The relationship between the basal coronary translesional pressure ratio and fractional flow reserve.

AIM: Fractional flow reserve (FFR) allows for physiological definition of coronary lesion severity but requires induction of maximal coronary circulation hyperemia with administration of adenosine leading to coronary resistive vessel vasodilatation. However, the hyperemic response to adenosine, and therefore the calculation of FFR, may be affected by dysfunction of the coronary microvasculature. The aim was to define the relationship between basal Pd /Pa and FFR and identify lesion-independent predictors of the change in Pd /Pa with hyperemia. METHODS AND RESULTS: One hundred and sixty-six consecutive patients undergoing FFR measurement were prospectively enrolled (mean age 62.6 ± 10.3 years, 27% females). Basal Pd /Pa , FFR, and delta Pd /Pa (difference between basal Pd /Pa and FFR) were recorded. Independent predictors of delta Pd /Pa included angiographic lesion severity, lesion length, gender, body mass index, and total cholesterol:HDL cholesterol ratio. The best basal Pd /Pa cutoff value to predict lesion physiological significance was 0.87 (positive predictive value of 100% for an FFR value ≤0.80) and the best cutoff for nonsignificance was 0.93 (negative predictive value of 98% for an FFR value >0.80). CONCLUSION: The delta Pd /Pa may be affected by patient gender, body mass index, and cholesterol profile. A basal Pd /Pa value of ≥0.93 is highly predictive of an FFR >0.80. Conversely, a basal Pd /Pa value of ≤0.87 is highly predictive of an FFR ≤0.80. © 2017 Wiley Periodicals, Inc.

Inferolateral ST-segment elevation associated with a gastric variceal bleed and the use of a Minnesota tube.

The use of Minnesota and modified Sengstaken-Blakemore tubes for balloon tamponade in acute variceal haemorrhage has declined with the availability of modern endoscopic techniques. However, in massive uncontrolled haemorrhage their use may still be required. They are very effective in controlling acute bleeding, but are associated with a range of potentially serious complications. This case demonstrates an unusual complication of the use of a Minnesota tube in a gentleman with a large gastric variceal bleed. The patient developed inferolateral ST-segment elevation on a 12-lead ECG which resolved rapidly following aspiration of 2000 mL of blood from the gastric port of the Minnesota tube. It was thought that the distension of the stomach, along with the traction applied to the Minnesota tube, resulted in external compression of the diaphragmatic surface of the heart and the observed ECG changes.