Hiroki Emori

Local Matrix Metalloproteinase 9 Level Determines Early Clinical Presentation of ST-Segment–Elevation Myocardial Infarction

Objective—Early clinical presentation of ST-segment–elevation myocardial infarction (STEMI) and non–ST-segment–elevation myocardial infarction affects patient management. Although local inflammatory activities are involved in the onset of MI, little is known about their impact on early clinical presentation. This study aimed to investigate whether local inflammatory activities affect early clinical presentation. Approach and Results—This study comprised 94 and 17 patients with MI (STEMI, 69; non-STEMI, 25) and stable angina pectoris, respectively. We simultaneously investigated the culprit lesion morphologies using optical coherence tomography and inflammatory activities assessed by shedding matrix metalloproteinase 9 (MMP-9) and myeloperoxidase into the coronary circulation before and after stenting. Prevalence of plaque rupture, thin-cap fibroatheroma, and lipid arc or macrophage count was higher in patients with STEMI and non-STEMI than in those with stable angina pectoris. Red thrombus was frequently observed in STEMI compared with others. Local MMP-9 levels were significantly higher than systemic levels (systemic, 42.0 [27.9–73.2] ng/mL versus prestent local, 69.1 [32.2–152.3] ng/mL versus poststent local, 68.0 [35.6–133.3] ng/mL; P<0.01). Poststent local MMP-9 level was significantly elevated in patients with STEMI (STEMI, 109.9 [54.5–197.8] ng/mL versus non-STEMI: 52.9 [33.0–79.5] ng/mL; stable angina pectoris, 28.3 [14.2–40.0] ng/mL; P<0.01), whereas no difference was observed in the myeloperoxidase level. Poststent local MMP-9 and the presence of red thrombus are the independent determinants for STEMI in multivariate analysis. Conclusions—Local MMP-9 level could determine the early clinical presentation in patients with MI. Local inflammatory activity for atherosclerosis needs increased attention.

TCT-542 Usefulness of QFR measurement for non-culprit lesion of ACS patients

The use of fractional flow reserve (FFR) for assessing intermediate coronary lesions has gained worldwide acceptance in the cardiology community. The severity of non-culprit coronary artery stenosis during the acute phase of acute coronary syndrome (ACS) also can be reliably assessed by FFR. FFR

Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

BACKGROUND A novel index of the functional severity of coronary stenosis, quantitative flow ratio (QFR), may not consider the amount of viable myocardium in prior myocardial infarction (MI) because QFR is calculated from 3D quantitative coronary angiography.Methods and Results:We analyzed QFR (fixed-flow QFR [fQFR] and contrast-flow QFR [cQFR]) and fractional flow reserve (FFR) in prior-MI-related coronary arteries (n=75) and non-prior-MI-related coronary arteries (n=75). Both fQFR and cQFR directly correlated with FFR in the prior-MI-related coronary arteries (fQFR: r=0.84, P<0.001; and cQFR: r=0.88, P<0.001) and the non-prior-MI-related coronary arteries (fQFR: r=0.91, P<0.001; and cQFR: r=0.94, P<0.001). fQFR was significantly smaller than FFR in the prior-MI-related coronary arteries (0.73±0.14 vs. 0.79±0.11, P=0.002), but there was no significant difference between fQFR and FFR in the non-prior-MI-related coronary arteries. The value of cQFR minus FFR was significantly lower in the prior-MI-related coronary arteries compared with the non-prior-MI-related coronary arteries (-0.02±0.06 vs. 0.00±0.04, P=0.010). The diagnostic accuracy of fQFR ≤0.8 and cQFR ≤0.8 for predicting FFR ≤0.80 was numerically lower in the prior-MI-related coronary arteries compared with the non-prior-MI-related coronary arteries (fQFR: 77% vs. 87%; and cQFR: 87% vs. 92%). CONCLUSIONS When FFR is used as the gold standard, the accuracy of QFR for assessing the functional severity of coronary stenosis might be reduced in the prior-MI-related coronary arteries compared with non-prior-MI-related coronary arteries.

Effects of intravenous bolus injection of nicorandil on renal artery flow velocity assessed by color Doppler ultrasound

BACKGROUND Previous animal studies have shown that a potassium channel opener, nicorandil, provokes vasodilation in renal microvasculature and increases renal blood flow. We conducted a clinical study that aimed to evaluate the effect of nicorandil on renal artery blood flow in comparison with nitroglycerin by using color Doppler ultrasound. METHODS The present study enrolled 40 patients with stable coronary artery disease who had no renal arterial stenosis and renal parenchymal disease. The patients received intravenous administration of nicorandil (n=20) or nitroglycerin (n=20). Before and after the administration, renal artery blood flow velocity was measured by color-guided pulsed-wave Doppler. RESULTS The peak-systolic, end-diastolic, and mean renal artery blood flow velocities before the administration were not different between the nicorandil group and the nitroglycerin group. The peak-systolic (79±15cm/s to 99±21cm/s, p<0.001; and 78±19cm/s to 85±19cm/s, p=0.004), end-diastolic (22±5cm/s to 28±8cm/s, p<0.001; and 24±6cm/s to 26±6cm/s, p=0.005) and mean (41±6cm/s to 49±9cm/s, p<0.001; and 43±9cm/s to 45±9cm/s, p=0.009) renal artery flow velocities increased significantly in either group. The nominal changes in the peak-systolic (20±10cm/s vs. 7±8cm/s, p<0.001), end-diastolic (5±4cm/s vs. 2±3cm/s, p=0.001), and mean (8±5cm/s vs. 2±2cm/s, p<0.001) renal artery blood flow velocities were significantly greater in the nicorandil group compared with the nitroglycerin group. CONCLUSION Intravenous nicorandil increased renal artery blood flow velocity in comparison with nitroglycerin. Nicorandil has a significant effect on renal hemodynamics.

TCT-529 The correlation between Quantitative Flow Ratio (QFR) and Fractional Flow Reserve (FFR)

Fractional Flow Reserve (FFR) is an indispensable device to identify coronary stenoses causing myocardial ischemia. But FFR is more invasive than coronary angiography and require additional cost, time and efforts. Quantitative Flow Ratio (QFR) is a novel method for rapid computation of FFR with

Three-vessel fractional flow reserve measurement for predicting clinical prognosis in patients with coronary artery disease

Coronary artery disease is a common form of heart disease affecting large numbers of people across the world. Coronary artery disease is caused by atherosclerosis that narrow the coronary artery lumen and limit myocardial blood supply.

TCT-580 Optical coherence tomography predictors for edge restenosis after everolimus-eluting stent implantation

Restenosis in reference segments adjacent to the proximal and distal border of the stent (so-called “stent edge restenosis [SER]”) remains a potential limitation of drug-eluting stents. The aim of this study was to determine optical coherence tomography (OCT) predictors for angiographic late SER

PLAQUE MORPHOLOGY CAN BE A PREDICTOR OF FUTURE CORONARY EVENTS IN RELATION TO LESIONS OF DEFERRED FRACTIONAL FLOW RESERVE-NEGATIVE STENOSIS

It is unknown whether plaque characteristics are associated with future plaque progression in coronary lesions after deferral of coronary intervention. Between 2008 and 2013, 234 patients underwent both fractional flow reserve (FFR) and optical coherence tomography (OCT) examination for evaluating