Babu Ezhumalai

Cardiac syndrome X: Clinical characteristics revisited

BACKGROUND Cardiac syndrome X includes a heterogenous group of patients with angina but normal epicardial coronaries in angiography. OBJECTIVE Our objective was to study the clinical characteristics of patients with cardiac syndrome X. METHODS Data of patients who underwent coronary angiography over a period of one year was retrospectively analyzed. Those with normal or non-obstructive coronaries in angiography with chest pain were included in this study. RESULTS 1203 patients underwent coronary angiography during the study period. 105 (8.7%) patients fulfilled the inclusion criteria. There were 52 (49.5%) males and 53 (50.5%) females including 31 (29.5%) postmenopausal women. Many patients had atherosclerotic risk factors. Typical angina and atypical chest pain were reported by 63 (60%) and 42 (40%) patients, respectively. ECG was normal in 46 (43.8%) and abnormal in 59 (56.2%) patients. The most common abnormal finding in ECG was ST-T changes seen in 49 (46.7%) patients. Regional wall motion abnormality with mild left ventricular systolic dysfunction was seen in 4 (3.8%) patients while 101 (96.2%) patients had normal ventricular function in echocardiography. TMT was positive for inducible ischemia in 35 (33.3%) patients and inconclusive in 10 (9.5%) patients. Angiography showed normal epicardial coronaries in 85 (80.9%) patients. CONCLUSIONS Cardiac syndrome X constitutes a significant subset of patients undergoing coronary angiography. It is essential to identify and treat them specifically for microvascular angina. Many of them have atherosclerotic risk factors but their presentation is different from those with obstructive coronaries.

Effects of subcutaneously infiltrated nitroglycerin on diameter, palpability, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography.

BACKGROUND The success of transradial catheterization depends on meticulous access of radial artery which in turn depends on palpating a good radial pulse. OBJECTIVES Our objectives were to analyze the effects of subcutaneously infiltrated nitroglycerin on diameter of radial artery, palpability of radial pulse, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography. METHODS Patients undergoing transradial coronary angiography were randomized to Group NL or Group SL. In Group NL, 3 ml of solution containing nitroglycerin and lignocaine was infiltrated subcutaneously at the site intended for puncture of radial artery. Similarly, saline and lignocaine were infiltrated in Group SL. Diameter of radial artery was objectively assessed by ultrasonography. Measurements were performed at baseline and repeated at 1 min after injecting the solutions. The ease-of-puncture was evaluated by the number of punctures and the time needed for successful access of radial artery. RESULTS Both groups had 100 patients each. Baseline diameter of radial artery was similar between two groups. The post-injection diameter of radial artery increased by 26.3% in Group NL and 11.4% in Group SL. Nitroglycerin significantly improved the palpability of radial pulse, reduced the number of punctures and shortened the time needed for successful access of radial artery. Pre-cannulation spasm of radial artery occurred in 1% of Group NL and 8% of Group SL. CONCLUSIONS Subcutaneously infiltrated nitroglycerin leads to significant vasodilation of radial artery. This avoids pre-cannulation spasm of radial artery, enhances palpability of the radial pulse and thus makes the puncture of radial artery easier.

Comparison of diagnostic utilities of ankle–brachial index and Carotid intima-media thickness as surrogate markers of significant coronary atherosclerosis in Indians

AIM We aimed to compare Ankle-brachial index (ABI) and Carotid intima-media thickness (CIMT) as surrogate markers of significant coronary atherosclerosis in South Indians with coronary artery disease (CAD). METHODS AND RESULTS There were two groups: CAD group (n = 59) and Control group (n = 55). Mean ABI (0.82 ± 0.06 vs. 1.16 ± 0.11, p < 0.0001) and mean CIMT (0.74 ± 0.22 mm vs. 0.45 ± 0.09 mm, p < 0.0001) were statistically different between two groups. ABI < 0.9 (sensitivity: 91.53%, specificity: 100%) and CIMT > 0.63 mm (sensitivity: 61.02%, specificity: 98.18%) implied significant CAD. ABI and CIMT were negatively correlated to one another. With increasing severity of CAD, ABI decreased but CIMT increased. CONCLUSION ABI and CIMT are simple noninvasive tools providing insight into coronary atherosclerosis. They can be done at bedside and easily repeated than coronary angiography. ABI < 0.9 is a better surrogate marker of significant coronary atherosclerosis than CIMT > 0.63 mm in South Indians with CAD.

