Lesion regression after percutaneous coronary intervention for unprotected left main trunk disease

BACKGROUND: Although some studies have documented the six-month angiographic outcomes of percutaneous coronary intervention (PCI) with new devices for unprotected left main trunk disease (ULMTD), a long-term angiographic analysis is mandatory to evaluate the safety and effectiveness of this procedure. This study aims to assess a long-term (one year or more) angiographic analysis after PCI for this lesion. METHODS: PCI was performed for 225 ULMTD with de novo or restenotic lesions. There were 19 deaths and 12 repeat PCIs during the hospital stay. The remaining 194 lesions were followed, and 126 lesions showed no angiographic restenosis or target lesion revascularization within six months. Finally, long-term quantitative angiographic follow-up was completed in 78 lesions (mean 2.4 years, maximum 7.5 years after PCI). RESULTS: Minimal lumen diameter increased significantly from 2.46?± 0.59?mm to 2.72?±?0.65?mm (p?< 0.0001) and percent diameter stenosis decreased significantly from 26?± 14% to 19?±?14% (p?<?0.0001) between the six-month and the long-term follow-ups. No additional restenosis or new lesions were found at long-term follow-up, and significant lesion regression was ascertained in each procedure (directional coronary atherectomy, p?<?0.005; ballooning, p?<?0.005; stenting, p?< 0.05).</emph> CONCLUSIONS: These findings support the safety and effectiveness of PCI for ULMTD during the long-term period. (Int J Cardiovasc Intervent 2003; 5: 132-136)     

Predictors of long-term outcomes in patients after elective stent implantation for unprotected left main coronary artery disease

The purpose of this study was to investigate the predictor of long-term outcomes in patients after stent implantation for unprotected left main coronary artery (LMCA) disease. Coronary stenting has recently been advocated as an alternative procedure for LMCA disease. Information on the predictors of long-term outcomes in patients after stent implantation for unprotected LMCA disease is not clear. Seventy six patients (51 men and 25 women, age 68 ± 10 years) with medically refractory angina received coronary stenting for unprotected LMCA disease. During a follow-up period of 40 ± 26 months, 7 patients (9%) died because of cardiovascular disease in 5 (7%) and noncardiovascular disease in 2 (3%). In the other 69 patients, 19 patients (25%) needed repeated percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG). In a univariate analysis, only female sex was related to the repeated PCI and/or CABG (P = 0.04). A history of cerebral vascular attack (CVA) (P = 0.005), anemia (P = 0.03) and lower left ventricular ejection fraction (LVEF) (P = 0.008) were related to the cardiovascular mortality. A history of myocardial infarction (P = 0.03), a history of CVA (P = 0.02), anemia (P = 0.02), and lower LVEF (P = 0.002) were related to the total mortality. In a multivariate analysis, female sex (P = 0.007; odds ratio 5.29, 95% confidence interval [CI] 1.57–17.80) and young age (P = 0.025; odds ratio 3.92, 95% CI 1.19–12.98) could predict the repeated PCI and/or CABG. Only a history of CVA could predict the cardiovascular mortality (P = 0.027; odds ratio 34.18, 95% CI 1.49–783) and only lower LVEF could predict the total mortality (P = 0.027; odds ratio 13.26, 95% CI 1.34–131). Female sex and young age could predict the repeated PCI and/or CABG in patients after stent implantation for unprotected LMCA disease. Furthermore, a history of CVA could predict the cardiovascular mortality and lower LVEF could predict the total mortality.     

Coronary angioplasty in high-risk patients with left main coronary stenosis: Results from the national registry of elective supported angioplasty

