Effect of rotational atherectomy on the coronary microcirculation in patients with angina pectoris.

OBJECTIVES: The coronary microcirculation can be impaired by ablated debris just after a rotational atherectomy procedure, but the specific effects of rotablation on the microcirculation have not been investigated. The present study examined the effects of rotational atherectomy on the coronary microcirculation by analyzing coronary flow reserve (CFR) and the component parameters of the coronary flow-pressure loop. METHODS: This study included 31 patients with angina pectoris who underwent stent implantation after rotational atherectomy and with < 50% diameter stenosis at 6-month follow-up (i.e. without clinical restenosis). The CFR, the flow-pressure slope index (FPSI) and zero-flow pressure were measured using the FloWire Doppler guidewire in both treated and untreated reference vessels without stenosis immediately after and on 6 months from the rotational atherectomy procedure. RESULTS: CFR and FPSI in the treated vessels were significantly lower than in the untreated reference vessels without stenosis just after rotational atherectomy (CFR: 2.1 +/- 0.5 vs 2.6 +/- 0.7, p < 0.05; FPSI: 1.61 +/- 0.8 vs 2.35 +/- 0.9 cm/sec/mmHg, p < 0.05), but no significant differences were observed in CFR or FPSI between these same sets of arteries at follow-up. There was also a significant correlation between the extent of attenuation of CFR and total ablation time (r = - 0.54, p < 0.01). CONCLUSIONS: Rotational atherectomy attenuates CFR by reducing coronary artery conductance, probably due to coronary microvessel obstruction with the debris ablated during the procedures of rotational atherectomy.

Primary cardiac lymphoma presenting clinically as restrictive cardiomyopathy.

An unusual case of primary cardiac lymphoma presenting as restrictive cardiomyopathy with arrhythmia is reported in a 72-year-old woman who was admitted for evaluation of exertional dyspnea and palpitations. Electrocardiography (ECG) showed atrioventricular dissociation and right heart cardiac catheterization revealed a typical 'dip-and-plateau' waveform. Restrictive cardiomyopathy was suspected because computed tomography (CT) did not reveal pericardial thickening, calcifications, or an effusion. Heart failure initially improved with diuretic therapy, but subsequently worsened, and the patient experienced a syncopal episode. ECG showed atrial fibrillation, and CT revealed a large mass in the right atrium and multiple tumors in the liver, which needle biopsy confirmed as diffuse large B-cell lymphoma. Chemotherapy induced complete remission, and her heart failure markedly improved. The 'dip-and-plateau' waveform was no longer detected on repeat cardiac catheterization and the ECG showed restoration of sinus rhythm. Clinically, the diagnosis was primary cardiac lymphoma.