Cilostazol decreases total atrial conduction time in patients with peripheral artery disease.

OBJECTIVE: Total atrial conduction time (TACT) is the most important parameter in predicting the development of new-onset atrial fibrillation. We investigated the effect of cilostazol therapy on TACT in patients with peripheral artery disease. METHODS: Thirty patients with peripheral artery disease were treated with cilostazol (200 mg/day) for 6 months. The baseline echocardiographic total atrial conduction time parameter was compared with the 6-month follow-up. RESULTS: The TACT duration was decreased in all patients compared with the baseline after therapy (121.8 ± 19.3 vs. 109.1 ± 15.9 milliseconds, p<0.001). However, left atrial (LA) diameter was not changed with the therapy. The reduction of TACT duration was correlated with the increase in mitral E wave velocity/mitral A wave velocity ratio (r=-0.48, p<0.003). CONCLUSION: Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease, which may also prevent the development and/or recurrence of atrial fibrillation (AF).

Echocardiographic evaluation of right ventricular functions after successful percutaneous recanalization of right coronary artery chronic total occlusions.

BACKGROUND: No data exist on regarding possible improvement will occur in right ventricular (RV) functions after successful recanalization of right coronary artery chronic total occlusions (RCA CTOs). AIM: Our aim was to evaluate the revascularization induced changes in RV functions by novel echocardiographic techniques like tissue Doppler imaging (TDI) and two dimensional speckle tracking echocardiography (2DSTE). PATIENTS AND METHODS: Forty-one consecutive successfully recanalized patients with RCA CTOs were included in our study. All included patients underwent standard echocardiography with TDI and 2DSTE to assess RV function before procedure and repeated after 24 hours and 1 month. RESULTS: There were no significant changes in tricuspid annular plane systolic excursion, systolic myocardial velocities, and fractional area change values. However, RV global longitudinal strain and systolic strain rate values showed a significant increase at 24 hours after percutaneous coronary intervention compared to baseline (-23.6±4.1% vs. -19.7±3.9%, p < 0.001 and -1.55±0.18s-1 vs. -1.18±0.17s-1, p < 0.001, respectively). Moreover, improvement of the RV functions in patients with RCA CTOs was further suggested by the higher RV isovolumic acceleration values at 1-month compared with baseline (2.29±0.62 vs. 2.05±0.5 m/s2, p = 0.014). CONCLUSIONS: TDI derived isovolumic acceleration and 2DSTE derived global longitudinal strain and systolic strain rate values showed improvement in RV functions after successful percutaneous recanalization of RCACTOs suggesting viability of RV in chronic ischemia.

Safety of balloon pre-dilatation in the treatment of severe carotid artery stenosis.

AIM: To assess early outcome of predilatation prior stenting of severe carotid artery stenosis and to evaluate early major adverse cardiovascular and cerebral events (MACCE). PATIENTS AND METHODS: The study group consisted of 265 consecutive patients (200 males, 65 female, mean age 66.7 ± 8.6 years) in whom 275 percutaneous transluminal angioplasty (PTA) procedures of carotid arteries were performed. Staged carotid stenting was performed in patients with bilateral carotid stenosis. Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: direct carotid stent implantation without previous pre-dilation was performed in 233 patients (direct stenting group) and predilatation was performed in 42 patients (predilatation group). Early events were recorded and analyzed subsequently. RESULTS: We treated 275 carotid stenoses and the stent was implanted in all patients. Ten patients (3.7%) were treated by staged carotid artery stenting (CAS) due to bilateral carotid artery disease. The technical success rate was 97.1%. During 1-month follow-up, the prevalence of primary endpoint was 2.18%. The prevalence of MACCE at 30 days was higher in the predilatation group (2.4% vs. 2.1%; p = 0.924). Also periprocedural rate of hypotension was higher in predilatation group (7.1% vs. 1.7%; p = 0.04). CONCLUSIONS: Balloon predilatation prior to stenting can be performed to treat severe carotid artery stenosis with acceptable periprocedural complication rate.