To assess the outcome of PTCA in circulatory supported patients with left main coronary artery (LMCA) stenosis, the National Registry of Elective Supported Angioplasty data bank was searched. Patients entered in the registry were considered high-risk PTCA and the PTCA was performed using percutaneous cardiopulmonary bypass (PCPB). Criteria for high risk was left ventricular ejection fraction <25% or a target lesion supplying >50% of functioning myocardium. Of 455 patients entered in the registry, 61 (13.3%) had LMCA stenosis >60%. There were 42 patients in whom the PTCA target vessel was the LMCA (PTCA-LMCA) and 19 in whom it was vessel(s) other than the LMCA (PTCA-OTHER). The mean age was similar in the 2 groups (65 ± 10 vs. 68 ± 9yrs, p = ns). The left ventricular ejection fraction (LVEF) was higher in PTCA-LMCA than in PTCA-other (38 ± 16% vs. 27 ± 16%, p <0.05). The number of vessels dilated/patient was higher in PTCA-LMCA than in PTCA-OTHER (2.1 ± 1.0 vs. 1.1 ± 0.3, p <0.001). There were a total of 10 in-hospital deaths (16%) in patients with LMCA >60% stenosis. This exceeds the mortality of the patients with <60% LMCA stenosis entered in the registry (4.5%, p <0.001). There were 6 in-hospital deaths (14%) in PTCA-LMCA and 4 (21%) in PTCA-OTHER (p = ns). PTCA in the presence of LMCA stenosis, whether the LMCA is the target vessel or not, carries a very high risk, independent of LVEF or the number of vessels dilated, despite the use of PCPB.     

Results of percutaneous drug‐eluting stent implantation for unprotected left main coronary disease according to left ventricular systolic function

Objectives: We aimed to appraise the early and long‐term outcome after percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) in patients with unprotected left main disease (ULM) and left ventricular systolic dysfunction (LVD). Background: PCI with DES has being performed with increasing frequency in subjects with ULM and LVD, but few specific data are available. Setting and Patients: We identified patients undergoing PCI with DES for ULM at our Center and distinguished those with ejection fraction (EF) >50% from those with 40% <EF ≤50% and those with EF ≤40%. The primary end‐point was the rate of major adverse cerebro‐cardiovascular events (MACCE, ie death, myocardial infarction [MI], stroke, repeat PCI or bypass surgery). Results: A total of 197 patients were included, 57.4% with EF >50%, 32.0% with 40% <EF ≤50%, and 10.6% with EF ≤40%. In‐hospital mortality was significantly higher in those with EF ≤40% (9.5% vs. 0 and 3.2%, P < 0.001). A total of 96% patients were followed for 23 ± 14 months, yielding a MACCE rate of 44.2% (41.6% in those with EF >50%, 41.6% in those with 40% <EF ≤50%, and 61.9% in those with EF ≤40%, P = 0.4). Specifically, death occurred in 2.7%, 7.9%, and 28.6% (P < 0.001), cardiac death in 1.8%, 4.8%, and 23.8% (P = 0.001), MI in 8.0%, 7.9% and 0 (P = 0.4), and TVR in 15.9%, 11.1% and 33.3% (P = 0.6). Conclusion: Systolic ventricular dysfunction is highly correlated with in‐hospital and long term death rates in patients undergoing PCI with DES for ULM disease. However it does not confer an increased risk of nonfatal adverse events or stent thrombosis. © 2009 Wiley‐Liss, Inc.     

Catheter ablation for atrial fibrillation results in greater improvement in cardiac function in patients with low versus normal left ventricular ejection fraction

Purpose

It is still unknown whether left ventricular ejection fraction (LVEF) might affect the magnitude of improvement after atrial fibrillation (AF) ablation on cardiac function in persistent or longstanding persistent AF (CAF) patients.

Method

We performed echocardiography in 35 patients with CAF before and after catheter ablation (CA). Patients were stratified by LVEF into two groups prior to CA—normal LVEF (≥50 % LVEF, N group, n?=?24) and a low LVEF group (<50 % LVEF, L group, n?=?11). Patients were followed at 1 month, 3 months, 6 months, 1 year, and 2 years after ablation.

Results

After 15.8?±?7.4 months follow-up, the L group showed greater improvement in LVEF and left atrial ejection fraction (LAEF; N group vs L group: LVEF difference (%), 5?±8 vs 20±?13, p?<?0.01; LAEF difference (%), 11?±?12 vs 21?±?10, p?<?0.05). LA maximal volume and E/e′ showed the same tendency after ablation, although the extent of improvement was not statistically significant. Both groups showed almost the same time course of improvement up to 2 years, although the L group showed earlier recovery in LVEF.

Conclusion

The greater improvement in several cardiac functions was seen in patients with greater LV dysfunction, after the CA for CAF.     

