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Barutcu, Irfan; Esen, Ali; Ozdemir, Ramazan; Acikgoz, Nusret; Turkmen, Muhsin; Kirma, Cevat
doi: 10.1007/s10554-009-9435-4pmid: 19214774
Several previous studies suggest that myocardial bridging (MB) is associated with ischemia and rhythm disturbances. We sought to examine exercise-induced changes in P wave duration and dispersion (PWD), the markers of atrial conduction abnormalities in patients with isolated MB of left anterior descending artery (LAD) and control subjects. Eighteen patients with MB of LAD (group-I) and 22 subjects with angiographically demonstrated normal coronary arteries (group-II) underwent treadmill exercise testing. Before and after exercise ECG was recorded at a paper speed of 50 mm/s. The change in maximum and minimum P wave duration was measured manually and difference between two values was defined as PWD. There was no difference between two groups in terms of demographic properties. Baseline maximum and minimum P wave duration and PWD durations were similar in both groups and they did not change after exercise. (Group-I: before and after test; 114 ± 10 vs. 114 ± 9, 66 ± 13 vs. 67 ± 10, and 47 ± 9 vs. 45 ± 13 ms, P > 0.05, group-II; 113 ± 9 vs. 115 ± 8, 68 ± 11 vs. 68 ± 11, 45 ± 11 vs. 48 ± 15 ms for each, respectively). In addition there was no significant correlation between PWD and P wave duration and echocardiographic variables. In patients with MB of LAD, PWD and P wave duration were not different than healthy subjects and treadmill exercise testing did not induce atrial conduction abnormalities in both groups.
Funada, Ryuichi; Oikawa, Yuji; Yajima, Junji; Kirigaya, Hajime; Nagashima, Kazuyuki; Ogasawara, Ken; Matsuno, Shunsuke; Inaba, Toshiro; Nakagawa, Yuya; Nakamura, Michinari; Kurabayashi, Masahiko; Aizawa, Tadanori
Dong, Lili; Zhang, Feng; Shu, Xianhong; Zhou, Daxin; Guan, Lihua; Pan, Cuizhen; Chen, Haozhu
doi: 10.1007/s10554-009-9458-xpmid: 19360478
Left ventricular (LV) torsional deformation plays an important role with respect to LV ejection and filling. However, no data are available on the impact of overload relief on LV torsional deformation after transcatheter ASD closure. This study sought to evaluate LV twist and untwisting before and early after device closure of ASD using the speckle tracking imaging (STI). We acquired basal and apical LV short-axis ultrasound images in 30 asymptomatic patients (29 ± 9 years, 9 males) scheduled for percutaneous closure of an ASD before and 1-day after transcatheter ASD closure. All data were offline analyzed with Echopac 7.0 software. After transcatheter ASD closure, there was no significant difference in peak apical rotation and time to the peak (P > 0.05 for both). However, a significantly improved basal rotation was recorded, including significantly increased peak clockwise rotation (−7.1 ± 3.2° vs. −5.4 ± 2.9°, P = 0.014), decreased initial counterclockwise rotation (2.0 ± 1.8° vs. 5.1 ± 3.2°, P < 0.001) and shortened time to peak clockwise rotation (105.5 ± 16.5% vs. 118.0 ± 18.5% of systolic period, P = 0.001). LV twist was significantly improved in patients with ASD after the device closure (16.1 ± 6.7° vs. 12.2 ± 6.3°, P = 0.001), whereas there was no significant difference in peak untwisting rate, time to the peak and untwisting during IVRT (P > 0.05 for all). In conclusion, LV systolic twist could be significantly improved but diastolic untwisting remained unchanged after transcatheter ASD closure. This improvement was mainly attributed to the improved LV basal rotation rather than the unchanged apical rotation.
