein levels (r=-0.21, P=0.01), left atrium diameter (r=-0.22, P<0.01), mitral E deceleration time (r=-0.19, P=0.02), and mitral A velocity (r=-0.27, P<0.01), whereas mitral E/A ratio was significantly and positively correlated with CFR (r=0.26, P<0.01). CONCLUSIONS: CFR is impaired in subjects with prehypertension, but this impairment is not as severe as that in hypertension.

Diffusion-weighted MR imaging of kidneys in renal artery stenosis.

OBJECTIVE: The purpose of our study was to evaluate perfusion and diffusion of kidneys in renal artery stenosis (RAS) and any correlation between stenosis and ADC values and whether this imaging modality may be a noninvasive complementary assessment technique to MR angiography before interventional procedures. MATERIALS AND METHODS: Twenty consecutive patients suspected of having renal artery stenosis were evaluated with renal MR angiography to exclude stenosis and were then included in the study. Transverse DW multisection echo-planar MR imaging was performed. In the transverse ADC map, rectangular regions of interest were placed in the cortex on 3 parts (upper, middle, and lower poles) in each kidney. ADCs of the kidneys were calculated separately for the low, average, and high b-values to enable differentiation of the relative influence of the perfusion fraction and true diffusion. The ADC values of 39 kidneys (13 with renal artery stenosis and 26 normal renal arteries) were compared, and the relationship between stenosis degree and ADC values was calculated. RESULTS: RAS was detected in 11 of 20 (55%) patients with MRA. Thirteen of 39 kidneys demonstrated RAS, and 26 were normal. The ADClow (1.9+/-0.2 versus 2.1+/-0.2; P=.020), ADCaverage (1.7+/-0.2 versus 1.9+/-0.1; P=.006), and ADChigh (1.8+/-0.2 versus 2.0+/-0.1; P=.012) values were significantly lower in patients with kidneys with arterial stenosis than that in patients with kidneys with normal arteries. Statistical analysis revealed that stenosis degree correlated strongly with ADClow (r=-.819; P=.001), ADCaverage (r=-.754; P=.003), and ADChigh (r=-.788; P=.001). The ADClow, ADCaverage, and ADChigh values were significantly lower in patients with kidneys with arterial stenosis than that in patients with kidneys with normal arteries. CONCLUSION: We think that DW MR imaging of kidneys with RAS can help determine the functional status of a renal artery stenosis.

Smoking mentholated cigarettes impairs coronary microvascular function as severely as does smoking regular cigarettes.

OBJECTIVE: Smoking mentholated cigarettes inhibits the metabolism of nicotine and increases systemic exposure to cigarette smoke toxins. However, the possible effects of smoking mentholated cigarettes on coronary microvascular functions are unknown. We sought to investigate whether smoking mentholated cigarettes impairs coronary flow reserve (CFR) more so than smoking regular cigarettes. METHODS: Twenty otherwise healthy smokers of regular cigarettes (6 women, 14 men; mean age, 25.6 +/- 6.4 years) and 22 non-smoking control subjects were included in the study. To compare the acute effects of mentholated (0.9 mg nicotine, 11 mg tar, 12 mg carbon monoxide) and regular (0.9 mg nicotine, 12 mg tar, 12 mg carbon monoxide) cigarettes on CFR, all subjects underwent an echocardiographic examination that included CFR measurements at baseline. Twenty to 30 minutes after subjects had smoked 2 regular cigarettes and 2 mentholated cigarettes, CFR was again measured in subjects in the smoking group. RESULTS: In response to smoking 2 regular and 2 mentholated cigarettes, CFR values declined from 2.56 +/- 0.60 to 2.06 +/- 0.38 (P < 0.004) and from 2.56 +/- 0.60 to 2.14 +/- 0.30 (P < 0.005), respectively. Smoking mentholated and regular cigarettes impaired CFR to the same degree (P = 0.547). CONCLUSIONS: When compared with smoking regular cigarettes, smoking mentholated cigarettes has similar acute detrimental effects on coronary microvascular functions.