Refining rather than redefining the BVS in "real world".

Key Points The article outlines the factors influencing acute recoil of BVS after implantation, especially the role of lesion preparation and predilatation. It attracts attention to “optimal implantation technique” of BVS in complex “real world” patients to improve outcomes and avoid scaffold thrombosis. Large multicenter registries/trials in complex lesions utilizing “optimal implantation techniques” could establish the role of BVS in our “real world” practice.The article outlines the factors influencing acute recoil of BVS after implantation, especially the role of lesion preparation and predilatation. It attracts attention to “optimal implantation technique” of BVS in complex “real world” patients to improve outcomes and avoid scaffold thrombosis. Large multicenter registries/trials in complex lesions utilizing “optimal implantation techniques” could establish the role of BVS in our “real world” practice.

Coronary sinus diameter by echocardiography to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia

BACKGROUND Coronary sinus (CS) has been shown to be larger in patients with atrioventricular nodal reentrant tachycardia (AVNRT). We sought to determine if echocardiographically measured CS diameter can help identify the mechanism of tachycardia in patients with narrow complex tachycardia without preexcitation before the invasive electrophysiology study. METHODS Forty four patients with documented narrow complex, short RP tachycardia who were scheduled for an electrophysiology study were included. Based on the electrophysiology study, patients were divided into those with AVNRT and those with a concealed accessory pathway and atrioventricular reentrant tachycardia (AVRT). Proximal CS diameter (CSp) measured at the ostium and mid CS diameter (CSm) 1 cm distal to the ostium using transthoracic echocardiography. RESULTS CSp was significantly larger in patients with AVNRT than AVRT (14.1 ± 5 vs. 9.9 ± 2 mm, p < 0.0001). CSm diameter was not significantly different between the two groups. A cut-off of CSp > 11.2 mm identified AVNRT with a sensitivity of 92.6% and specificity of 76.9%. CSp was a better discriminant (AUC 0.89, 95% CI 0.75-0.97) compared to age (AUC 0.74, 95% CI 0.58-0.87) or tachycardia rate (AUC 0.60, 95% CI 0.44-0.76). CONCLUSIONS Echocardiographic measurement of the diameter of CS ostium can help in identifying the mechanism of the tachycardia before the invasive electrophysiology study.

TCTAP C-232 Percutaneous Interventional Therapy for May-Thurner Syndrome

### Patient initials or identifier number Mr. RA ### Relevant clinical history and physical exam A 58 years-old gentleman Mr. RA with past history of Ischemic stroke 15 years back, operated and received radiotherapy for carcinoma of vocal Cord 4 years back, presented now with pain and swelling in

TCT-434 Implantation of Absorb Bioresorbable Vascular Scaffolds in Small Vessel Coronary Artery Disease: Long-term follow-up

Jouke Dijkstra, Evald Christiansen, Niels Holm Aarhus University Hospital, Skejby, Viby J, Denmark; Aarhus Universitetshospital, Skejby, Aarhus, Denmark; Terumo, Aarhus, Denmark; Hospital U. Central de la Defensa Gómez Ulla; Shanghai Jiao Tong University, Shanghai, Shandong, China; Aarhus University Hospital, Aarhus N, Denmark; LUMC, Leiden, Netherlands; Aarhus University Hospital, Aarhus, Denmark; Aarhus University Hospital, Aarhus N, Denmark