Gayed, Isis; Gohar, Salman; Liao, Zhongxing; McAleer, Mary; Bassett, Roland; Yusuf, Syed
doi: 10.1007/s10554-009-9440-7pmid: 19234869
Purpose This study aims to identify the clinical implications of myocardial perfusion defects after chemoradiation therapy (CRT) in patients with esophageal and lung cancer. Methods We retrospectively compared myocardial perfusion imaging (MPI) results before and after CRT in 16 patients with esophageal cancer and 24 patients with lung cancer. New MPI defects in the radiation therapy (RT) fields were considered related to RT. Follow-up to evaluate for cardiac complications and their relation with the results of MPI was performed. Statistical analysis identified predictors of cardiac morbidities. Results Eleven females and twenty nine males at a mean age of 66.7 years were included. Five patients (31%) with esophageal cancer and seven patients (29%) with lung cancer developed myocardial ischemia in the RT field at mean intervals of 7.0 and 8.4 months after RT. The patients were followed-up for mean intervals of 15 and 23 months in the esophageal and lung cancer groups, respectively. Seven patients in each of the esophageal (44%) and lung (29%) cancer patients (P = 0.5) developed cardiac complications of which one patient with esophageal cancer died of complete heart block. Six out of the fourteen patients (43%) with cardiac complication had new ischemia on MPI after CRT of which only one developed angina. The remaining eight patients with cardiac complications had normal MPI results. MPI result was not a statistically significant predictor of future cardiac complications after CRT. A history of congestive heart failure (CHF) (P = 0.003) or arrhythmia (P = 0.003) is a significant predictor of cardiac morbidity after CRT in univariate analysis but marginal predictors when multivariate analysis was performed (P = 0.06 and 0.06 for CHF and arrhythmia, respectively). Conclusions Cardiac complications after CRT are more common in esophageal than lung cancer patients but the difference is not statistically significant. MPI abnormalities are frequently seen after CRT but are not predictive of future cardiac complications. A history of arrhythmia or CHF is significantly associated with cardiac complications after CRT.
Hansch, Andreas; Pfeil, Alexander; Rzanny, Reinhard; Neumann, Thomas; Kaiser, Werner
doi: 10.1007/s10554-009-9457-ypmid: 19357991
This study sought to evaluate whether representative abnormalities can be identified by first-pass perfusion (FPP) studies in patients with Churg-Strauss Syndrome (CSS), a rare disease characterized by small-vessel vasculitis. Seven patients with CSS (3 men, 4 women; mean age 55 ± 7 years) were investigated. Echocardiography was performed in all patients and coronary angiography in 5 patients. Magnetic resonance imaging (MRI) was performed with a 1.5 T whole body scanner in all patients. Functional cardiac imaging, T2-weighted turbo inversion recovery magnitude images, and T2-weighted turbo spin echo sequences with fat saturation were also performed. Cardiac viability was assessed by myocardial FPP imaging at rest and by delayed contrast enhancement (DCE) images. The FPP was abnormal in 5 of the 7 CSS patients. The abnormality was localized in the subendocardium of the left ventricle, particularly in areas of myocardial inflammatory edema. All patients showed subendocardial DCE abnormalities in the left ventricle, and 2 patients also in the right ventricle. The localization was typically subendocardial. This study describes a myocardial FPP deficit at rest in patients with CSS. The deficit is localized in areas of inflammatory myocardial edema. This diagnostic technique and image evaluation is simple, quick, and harmless. Due to the rarity of CSS, further studies are necessary to evaluate the impact of these findings.
