David Tesar

Relationship of C-reactive protein to presence and severity of coronary atherosclerosis in patients with stable angina pectoris or a pathological exercise test.

BackgroundC-reactive protein (CRP) level is a sensitive marker of inflammation and a probable predictor of cardiovascular risk. The aim of this study was to assess the relationship between the presence and the extent of coronary atherosclerosis and CRP level in patients referred for coronary angiography for stable angina pectoris or a pathological exercise test. Patients and methodsA group of 200 patients were prospectively analyzed for the relationship between the presence and extent of coronary atherosclerosis and high-sensitivity CRP. Patients with stable angina pectoris or a pathological exercise test were included. ResultsFor the whole group the CRP geometric mean was 2.92 mg/l and the median 3.0 mg/l. There was no difference between groups of patients with different extents of coronary lesions (P  = 0.320, one-way analysis of variance). In patients without significant coronary disease the CRP geometric mean was 3.1 (2.28–4.21) mg/l with a variation coefficient of 118.4%; in patients with coronary artery disease the geometric mean was 2.83 (2.34–3.43) mg/l with a variation coefficient of 104.0%. The difference in CRP between both groups was not significant (P  = 0.601). There was also no significant difference in CRP levels between groups of patients with and without a history of myocardial infarction (2.65 (2.08–3.36) mg/l and 3.18 (2.54–3.98) mg/l, P  = 0.266) respectively. There was no correlation between the classification of angina pectoris and the logarithm of CRP level (P  = 0.331). This relationship was not confirmed even in the group of patients with significant coronary artery disease (P  = 0.693). ConclusionsCRP level is not related to the extent or the presence of coronary atherosclerosis assessed by coronary angiography, history of myocardial infarction or class of stable angina pectoris in patients referred for coronary angiography for stable angina pectoris or a pathological exercise test.

The anomalous origin of the left coronary artery from the right aortic sinus: is the coronary angiography still a 'gold standard'?

Coronary artery anomalies remain a poorly understood topic in modern cardiology. The most important issue is the origin of the left coronary artery or the left anterior descending artery from the opposite aortic sinus, frequently associated with sudden cardiac death. We report our experience concerning the evaluation of these anomalies. From 15 April 1997 to 1 December 2004, we performed 13.407 coronary angiographies and found eight patients with these anomalies. In seven patients the coronary angiography was sufficient for the ultimate decision. However, in one case was the angiographic signs contradictory and the optimal imaging of the coronary tree was received by the multi-slice spiral computer tomography. We consider the coronary angiography a sufficient method of evaluation in most of the patients with the coronary artery anomalies, but the ‘gold standard’ is 3-dimensional examination by the multi-slice computer tomography or the magnetic resonance. The computer tomography is the method of the choice to distinguish interarterial, intraseptal and prepulmonary course of the left coronary artery originating from the right aortic sinus.

Effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy on Doppler Tei index: a midterm follow-up.

Alcohol septal ablation (PTSMA) improves outflow gradient, left ventricular (LV) diastolic function, and symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). Tei index (TI) is a Doppler parameter reflecting both systolic and diastolic LV function. Midterm changes of TI after PTSMA have not been determined up to now. Twenty‐seven consecutive patients (mean age 53 ± 13 years) with symptomatic HOCM underwent PTSMA procedure. Clinical and echocardiographic data were collected at baseline, 6 and 12 months after PTSMA. TI decreased from 0.67 ± 0.11 to 0.55 ± 0.06, isovolumic contractile time (ICT) decreased from 74 ± 20 to 48 ± 11 ms, isovolumic relaxation time decreased from 146 ± 25 to 117 ± 9 ms, and LV ejection time decreased from 330 ± 42 to 298 ± 13 ms. LV remodeling was determined by LV dimension increase from 46 ± 6 to 48 ± 6 mm and basal septum thickness reduction from 22 ± 4 to 15 ± 3 mm. LV ejection fraction decreased from 78 ± 7 to 73 ± 6% and maximal outflow gradient decreased from 69 ± 44 to 15 ± 11 mmHg. All changes were statistically significant (P < 0.01). Symptomatic improvement was characterized by relief of dyspnea (2.5 ± 0.7 versus 1.4 ± 0.6 NYHA class; P < 0.01) and angina pectoris (2.6 ± 0.9 versus 0.7 ± 0.7 CCS class; P < 0.01). PTSMA is an effective method of therapy for HOCM. Shortening of TI suggests the improvement of LV myocardial performance in the midterm follow‐up.

Direct stenting without predilatation: a new approach to coronary intervention.

BackgroundImplantation of coronary stents after predilatation is a standard approach in the treatment of most coronary lesions. Stenting without predilatation could be a possible alternative way of treating a certain subset of patients. ObjectiveTo identify a group of patients suitable for this optional method, to evaluate their immediate clinical and angiographic outcomes and to test the feasibility and safety of this new therapeutic concept. MethodsNinety selected patients with 91 lesions were treated by implantation of coronary stents without predilatation. ResultsThe mean duration of this procedure was 12.3 ± 9.1 min and the fluoroscopic time was 3.6 ± 2.9 min. The stenoses before and after this procedure were 77 ± 10 and 5 ± 9%, respectively. Predilatation, postdilatation or implantation of an additional stent was necessary for seven patients. Primary success rate was 92% with an excellent immediate clinical and angiographic outcome. No major complications occurred during direct stenting. ConclusionDirect stenting is feasible using commercially available stents and could be performed for about 20% of patients for whom coronary intervention is indicated. The proper selection of lesions is of crucial importance. Lesions eligible for direct stenting should be without visible calcifications and on vessels without proximal tortuosity. This procedure proved to be safe and successful in this series of coronary interventions.

Treatment of recurrent coronary rupture by implantation of three coronary stent-grafts

The authors report a case of recurrent left anterior descending artery rupture during coronary interventions in a 70-year-old man. Coronary artery rupture was treated successfully by percutaneous coronary stent-graft implantation. Based on this experience, the authors advise against repeat angioplasty of a coronary artery which has ruptured during a prior intervention. Membrane-covered stents should be the first choice in the treatment of life-threatening coronary artery rupture. (Int J Cardiovasc Intervent 2003; 5: 88-91)

The Paramount Role of the Anterior Communicating Artery in the Collateral Cerebral Circulation.

Clinical manifestation of carotid occlusive disease is largely dependent on the severity of stenosis and the capability of collateral circulation. However, due to the complexity and difficulty in evaluation, cerebral collateral circulation has, so far, remained underappreciated. We report a patient with advanced extracranial arterial disease (including the right subclavian steal, occlusion of the right external carotid artery, and severe stenosis of the left vertebral artery), who underwent transient right internal carotid artery occlusion during carotid intervention. Throughout the occlusion, the flow into the right hemisphere (monitored by transcranial Doppler ultrasound in the right middle cerebral artery) was sufficient despite almost totally dependent on the anterior communicating artery, which highlights its role as the most potent collateral pathway.