Gordana Teofilovski-Parapid

Noninvasive assessment of myocardial bridging by coronary flow velocity reserve with transthoracic Doppler echocardiography: vasodilator vs. inotropic stimulation

BACKGROUND To consider hemodynamic assessment of myocardial bridging (MB) adequate, it is believed that inotropic stimulation with dobutamine should be estimated because its dynamic nature depends on the degree of extravascular coronary compression. This study evaluated comparative assessment of hemodynamic relevance of MB using coronary flow velocity reserve (CFVR) measurements by transthoracic Doppler echocardiography (TTDE) with vasodilatative and inotropic challenges. METHODS This prospective study included forty-four patients with angiographic evidence of isolated MB of the left anterior descending coronary artery (LAD) and systolic compression of ≥50% diameter stenosis. All patients were evaluated by exercise stress-echocardiography (ExSE) test for signs of myocardial ischemia, and CFVR of the distal segment of LAD during iv.infusion of adenosine (ADO:140μg/kg/min) and iv.infusion of dobutamine (DOB:10-40μg/kg/min), separately. RESULTS Exercise-SE was positive for myocardial ischemia in 8/44 (18%) of patients. CFVR during ADO was significantly higher than CFVR during peak DOB (2.85±0.68 vs. 2.44±0.48, p=0.002). CFVR during peak DOB was significantly lower in SE-positive group in comparison to SE-negative group (2.01±0.16 vs. 2.54±0.47, p<0.001), but not for ADO (2.47±0.51 vs. 2.89±0.70, p=0.168), respectively. Multivariable logistic analysis showed that CFVR peak DOB was the most significant predictor of functional significant MB (OR 0.011, 95%CI: 0.001-0.507, p=0.021). Receiver-operating characteristic curves have shown that TTDE-CFVR obtained by high-dose of dobutamine infusion is better than those by adenosine regarding to functional status of MB (AUC 0.861, p=0.004; AUC 0.674, p=0.179, respectively). CONCLUSIONS Non-invasive CFVR measurement by TTDE during inotropic stimulation, in comparison to vasodilation, provides more reliable functional evaluation of MB.

Poster 112: The influence of a combination of infrared light with transcutaneous electric nerve stimulation in patients with cervical symptoms of ankylosing spondylitis.1

Abstract Objective: To study the advantages of a home treatment combination of infrared (IR) light with transcutaneous electric nerve stimulation (TENS) over the classic approach of nonsteriodal anti-inflammatory drugs (NSAIDs) in treating ankylosing spondylitis (AS). Design: Prospective randomized follow-up study. Setting: Academic medical center. Participants: Patients were randomized into 2 groups (20 each). All were men, ages 30 to 40 years old, with cervical symptoms of AS. Interventions: Range of motion of the cervical spine and presence of pain in the neck were evaluated in each group. Patients in both groups underwent kinesitherapy during 2 weeks. Also, group 1 took NSAIDs (7.5mg of meloxicam twice a day), while group 2 had TENS (30min) applied with IR lamp 300W (20min) over the cervical region every morning. Main Outcome Measures: Pain decrease and movement increase. Results: After 2 weeks, in group 1, 60% of the patients experienced a reduction in pain, while 25% experienced an increased amplitude of neck movements. In group 2, 40% experienced a reduction in pain and 75% had a significant increase in neck movements. Conclusions: Application of TENS with an IR lamp is useful and practical in home treatment of patients with cervical symptoms of AS. Also, we must not forget kinesitherapy and NSAIDs, which are a necessary part of treatment.