Anxiety disorders are associated with increased plasma adrenomedullin level and left ventricular hypertrophy in patients with hypertension

Objective: To investigate the association between anxiety disorders and left ventricular hypertrophy in patients with essential hypertension.

Methods: Left ventricular structure and function were assessed with echocardiography in 56 patients with essential hypertension and anxiety disorder (study group) and in 56 patients with hypertension only (control group). Serum adrenomedullin levels were also measured in these patients.

Results: There was no statistically significant difference in the left ventricular ejection fraction between the study and the control group (54.21?±?88.81% versus 56.01?±?7.85%, p?>?0.05). The left ventricular mass index (LVMI) in study group was higher than in control group (137.05?±?9.42 versus 123.57?±?7.01?g/m², p?=?0.001). The plasma levels of adrenomedullin in study group was higher than in control group (25.97?±?5.48 versus 18.32?±?6.97?ng/L, p?=?0.001). Levels of plasma adrenomedullin were positively correlated with LVMI in the study (r?=?0.734, p?r?=?0.592, p?Conclusion: Anxiety disorders are associated with elevated plasma adrenomedullin levels and increased left ventricular hypertrophy in patients with essential hypertension. The clinical significance of these changes requires further investigation.     

Improvement of left ventricular diastolic function and left atrial reverse remodeling after catheter ablation of premature ventricular complexes

Aims

Catheter ablation of premature ventricular complexes (PVC) improves left ventricular (LV) systolic performance in certain patients; however, the effect on diastolic function and left atrial (LA) remodeling is unclear. We assessed the effects of catheter ablation of PVCs on parameters of LV diastolic function and LA remodeling.

Methods

Forty-seven patients (age 65?±?10 years, 46 men) who underwent catheter ablation for symptomatic PVCs were evaluated using two-dimensional echocardiography before and 6?±?2 months after ablation. The measured diastolic indices included mitral inflow parameters (E wave, A wave, E/A ratio, and deceleration time (DT)), mitral lateral annulus early diastolic velocity (Ea), and E/Ea ratio. The LA volume was measured using modified biplane Simpson's method. We also compared the changes in the left atrial volumes and left atrial volume index (LAVI) after PVC ablation.

Results

After catheter ablation of PVCs, the mean LV ejection fraction (EF) increased significantly (49.9?±?10.3 vs. 42.8?±?11.8, p?<?0.01). Significant improvement was also seen in A wave velocity (71.3?±?17.1 vs. 59.5?±?15.1 cm/s, p?=?0.039), E/A ratio (1.42?±?0.6 vs. 1.07?±?0.5 ml, p?=?0.034), Ea (8.9?±?3.9 vs. 6.8?±?2.9 cm/s, p?=?0.04), and E/Ea ratio (15.4?±?5.8 vs. 10.6?±?3.4, p?=?0.027), whereas mitral E and DT did not show significant change. LAVI decreased significantly after ablation (44.4?±?14.8 vs. 36.7?±?12.5, p?<?0.001). Significant improvement in LAVI was also seen in patients with normal baseline LVEF (p?=?0.04).

Conclusion

Catheter ablation of PVCs improved LV diastolic function and resulted in left atrial reverse remodeling.     

Coronary perfusion pressure and left ventricular hemodynamics as predictors of cardiovascular collapse following percutaneous coronary intervention

Background/Purpose

Appropriate patient selection for mechanical circulatory support following percutaneous coronary intervention (PCI) remains a challenge. This study aims to evaluate the role of coronary perfusion pressure and other left ventricular hemodynamics to predict cardiovascular collapse following PCI.

Recovery of left ventricular function after percutaneous revascularization of a left main chronic total occlusion

Surgical revascularization of left main and/or three‐vessel coronary artery disease (CAD) is associated with improved survival in patients with left ventricular dysfunction when compared to medical therapy and can result in improved left ventricular ejection fraction (LVEF) [ 1 ]. Multivessel percutaneous coronary intervention (PCI) is equivalent to surgery regarding short and intermediate term mortality, and left main PCI has emerged as a safe and effective alternate to surgical revascularization [ 2 ]. However, outcomes of unprotected left main PCI in patients with severely depressed LVEF have not been examined. We report a patient with left main chronic total occlusion, multivessel CAD, and dilated cardiomyopathy, in whom complete revascularization via PCI resulted in decreased left ventricular size and improved LVEF. © 2012 Wiley Periodicals, Inc.     