Dockum, Willem; Knaapen, Paul; Hofman, Mark; Kuijer, Joost; ten Cate, Folkert; ten Berg, Jurrien; Beek, Aernout; Twisk, Jos; Rossum, Albert
doi: 10.1007/s10554-009-9437-2pmid: 19234870
Showing 1 to 10 of 14 Articles
doi: 10.1007/s10554-009-9446-1pmid: 19263239
The aim is to compare virtual histology which uses spectral analysis of backscattered intravascular ultrasound (VH–IVUS) and multidetector-row computed tomography (MDCT) for the characterization of coronary atherosclerotic plaques obtained by directional coronary atherectomy (DCA). We performed DCA in 15 de novo native coronary stenotic lesions (15 patients) and selected one or two segments within the plaque from each patient (total 29 segments). Then, we evaluated the accuracy of the VH–IVUS findings in 50 sites among the 29 segments compared with the histopathology findings. MDCT was performed in all patients before percutanous coronary intervention (PCI), and CT density values were measured. VH–IVUS data analysis correlated well with histopathological examination (predictive accuracy: 66.7% for fibrous, 100% for fibro-fatty, 100% for necrotic core, and 100% for dense calcium regions, respectively). In addition, CT density values between fibrous and fibro-fatty plaques classified by histopathology were 100.0 ± 26.0 HU versus 110.4 ± 67.9 HU, there were no difference among them (P = 0.594). These findings indicated that the validation of plaque characteristics using VH–IVUS correlates well with histopathology. While tissue characterization using CT density could be difficult to distinguish between fibro-fatty and fibrous tissue.
Objectives The aim of this study was to evaluate the effects of alcohol septal ablation (ASA) on coronary blood flow in symptomatic hypertrophic obstructive cardiomyopathy (HOCM) using cardiac MR (CMR) coronary flow measurements. Background CMR flow mapping enables quantification of coronary blood flow in a noninvasive way. Both left ventricular outflow tract (LVOT) gradient reduction and myocardial scarring after ASA are expected to influence left anterior descending (LAD) coronary blood flow. Methods Cine, contrast-enhanced (CE) imaging and breath-hold CMR phase contrast velocity mapping were performed at baseline and 1 and 6 months after ASA in seven patients. Changes of coronary blood flow were related to left ventricular (LV) mass reduction, enzyme release, volume of ethanol administered, LVOT gradient reduction, and LV rate pressure product (LVRPP). Results A significant mass reduction was observed both in the target septal myocardium and in the total myocardium (both P < 0.01). Mean myocardial infarct size was 23 ± 12 g (range 7.3–41.6 g). LVRPP decreased from 13,268 ± 2,212 to 10,685 ± 3,918 at 1 month (P = 0.05) and 9,483 ± 2,496 mmHg beats/min at 6 months’ follow-up (P < 0.01). LAD coronary blood flow decreased from 100 ± 37 ml/min at baseline to 84 ± 54 ml/min (P = 0.09) at 1 month and 67 ± 33 ml/min at 6 months follow-up (P < 0.01). A significant correlation was found between the change in LVRPP and LAD coronary flow at 1 month follow-up (r = 0.83, P = 0.02). CE-infarct size tended to modulate the blood flow changes over time (P = 0.12); no correlation was observed between enzyme release, volume of ethanol or both septal and total mass reduction and coronary blood flow. Conclusion The reduction in coronary blood flow is primarily associated with diminished LV loading conditions, whereas the induction of metabolically inactive myocardial scar tissue by ASA did not significantly influence the changes in coronary blood flow.
Cardiovascular magnetic resonance (CMR) very early after primary percutaneous coronary intervention (PPCI) may lead to instability or early stent complications. However, CMR in the hyperacute phase of STEMI may improve risk stratification. We investigated feasibility and safety of CMR in the hyperacute phase of STEMI immediately after PPCI. One hundred and twenty eight consecutive patients immediately after PPCI for STEMI. Sixty four underwent CMR <12 h after PPCI versus 64 matched controls. Outcomes were followed over 6 months. CMR in hyperacute STEMI was not associated with in-hospital death, infarct expansion, or urgent revascularization (P = NS). CMR (32 ml gadolinium contrast) immediately after PPCI (180 ml iodine contrast) did not increase nephropathy. CMR did not increase major adverse cardiac events (5 vs. 8%, P = 0.16) or recurrence of angina (6 vs. 8%, P = 0.73) at 6 months. CMR immediately after PPCI is feasible and safe, allowing very early risk stratification in STEMI.