Improvement in Left Ventricular Function with Intracoronary Mesenchymal Stem Cell Therapy in a Patient with Anterior Wall ST-Segment Elevation Myocardial Infarction

Background/Aims

The progression and development of congestive heart failure is still considered a large problem despite the existence of revascularization therapies and optimal, state-of-the-art medical services. An acute myocardial infarction (AMI) is a major cause of congestive heart failure, so researchers are investigating techniques to complement primary percutaneous coronary intervention (PCI) or thrombolytic therapy to prevent congestive heart failure after AMI.

Methods

Twenty-six patients with successful PCI for acute ST-segment elevation anterior wall myocardial infarction were assigned to either a control group (n?=?12) or a bone marrow mesenchymal stem cells (BM-MSC) group (n?=?14). The control group received optimum post-infarction treatment, and the BMSC group received intracoronary delivery of autologous BMSC at 1 month after PCI with the optimum medical treatment. The primary endpoint was a left ventricular ejection fraction (LVEF) change from baseline to 4-month follow-up, as determined via myocardial single-photon emission computed tomography (SPECT).

Results

The global LVEF at baseline (determined 3.5?±?1.5 days after PCI) was 35.4?±?3.0% in the control group and 33.6?±?4.7% in the BM-MSC group. BMSC transfer enhanced left ventricular systolic function primarily in anterior wall myocardial segments adjacent to the LAD infarcted area. Four months later, via SPECT, global LVEF had increased by 4.8?±?1.9% in the control group and 8.8?±?2.9% in the BM-MSC group (p?=?0.031). The cell transfer did not increase the risk of adverse clinical events, in-stent restenosis, or proarrhythmic effects. The echocardiographic evaluation also revealed a significant increase in the LVEF value from baseline to the 4-month (9.0?±?4.7 and 5.3?±?2.6%, p?=?0.023) and 12-month (9.9?±?5.2% and 6.5?±?2.7%, p?=?0.048) follow-up in the BM-MSC group but not in the control group.

Conclusions

Intracoronary administration of autologous BM-MSC was tolerable and safe with significant improvement in LVEF at 4-month (SPECT and echocardiography result) and 12-month (echocardiography result only) follow-up in patients with anterior AMI.

     

Clinical outcomes and predictors of unprotected left main stem culprit lesions in patients with acute ST segment elevation myocardial infarction

Objectives : We aimed at comparing the clinical outcomes of the patients who underwent percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI) due to left main coronary arteries (LMCA) and non‐LMCA determining the predictors of mortality in the patients. Background : There are few data regarding the midterm prognosis of STEMI due to LMCA as compared with them due to non‐LMCA. Methods : A total of 4,697 patients with STEMI (61 patients with LMCA and 4,636 patients with non‐LMCA) were enrolled in a nationwide Korea Acute Myocardial Infarction (MI) Registry between November 2005 and September 2009. The primary endpoints was a composite of cardiac death, nonfatal MI, and target lesion and vessel revascularization (TLR/TVR) during a 12‐month clinical follow‐up. Results : The LMCA group had a higher incidence of total major adverse cardiac events (MACEs) (26.2% vs. 7.8%; P < 0.001) at 12 months, which was largely attributable to cardiac deaths at 1 month (21.3% vs. 3.8%; P < 0.001). Therefore, there was no statistical difference in cardiac deaths, nonfatal MI, TLR/TVR, and MACEs after 1 month between the two groups. Presenting in cardiogenic shock (HR, 4.25; 95% CI, 1.01–17.97; P = 0.049) and heart rate ≥100 bpm (HR, 4.97; 95% CI, 1.18–21.00; P = 0.029) were independent predictors of cardiac death due to LMCA. Conclusion : Patients with STEMI and a LMCA had poor clinical outcomes, which is attributable to hemodynamic deterioration during the periprocedural period. However, after that time, midterm MACEs of the survivors following the periprocedural period may not be different between STEMI due to LMCA and non‐LMCA. © 2011 Wiley Periodicals, Inc.     

Sirolimus- vs. paclitaxel-eluting stents for the treatment of unprotected left main coronary artery stenosis: Complete 2-year follow-up of a two-center registry

Background

The feasibility of percutaneous coronary intervention (PCI) using drug-eluting stents and its comparability with bypass surgery in treatment of unprotected left main coronary artery (LMCA) stenosis has been shown previously. We compared the mid-to long-term outcome between sirolimus-(SES) vs. paclitaxel-eluting stents (PES) in an all-comer analysis that included all patients with unprotected LMCA stenosis who underwent PCI with SES or PES.

Methods

From March 2003 and June 2007, 196 patients underwent PCI with SES or PES for unprotected LMCA stenosis at Seoul National University Main or Bundang Hospital; SES was implanted in 141 patients and PES in 55 patients. The baseline clinical and procedural characteristics were mostly similar between the SES and PES group.

Results

After 2 years of follow-up, there were no differences in the rate of cardiac death (9.1% vs. 8.5%) and nonfatal MI (5.5% vs. 2.8%) between the two groups. However, the risk of repeat revascularization tended to be lower in the SES group compared with the PES group [TLR, 9.9% vs. 20.0% (P = 0.06); TVR, 17.7% vs. 30.9% (P = 0.05)], which did not reach statistical significance. The rate of stent thrombosis (ST) was also similar between the two groups (3.6% vs. 2.1% for definite ST, 3.6% vs. 2.8% for definite + probable ST).

Conclusions

In all-comers undergoing first generation DES implantation for unprotected LMCA stenosis, PES and SES showed comparable 2-year clinical results regarding hard endpoints and major adverse cardiac events.     

Angioplasty of unprotected left main coronary stenosis: Real world experience of a single-operator group from eastern India

BackgroundCoronary artery bypass graft surgery is the standard treatment of unprotected left main coronary stenosis (ULMCA). However, in the real world scenario, many of these patients are unfit for CABG or prefer angioplasty as an alternative when offered the choice.MethodsA total of 86 clinically stable patients with ULMCA stenosis who were unfit or unwilling for CABG underwent PCI with DES at two tertiary care centers in Kolkata. Patients were followed up prospectively for a median of 34.6 months for major adverse cardiovascular events. Angiographic follow-up was done after 1 year of index procedure or earlier, if indicated.ResultsFifty-five patients (64%) had distal left main stenosis. Two-stent technique was used in 19 patients (22%) and single-stent technique in 36 patients (42%) with distal left main lesion. Thirteen patients (15.1%) had left ventricular ejection fraction (LVEF) of ≤45%. There was no in-hospital death, MI, or stent thrombosis. During follow-up, major adverse cardiac event (MACE) occurred in 9 patients (10.5%). Our study revealed significantly greater MACE in patients with distal left main lesion with LVEF ≤45% (50% vs 6.38%, p = 0.0002), high SYNTAX score (36.36% vs 6.82%, p = 0.008), and diabetes (17.95% vs 0.00%, p = 0.07). Overall, also patients with Diabetes, LVEF ≤ 45%, and SYNTAX score >32 had significantly higher MACE. Use of IC Stent, IVUS, or procedural strategy in distal lesion did not affect MACE.ConclusionIn selective patients with low-intermediate SYNTAX score and without diabetes and LV dysfunction, ULMCA PCI with DES is feasible.     

Comparison of subclinical left and right ventricular systolic dysfunction in non-dipper and dipper hypertensives: impact of isovolumic acceleration

Objectives: To evaluate subclinical left ventricular and right ventricular systolic impairment in dipper and non-dipper hypertensives by using isovolumic acceleration.

Methods: About 45 normotensive healthy volunteers (20 men, mean age 43?±?9 years), 45 dipper (27 men, mean age 45?±?9 years) and 45 non-dipper (25 men, 47?±?7 years) hypertensives were enrolled. Isovolumic acceleration was measured by dividing the peak myocardial isovolumic contraction velocity by isovolumic acceleration time.

Results: Non-dippers indicated lower left ventricular (2.2?±?0.4?m/s² versus 2.8?±?1.0?m/s², p?2 versus 3.5?±?1.0?m/s², p?=?0.012) compared with dippers. Left ventricular mass index (p?=?0.001), interventricular septal thickness (p?=?0.002) and myocardial performance index (p?p?=?0.002), mass index (p?=?0.001) and right ventricular myocardial performance index (p?Conclusion: The present study demonstrates that non-dipper hypertensives have increased left and right ventricular subclinical systolic dysfunction compared with dippers. Isovolumic acceleration is the only echocardiographic parameter in predicting this subtle impairment.     

Percutaneous versus surgical revascularization for multivessel coronary artery disease: A single center 10 year follow‐up of SOS trial patients

Objectives: To compare 10 year outcomes including death, left ventricular ejection fraction (LVEF), major adverse cardiovascular and cerebrovascular events (MACCE), repeat revascularization (RR), and severity of angina (CCS) after randomization to stent supported percutaneous coronary intervention (PCI) or surgical revascularization (CABG) in a single center participating in the SOS trial. Background: Randomized studies show increased RR following PCI, but otherwise similar results to CABG in selected mutlivessel disease patients with up to 5 year follow up. There is no 10 year data available. Materials and methods: The analysis involved 100 patients randomized into the SOS study in Poland. Results: Patients were well matched for baseline demographic and angiographic characteristics. During 9.6 ± 0.85 year observation, there was no significant difference between groups for survival, CCS, and LVEF. Increased RR occurred following PCI; 21 (42%) vs. 9 (18%), P < 0.05. As a consequence, the MACCE was also significantly higher following PCI; 36 (72%) vs. 28 (56%), P < 0.05. Excess RR predominantly occurred in the first year and diminished over time with numerically less RR following PCI from year 5 to 10; 2 (4%) vs. 7 (14%), P = ns. Conclusions: These findings suggest that patients with multivessel coronary artery disease technically suitable for either stent supported PCI or CABG have very similar 10 year outcomes with respect to mortality, angina class, LVEF, and MACCE other than RR. Excess RR following PCI predominantly occurs in early years and is numerically lower following PCI in years 5–10. This underscores the need for longer‐term follow up from randomized trials. © 2009 Wiley‐Liss, Inc.     

Mean platelet volume predicts left descending artery occlusion in patients with non-ST-elevation myocardial infarction

Abstract

Platelets play an important role in atherothrombosis. As the most common site plaque occurs, left anterior descending artery (LAD) infarct location always associate with poor prognosis. We sought to assess whether mean platelet volume (MPV) could predict LAD infarct location and short-term clinical outcome. In this study, 190 consecutive patients with non-ST-elevation myocardial infarction (NSTEMI) were enrolled. Clinical, electrocardiography and laboratory characteristics were measured. All patients underwent coronary angiography examination and had definite culprit vessel during hospitalization. The results showed that MPV was smaller in patients with a LAD infarct location than that of left circumflex artery or right coronary artery (9.0?±?1.5 versus 9.8?±?1.6, p?<?0.001). Multivariate analysis also showed that MPV was the only independent factor to predict LAD infarct location [Odds ratio (OR)?=?0.65, 95% confidence interval (CI) 0.53–0.80, p?<?0.0001] in patients with NSTEMI. B-type natriuretic peptide and electrocardiography were unreliable predictive factors to locate culprit vessel. Receiver operating characteristic curve analysis showed MPV (area under the curve: 0.65, 95% CI 0.56–0.74, p?<?0.01) could reliably discriminate those patients with NSTEMI who had a major in-hospital event. Multivariate regression analyses also showed that MPV (OR?=?1.46, 95% CI 1.15–1.86, p?<?0.01) were predictors of major in-hospital events. In conclusion, MPV was the only factor independently associated with LAD infarct location in patients with non-ST-elevation myocardial infarction.     

Feasibility of primary clot extraction prior to percutaneous coronary intervention in acute myocardial infarction

Objectives : To test the feasibility, safety, and in‐hospital outcomes of utilizing the FilterWire EZ to extract clot prior to percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (MI). Background : PCI in patients with acute MI is associated with a higher incidence of distal embolization, no‐reflow, or slow flow partly due to the presence of clot burden. Methods : The authors describe the feasibility, safety, and outcomes of using a FilterWire EZ distal protection device as a clot extraction device in patients who presented with acute MI and documented clot on coronary angiography. Results : Fifteen consecutive male patients with a mean age of 54 ± 8 years presented with acute MI (60% ST elevation MI). MI involved left anterior descending artery (n = 4), circumflex artery (n = 3), and right coronary artery (n = 8). Clot extraction followed by PCI reduced the percent diameter stenosis from 94 ± 12 to 65 ± 11 (P < 0.001) and restored TIMI 3 flow in all patients without distal embolization. The angiographic, procedural, and clinical success rates were 100%. The mean left ventricular ejection fraction (LVEF) was 52 ± 8% (range 30–62%) with only three patients (15%) who had an LVEF <50% and five patients (33%) without apparent wall motion abnormalities on echocardiography. Conclusions : Clot extraction before PCI during acute MI in native coronaries is feasible, safe, and effective in restoring TIMI 3 flow without distal embolization. Whether this approach results in better outcomes and improved LV function compared with standard therapy alone requires further investigation. © 2008 Wiley‐Liss, Inc.     

经皮冠状动脉介入治疗对冠状动脉慢性完全闭塞病变患者左心室重构及心功能的影响

目的评价经皮冠状动脉介入治疗(PCI)对伴左心室收缩功能不全的冠状动脉慢性完全闭塞(CTO)患者左室重构及心功能的影响。方法选择该院心内科住院患者88例,经冠状动脉造影(CAG)证实均为伴左心室收缩功能不全的慢性冠状动脉闭塞病变,根据是否对CTO病变行PCI治疗,将患者分为PCI治疗组(n=48)和药物治疗组(n=40)。于CAG术前及术后1周、3个月、6个月分别进行超声心动图检查,计算校正的舒张末期容积指数(LVEDVI)、收缩末期容积指数(LVESVI)和左室射血分数(LVEF),比较两组患者左室重构及心功能的差异。结果两组CAG基线资料比较,差异无统计学意义。CAG术后1周时两组LVEDVI、LVESVI、LVEF比较,差异无统计学意义。3个月时PCI组LVEDVI较术前显著降低,LVEF显著提高;与药物治疗组相比,差异也有统计学意义。6个月时PCI组LVEDVI进一步降低,LVEF进一步提高。结论PCI能够改善伴左心室收缩功能不全的CTO患者左心室收缩功能,改善左心室重构。     

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Patients with diabetes mellitus (DM) have more severe coronary artery disease and a two‐ to fourfold higher risk for myocardial infarction and death as compared to patients without DM. In this study, we analyzed coronary anatomy, left ventricular ejection fraction, and cardiac risk factors in patients with DM referred for coronary angiography and compared them with findings in nondiabetic patients. Coronary anatomy was assessed in a total of 6,234 patients and left ventricular ejection fraction in a subset of 4,767 (76.5%) patients. Diabetic patients (n = 641) were older (60.8 ± 9.6 vs. 58.5 ± 10.5 years; P < 0.0001) and had higher rates of hypertension (65% vs. 47%; P < 0.0001). Three‐vessel disease (DM 44.7% vs. no DM 25.4%; P < 0.0001) and reduced left ventricular ejection fraction (DM 58.4% ± 15.2 vs. no DM 63.9% ± 13.2; P < 0.0001) were significantly associated with DM. After adjustment for age and other vascular risk factors, the presence of DM was associated with a higher atherosclerotic burden. We conclude that advanced coronary heart disease and left ventricular dysfunction are highly prevalent in diabetic patients, independent of age and other cardiovascular risk factors. Thus, cardiac assessment in diabetic patients should, in addition to optimal diabetic control, involve screening for left ventricular dysfunction. Cathet Cardiovasc Intervent 2004;62:432–468. © 2004 Wiley‐Liss, Inc.     

Role of global longitudinal strain in assessment of left ventricular systolic function in patients with heart failure with preserved ejection fraction

Objectives

To detect systolic dysfunction in heart failure with preserved ejection fraction (HFpEF) patients by using global longitudinal strain (GLS).